Ep 13: How to reduce fatigue in shift workers: The role of evening light. A conversation With Despina Artenie

Posted February 28, 2023

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Show Notes —

Fatigue is a common problem in the workplace. It’s even more common and well-documented in people who work night shifts because of the lack of sleep they experience. It can cause different problems in our body systems that can, later on, affect the quality of our lives.

It’s a good thing that in some workplaces fatigue is monitored among their employees and interventions are being implemented. However, in healthcare, this type of monitoring is not present and there is a lack of training available.

In this episode, Nathan Illman talks to Despina Artenie, a psychologist who has conducted some research looking at ways to improve fatigue in night shift workers. She shares the interventions they implemented in her study, the results, and some useful recommendations for night shift workers.

Listen and learn in this episode.

KEY TAKEAWAYS FROM THIS EPISODE

Working night shifts can lead to sleep problems, and digestive and metabolic problems, and can affect our overall health.

Our normal circadian rhythm or biological clock is heavily influenced by daylight. This is due to the way we evolved with the Earth’s continuous shift in light/dark cycles across 24 hours.

This leads to alertness during the day and sleepiness at night. This is why, as humans, we work during the day and rest and regenerate at night.

During a night shift, the body clock flips. The continuous shifts of schedules cause a circadian misalignment. All the jumping back and forth makes it hard to get good quality sleep.

The most potent way to adapt to the shifts is to control light exposure. This taps into the evolutionary mechanisms in our brains.

The issues with controlling light exposure of shift workers are the fact that the conditions at work are out of their hands and that light exposure is quite time-sensitive.

Below we explain Despina’s research study and how she and her colleagues provided artificial evening light to nurses:

Interventions given to nurses in the study:

Using a lightbox to get 40 minutes of bright light exposure using the lightbox as late as possible before going to work
Avoiding light in the morning after a shift by wearing sunglasses
Sleeping in the morning in a dark environment or using an eye mask

Interventions on the active control group:

Eating a meal before going to work
Eating low-protein meals when eating at night

Results: The study found that the light exposure intervention did indeed reduce subjectively reported fatigue in the experimental group.

Conclusion: 40 mins of evening light exposure is a safe, acceptable, and effective means of reducing fatigue in shift workers. It can be done at home for a low cost.

Quick recommendations that can help with fatigue or sleep problems:

Nap in the afternoon between 2 pm to 6 pm.
Try to get a proper dinner before the shift.
Have a healthy snack if you’re hungry.
Have a low-protein breakfast.
Drink water proactively.
Try to socialize with your work colleagues to keep yourself alert.
Try not to drink caffeinated drinks 3 hours before sleeping.
Mind your sleeping hygiene by blocking external noise and not using your phone before sleeping or with 100% brightness.

Lightbox recommendation: 10,000 lux of wide spectrum light and has a UV filter, use at arm’s length.

Website: https://www.nursewellbeingmission.com

Facebook Group: https://www.facebook.com/groups/nursewellbeingmission

E-mail Address: nathan@nursewellbeingmission.com

Transcription —

Nathan Illman 00:00

Welcome back to the podcast. Everyone is Nathan here, or welcome for the first time if this is the first episode you are listening to. So for those of you who don’t know me, I have a real interest in the area of sleep, something that I became interested in when I was doing my doctoral research, I looked at sleep and trauma, and I’ve had a personal interest in it over time having experienced insomnia myself and overcoming that. And it’s just I think it’s a fascinating area and one that is extremely important for health, physical health, and mental health. And it’s something that I believe that nurses and midwives should be given much more support around.

Nathan Illman 00:39

In this episode, I’m really excited to bring you a conversation that relates directly to this interest of mine in sleep, I speak to Despina Artenie who is a psychologist who has conducted some research looking at ways to improve fatigue in night shift workers. So obviously, sleepiness and fatigue are very much related to sleep, because not having enough sleep can lead to fatigue and sleepiness. And in this really fascinating conversation about her research, we talk about the role of evening light exposure to help reduce fatigue in shift workers. Now, we talked about the science a bit more in the episode, but it really relates to night shifts basically messing up sleeping patterns, because of having to rotate between working through the night when your body would normally be asleep and then sleeping during the day. And then if you’re rotating shifts, having to switch that up every few days. So Despina’s work that she has recently published looks directly at trying to manage the fatigue that is so common in shift workers at night. And this has really massive implications for things like medical errors, for example, and people’s performance at night, but also their well-being as well, which is something that we explore within this episode.

