Advice needed...how to survive the night shift commute...literally.

[NeoPediRN]

I'm not sure if what I experience is normal or not. Over the past few years I've had a hard time staying awake in general behind the wheel if I'm driving for longer than 1/2 hour - 45 minutes. During the day it's easier, but even if I get a good night's sleep, I have to work on consciously reminding myself to stay awake. It only happens to me while driving.

I rotate day/nights 12 hour shifts and commuting after a night shift is extremely difficult. Taking a brief nap before heading home only makes it worse. I have tried: blasting the radio, singing along, eating ice, chewing gum, coffee 1/2 hour before my shift ends, rolling the windows down and sticking my head out, putting on the a/c, making myself freezing cold so that I'm too uncomfortable to want to drift off, eating breakfast in the car on the way home. I mean, you name it and I've tried it...and it makes no difference. I can literally feel sleep coming over me and a heaviness in my brain, and there's not much I can do about it. I drift off at red lights until a car behind me honks, I start falling asleep behind the wheel during the drive and my body jumps as I wake up quickly. I will also slam on the brakes in the middle of driving as I wake up thinking I'm about to hit something, but I'm nowhere near anything. Last year I fell asleep driving home after an overnight double and hit a snow bank 1/2 mile from my house. Thank God there was a blizzard and no one else on the road. I don't do overnight doubles anymore because of that, but it still doesn't solve the problem. I swerve at least once every morning, everything starts getting surreal, and often I don't remember driving home or I feel like the drive is a dream even though I know I'm awake, if that makes any sense. It's even started happening after day shifts, but nowhere near as bad as driving home after a night shift. The only thing that keeps me awake is if I come close to getting in an accident and I feel the adrenaline rush. That usually lasts long enough to get me close to home before it starts happening again. I'm so afraid I'm going to get seriously hurt or seriously hurt someone else. I live too far to use public transportation, and I've even thought about giving up the specialty I love to get any job close by, but there aren't many hospitals right near me and the ones that are, aren't hiring anyway.

Has anyone experienced this before or is there something wrong with me? Does it get better with time? I've been commuting after night shifts for about 18 months and it isn't getting better. Does anyone have other tips/tricks that have worked for them? I can't have a lot of caffeine or use energy drinks because I have a congenital heart condition. Thanks in advance, and please, no flames. I'm aware what I've shared is dangerous and I'm coming here for advice because I feel at a loss. I have to work, and commuting with someone else isn't an option, I live about 45 minutes northeast of my work and everyone lives in the city or south of.

[bjaeram]

Getting out and walking, streching my legs really helps me. Are you getting enough sleep in general? I would talk to your doctor and see if anything else can be done.

As far as losing your license I doubt your doctor would do that to you without trying to fix the problem first. You will lose it much quicker by falling asleep and killing someone!

As far as the poster that said doctors can't take away your license that is not true. They can and do. I've seen it in seizure and head injury patients. I doubt they would in this case but they do have the ability to.

[April, RN, BSN, RN]

I am very familiar with your commute. Those highways can be dangerous even if you aren't dead tired! I know it's a long shot being relatively new to your job, but is it at all possible to transfer to another department in your hospital that has all day shifts? I know leaving your current job wouldn't be ideal but obviously your safety has to take priority here.

[jmtndl]

Please stop before you kill somebody! I beleive that a day/night rotation is irresponsible for employers to force, and that no one shuld be forced to work nights at all. If you are and cannot get enough sleep to be safe, it is your moral obligation to change your job!I am a dyed-in-the-wool night person but have friends who cannot and will not work nights I know there can be family obligations, but if you are dead, you really can't meet them.

[vamedic4, EMT-P]

Some people's bodies just don't adjust to working nights. I used to work a D/N rotation and it got ugly sometimes coming home in the morning. I did the same things you did, drifting, nodding off and catching myself seconds later, falling asleep at stoplights. For me it was a matter of getting more sleep during the day. Your situation is most likely due to your body's inability to accept either the night shift or the changing of it's Circadian rhythm every few days. Not everyone can do it. It's not your fault at all, you've just got to find something that works for you...like a day position. Talking to your doctor is an excellent idea, and he can recommend meds that are specific to your situation and your concerns. None of us want anything to happen to you, that's for sure. Talk to him and let us know how things are going.

[pielęgniarka, RN]

I hope you are not driving around when I am, and especially not when my children are taking a bus to school. I admire that you are looking for help but you really need to quit driving like that before you kill someone or yourself. Go see your doctor & see what can be done. You HAVE to stop driving like that.

I used to do extended hours homecare and had some night shifts with an 1+hour drive home. I would find myself starting to feel drowsy and unsafe during the commute, and I would need to find a spot to pull over and sleep for a little bit. All the coffee, jumping jacks, open windows and radios cranked in the world wouldn't help me, I just need to sleep.

Now I work in the town I live in. I have a 5 minute commute, it was worth the job change!

