Sleep like your life depends on it
A version of this blog was originally posted as part of Wellness Week 2026 for the Canadian Association of Emergency Physicians (CAEP). https://caep.ca/caep-emergency-medicine-wellness/wellness-committee/wellness-week-january-19-23-2026/
Picture this: It’s your third evening shift in a row. You’ve been sleeping like a caffeinated toddler thanks to a family crisis, and a patient with six months of occasional toe pain is now yelling at you for asking about their family doctor. They accuse you of being “insensitive,” and suddenly you’re wondering if you’re the problem—or if it’s the fact that your circadian rhythm is currently being slow-roasted like a rotisserie chicken. Two days later the patient files a complaint, and now you’re half-convinced the universe wants you to take an office job somewhere involving ferns and Muzak.
Before you start Googling “non-clinical careers where nobody yells at me,” let’s talk about what’s actually happening: shift work, fatigue, and the very real ways they warp your brain, your health, and your reactions to frustrated humans with no GP.
Shift work doesn’t just make you tired; it reshapes your long-term morbidity and mortality—and not in a pretty way. Circadian misalignment (a fancy term for “your internal clock is screaming”) is associated with:
Metabolic syndrome—including diabetes, hypertension, dyslipidemia and abdominal obesity
Increased rates of cardiovascular disease
Menstrual irregularities and dysmenorrhea
Depression, anxiety, burnout
Cancer (Yes. Cancer.)
Add in the classic EM tradition of driving home half-unconscious after a night shift, and the risk of motor vehicle collisions goes up, too. And it’s not just your health. Night shifts are associated with a higher risk of workplace accidents—which is unsurprising when your brain is functioning at the level of a warm bowl of oatmeal.
We all know we’re slower and grumpier at 4 a.m., but the cognitive toll is deeper:
Reduced alertness and overall activity at night
Slower reaction times and lapses in attention
Reduced concentration and impaired data processing
Worsening performance across consecutive night shifts—especially memory and attention
So would you have de-escalated that angry toe-pain patient more effectively if you were rested? Probably. Fatigue constricts emotional bandwidth, narrows cognitive flexibility, and shortens your fuse… which is a tough combo when someone is yelling at you because their x-ray from last month was normal.
But what about those colleagues who seem to thrive on night shifts? Not all shift workers are built the same. The way shift work affects you depends on:
Internal factors: your chronotype (“morning lark” vs “night owl”), genetic traits, vulnerability to sleep loss
External factors: family roles, social obligations, commuting
Workplace factors: staffing, workload, policies, hazards (Gurubhagavatula et al., 2021)
Some emerg docs glide through nights effortlessly, like vampires kicking ass. Others drag themselves through the dark like Victorian chimney sweeps. And some can only tolerate nights when the stars align, the in-laws take the kids, and the dog doesn’t throw up on the carpet.
Understanding this interplay is key to scheduling that doesn’t destroy people. We need to create shift scheduling that allows for this individual variability, and create the flexibility normal busy humans need. What strategies are valuable for healthier shift scheduling?
1. Match shifts to chronotype and lifestyle
Night owls → more evening shifts
Morning larks → more morning shifts
Nobody → back-to-back nights on short recovery
Aligning shifts with chronobiology increases sleep duration—and makes people hate their jobs less.
2. Use forward-rotating schedules
Day → evening → night
NOT the reverse.
Backward rotation is like telling your circadian system to somersault while on fire.
3. Build in adequate recovery time
Less than 11 hours between shifts = insomnia, excessive sleepiness, cranky humans.
More consecutive shifts = longer recovery needed.
4. Shorter shifts are more efficient
Shifts >12 hours = higher risk of mental fatigue and errors.
Shorter shifts (7–8 hours) = better productivity.
Casino shifts (10 p.m.–4 a.m. or 4–10 a.m.) show promise in protecting “anchor sleep”—your precious nighttime sleep block.
5. Tailor the schedule to department realities
No two EDs are the same. Useful factors to consider:
Patient arrivals and acuity
Physician productivity
Breaks (yes, breaks, we should have them)
Day-of-week variability
Rural docs juggling office work
Preferences and personal circumstances
Hiring nocturnists, incentivizing less-loved shifts, and compensating for wrap-up time can all reduce burnout.
And above all, we need transparency, fairness and consistency. Clear rules for holidays, weekends, sabbaticals, and shift distribution prevent simmering resentment—the kind that boils over in group chats at 2 a.m.
Why Sleep Really Matters
We’re not whining about inconvenience; we’re talking about safety, health and career longevity. Poor scheduling and chronic sleep disruption don’t just make shifts unpleasant—they shorten careers, increase medical errors, and harm clinicians’ physical and mental health.
Emergency medicine needs leaders willing to embrace data-driven scheduling that respects human physiology. Not rigid, one-size-fits-all templates. Not martyr culture. Not “we’ve always done it this way.”
We need schedules that keep us healthy enough to keep doing the job. Because your sleep isn’t a luxury. It’s not optional. And in emergency medicine, your life—and your patients’ lives—genuinely depend on it.
#sleep #shiftwork #wellbeing #longevity #emergencymedicine #thriving