Nathan Illman 01:57

So if you don’t already follow us on social media, you can find us on Instagram, it’s @_nursewellbeingmission, you can find me on LinkedIn, Nathan Illman, check out our website and look at our community that you can sign up for free to get loads of resources and things related to what we discuss within this podcast. And if you like this podcast, then I’d be really grateful if you could leave us an honest review on Apple podcasts or wherever you listen to this. This is going to be an amazing episode for anyone who is a night shift worker because of the practical steps that Despina outlines that you can try. And for people who are supporting other people who work night shifts. Let’s dive into the conversation right now.

Nathan Illman 02:46

Welcome to the Nurse wellbeing mission podcast hosted by me Nathan Illman. This is the place where nurses and midwife while being at the top of the agenda. Each episode aims to help nurses and midwives around the world flourish the informative, inspiring, and practical content and conversations.

Nathan Illman 03:10

Despina thank you so much for joining me on the podcast. It’d be great if you could just introduce yourself. Tell us a little bit about your background, why you’re interested in studying fatigue, and maybe just a little bit about yourself.

Despina Artenie 03:26

Yeah, of course. So my name is Despina. I’m a Ph.D. student in clinical psychology here in Montreal. And I’ve been doing research on how to reduce fatigue in shift workers for maybe five, or six years now. And this is good timing because we’re just publishing the findings of our latest RCT so we can talk about that. I became interested in the topic because one of my colleague’s mom is a nurse well used to be a nurse and he would see his mom come back from night shift tired all the time. And then he took the sleep class and he’s like, and then when I when we met with my colleague, Jan, and Mary, this is the trio that does all the research. He’s like, I have this idea. And then we’re like, all right, knowing nothing about the topic, and then five, six years later, we have like three papers. So it’s very funny to me, but in the meantime, also I started, I was I became a shift worker myself. So now I work. I work in hospitals. I work in the emergency room as a crisis counselor. So I’ve done my fair share of nightshifts and I work with nurses and doctors. So it all kind of came together as an orientation that makes sense to me. And as part of this research, really, our aim was just to take all this like hard science and try to translate as much as possible into actionable things that people can do. So we also came up with fatigue workshops, trying to make our suggestions as tangible as possible. Because if there’s anything that we know is that people in healthcare don’t have time, so we can’t just waste it. We’re gonna give information, it has to be good. And it has to be actionable. So that’s kind of the framework that I’ve worked in for the past couple of years.

Nathan Illman 05:31

Fantastic. Well, we’re certainly going to, I’m certainly going to try and draw some practical information from you in this in this conversation. I think people listening will be really, really pleased to hear that. So we just start by talking about the kind of problem at hand. So what is the work? What is the difficulty with fatigue? What kind of problems does it cause in nightshift workers? And why is it something worth studying in the first place?

Despina Artenie 05:58

Yeah, of course. So obviously, I think anybody who’s worked a night shift can see that fatigue is a problem. And it’s a well-documented one. And essentially working night shifts, leads to insomnia, leads to other types of sleep problems, and just can affect different spheres of your life can affect your digestion in the long term. It can have effects on your metabolism. It can increase the risks of cancer. A whole host of things are backed up by research to various degrees. So we can have these effects, but it doesn’t mean that it necessarily has them on you, which is something that we do try to emphasize the point is also not to necessarily just scare people, but it is a problem. And a lot of people who work nightshifts, because it has very specific effects on their bodies. Should I think we believe that they should get trained on like, what can we do to mitigate these effects? And usually, they’re not. So like, it was surprisingly hard to find evidence on who’s getting trained, like we know, for instance, that in aviation, like they’re good with fatigue like they track it, they realize that there are like consequences associated with it, and they’re serious. But in healthcare, we don’t see the same type of monitoring, even though we know that errors increase at night, we know that tired nurses just don’t do as well. And you know, and we also know that it’s a job with a lot of turnovers, and fatigue could be a factor that contributes to that stuff. So basically, what we’re trying to address with this research is the lack of training available. And because there are things that can be done, of course, they’re not perfect, and we don’t have like a perfect science on like, do this do that. You can’t take a magical pill, but there are things that you can do that combined can increase your well-being and reduce that fatigue and just make you just generally better working.