[MassED, BSN, RN]

I don't get the discussion path about docs taking away licenses for being sleepy and needing help to not fall asleep? First of all, docs can't take away licenses... boards do. And since when does going to your doctor to discuss a need fall under the concern about licensing and nursing practice, when we're talking about staying awake while driving after working??? I'm not getting it....

doctors, nurses, police officers, and anyone else who works night shift and has to stay awake for a commute home deals with the same issue, so it's not taboo. Most of us have been there and speaking to your doctor about doing so safely is responsible and has no relation to a discussion with your doc about driving and seizures, head injuries, etc. Just not the same category. Being tired is not a hazard that would make someone think they can't talk to their doctor for fear of being reported, like having a seizure history and driving. Please!

[Esme12, ASN, BSN, RN]

I don't think doctors can report anything to the dmv nor any other agency accept abuse. They should be confidential with you.

Actually you are wrong.....they also report seizure activity with a 6 month seizure free restriction on your drivers license. "Shift sleep disorder" is not reportable to the DMV. Provigil is the RX. RN4 wee ones need to go to the MD and discuss her concerns.....

RN 4 wee ones.......I too live around boston......when I worked on the north shore I had a 52 mile one way commute from outside 128.........I have fallen asleep sitting in traffic on 128 (12-hate as I call it) too numerous of times to count only to be rudely awakened by foul language and loud horns........some people have no sense of humor. I too had small ones and my hubby and I worked opposite shifts.....we spared alot of day care costs. Like you I was a transplant from another part of the country with no family to help.

AHHHH........the blizzard couple years back......it took me 6 hours to get to work.....by the time I admitted to myself I should not be on the road..........I was at the half way point......the dedication of nursing:rolleyes:.

To survive.........I always had a double mocha something to drink.......I would sometimes catch a quick nap at the hospital right before I would leave........I have pulled my car over off the highway......found a shopping center in a populated area and nap.....I would set my phone to wake me up. If I had to get directly home because of child care........my hands free became my savior. I would call my parents the mornings I was most vulnerable........to chat my way home...........I would also clean my car sitting in traffic.......I had a swifter, windex wipes, armor all wipes, and a dustbuster:lol2:.......my car had never been so clean. I always tried to work weekends when I could sleep and there would be less traffic......I worked fri 12, Sat 12, Sun 8.......it is hard to work nights......I found I could not work anyother shifts when doing nights......it was straight nights or not at all and I kept those hours (sort of) on my days off to keep a rhythm......do you realize how much laundry you can get done? Plus I had an understanding husband...

I hope this helps............

[redessa]

You say you've considered finding a job closer to home. What about finding a home closer to your job? If you don't want to move, but you've mentioned how expensive it would be to rent a hotel all the time after work, maybe find a cheap apartment or rent a room from someone for a couple hundred a month where you can crash as needed.

Really anything to get you off the road like that would be worth the added cost, IMO.

[klone, MSN, RN]

I considered asking my doctor about Provigil since it's short acting, but I'm afraid of getting my license medically suspended. I have to be able to drive to be able to work. I also can't take anything that will speed up my heart. I was prescribed an allergy medicine with pseudoephedrine one time and even that gave me nasty tachyarrhythmias.

I used to take Provigil, and IIRC, it didn't cause tachycardia, no more so than, say, a cup or two of coffee. When I first started taking it, my hands were a little trembly, but that was it.

Why do you think taking provigil would get your license suspended?

[klone, MSN, RN]

Here are my thoughts, as someone who deals with something similar, to a lesser extent:

I work 3 12s in a row. The first shift back, I generally would never nap beforehand. That drive the following morning after my first shift is SCARY. I've found that if I force myself to take a 2-3 hour nap in the afternoon before that first shift (and I will take a Benadryl at around 11 am so that I actually WILL sleep the full 2-3 hours), I have a lot easier time staying awake on that drive home. And the next two shifts, when I've had a full day of sleep beforehand, generally is no problem at all.

You're falling asleep at the wheel because you're not getting enough sleep before your shift. It's as simple as that. You need to figure out how to get MORE sleep between shifts. What is your sleep pattern like prior to your shifts? Are you getting at least 6 hours of sleep before your shift (preferably 7>)? If not, you need to figure out a way to get more sleep, even if that's taking some sort of sleep aid.

No, your doctor cannot report you to the DMV for this.

[Music in My Heart]

I hope you are not driving around when I am and especially not when my children are taking a bus to school. I admire that you are looking for help but you really need to quit driving like that before you kill someone or yourself. Go see your doctor & see what can be done. You HAVE to stop driving like that.[/quote']Ditto.

I would also point out to the OP that, beyond the personal risk and the questionable morality of your decision to drive impaired, you are also facing criminal prosecution for impaired driving as well enormous liability in the event that you do hurt somebody. Part of the liability equation examines whether you did (or whether a prudent person would) know that your actions created the risk. You obviously do and the prudent people here obviously do, too.

Please get help immediately. The risks are just not worth it - and it's not reasonable to subject others to the consequences of your extremely dangerous (and irresponsible) behavior.

[klone, MSN, RN]

I don't get the discussion path about docs taking away licenses for being sleepy and needing help to not fall asleep? First of all, docs can't take away licenses... boards do. And since when does going to your doctor to discuss a need fall under the concern about licensing and nursing practice, when we're talking about staying awake while driving after working??? I'm not getting it

People are talking about driver's licenses, not nursing licenses. The concern is about a doctor reporting her to the DMV.