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altDear Broca,
I have been working rotating shifts for over 20 years. I started out drinking a glass of wine to unwind from the shift when unable to fall asleep on my own. Now several years later I find that I am requiring two to three glasses of wine to fall asleep. Is this a problem?

Dear Reader,
Habits sneak up on us when our frontal lobes get lazy. Why think about new ways to reign in our kids or banter with our partner when we have all this subcortical circuitry primed, waiting and as worn in as an old Lazy Boy? But taken to extremes, our habits can begin to slide into addiction.  Our frontal cortex may still be screaming “What the @!$@ are you thinking!!”, but our  reward circuitry is no longer listening. It has become so over stimulated that it’s consumed only with satisfying its mighty craving for just one last fix.

Determining whether your increased use of alcohol to wind down after a stressful shift is problematic requires an honest examination of your drinking patterns. The fact that you are worried about it is a big red flag. Sometimes at work I still hear those sage soundbites from my residency: “If you think about doing an LP in a febrile infant you should probably do it,” or “If you think about reporting child abuse, you need to do it.” Now in retrospect, some of these hunches weren’t all that evidence-based but you get the picture: If a concern crosses your mind and is bugging you, you have to address it.

According to the CDC , moderate drinking is defined as having no more than 1 drink per day for women or 2 for men, while heavy drinking is the average daily consumption of anything more. Granted, where the bell curve ends and the early stages of a problem begin can be a bit blurry but if there are other signs such as strong cravings for a drink, the inability to stop even after injury or family requests, increased tolerance or the development of  withdrawal symptoms, it is very likely that you have a significant alcohol problem.

To address your concern, you might want to consciously change your routine after your shift. Consider working out, taking your dog for a walk, watching a video, meditating, cooking, etc... But if this doesn’t work, it is time to get help while your frontal lobe and subcortical brain are still on talking terms. We are a proud profession with high expectations for what we should be able to handle alone. Our jobs are extremely stressful and we all carry that stress somewhere. Talking with a peer, spouse, therapist or religious leader may provide more insight about whether additional treatment is necessary. In the long run, consciously and constructively adapting to stress will help keep our patients and ourselves healthier.

This month’s Broca’s Area is written by Jeannette Wolfe, MD, an active member and lecturer in the ACEP Wellness Section
 

Comments   

# Evan Weinstein MD, EMTP, FAAEM 2008-10-16 22:35
I think the key has to do with what the wine does for the Reader. If it is part of an enjoyable activity that leads to winding down, then it is fine. If the alcohol is used as a sedative, that is more of an issue. The question then is, can the sleep schedule or shift schedule be changed in such a way to lead to being more reliably tired?
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# physicianSherry Schaden 2008-12-03 19:06
The rotating shifts are keeping your body clock in permanent disarray. Visit your doctor and get an Rx for Sonata. It’s very short-acting, safe for long-term use and works consistently. Give up the wine at bedtime. I knew someone whose wine after a shift turned into an 8 oz gulp of vodka.
You could also sleep as best as you can without the wine and use Provigil. It’s approved for shift work but is very expensive.
Your insomnia is caused by your shift work…it’s not your fault. It’s OK to take a medication if you cannot change your schedule.
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