Nathan Illman 08:10

I really like the fact that behind this, again, is this sort of this practical application, right? It sounds like you’re being driven not just by now, this is just something that could be interesting to research, but it’s really looking at, you know, how can we address this gap in a particular industry, healthcare of the sort of closing the gap and providing tools for people to actually use to improve their well being and their performance as well, I guess. So shall we? It’s probably helpful, I guess, if we just talk a little bit, and don’t have to go into a huge amount of detail. But should we just talk a little bit about sleep and how sleep works? And why are night shifts, sort of particularly difficult with perhaps like rotating night shift and that sort of thing? You just give us a little bit of an overview of that.

Despina Artenie 08:55

Yeah, so everybody knows asleep works. But here are some of the mechanisms that make it harder to sleep, basically, A. when you work shifts, so the idea is that we all have circadian rhythms. So circadian rhythms are essentially what we commonly call biological. We call like the biological clock. So we have we all have this biological clock that makes it so that we’re more alert during the day and that we tend to be more sleepy at night. And this has evolved over. I mean, this is most animals have these and it has evolved over time. So we’re used to being on this like a 24-hour, slightly longer cycle. And the thing is that when you work shifts when you are day shifts, that’s fine because your body’s more first most awake, most alert, most functional during the day, and then at night, it performs its other functions, right? Your rest, you regenerate whatever happens at cellular levels. But the problem when you work night shifts is that that flips, you’re then expected to suddenly be awake and competent and be responsible for people’s lives when your entire biology is telling you to sleep. And then the contrary, like you leave where there’s sunlight, and like you see people, you know, going to work and the social pressure and like the biological pressure is for you to keep going when we’re supposed to be doing is like starting to sleep. So this flip here is what makes it really hard to sleep after night shifts. And then also, basically, once you’ve done a series of night shifts, a lot of the time your body will start slowly shifting its rhythm back to like accommodate that. So which is and then all of a sudden, you’re used to after a couple of night shifts, you wake up, you go to bed normally at 3 am. But then you have to start waking up at 7 am. Again, because here come your day shifts. So that’s another form of what we call a circadian misalignment when your body doesn’t your body’s biology doesn’t work with the demands of the environment. So all of this jumping back and forth is what makes it really hard to get good quality sleep.

Nathan Illman 11:33

Yeah. And I think it’s really important to think about that evolutionary side of things, isn’t it? Because it’s essentially what is unnatural, isn’t it? It’s you’re pushing against, like millions of years of evolution, because our bodies are aligned to light other external light the sun, that is how mammals how we’ve evolved is to be sort of in sync with the rising and setting of the sun. And that’s how our functions work. So especially rotating night and day shifts is very difficult, isn’t it for the brain, and then the body to sort of work against that, basically, and to try and to try and adapt?

Despina Artenie 12:12

Yeah, exactly. Because if let’s say you just work nights, you could if your social life permits it, try to adapt to be more of a night person. But if you’re constantly rotating, you don’t have that luxury, right, you have to kind of learn how to adapt to both. I

Nathan Illman 12:32

think something that’s interesting as well to sort of know is even when people work, they’re working just night shifts, and they sort of feel like they’ve adapted to a certain extent with the way they sleep. As you mentioned, the sort of functions that our body has during nighttime. Like, your body is still trying to do those nighttime functions, even if you think you’ve flipped your sleep cycle, right? So your body still isn’t metabolizing in the same way, well, that kind of cellular growth and repair and stuff. So even though you think that you’ve kind of flipped over and you might have optimized things by sleeping during the day, and working at night, there’s still stuff going on that essentially could be damaging your body in some way. So let’s talk about your research. So you did a pilot study, you’ve done a review article, and you’ve just followed up with this great randomized control trial. So you want to talk us through the sort of premise of the study and the intervention? And just tell us about the findings. That’d be really, really great.

