DR MAX PEMBERTON: I know the terrible toll of lockdown ‘jet-lag’
- Night shifts have greater risk of developing a mood disorder such as depression
- Dr Max Pemberton has spent a week working nights in A&E at a London hospital
- NHS psychiatrist reveals disrupted sleep patterns can feel like ‘jet-lag’
This column is being written in the middle of the night. At least, it feels like that, but the sun is shining outside. While most people are just starting work, it’s nearly my bedtime.
Things seem so topsy-turvy because I’ve just spent a week working nights in A&E. It feels like I’m severely jet-lagged, but alas I’ve been holed up in a London hospital rather than relaxing in some tropical paradise.
Although most people don’t have to endure the upheaval of night shifts, I do think many are suffering from very disrupted sleep patterns, resulting in a similar ‘lockdown jet-lag’.
The main cause of this, for both night-shift workers and those staying at home, is the fact that neither of us are getting enough daylight. It messes up our body clock. This is driven by our circadian rhythm, which tells us when to wake up and when to sleep.
UK-based psychiatrist Dr Max Pemberton explores how disrupted sleep patterns can result in a similar feeling to ‘jet-lag’ (file image)
The main driver for this is light. Our eyes capture changes in light levels outside and relay this to specialised cells in the brain. These respond by releasing hormones — melatonin and cortisol — which make us feel sleepy or alert respectively.
Working a night shift disrupts this pattern — it’s dark, so the brain releases melatonin to make us sleepy, but in fact we need to stay awake. The confusion can result in ‘shift work sleep disorder’, characterised by insomnia and excessive sleepiness.
As well as a higher risk of accidents, poorer work performance and attention difficulties, it’s also associated with mental health problems.
A review of studies showed that those working night shifts have a 42 per cent greater risk of developing a mood disorder such as depression.
Lockdown, especially this one, has meant most of us now spend seemingly endless periods indoors with limited exposure to natural light. Of course, as it’s winter there are fewer hours of sunlight anyway.
I have several patients in my outpatient clinic who find their depression comes on with almost clockwork precision when the clocks go back in autumn, and lifts again in spring. One woman changes from being happy-go-lucky to suicidal every October. She has developed a routine whereby she starts anti-depressants at the start of autumn and ensures she gets as much sunlight as possible — even going on her ‘summer’ holiday in late November.
This pattern has been dubbed SAD — seasonal affective disorder — and I think it happens to a lesser degree (what doctors call ‘subclinical’) in lots of people.
Being cooped up inside the house and not seeing enough sunlight will be impacting the mood of many people nationwide. The last couple of weeks have been very tough on our mental health. Of course, the stresses of the pandemic are no doubt playing a big part. But I also think that the disruption to sleeping patterns caused by a lack of light are a factor, too.
Dr Max (pictured) recommends avoiding alcohol and sticking to a pattern, don’t be tempted to lie in for more than 20 minutes
The dark days and the loss of structure and routine during lockdown has meant we’re all suffering from this semi-jet-lag. This is added to by the temptation to stay up late binge-watching a series then have a lie-in.
Does this sound familiar? If so, I’ve learned a few things from doing nights that should help.
First, avoid alcohol. It’s tempting to use it to try to wind down, but it actually interferes with the body’s ability to synchronise itself and doesn’t give you proper, deep sleep.
Next, try to find a pattern and stick to it. Even if you do find yourself staying up later than usual (just another episode of Bridgerton!), get up at the same time you would do normally — don’t be tempted to lie in for more than 20 minutes.
I’ve also found using a special lamp that mimics daylight helps. I have one that I use while doing night shifts and just after. I sit for an hour with it on when I wake up (as it’s the evening and dark outside), and when I’m back on day shifts for a few days in the late afternoon/early evening.
For patients who are really struggling to get their rhythm back, I sometimes prescribe melatonin. Taken before bedtime, this helps mimic the circadian rhythm and kick-start the normal sleeping pattern.
Finally, remember, it’s February now! Spring will be here soon enough and we can wave goodbye to lockdown jet-lag for good.
Recent study claimed half of people in their 20s forget why they enter a room once a week
- Have you ever gone into a room and forgotten why? Lost your keys then discovered them in your hand? When this happens, particularly when you’re middle-aged or older, it often pulls people up short, as they have a sudden panic that it could be a symptom of something else. Am I losing my memory? Do I have dementia? When I worked in a memory clinic, we would have quite a few referrals from people who would lose their keys or forget people’s names and wanted to be checked out. Invariably, we just offered them reassurance. In fact, older people are far from unique in having these lapses of memory. I was fascinated to read a study this week that showed half of people in their 20s forget why they enter a room once a week, with two in five saying they misplace their phone at least once a week, and nearly half forgetting to buy things on their shopping list once a week. It goes to show how poor our memory really is.
But as we age, we start to notice this more, simply because we are more worried about our memory failing. In fact, it may well be as good (or bad) as it always has been, but these incidents take on more meaning.
Don’t ban vaping — it works!
The European Commission plans to recommend that EU countries ban vaping in public places. It’s part of a push to ensure only five per cent of the bloc’s population uses tobacco by 2040. This is very wrongheaded, especially as we’ve seen how cigarette smoking increases the risks of Covid.
We should instead be doing all we can to move people from cigarettes to vaping. I think the pandemic has given us the perfect opportunity to ban cigarettes entirely — and I say that as a former heavy smoker. The invention of e-cigarettes has meant that smokers who don’t want to quit have a viable alternative. There is no reason to still sell conventional cigarettes, which are one of the most deadly products ever created. If they were invented today, there is no way they would ever be allowed. We should be focusing our attention on stubbing them out for good.
- The tragic story of a social worker who died after having liposuction in Turkey shows how risky going abroad for surgery can be. Abimbola Bamgbose, 38, died from peritonitis and multi-organ failure last year after a botched procedure. The language barrier meant the mother-of-three from Dartford, Kent, couldn’t explain to doctors the pain she was in. The temptation for these operations will no doubt arise again when we can travel. They often seem ‘cheap and cheerful’, but I’ve seen many bungled tummy tucks, breast enlargements and gastric bands. They can be deadly.
Coal Town Coffee are trying to help frontline NHS workers
Dr Max prescribes…
Morning brew for NHS
I love this little coffee firm (coaltowncoffee.co.uk) that was set up to re-invigorate a Welsh former mining town. It’s now trying to help frontline NHS workers. You buy a bag to donate and the company matches your donation and arranges for it to be delivered to a local ICU. If the scheme is a success, it plans to roll it out across the country. I drink the coffee every morning and would highly recommend it.
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