Night shift tips for doctors: sleep, naps, caffeine and the drive home

Why nights feel the way they do

Two things decide how sleepy you are. One is sleep pressure, which builds the longer you're awake and drains while you sleep. The other is your body clock, which pushes you towards sleep in the small hours whatever you've done. On a night shift both work against you at once, which is why the hours around 4am feel so heavy.

The BMA's 2024 briefing gives a figure I find sobering. After 17 to 19 hours awake, your reaction times can match someone with a blood alcohol level of 50 mg per 100 ml. That's the drink-drive limit in Scotland.

The body clock also explains why sleeping in the day is hard even when you're exhausted. Daylight tells it to wake you. If you want the neuroscience, our textbook chapter on sleep timing and deprivation covers the two-process model properly, and it's examinable in Paper A.

Before your first night

The aim is to start the first shift as recently slept as you can. The Association of Anaesthetists suggests an afternoon nap before the first night, because it shortens the time you've been continuously awake. A lie-in that morning is the alternative if you can't nap.

• Sleep normally the night before. Don't try to stay up late to "shift" your clock. Your body doesn't move that fast.

• Nap in the afternoon. Somewhere dark, with an alarm set. If sleep won't come, lying still with your eyes closed is still rest.

• Eat a proper meal before you leave. It's easier than finding one at 2am.

• Set up your bedroom for daytime sleep. Blackout blinds or an eye mask, earplugs, and a cool room.

• Tell the people you live with. Ask them to keep the house quiet in the day, and don't book deliveries for the days between nights.

• Plan the trip home now. Is there a way home that doesn't mean driving? Is there a bus, a lift or a partner who could collect you?

I pack my food the day before: a main meal I can heat, fruit and something with protein. It's one less decision to make when I'm tired.

A sleep plan for a run of nights

Between nights, what I've found helps most is protecting one block of sleep at the same clock time every day. Some people call this an anchor sleep. It's my habit, not a rule from the guidance, though it fits the BMA's advice to keep regular sleep times. On a short run of nights, it means one sleep window you keep until the last shift.

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Get home and into bed as quickly as you can. Have a light snack first, so hunger doesn't wake you at noon. Keep the room dark and the phone on silent, and skip the screen time in bed.

Alcohol is a poor sleep aid after nights. The BMA guidance advises avoiding it before you sleep, along with caffeine and nicotine.

If you wake after four hours and can't get back off, don't lie there fighting it. Get up, eat, get some light, and take a short nap before the next shift instead.

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Take your breaks, and plan them early

In England, a resident doctor on a night shift of 12 hours or more is entitled to three 30-minute paid breaks. The contract lets you combine them into one longer break if you need to, taken as close to the middle of the shift as possible. In psychiatry that's the difference between a real nap and none at all.

Driving home after nights

This is the most dangerous part of a night shift, and it's the one we talk about least. The Fight Fatigue campaign began after a trainee anaesthetist fell asleep at the wheel driving home from a night shift in 2015, and died.

The Highway Code (rule 91) is blunt: don't begin a trip if you're tired, and if you feel sleepy on the road, stop somewhere safe. A hard shoulder doesn't count.

What your contract gives you

In England, if you tell your employer you feel unable to travel home after a night, long or late shift because of tiredness, they must provide somewhere to sleep where possible, free of charge. If they can't, they must cover the cost of getting you home safely.

Where needed, they also cover reasonable costs of getting back for your next shift or your car, under local policy. The same applies if you're on call from home, get called in overnight and feel unsafe to drive back.

"I'm too tired to drive home safely. Can you tell me where I can sleep, or how to book a taxi?"

Find out in your first week how your trust handles this. Knowing where the room is, or who books the taxi, makes it far easier to ask at 9am.

Sleep after night shift, and getting back to normal

After the last night, the Association of Anaesthetists suggests a short sleep in the morning, then getting up. Go outside in the afternoon, and go to bed at your usual time. Avoid a long lie-in the next day.

None of this makes nights easy. It does make them safer, for you and your patients, and it makes the week afterwards much less of a write-off.

Raj

References

1. British Medical Association. Fatigue and sleep deprivation (guidance for doctors, 2024 briefing and Fatigue and Facilities Charter). 2019, updated 2026. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/creating-a-healthy-workplace/fatigue-and-sleep-deprivation

2. Association of Anaesthetists. Fight Fatigue: tips for night shifts. 2018. https://anaesthetists.org/Home/Wellbeing-support/Fatigue/Tips-for-night-shifts

3. NHS Employers. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 (version 14, Schedules 3 and 13). 2016, updated 2026. https://www.nhsemployers.org/publications/doctors-and-dentists-training-terms-and-conditions-england-2016