Despina Artenie 13:36

Yeah, of course. So we started with the question of how can we make a feasible intervention for nurses to help them adapt to night shifts, and what to adapt to night shifts, we mean, to shift their body clock later, so they’re more alert later during the day. And so then they’re more sleepy in the morning when they need to sleep. And like we’ve mentioned, from an evolutionary perspective, when the most potent way to achieve those shifts is by controlling people’s light exposure. So essentially, you give them bright light at a certain time, and arguably as important, you get them to avoid light at other times. So usually what happens in lab studies is that you get people so you’d get people to get this light exposure that is timed to their body clock late at night. That’s usually where we see the most potent effects. and then they avoid light in the morning and then with that technique, you see that their body clock will shift. The issue with giving people light at night, during the night is that they’re at work right And that means that a lot of the conditions are out of their hands, maybe they don’t have institutional approval to use light at night. So or like to have or have a light box, but maybe they just don’t even have a space where they can use a light box, maybe using a light box on the unit will disturb patients or something. So like it adds this element that makes it not feasible. And then the other issue is also that light exposure is quite time-sensitive. So the effect of the light can flip depending on when you give it so you would, the way that it works is that you have what’s called the body temperature minimum. And that’s the time during the day when your core body temperature is at its lowest. So if you’ve ever pulled an all-nighter, and then you start getting the shivers between like three to 4 am, that’s, that’s where you have your lowest body temperature. So if you give light before that, then that will shift your body clock later, which we call phase delay, which is what we would want to adapt to a night shift. And then if you give the light after that body temperature minimum, it produces the opposite effect, which means that you have to be careful when you give it and sometimes if you’re giving it at night, and you don’t know exactly when you giving it you could actually be messing yourself up a little bit more like you’re trying to delay but then you actually advance and then you’re worse off than when you started. So these are the two main constraints when it comes to some of the big ones when it comes to light exposure. So you want to make it more feasible by trying to see if can we give it to people before they actually go to work. So that way it’s in their control. So we gave 33 nurses working rotating shifts at two hospitals in Montreal, gave them like boxes, and I can show you the lightbox.

Nathan Illman 16:57

I was actually thinking about this I was thinking of a picture on Amazon or something.

Despina Artenie 17:01

This is the I just disclosure, I use one every I use the light box every morning just for a seasonal effect of effect.

Nathan Illman 17:10

Right? Well, that’s another topic, isn’t it, we will have to focus on that.

Despina Artenie 17:14

And yeah, so we gave them a lightbox exactly like this model. And then we told them to get 40 minutes of bright light exposure as late as possible before they go to work. And that usually happens, usually, their shifts started at seven or 7:30. So it would be slightly before that. And then we also told them to avoid light in the morning by wearing sunglasses. Because if you also get light in the morning, that taps into that phase-advancing portion of your biological clocks, and then it does whatever you did in the evening. So sunglasses are very important.

Nathan Illman 17:53

So because it’s off to the minimum body temperature

Despina Artenie 17:57

exactly

Nathan Illman 17:57

the light and even a little bit of light in the morning, it triggers that thing and pushes things out. And that’s not what you want.

Despina Artenie 18:04

That’s not what you want. And with some caveats, there are always caveats when you talk circadian rhythms. But that’s the general idea of the timing of the light. And then we added some other things that we’ve seen in other studies help. So we also told people, that the idea is you want to maximize the amount of time that you sleep because you will have some sort of sleep debt. So you tell people to sleep in, in the morning on the day of their first night shift to try to nap in the evening if they can. And when they sleep to sleep in a darkened environment because again, when you sleep during the day, you get more ambient light. So you need to make sure that there is no light. So because it can also affect your circadian rhythms and just generally your quality of sleep if you sleep. If they don’t sleep in a dark environment, so we gave them a sleep mask. So that was the intervention. And people followed in the pilot study, followed it for, I think, two to five consecutive shifts depending on their work schedules, which vary quite a bit because it was a field study. And then they did it for twice as long during the second study during the randomized control trial where we did two periods of them using it. And then so in the first study, we compared it, we compared them following the intervention versus not following the intervention. And we did find that the intervention reduced fatigue and errors. And it also led to longer sleep and we also saw a bit of an increase in a positive mood. And this is from 15 minutes of bright light exposure before the shift, which is quite nice because it’s very different from like three hours of light exposure from one to three which is blue it’s something you’d see in lab studies. And then we wanted to replicate these findings. So we ran a randomized control trial. And then what we did here is we wanted to have active control. So an act of control is also a control that does things. So like controls for people’s expectations, because in this sense, everybody would expect to improve. So then we gave them an intervention that leads to better alertness during the night but doesn’t affect circadian rhythm. So we use food in this case. So we tell people to eat, and how to eat in order to maximize their alertness. So eat before going to work. And if you’re going to eat during the night, try to eat low-protein meals. Because those are harder to digest, and they can slow you down. So then what we saw here is that, again, we replicated that there was a positive effect for errors. So and it’s what I find quite impressive is that so in the first study errors were reduced by I believe, 53%, or something like that, and in this one by 56. So that’s over 50%, right, like, it’s quite an impressive drop in the error rate. And then we also saw that the intervention reduced fatigue. And there’s also a small increase in sleep duration and mood. But those were quite small, but generally, the overall effect was quite positive. And we also saw positive effects from the control intervention on their fatigue. So overall, we got quite positive findings from an intervention that’s relatively non-invasive, it does require people to come in, so they have to get light exposure before every night shift. They have to wear their sunglasses in the morning, they have to pay attention to their sleep. But it’s quite feasible and people rated it as quite feasible in the study themselves, and nurses said that they’d be willing to implement it in long term.

