Chinyelu Oraedu, MD, a nocturnist, first decided to try the nighttime schedule right out of residency when her twin boys were 3 years old and her daughter was just a few months old.

“I said, ‘OK, it’s going to give me more time with the kids.’”

However, 10 years later, Oraedu reached a breaking point. She developed obesity and noticed possible symptoms of sleep apnea. In addition, her mother had type 2 diabetes, and she knew she, too, was at risk.

“I just watched myself spiral out of control,” Oraedu, a night shift hospitalist at a hospital in Fairfield County, Connecticut, told Medscape Medical News. “I couldn’t recognize myself.”

Then the COVID pandemic hit. Her kids and husband were at home. Oraedu had more time for herself because she wasn’t driving them to activities. Meanwhile, she watched patients with COVID with chronic, poorly controlled medical illnesses, including people with undiagnosed medical conditions, fared worse during their hospitalization. They had a higher rate of morbidity and mortality due to COVID.

“And it got me thinking that the more time I make for myself that perhaps I can actually change my health.... I can change the trajectory of my life by engaging in those activities that promote longevity — eating better, sleeping longer, exercising,’” she said.

So she hired a coach. “Somebody who gave me accountability.”

The Toll of Night Shift Work

Millions of people work the night shift full-time in the United States.

Working at night can provide incentives such as it generally pays more than daytime work and can offer people opportunities to train, develop a business, or spend time with their children during the day, Oraedu said. However, working those hours is hard and runs against the grain of most people’s biology, she said.

For example, night shift workers — especially those who have worked 10 years or longer on the overnight shift — are more at a risk for certain health conditions such as metabolic disorders, cancer, heart disease, and stroke, according to the CDC.

Oraedu attributes her weight gain to poor eating habits on and off the night shift and lack of consistent sleep.

“Part of the reason night shift workers struggle with nutrition and obesity…is lack of access to healthy meals at night,” Oraedu said. For example, she’s worked at hospitals where the cafeterias close at 3 PM. After that if you don’t bring your own food, your options are limited to vending machines or food delivery, she said.

Also, “if you don’t have sufficient sleep…your hormones are going to be in disarray and your appetite will be extremely difficult to control,” she said.

Fortunately, there are nutrition hacks and ways to structure your days — small tweaks — to help optimize sleep, nutrition, and time with family, Oraedu said.

From No Schedule to a Routine

Early in her career, when Oraedu would arrive home from work in the morning, she didn’t have any sort of schedule. She would drive her children to school and then do random things such as organize her closet or do laundry before going to sleep. Given that she had to pick up her children from school at around 2 PM, she would only get about 4-5 hours of fragmented sleep. Then she would start the process again for her next night shift.

“And then you find out that the primary reason you started working at night — so you can spend time with your children — you probably may not even have the energy to do that,” she said.

Starting in 2020, Oraedu changed her diet and lifestyle with the assistance of her coach, and she cut down her work schedule to part time. She lost 65 pounds, dropping from 235 pounds to 170 pounds. She even started her own coaching business, Dr. Yel’Ora Lifestyle & Obesity Coaching for Night Workers.

Hiring help for her kids was essential, she said, as it enabled her to get extra sleep and get herself on a schedule.

Oraedu also started doing something new, planning her meals focusing on simple, easy-to-prepare meals that didn’t take away from her need for good quality sleep.

While at work, she started drinking “low-calorie sips” such as water with cilantro (nothing with sugar in it) and “flavorful soups” with vegetables and protein. Her advice to friends, colleagues, and her coaching clients is to focus on simple meals filled with protein (which helps you feel full, she said) and to stay hydrated.

Nowadays, Oraedu times her meals and doesn’t eat past 8 PM. “The body is not programmed for you to eat at all times,” she said. Late night eating could predispose you to impaired glucose tolerance. She also tries to avoid coffee at least 4 hours before the end of her shift to make it easier for her to sleep once she goes home.

Oraedu also encourages other nocturnists to try to take naps during their shift if they can give their caseload and if hospital policy allows. And if you work with another nocturnist, you could consider taking 30-minute breaks if the hospital allows them.

