“If I couldn’t even figure out what goes into my lunch box, how could I possibly have multitasked . . . on a busy unit?”

Awake for 40 hours.

Photo by Jeff Greenberg. The ImageWorks.

I recently had the disorienting experience of being awake for 40 hours. This had to do with a family member’s interminable emergency department visit, a 3 a.m. car breakdown, and a post-ED MRI and medical visit.

I’ve never been up for 40 hours in my life. I didn’t pull “all-nighters” in school before exams, and never worked longer than a double eighthour shift. Partying the night away wasn’t in my DNA. So this experience was strange and new, and something I pondered over for days afterward.

An ‘otherworldly’ state.

By the time I’d been up for 24 hours straight, I was operating at a level about two beats behind everyone around me. Physically, I felt a little off-balance, as though I might fall if I didn’t step carefully. My brain seemed mired in muck, and I found myself trying to recall what I knew about depleting bodily stores of ATP. Preparing to return to work around hour 26, I stared into my lunch box. I couldn’t remember what food I was supposed to pack for the day.

Later in the afternoon, after the MRI had been completed, we sat down with the doctor to discuss the results. I was pretty sure this was not going to be good news. As the physician walked into the room, I think she was trying to put me at ease when she remarked, “You look pretty good for someone who’s been up for 40 hours.” I had a sudden, hysterical urge to blurt out Gloria Steinem’s remark on her 40th birthday: “This is what 40 looks like.” But all I managed in response was, “Oh.”

My low level of functioning, especially my inability to think clearly, was unfamiliar, otherworldly, and a little frightening. I had a sick family member and animals to care for. All depended on me for their safety and sustenance. I couldn’t stay in this shape for long and still be of use to anyone.

How much sleep deficit is too much?

A few nights of sleep passed before I felt close to normal. As I relaxed again into my usual routine, I was still examining this experience. I see much of my daily life through the lens of my nurse-self, so I kept wondering about sleep and work. Do nurses who are acutely or chronically sleep-deprived experience anything like my physically and mentally altered state? How much sleep deficit is too much? If I couldn’t even figure out what goes into my lunch box, how could I possibly have multitasked if I were back on a busy unit? Could even a barcode system have ensured that I got the right meds to the right patients?

All of this made me think about today’s debates over 12-hour shifts, especially when such long shifts are worked for many days in a row. (“Please, please, we’re short again tomorrow. Can you come in an extra day?”) A lot happens when we don’t give our bodies time within a 24-hour cycle to rest and repair.

Fighting night-shift fatigue.

The short- and long-term health hazards of regularly denying ourselves the “luxury” of sleep are discussed in “Fighting Night-Shift Fatigue” in this month’s issue (free until June 4). While staff on the night shift are more likely to experience disrupted sleep, fatigue is a nursing problem that has probably affected most of us at some point in our careers. The consequences of sleep deficits are well-documented, and new research is looking specifically at 12-hour shifts and their effects on nurses.

This month’s news article on fatigue shares some known risks—did you know that according to the AAA Foundation for Traffic Safety, less than four hours of sleep in 24 hours increases a driver’s risk of crashing by 11.5 times?—and points out a new position statement from the American Academy of Nursing, Reducing Fatigue Associated with Sleep Deficiency and Work Hours in Nurses.

Have you ever experienced intense fatigue as a nurse?