Nathan Illman 22:17

That’s amazing. I mean, you know, that figure 56 and 53% of reduction in errors. Did I get that right?

Despina Artenie 22:26

Yes. Now, I’m wondering if that percentage is plus or minus one percent.

Nathan Illman 22:36

Yeah. I mean, from an organizational perspective, as I’m just a public health perspective, I mean, it’s incredible, isn’t it? Of course, there are self-perceived errors, aren’t they? But still, it was really impressive. And there’s this sort of like double whammy effect, isn’t it individually for nurses, it helps reduce fatigue, but then if they’re actually reducing errors, that’s going to be a nicer shift. Right? If you feel like you’re just before

Despina Artenie 23:02

I double check the numbers. It’s actually 67%. Yeah, so ya know, it’s quite, it’s honestly, it’s quite impressive. We’re still I mean, and we probably wouldn’t have believed it. If we didn’t replicate it.

Nathan Illman 23:18

Yes.

Despina Artenie 23:23

Yeah, that was a fluke.

Nathan Illman 23:25

So I want to just go back to the protocol because I know people listening to this will be sort of thinking right after I’ve listened to this, what can I do? Like, I want to, I want to stop listening to this. And tonight, I want to try this out. So let’s just talk about some of the practicalities. So I know you spoke about the lightbox. What? Because light boxes differ in the amount the intensity of their light dome? So there’s a measure called Lux, which is yes. Which is would you want to just tell us a little bit about that and what you’d recommend based on what you used in your study?

Despina Artenie 23:59

Yeah. So in terms of lux, um, so basically the recommendation is anything above 1000 Lux should work. I think we use 5000 in our study. The thing about Lux is that they vary with distance. So what you want to get is if you want to get a lightbox is something that nominally emits 10,000 lux of wide spectrum light and that has a UV filter. Usually, they all do but just these are usually the considerations and they can be quite affordable you can get nicer models you can also get. I’ve seen them sold at drugstores and trying to not be Canada’s what translates here, I don’t want to just see Amazon but you can buy on Amazon if you want. Yeah.

Nathan Illman 24:57

Online retailers. Yeah.

Despina Artenie 25:00

Your friendly online retailer.

Nathan Illman 25:05

Yeah, I mean, they’re really widely available now are there? I think, because of the research, especially that’s been done around seasonal affective disorder as well, that has made they sort of proliferated over the past sort of 10 years or something. And the technology has become a lot cheaper to buy. So it really is an affordable sort of solution. And I suppose, again, like we said, maybe do another podcast for this. But yeah, if you hit somebody who does suffer from a sort of mood, the low mood in the winter as well, they can be helpful for that. So something I wanted to ask actually. So the intensity is important, the 10,000 lux. So, you know, let’s pretend I’m a nurse, I put it on, I set a timer, 45 minutes before I go on shift if you’re in the room. So how did what did you recommend to the nurses?

Despina Artenie 25:53

Yeah, we tell people for it to be at arm’s length. You don’t have to look directly at it. Because it’s honestly it’s quite lightweight. I’ll demonstrate. See. It’s like, it’s quite right.

Nathan Illman 26:08

Listening to this, the speaker has just suddenly been spotless.

Despina Artenie 26:13

Exactly. So I don’t use it for Zoom meetings. Right. So you can keep it at arm’s length. And you don’t have to look directly at it. I usually, I mean, when I just use it because it does have an acute effect where it’s alerting so I use it in the morning, usually. So you can use it as I will work as I’m on the computer. As I eat breakfast, I can even put on my makeup, you can do whatever you need to do when you get ready and use it. You don’t have to just stare at it. People do all kinds of things. Yeah.

