Help me get to sleep

December 7, 2011 2:45 AM

I'm a nursing student and I've stopped sleeping the night before clinical. I could handle it when there was only one clinical day a week, but now there is two and I'm struggling.

I've dealt with very minor insomnia before. Nothing consistent, and for the past few years I sleep straight through the night whenever I go to bed. I always go to sleep around 8:30 pm and wake up at 4:30 or 5 no matter the day of the week.

I'm a new nursing student and I slept fine for the first couple clinical days (once a semester) but then I just stopped being able to. I live quite far from the hospital and my teacher doesn't post our assignments until the afternoon of the day before so I have a lot of work to do that evening. Afterwards I just lay in bed until 2 or 3 am.

I actually feel ok when I get up and go to clinical the next day when I've only lost one night of sleep (although I know my judgement is impaired). But now we have 2 clinical days in a row, the hospital is even farther away from my house, and I am running on ~6 hours of sleep for two nights. I'm really feeling tired this morning.

I think I am (very reluctantly) going to call out of clinical today because of patient safety reasons, but this is a strike against me and it can not happen again. I need to figure something out before this time next week.

- When I am lying in bed I'm not actively worrying about or even thinking about school or clinical, or anything. I'm just concentrating on my breathing, a happy part of my day, or nothing at all. If I try to get up and read I am way too tired to do so, but still can't fall back asleep.

- Sometimes I end up sleeping for around an hour or 45 minutes, but often I go straight through without sleeping.

-I've tried melatonin but it did nothing.

- Normally I would have a glass of wine or a strong drink, but I am on accutane and I am not able to drink alcohol. Therefore, no suggestions to have a glug of whiskey before bed, please.

I am reluctant to ask my doctor for sleeping pills because I sleep great 5-6 nights out of 7 and I don't want to become addicted. I'm also paranoid of taking drugs that could interact with the accutane.

Any suggestions? I am at a loss and really mad that I have to miss clinical this week.

posted by pintapicasso to health & fitness (10 answers total)

Modern prescription sleep aids are appropriate for occasional use and not addictive, and a doctor or pharmacist can address the drug interaction question. You have nothing to lose and a lot to gain by discussing your sleep problems with a doctor.
posted by Orinda at 4:19 AM on December 7, 2011 [8 favorites]

Sounds like you have a regular sleep routine where you sleep at 830pm, but with your late assignments you may stay up after that? or at least your evening routine is changed. This change could possibly be affecting your ability to sleep.

Could you ask your teacher if it's possible to get your assignments earlier?

Also, common agents used for insomnia (ambien, lunesta, trazodone, sonata, benadryl [which you can get without a prescription]) do not interact with accutane, but I have no idea what other medications you take so talk to your doctor to make sure they're safe. If you do try a sleeping med, try it on a weekend when you don't have school the next am, so you make sure you're not too sleepy with the medication.
posted by slomodinkens at 4:36 AM on December 7, 2011

I'm a nurse and I've got to say, if you think the sleeping problems are bad now, wait until you start shift work! Once you start doing morning shifts, evening shifts and night shifts and your sleeping pattern is all over the place it'll become really hard. There's a reason many doctors and nurses happily use sleeping pills for the occasional bump into sleep, and modern ones are not physically addictive or particularly dangerous. If one to two clinical days a week are this distressing though you may need to seriously re-examine if this is the career for you.

My advice right now would be to just go to the clinical day tired. If they're putting nursing students in any kind of position to be dangerous to patients they should be shot (and I hightly doubt they are, even our students on their last rotations before graduation aren't allowed to do anything without supervision) and you're going to have to go to work without decent sleep often during your career. I haven't worked at a hospital yet that didn't have you doing the occasional late-early (finish work at 11pm, start again at 7am) and no-one sleeps well on those ones so you may as well get used to it now.
posted by Silentgoldfish at 4:37 AM on December 7, 2011 [2 favorites]

Also a nurse here. I also would encourage you to go to your clinical today. I realize it feels like a patient safety issue, but usually part of this insomnia business before clinicals is because of some underlying stress about the day ahead, or just not being able to "shut off" your brain. This is reasonable, because nursing is a stressful profession. The easiest way I found to get over the insomnia I had before clinicals was just to soldier through, drink a good cup of coffee and OJ for some energy in the morning, and go to the dang clinical to prove to your unconscious brain that it can be done. You will gain NOTHING by calling out today, and it will reflect extremely poorly on you to your professors because nursing is a 24 hour profession. Lots of us go to work without a solid 9 hours to sleep and while it is certainly not ideal, in the real world when you call out, someone else has to be called IN. Instructors are very keenly aware of this if they've worked as a floor nurse for any length of time and it's better to save your call outs for when you're really sick, because chances are they only give you a certain number of times to be absent and then you're gone from the nursing program.

