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I've come up with four steps that I teach to clinicians. I teach to adolescents at school. I teach in schools and then I'm actually starting to teach people in the Navy as well who have to do shift works too. Uh, and the four things are the forays, er, and they are firstly to accept, then to anticipate, then to act and adapt. So we're gonna go into detail to explore what they are and they're four steps that can help you manage, shift working and they're all downloadable on the PDF that I've shared with you. So firstly accept. So this is all about accepting that it is a challenge. Yeah, that you are choosing a career that's really important. You've got Iki Gui to quote the Japanese. You've got a, a job that is important for you. It's important for your c your, your tribe, it pays you and it gives you opportunities but it does come at a price. It does challenge you and so it needs to be safe for you, for you to get home safe at the end of the shift to not crash your car, but also to preserve your lifespan. I personally want to teach my grandkids tai Chi. And so I've said it in my mind to manage shifts well, so I keep that promise. It needs to be safe for others. So I think it's all about performing well and minimizing mistakes and errors, incidents and injuries. It needs to have some social consideration. So you can live happily and harmoniously with your family and then sustainable. You need to be able to cover the rotter. So just a recap, not crash a car to have a long healthy life. With those you love to not have needle stick injuries and not injure those you're caring for to have time where you're at your best with your families and friends and also to cover the rot up. If you can accept that we can then anticipate. So this is about looking at your personal clock and maybe designing it. So it works with you and I've put a clock with two times here because it's really important to almost have a dual clock though. I know wristwatch, I've got dual times. One time is in your normal working time where you're synchronized with everyone else. But the other is to set a dual time for the time zone that you're traveling to. So if you're doing a night shift, it's like you're traveling to Australia and we're gonna look at a bit more detail here and I've just put four key times or prime times, which is really important to write down and work out for you before you start going onto shifts. So you can anticipate and prepare. So one is what's normal for you. So I said, I normally wake up at six. This is a typical working diet and then I wind down at nine and then I'm in bed at 10. Yeah. But then you might be having long days where you're working later, like I'm doing here and you might have those long days at work. Um And so you need to adapt to those longer days to make sure you still eat. You still have rests and that you can still synchronize your body clock. So when you get home, you're not suddenly watching Netflix and staying up later, too late where you're messing up your brain's function or there's a night shift and I've just switched it all by, by 12 hours. So these people are, for example, waking up at 6 p.m. working at eight till 8 a.m. and then wind down at nine for going to bed at 10. So this is all about designing your clock just right for you. And then between those two, there are lates and early and I'm just remember what I said, you try not to shift your body clock if you can help it. And if there's one key take home from this, it's if you're doing eight lates and ears, try and stick as best you can to the same wake up time and bedtime if you can, your body clock won't get out of sync. And as a result, it then synchronizes. So you, you reduce your risk of diabetes and obesity because you metabolize food at the right times. So this is the next poll is, what sort of shifts do you do? So I'm just gonna ask you now, it's multiple choice and you can choose multiple factors. I just wanna know what sort of shifts do you do? Knowing those factors there? So, the options are none, long days, nights, early lates or something other that I haven't thought of while they're doing that. And I'll say I do long days and occasional nights because I'm a dad sometimes do the out of hours GP shifts. You what do you do? Let's have a look at the pole. So all of your shift workers, we all do that. 100% long days nights, 80% early's 40 late, 20 other, this is the bit I'm intrigued about what's the other type of shifts that you do? Because I, I've around and spoken to lots of, of foundation doctors. Um, and they each have their own unique Rotas. Could you type it in the Q and A? What? The unique type of rota you do? That's other because I'd love to learn from you. That would be fantastic. Thanks for sharing. So here we've anticipated the next one is act. So I'm gonna ask you now, uh, upon that what you could do then to, to, from some of the factors that you've learned about getting your left right about your prime times. What could you do before I start filling in these gaps? To set your body clock to get your down head down easily and perform well and to rise and shine. Can you have a ponder? What would you do? Well, we spoke about getting your left right. So trying to get your light exercise, food temperature, soothing and sleeping environment. So you've got your baseline tip top. So it's like filling up your tanks before you're about to then take off. So how could you start your first day, you know, the day before your night shift and then how could you manage those night shifts? So you're fresh at night, but also can get your head down when you get back home. And then once you've finished your run of night shift, how could you get your body clock back in check really quickly and then rise and shine? So you're back on track. We're gonna go through each of those stages in detail. Now, so before you fly, it's about setting your body clock. So we spoke about making sure you get