Chapter 3 - Strategies To Manage Fatigue

Get a good night's sleep

To help your body get ready to sleep, keep to a regular routine. Doing little things like brushing your teeth every day in the same order before bed can train your body to associate them with bedtime and sleeping, even if it's daytime and your body is normally awake.

Spend a few minutes winding down before bed. A little light exercise can sometimes help, although avoid anything strenuous at least an hour before trying to fall asleep.

Your body is programmed to digest food best during the day, so it's better not to eat a big meal just before bedtime. A light snack may be okay. Avoid anything with caffeine, such as coffee or energy drinks. Alcohol is not a good idea either, because you won't sleep as deeply and won't wake up feeling as refreshed.

Make your bedroom as comfortable a place to sleep as possible. Because light makes your body think it's time to wake up, your room should be dark. And not too warm - somewhere between 18°C and 24°C is a good temperature for sleeping.

Some fresh air can help as well. Try to use your bedroom only for relaxing, sleeping, and sex. Move potential distractions such as televisions and computers to another room.

Make sure you won't be disturbed. Use an answering machine for the telephone. If there are children around, make sure they won't wake you - tell your family about your schedule and put a sign on your fridge or bedroom door. If noise is keeping you awake, try using ear plugs. Because noise can sometimes disturb your sleep without actually waking you, some people use "white noise," such as a fan or an untuned radio, to help dampen other sounds.

If you can't get to sleep, it's sometimes better to get up and do something relaxing instead of tossing and turning. Try reading or taking a bath.

If your work schedule changes, try changing your bedtime by an hour or two each day to get your body gradually used to your new shift.

Take a nap

While a nap is no substitute for a good night's sleep, it can help you recover from fatigue and make you feel refreshed. How long you should nap depends on how much time you have available. You’ll feel more refreshed if you wake up naturally at the end of a sleep cycle. However, a nap should be at least 10 minutes long.

Remember that when you wake up, you may feel groggy and disoriented for about 20 minutes. This is especially true if you're wakened by an alarm instead of waking up naturally, or if you awaken from a particularly deep stage of sleep. This is known as sleep inertia. If you're planning a nap, make sure you build in time to properly wake up before taking on anything that requires full concentration, such as driving.

Although it doesn't seem to matter what time of day you take a nap, it's easiest to fall asleep when your body is most tired mid-afternoon and between midnight and 6 a.m.

Sleep disorders

If you don’t feel refreshed despite getting lots of sleep, or if you have ever been told that you stop breathing in your sleep or that you wake with a choking noise, you may suffer from a sleep disorder. Other warning signs include heavy snoring, restless legs, and sudden "sleep attacks" during the day. Sleep disorders disrupt your sleep, leaving you fatigued and unable to concentrate. Over time, they can lead to serious health problems.

Talk to your doctor. More information on sleep disorders is available on the Canadian Sleep Society’s website (www.css.to), which also includes a list of sleep medicine clinics in Canada.

Use drugs intelligently

Caffeine is one of the mostly widely used drugs in our society. Many people use the caffeine in a strong cup of coffee or tea to get their day started and to fight off feelings of fatigue as the day wears on.

Caffeine is also found in cola drinks, such as Pepsi or Coke, and in energy drinks such as Red Bull. You can also buy caffeine pills such as No-Doze. Keep in mind that you can develop a tolerance to caffeine - if you drink coffee regularly, you may need more than a cup to keep you alert when you're really fatigued. You can also develop a dependence. Many people develop withdrawal symptoms such as headaches when they try to go without.

The sugar in caffeinated drinks can actually work against the stimulating effect of the caffeine and reduce your alertness after the initial effect wears off.

Remember that stimulants only hide or postpone the effects of fatigue. They do not replace the need for sleep.

Some people use alcohol to help them relax before bedtime. While a couple of drinks may help you fall asleep more easily, alcohol tends to disrupt your sleep cycle and often produces a light, restless sleep that leaves you less refreshed.