Bhavesh Patel, MD, a nocturnist from Northwest Permanente in Vancouver, Washington, is able to switch easily between night and day shifts (he works two night shifts and two day shifts per week). Hence, he does not have the sleep challenges other nocturnists have, a hospital spokesperson said on his behalf. “However, blackout curtains and sound machines can be very helpful,” he said.

‘Make It Count’ With Your Kids

The hardest part about being a nocturnist is for your family, Patel said, “because when you’re on at night and your spouse is working during the day, they’re alone in the evening.”

“We just try to be organized and then use a day off as a family day,” he said in an email. “Especially when we are busy. The other great thing we do is use vacations to hang out and be present with our kids.”

When her children were younger, Oraedu kept a schedule on the wall at home for them to keep track of when she would be home and when she would be at the hospital so that they could be mentally prepared for when she was or was not available to them. During that timeframe, she also talked with her children’s teachers about the fact that she worked nights and asked them for advanced notice about important school events so that she could try to schedule her work around them.

“I just can’t be there all the time, but when I’m there, I make it count,” she said.

Hospitals that allow flexible scheduling can help nocturnists balance the demands of work and family in ways that would allow a nocturnist to, for example, attend a child’s school event they just recently found out about, Oraedu said.

Working Solo vs as Part of a Team

In the beginning of her career, Oraedu was the only nocturnist covering the patients at her hospital during the overnight hours, she said.

“.... That is the case in some hospitals where a nocturnist may be the only doctor doing admissions and covering the patients on the medical floor,” she said, although hers is a training hospital and she did have residents working with her.

“You make a lot of tough decisions in the middle of the night with patients who are acutely ill,” Oraedu said. “.... So you deal with real-life bedside emergencies because there’s nobody else in house and it just gives you compassion.”

Eventually, her hospital hired a second nocturnist which was helpful, Oraedu said.

She doesn’t think it’s okay for nocturnists to work alone at night. “...for the same reason that you just need support. It’s good to have a second person,” she said.

“Twelve-hour shifts are...pretty long,” she added. “Your energy level wanes at some point overnight.” Most day jobs are 8 or 10 hours.

Find an organization that values your effort and time, Patel said. “If the organization prioritizes your health and makes your workload manageable, it makes your life a lot easier.”

Payment Structure Matters

For Patel, his schedule works for now. Each week, he works two night shifts (5 PM to 5 AM) and two day shifts. His current caseload is consistently manageable based on his employer’s value-based system, he said. This means his productivity is measured by patient outcomes and not by the number of patients he sees. Normally, he handles four to five admissions per night.

“A really busy night might include eight hospital admissions. And I cross-cover maybe 30-40 patients. It’s much more manageable and sustainable,” he said, as compared to his previous work for a fee-for-service healthcare system where he used to handle 22-23 patient encounters a day and 10-15 hospital admissions a night, while cross-covering 100 patients.

He appreciates being able to practice value-based care, he said. In his hospital, there is a care coordinator who works to try to prevent unnecessary readmissions.

“The patient care coordinator contacts other entities on my behalf to eliminate barriers, such as transportation challenges, social work issues, and home health orders,” Patel said. Thus, he’s been able to focus on his clinical work instead of “serving as a case worker.”

Patel also likes the “many opportunities for variety and growth” such as leading the Care Without Delay team that brings together experts from a variety of disciplines to coordinate “seamless transitions of care to ensure hospital beds are available, whether patients are arriving from the emergency department, another unit, or being discharged home.”

He also has 3 weeks paid time off and education leave “so that was a huge selling point for me,” he said.

“A lot of people worry about serving as a nocturnist, but this shift offers more time and opportunity for career organization. And if you start with the right organization, you can often pivot over to daytime work,” he said.

It May Not Be Forever

As Oraedu continues her part-time nocturnist work, she considers daytime work options. She always wanted to be an oncologist but later developed an interest in perioperative care, an area of medicine dealing with getting patients ready for elective surgery. Some opportunities for being on medical boards involve daytime attendance too, she said.

“I just know that for career advancement, I needed to be seen during the day. I needed to share my thoughts. I needed to get involved in quality projects within the hospital...,” Oraedu said.

Also, because of the health risks involved in night shift work, she always knew it wasn’t her long-term goal.

“There’s a season in your life that you work at night,” Oraedu said, “and it’s important that you recognize when that season is over.”