your prime times, right? So actually setting reminders to wake up at the same time and then walk outside like get daylight ideally, within 90 minutes of walking, just a two minute stroll outside can have profound impact for your health and performance. And then similarly 90 minutes before bedtime because it takes 90 minutes to release your melatonin properly. So you can get to sleep faster and, and, and if you look at a phone before bed or switch on the lights, what you're doing is you're blocking your Melatonin release. And, and believe it or not, the team GB cyclist who did really well in the Olympics, one of the core factors they did for marginal returns was they actually gave everyone a little reminder to wear an a, a wristwatch to beep before their bedtimes to say, wind down, turn down the lights and put on a pair of blue blocking glasses. In fact, that just blocked out the blue light and only gave them that red wavelength of light 90 minutes before bed. And so when their head hits the pillow boom, they were gone with a large dose of Melatonin straight into sleep and they need to be at regular times with your regular bedtime. The other factor I've mentioned about getting your left right are factors that if you can manage those, your light, your exercise, your food, your temperature and your soothing, you can really do well and you can download that free PDF that I mentioned with a little on the fridge door checklist that you can use if you would like to improve your sleep and your cryobiology in one week looks a bit like that. So that's before you fly getting your baseline. The next thing is to take off. So this is the morning before the night shift. What we wanna do is delay your body clock naturally. So, rather than setting alarm, actually see if you can have a lie in and delay your waking by at least an hour. So you wake up naturally and if you can, you can de delay it even lighter later by just having low lights. So just ponder pottering around the house with low lights on. So not triggering the light to come. And for me, I used to wear blue locking glasses just to kind of delay that uh the other thing is have a late breakfast if you can delay your, your breakfast by even an hour, that will delay your natural body clock before your shift. So you're just moving closer to that time. And on the day of that uh night shift, if you can get a, a 90 minute nap, what you can do then is top up your, your tanks and reduce the Adena to remember that nodding dog sleep drive. And that way you're less likely to have that Adena build up while you're on the night shift and less likely to have those micro sleeps and those accidents. So top up your tank and then as soon as you wake up, try and get a bit of exercise and a late supper. And that way you're resetting those gi of exercise and food So your body clock starts to go later. Now, it will take a while to get it later. But that's a really good way of t of boosting it and then you're on the night shift in the night shift zone. So you're flying. So while you're working, keep fresh by sipping water and keep the lights bright. So cheers guys, I just have a little sip of water with you now. And that also triggers the vagus nerve which keeps us relaxed and ready. It makes it less stressful also, while you're sipping water, your nose breathing, which releases Gaba, which is another pause button and can dampen down the Amygdala response. So if you ever need to calm down during a night shift, just simply sipping some cold water can have a profound impact and it's much less uh unpleasant for your brain and body than sipping caffeine. The other thing is to be realistic, know that your performance is going to be impaired. Now, if you can, we know your performance will improve if you can take a 10 to 20 minute nap, which is not always the case, but it's much better than using caffeine sugar or alcohol for your longevity. But you can only really do that if you can hold each other's beeps and this is where relationships count. So just chatting with your mates and just saying, I'm not gonna sleep, I'm just gonna rest and have a, just a lie down for 10 minutes. Can you hold my beep for those 10 and that 10 minute can supercharge you. And if, when you do that, you just lie down in a position called semis supine with your knees, your foot back, flat on the ground, your knees bent. It can hugely restore your brain function and the ultra performers do it. Google, pay their staff to do it. I don't see why we can't look after each other and do it. And then when you get up again, just breathe in deeply and stretch your arms like Julie Andrews in the sound of music. And that switches on your reticular activating system and removes any kind of rest inertia, you're back on it again. Alternatively, splashing cold water on your face is a really good way of waking up after doing it. I mentioned food is really important. So if you can time restrict your eating, so you're not eating within uh um three hours of going to bed ideally at the end of your shift or let's just say at least two hours before going to bed, which is hard if you're working hard, try and cram in the food before bedtime. But if you can try and eat not too close to that bedtime and you'll sleep safely. And then the other thing is to drive home safe if in any doubt, pull over or go take public transport or splash water on your face, have the window open in your car or sing along again. Julie Andrews, put the sound of music soundtrack on, just sing along and belt it. You'll get home much safer. And then sleeping. I already mentioned don't eat or have bright lights before bed because you wanna get to bed fast. You can wind down with a candle if you don't burn your house down and it's safe or a hot shower or I have a red bike torch that I wear on my head. If I'm having a hot shower, just to keep the or not on my head in the shower, but just to give you red light. So you don't block your Melatonin before bed. I mentioned before some of