Nathan Illman 26:46

Okay, that’s good. I mean, that’s less restrictive, isn’t it? Because I think I can imagine some people being put off by thinking right, I’m just gonna sit in front of a light for 40 minutes before my shift. But that probably wouldn’t be too attractive an option for a lot of people.

Despina Artenie 27:00

No, exactly. And you can also like, if you want to, you can flick it on for longer, and you can just go back and forth and do whatever you need to do. And it doesn’t necessarily have to be consecutive.

Nathan Illman 27:11

Yep.

Despina Artenie 27:12

Yeah.

Nathan Illman 27:13

And then the sunglasses. So after the shift, do you have any recommendations, not for a brand necessarily, for his particular style…

Despina Artenie 27:23

So the idea is you want, so there are multiple schools of thought here. It’s one of the reasons I like this research. It really gets into the nitty gritty. It satisfies some, like the obsessional part of myself.

Nathan Illman 27:39

Yeah.

Despina Artenie 27:40

Like ideally, you would get blue-blocking sunglasses, which are orange-tinted. I personally find them horrendous. But if you’re the type that doesn’t mind, you can get those. You can also just get darker sunglasses, they also work, like in our study, we just literally told nurses to bring their own sunglasses, and we just check that they’re dark. So like, don’t go for Britney Spears in the early 2000s. Try to go for like a darker shade. And then it should be fine. The caveat there, though, is that the benefit of light in the morning is that as alerting, right? So if you’ve just finished a night shift, and we know that shift workers are at greater risk for car accidents. So if you’re driving home, and you don’t feel alert, don’t wear the sunglasses like you don’t want it’s not sure, you might not shift your circadian rhythms, but also you won’t get into a car accident, right? So that’s the caveat with wearing sunglasses in the morning. If you’re feeling sleepy, don’t contribute to that sleepiness.

Nathan Illman 28:51

Okay. This a great additional piece of safety advice.

Despina Artenie 28:54

Exactly. And on the contrary, if you’re feeling sleepy in the morning, and you’re about to drive home, I’m gonna take back all of my advice, I’d say that you do get bright light. So if you can like walk around a little bit for five minutes or something in like sunlight to wake up, let it wake you up a little bit and then drive. There is one study where they use a bright light. And they saw that in that lab study, obviously, it increased, like driving performance after a night shift. You can also use it in that way as well. Yeah.

Nathan Illman 29:31

Great. So I think it’d be useful actually, just to ask you a little bit because I know you do workshops and you mentioned, in the beginning, didn’t do but you talked about some other general recommendations, you’ve delivered this to nurses and other healthcare professionals or there’s some other kind of going a quick little recommendations that you’d like to mention as well that can be helpful for either fatigue or for sleep.

Despina Artenie 29:53

Yeah, of course. So if we’re going to talk about the more circadian stuff it’s good to know that if you’re going to nap in the afternoon, usually it’s easiest to nap between like two and 6 pm, roughly, because that’s when you have a dip in alertness. And again, consistent with our recommendations for the control group. Like if you want to maximize your alertness while you work, do try to get your proper dinner before you go to your night shift. And then try to if you’re hungry, try to snack try to have healthy snacks with you at work, and then have a low protein breakfast in the morning like oatmeal and a banana or something like that, that’s going to help and that’s also going to help with presumably with your sleep quality. And also, we know that people at night when they’re more tired, they tend to just eat more junk. So if you prepare your snacks in advance, and all of those things, it’s better for your alertness at the moment, but it’s probably also better for your health in the long run. And when one of my favorites is about drinking water. Because basically, if you’re dehydrated, that can lead to cognitive impairments. And by the time you’re thirsty, you’re already dehydrated. So one of the ways to make sure that you maintain your alertness throughout the night is to drink water as much as possible.

Nathan Illman 31:31

Proactively.