There are a variety of over-the-counter and prescription sleeping pills available to help you get to sleep. However, like caffeine, your body can develop a tolerance and a dependence. After about a week, you may have difficulty falling asleep without them. Over time, you may need a larger and larger dose to fall asleep. Sleeping pills are best used occasionally or for only a few days at a time.

You should be aware that while cold or flu medications that contain pseudo - ephedrine may dry up your runny nose, they can also act as a stimulant to keep you awake. And they may leave you dehydrated, which will also affect the quality of your sleep. Use a night version if you need to relieve cold symptoms.

One drug that is not available in Canada but can be purchased over the counter in the U.S. is the hormone melatonin. Your body makes melatonin naturally around the same time of day as your natural drive to fall asleep. Some people report that taking melatonin pills helps them sleep. Others, however, report that it causes headaches, occasional depression, daytime drowsiness, dizziness, and reduced alertness. There is still little evidence that it is effective as a sleeping aid.

Stay fit and healthy

Regular exercise helps you sleep well, stay healthy, and feel fit. It may not be easy to find a regular time to exercise if your work schedule keeps changing, but you don't need to join a gym or a local sports team to enjoy the benefits of exercise. Even going for regular walks can help improve your energy levels and stamina, reduce the risk of heart disease and other health problems, and help you feel better and sleep better.

Stay alert at work

As well as getting the sleep you need, there are other ways to make sure you're wide awake and alert when you need to be.

Take regular breaks. Don't take your coffee or lunch break at your work station. Get up, walk around a little, get some fresh air. A change of scene can help you relax for a moment and leave you feeling more awake and energized.

Eat properly. Snack bars or sugary foods can give you a rush of energy - a sugar high - but that's usually followed by a low that makes you feel tired again. Foods like potatoes, pizza, and white bread have a high glycemic or sugar index and can make you feel sluggish. It's better to eat a sandwich on brown bread, which will keep you going longer without getting tired. Foods with a low glycemic index include low-fat yogurt or cottage cheese, lean beef and chicken, and canned fish packed in water.

Stay hydrated. Not drinking enough can make you feel sleepy. But be careful what you drink - drinks that contain caffeine or alcohol can actually make you more dehydrated. Sugary drinks or fruit juices can make you feel more thirsty. It's often said that you should drink about two litres of water per day. You should pay particular attention if you work in a hot, dry, or air-conditioned environment. Or if your job is physically demanding and makes you sweat. Eating high fat or high salt foods can also make you dehydrated.

Make smart use of caffeine. Coffee, tea, colas and energy drinks can help you stay alert. Just remember that the more regularly you use them, the more you will need if you really need help staying alert.

If you start to feel sleepy at work…

Research has found that we're not very good judges of how sleepy we are. In fact, the more tired we are, the less able we are to judge our own levels of fatigue.
If you find yourself constantly yawning, your thoughts keep wandering, you suddenly realise you haven't been concentrating, your eyes close for a moment or go out of focus, and you have trouble keeping your head up, you have all the danger signs of being drowsy.

Take a break, if you can. Or a nap, if possible. Try rinsing your face with cold water. Have a sandwich and something to drink. Don't start work again until you feel fully alert.

If you can't take a break, you could try the usual tricks such as opening a window or drinking a cup of strong coffee. These may help for a while, but they are not dependable strategies.

Be careful on the drive home

One of the most dangerous things you can do when you're fatigued is drive to or from work. Depending on your shift, you may be driving during the very times that your body most wants to sleep.

You could have a coffee before leaving work, but remember it may affect your ability to get to sleep when you get home. You could also have a nap before you leave work, but don’t forget about the effects of sleep inertia. Be careful to wait until you're fully awake before getting behind the wheel. Drive carefully, don't speed to get home faster, and don't be shy about stopping to take a break or nap if you find yourself feeling sluggish.

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