While I wouldn't say at this point its necessary to reexamine your profession (back in school, I found clinical days very anxiety-producing and spent MANY nights wide awake all night but I'm happily employed as a nurse these days and couldn't see myself doing much else), but it's time to get real about the sleep issue. Kind of like when you have a newborn in the house and you have to get used to waking up every hour until it becomes just part of your sleep routine for a little while. Nursing is one of those professions where you have to take the sleep where you can get it and if it means taking a (safe, compatible with Accutane) sleeping pill once a week to get a few extra hours to snooze and refresh, that's what you have to do. The other option is to just ride it out and face the day ahead even if you're tired and your body will get used to having two days a week with suboptimal sleep, especially since you apparently seem to sleep very well the rest of the week. As far as trying to get to sleep - you can try stuff like white noise makers, guided meditation, or watching something mind-numbing on tv (1AM infomercials, anyone?), but sometimes a brain just won't give you a break. Whatever you do, don't lie in bed stressing about how you aren't going to sleep. Get up, write an email, have a little warm drink like a little chamomile tea or something, and then try going back to bed. Or you can just take an Ambien. :D

I'm sorry to sound unsympathetic because, really, I've been there and it's not fun at all, but seriously. Don't call out. This will do nothing but buy you an extra few hours of sleeplessness at home wondering whether your instructor thinks its ridiculous that you called out because you didn't sleep (he/she will). I'm sorry. This is a reality of the stress that is nursing school.
posted by takoukla at 5:03 AM on December 7, 2011 [8 favorites]

Please refer to this excellent recent post here on how to help babies go to sleep:

http://www.metafilter.com/110193/I-heard-a-noise-faint-monotonous-white
posted by rmmcclay at 5:47 AM on December 7, 2011 [1 favorite]

*pulls up chair and sits down*

Melatonin did bubkis for me. What proved to be the magic bullet for me (prescribed by my own doctor, even) was valerian capsules. You will of course check on how that reacts with the accutane, I'm sure; but she suggested the valerian (in capsule form specifically), and two of those an hour before bed helped a lot. But it's a cumulative thing; they work better if you keep at it.

Adding magnesium supplements also helped for me; I read in an AskMe of my own that magnesium helps keep you from waking up in the middle of the night. I also noticed that even if I did get less sleep than I wanted, it was better QUALITY sleep, so that also helped.

Finally: the mix CD I made after posting this question is magic. It'd mellow me out to the point that I zonked out after only 20 minutes or so. A similar mix of music you know calms you down, played softly in your room as you're trying to fall asleep, could do the trick too. (I posted the setlist I chose for my CD there if you want to try that; I'd also add a song I"ve discovered since then -- Sting's cover of the folk song "The Snow That Melts The Soonest" off his album If On A Winter's Night.)
posted by EmpressCallipygos at 7:15 AM on December 7, 2011 [2 favorites]

When I did clinicals in nursing school, our instructor gave a few people the ok to just come into the hospital super early in the morning on the day of clinical to get their assignments and do their prep work, instead of coming in the night before. It was no fun for them to get there at 4:30-5:00am for a 7am shift, but it was better than driving an hour each way the night before in addition to the morning commute. Perhaps you could set up something similar?

Everyone saying to suck it up because nursing schedules are weird -- I'm a nurse, and it's true that rotating days/evenings/nights does mess with your sleep schedule, but clinicals are a whole different beast. There's not really any good reason why you should have to prep the night before vs. the morning of, as long as you're prepared by the start of the shift.
posted by vytae at 9:52 AM on December 7, 2011

Yep, I'm going to nth the idea that the insomnia probably has something to do with stressing over the next day. I'm a year and a half into nursing school, and I still get the night-before jitters on Friday nights going into a clinic weekend (not so much on Saturday nights, because I'm so exhausted from not getting much sleep on Friday night).

Definitely check to see if you can come the morning of, although you may not be comfortable enough with your skillset and knowledge-base at this point to be able to be ready for the day without hours and hours of research. You'll get there, but I get the anxiety and the need for thoroughness now. Keep it in mind for future clinicals, when you're more comfortable and can get what you need from the patients' records quickly.

Don't be afraid of sleep aids, although I'd recommend you go to your doctor and get a prescription for one, as they and your pharmacist will know best what can and can't mix with your accutane. Also, STAY AWAY from Benadryl (diphenhydramine) for this purpose. I was using it regularly on my Friday nights, and couldn't understand why I was still so exhausted the next day. It wasn't until my Psych rotation this semester, when my professor told us about how Benadryl block's the brain's REM sleep cycle, that I finally realized that it was honestly pretty counterproductive. Yeah, it lets your body rest, but it doesn't let your mind rest, which is really what needs to happen for restful sleep. I'm thinking of asking my doctor about trazodone just for this purpose.

Good luck! It gets better, I promise!
posted by scarykarrey at 10:51 AM on December 7, 2011 [1 favorite]

So, I just got back from clinical and did fine; I'm glad I ended up going. I'll contact my doctor about getting a sleeping pill prescription for occasional use.

I ended up talking about it with my clinical professor when we were finished today and showed her this question. She got a real kick out of the answers from nurses ;)
posted by pintapicasso at 1:46 PM on December 7, 2011 [1 favorite]

Are you doing care plans? When I was in nursing school, care plans were what killed me. It helped to get a study buddy. We did our plans together.
posted by IndigoRain at 9:50 PM on December 7, 2011