Despina Artenie 31:31

Proactively. So like when we want to be corny. In our workshops, we just say to have a drinking buddy. So like and you turn it into a great drinking game that like every time I drink water, you drink water, and it just goes on. And then the other joke that I like to make because I’m full of myself, but it’s very true is that like the things that are quite a learning, if you’re very sleepy are to like physical activity, and also to just generally be engaged in what you’re doing. So there’s nothing more engaging than socializing and gossiping. So I’m saying that if you’re ever like quite really tired at the end of your rope, just try to walk around with a calling and like gossip, and then that will keep you awake. And obviously, you can nap if you’re sleepy. And then if you nap to eat, like even just that 10-minute nap can be beneficial. If you nap for let’s say 30 minutes, then you’re likely to have sleeping nourishes. So that part of that like feeling grogginess after you nap. So if you can, I mean, a lot of the times, it’s not possible to but if you can try to plan for an extra, like 15 minutes after your nap, so that when you wake up, you have time to get over the grogginess. Because if not it is possible that errors can increase. And let’s see what else could be interesting. Yeah. And then there are the obvious ones, but they’re just good to keep in mind that if you can’t like, there’s nothing wrong with drinking coffee. But keep in mind that caffeine has a pretty long half-life. So I mean the recommendation varies. We say to try not to drink it at least three hours before bed. Some people say six hours before bed. And I mean, we’re all people here, do whatever you can, but like, ideally, don’t drink it too close to the bed, because then it can impact your sleep. So you get into easily negative feedback loops. Yeah, so these are some of the stuff that and then there’s all the obviously the sleep hygiene stuff, which people know, but some of them are easy, is interesting to me, for instance, just the importance of having some sort of way to block noise during the day, because a lot of people have families and they’ll have like children screaming downstairs and they’re trying to sleep right. And even if you’re sleeping, your brain does pick up on noise which can affect the quality of your sleep. So something like a noise machine or a fan can really make a difference. Yeah.

Nathan Illman 34:20

Yeah, that’s the sleep environment is so important, isn’t it? And I think for most people, there are little things that can be done to optimize it even more. Like just sort of jumping on what you just said there. white noise machines are good in a sort of way of blocking out some external noise that can be really helpful. And, you know, you mentioned darkness as well. I think it’s getting good blackout blinds or curtains is a really good investment, isn’t it? Because as we’ve been talking about this whole episode, light has such a powerful effect on the brain. So even when your eyes are closed or whatever, it’s still affecting your brain, because it’s through your eyelids isn’t it basically? This still centers there.

Despina Artenie 35:02

And then also includes our beloved phone. Right? Sorry. I mean, again, it’s hard because people destress in different ways, right? You can tell one person to avoid light before you go to bed. But then they’re like, but I watched my Netflix show. And that’s why it’s destressing after like a long day, at the Long Night at the hospital. So again, do whatever works for you. But if you’re going to use your phone, you can turn down your brightness, right? Those are things that, you know, so you don’t have to not use them at all. But just make sure that you’re not at 100% brightness it can also make a difference.

Nathan Illman 35:35

Yeah, well, thanks so much for all of those really helpful practical points. I make sure that in the show notes for this episode, we have all of those written listed down so people can take a look at them. I’m really excited to see where the light exposure intervention goes. If you can’t remember what you told me before if you have you got another study you’re working on with that, or do you know anyone else who is working on that?

Despina Artenie 35:35

So we don’t have anything in the pipe right now. And we’re still excited about this study. But what basically where we are going forward is so when we are going to serve right now the RCTs and review and when we publish, the paper is going to be published, we also want to publish our website, which does have basically, which you will be people will be able to use to generate their own like light schedules based on their work times and tips that I’ve mentioned. And we’re with all the references and the science stuff that we’re going to keep up to date. And we’re also gonna keep giving workshops. So once the study is launched, the study that once the website is launched, I’ll make sure to let you get it, and you can share it with people.

Nathan Illman 36:50

Yeah, that will be really helpful. I’m sure people will be reaching out to get that definitely. Well, it’s been a real pleasure talking to you. Thank you so much for sharing the results of your study and all your other practical wisdom. Congratulations on the study. And I know you’re sort of getting it published at the moment. So I wish you the best of luck with that.

Despina Artenie 37:06

Thank you. And thanks for having me. I am always happy to talk about how to reduce fatigue. And personally, it’s one of the fun things for me to keep up with the literature and figure out what is the newest thing, the newest, most efficacious thing so ever have anything else to let you know?

Nathan Illman 37:24

Yeah, pretty well. Maybe you can come back sometime and tell us a bit more about what’s going on in the world, the research world next year, or something.