the hazards of alcohol. Um similarly, sleeping tablets can disrupt the quality of your sleep and the architecture of your sleep. So if you can try and avoid using downers to get down, but rather than natural methods, but there are some um there's some evidence that using periodically ashwagandha or magnesium threon eight can help you improve the quality of sleep by reducing your glutamate release. And some people use Melatonin. There is some controversial evidence about Melatonin not thought to necessarily be particularly effective but also crossing the blood brain barrier. There can be some issues and also the doses you can get can be supraphysiological and melatonin doesn't just affect our sleep. It affects our sex hormones and um uh our immune function. So I wouldn't use Melatonin too frequently. Certainly, no more than two or three nights a week. And then if you wake up before you intend to cos sometimes we do, our brains are wired. Just jot down your thoughts on a piece of paper or, but don't put the bright lights on because you don't want to wake yourself up and block the Melatonin and just go to another room that's dark and soothing if you can, if you can and if you really struggle and you, you have issues with insomnia, um do talk with your GP or, or get in touch with us. We run courses that support people with insomnia and then finally it's waking up. So when you wake up ready for work, you need to set your new wake up time with that wristwatch. Remember I said dual times, you want a new time to wake yourself up but then splash or shower with cold water and get some exercise. You know, you may be waking up at, at 6 p.m. So your body and brain may be out, sink a little bit. But if you can splash that cold water, you can get your body clock back on track again. And this is while you're on the night shift and then landing back in your normal time zone. You've done your run of nights, you can end your last light shift well by avoiding bright lights and caffeine because you don't wanna be too awake before you go to bed or block your Adena, your sleep fuel. The other thing you can do is take an early nap when you get home to top up your sleep time. So between 90 minutes and three hours, that's, you know, so you can just get enough to get you going, but not enough to block your complete night's sleep. So you don't wanna go to bed sit, you know, within eight hours, you don't, rather than you wanna wake up eight hours before your new normal bedtime. And that's where getting daylight is really important. If you do have a nap, when you get back, get some daylight and try and reset your body clock back to normal daylight hours and eat if possible and then try and safely stay awake that day, try and be active and engaging, but just try and avoid driving or doing anything too, too consequential and then unwind before bed and a journal is a great way of doing it. And I'm gonna mention why in the next slide just releasing your thoughts and positively plan your next few days. What am I gonna do to? Maybe your, your brain becomes more hopeless and depressed. If your shift worked, it basically says it's dangerous out there, don't go. And so if you can positively affirm and be grateful for things to look forward to, then you can change the valence and some of the neural modulators and that could hopefully get you back on top again. And then the final bit I mentioned was about adapting. So you've done a run of night shifts. You've got back on track again. It's still important to see how you can manage that. So here I mentioned journaling, just keeping a track while you're on nights can improve your recall while you're on nights because unfortunately, your memory gets disrupted by night shifts. So that way you can remember what happened, the good stuff and the bad stuff and you're less likely to unconsciously entra traumas into your mind and get your rem sleep disrupted. And so you can process the emotions and thoughts if you keep a journal while you're on nights as well as after. And there's a free downloadable PDF called Joyful Journaling that you can do try it if you'd like to learn a new skill about journaling massively improves your health and performance. The other thing is to talk with your team and your tribe. So the team you're working with as well as your tribe at home. It's important that you stay in touch. It reduces tachy kinin and we loan loneliness as, as bad as smoking for our health and you are unique, but you're not alone. You're doing a valuable job and I want you to be appreciated for it. I put an asterix here because there were some preemptive questions um from people who typed in before asking some things. And I wanted to mention a bit about those. So one question was, is there a big transition from going from F one to F two and from all of the F twos, I've spoken to, they say yes, there is, you are less sheltered as an F two doctor. However, in terms of the practical things of what to do, you already know how to do it. So all you do is you do it better and you do it with your team. You know, your team counts, so talk to your team, you are gonna be working more challenging shifts and making more decisions. But actually your team carries you through and to help you with that, you can actually get some guidance from the B MA about managing your ROTA. And so I've put here at the bottom that you can type in the good roster guidance. And if you type that in Google, they've got a specific PDF about how you can manage and negotiate your rota. Um And you can even do um a quality improvement project which covers something you must do and a wellbeing project that you can tailor to you on shift working. And if you want to do it, just get in touch with me and I can sign posts you to some, some resources about that. And then the other thing is about mind shift the mindset, just know you're doing hard work, but you aren't forgotten. You are a hero you've chosen to do this job and I want you to be healthy doing it.