Night Shift Substance Use: Which Products Help Keep You Awake?

For some reason it seems my shifts in the emergency department lately have consisted primarily of night and evening hours. And, now that I pick up shifts at two different hospitals, my schedule is less coordinated than ever. This leaves me working a night here, and evening there, and my sleep pattern erratic (along with my mood...). Such is the life of a night-shifter! 

While I handle odd hours better than some, staying awake all night definitely requires me to partake in heavily caffeinated beverages. I can often be found with a steaming cup of coffee and a chilled Diet Coke sitting simultaneously on my desk alongside a few salty snacks. I drink a lot of caffeine when working overnight but have yet to try energy drinks or caffeine tablets because, well, they kind of freak me out. So, I decided to take a look at the different products on the market to help keep busy night shift nurse practitioners awake.

The Rundown on Caffeine

Nearly all of us have experienced the effects of caffeine. Whether you down a morning cup of Joe to help you poop, drink an afternoon soda to stay alert, or use the drug pre-workout to give you a slight athletic edge, caffeine helps keep us awake, alert, and responsive. Caffeine stimulates the nervous system relieving short-term drowsiness.

While caffeine is generally a pretty benign stimulant, it's familiarity shouldn't be equated with safety. Side effects of caffeine include rapid heart rate, anxiety, depression, restlessness, nausea, frequent urination, and tremors. Large amounts of caffeine may prevent to absorption of calcium leading to osteoporosis. It can also lead to fibrocystic breast disease (that's a new one!). In some cases, caffeine has also been documented to increase insulin resistance and therefore should be used with caution in individuals with diabetes. Withdrawal effects may occur with prolonged use and include drowsiness, headache, irritability, and/or nausea. In serious cases, excess caffeine intake can cause seizures and may even be lethal. The lethal dose of caffeine is about 150mg/kg of body weight (about 242 cans of Diet Coke for a person weighing 160 pounds)-a diffucult amount to ingest in most cases. 

According to the Mayo Clinic, up to 400mg of caffeine per day appears to be safe for most healthy adults. Some antibiotics including Cipro can interfere with the breakdown of caffeine in the body increasing the drug's half-life. The medications theophylline (a bronchodilator) and the herbal supplement echinacea have similar effects. So, caffeine consumption should be limited while taking these medications. 

Here are a few caffeinated options for nurse practitioners to help with staying awake on the night shift and a look at their ingredient and safety profiles.

1. NoDoz

Product Description: NoDoz is a caffeine-containing table available over the counter in most pharmacies. 

Caffeine Content: 200mg/tablet or 75mg lozenge

Safety Considerations: Standard caffeine safety profile

2. Soda

Product Description: From Diet Coke and Dr. Pepper to Mountain Dew and A&W Root Beer, every American seems to love drinking a carbonated, caffeinated beverage from time to time...or every hour. 

Caffeine Content: Ranges from 34mg in a 12oz Coke to 45mg in 12oz of Diet Coke and 72mg in a 12oz Mountain Dew Baja Blast. 

Safety Considerations: Study after study warns of the health risks associated with both diet and regular sodas. These beverages may increase stroke and heart attack risk, cause weight gain, and potentially cancer. The bottom line? We aren't quite sure what the long-term health effects of drinking a daily soda amount to. At the very least, consider the sugar content of your soda pick to combat night shift weight gain. The safety of sugar substitutes used in diet sodas has also been called into question in recent years. Drink sparingly. 

3. 5-Hour Energy Shots

Product Description: This tiny little 2 to 3oz bottle contains just 4 calories, no sugar, and promises to help you keep alert and focused. Ingredients vary but most flavors contain caffeine, B vitamins, and the amino acid taurine. 

Caffeine Content: One shot contains 200mg of caffeine. Other brands of energy shots such as the ALRI Hypershot contain up to 500mg of caffeine per 2oz. 

Safety Considerations: The high caffeine content of these shots brings about concerns for their safety. If taken in combination with other stimulants, before exercise, or in individuals with underlying health problems, they may rev up heart rate and blood pressure to unsafe levels. The bottom line? One shot taken at 3am may help you stay alert while treating your next patient, but don't overdo it. 

4. Starbucks Refreshers

Product Description: I had to include this personal fave in the list. Light, refreshing, and easy to drink, these fruit-flavored beverages by Starbucks come either in a can or in a powdered flavor packet sold at your local grocery store. The drink features Green Coffee Extract giving the beverage caffeine content from the coffee bean without the dark, brewed flavor. 

Caffeine Content: 50mg per 12oz serving

Safety Considerations: Limit your intake. Starbucks Refreshers contain more caffeine than soda. The drinks also contain sugar and while low-cal, aren't calorie-free. 

5. Coffee

Product Description: Who doesn't like a good 'ole cup of Joe? Drink it hot, drink it cold, drink it with milk or drink it black, coffee is a staple in most nurse practitioner's morning routines. 

Caffeine Content: 120 to 160mg/8oz regular, 6 to 10mg/8oz decaf

Safety Considerations: Keep an eye on your serving size when sipping your favorite brew. Topping off your mug from the coffee pot throughout the evening may leave you with little idea as to your actual caffeine consumption. 

6. Tea

Product Description: From Oolong to black and green, sipping on a hot cup of tea can be a relaxing reprieve during a busy shift. Or, perhaps you prefer chilled or flavored varieties? Whatever your pleasure, there's a tea to give you a caffeine fix. 

Caffeine Content: 25mg/8oz in green tea, 55mg/8oz in Lipton tea

Safety Considerations: Check ingredients carefully in your favorite tea-containing beverage. Treats like sweet tea can quickly add up when it comes to calories. Some tea drinks marketed as 'energy' teas may also contain excessive amount of caffeine. 

While there's certainly no substitute for a good night's sleep and a pre-night shift nap, caffeine can be a major help in staying awake and alert during a busy shift. How do you like to keep alert during the night shift?

 

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