I have been working week-long night shifts recently, something I haven’t done since residency. And just like my hangovers, my recovery sleep seems to have only gotten worse. My night shifts are scheduled every other week, and so the weeks in between I try to adapt to regular sleep. It has not been easy, and I empathize with people who do this for many years. After speaking to patients, I have discovered other forms of working the night shift such as raising kids and caring for chronically ill loved ones. I’ll be working on a blog for new parents soon. I wanted to write this for all the night warriors who keep us safe, provide care, keep our power on and maintain the productivity of our nation.
How does shift work affect your health?
Awareness of the impact shift work has on our health is important.Pause. This is not about “I am doing ok” or “I’ll be fine” – this is about being honest with ourselves and taking steps to ensure our health is not severely impacted by poor sleep. Sleep issues are innocuous – but you will pay the price at some point. Studies have shown a higher risk of heart disease, mental health issues, diabetes, and obesity linked to shift work disorder. Anyone working outside the usual 8 am to 5 pm work hours is at risk. Does working irregular hours mean you have a ‘disorder’? It is a disorder if you either have sleep disturbance (sleep is broken up or unrefreshing) or have difficulty staying awake (reduced alertness or mental performance).
What can you do about it?
Irregular shift schedules such as night shifts, mixed with late shifts interspersed with a regular day shift is harder on your body rhythm. Try to organize it such that day shift moves into the late shift followed by the night shift. The forward movement of shifts is easier to adapt to and less disruptive as staying awake later is easier than forcing yourself asleep earlier. Another option is to do a continuous run of late or night shifts. I understand many of you may have no power to influence scheduling; I am happy to share resources that prove better scheduling improves productivity (and profits).
The amount of sleep is nearly as important as the ability to sleep in a continuous stretch. Adults need between 7-8 hours of sleep of consolidated (continuous) sleep to achieve adequate REM and NREM sleep cycles. Breaking up sleep into 2 periods which add up as close as possible to the recommended daily sleep amount, is not as good as sleeping in a continuous stretch, but better than short naps throughout the day.
A short nap prior or a scheduled nap during downtime at work is recommended to improve alertness and reduce accidents, without affecting post-shift sleep. These naps can range from 20-30minutes.
Medical grade melatonin (check with your local pharmacist) or a short-acting benzodiazepine (triazolam, zopiclone) can help with sleep initiation. The major concern with sleep aids (apart from melatonin) is the hangover effect and the sluggishness. Each drug has a slightly different action duration and will impact everyone differently. It is best to figure out the best fit by trial and error on days/nights you have no work following the use of a sleep aid.
Adequate light exposure pre-shift and during shift with limited exposure post-shift is important to synchronize the sleep-wake cycle. Some have had success with supplemental lightboxes (2500-10000lux) for the 20-minute duration, four to five times, throughout the shift – caution with pre-existing eye conditions. Immediately post-shift, avoid direct sunlight with sunglasses (or goggles), and limit screen time to help adjust the body for sleep.
Caffeine use is helpful, but should be avoided 4 hours prior to expected bedtime, while stimulants such as modafinil prior to starting the shift can improve alertness and work performance. However, some can have issues falling asleep post-shift as a result of stimulants while others have mood swings and elevated blood pressure. Tradeoffs exist – pick your poison. I have used stimulants effectively with patients with reduced job performance and alertness.
Poor sleep can lead to a lack of satiety and a tendency to ‘graze’. Avoid if possible – easier said than done when the Chinese takeout menu gets passed around at 11 pm. If you do indulge, surround yourself with high protein, low processed sugar, and low carbohydrate food options. Yes, you can. You must.
This tip is intuitive. Use blackout curtains, sleep in a cool and quiet environment. For those with pre-school children – I salute you.
This is my version of counting sheep. With your eyes closed, focus on each breath in, and out. Every time your mind drifts off to nagging thoughts, bring it back to breathing. Don’t fight the thoughts, don’t get frustrated. Gently nudge your attention back to breathing steadily. Sleep will come, I promise.
Common things are common.
While it takes a special person to work the night shift and own it, not all sleep issues are unique. Sleep apnea, restless legs syndrome, and insomnia are common sleep conditions that may co-exist with shift work disorder, affecting sleep – requiring a different treatment approach.
I miss my daylight and my early mornings at home with coffee in my den. I hope my night shifts don’t last longer much longer, some of you may not have that choice to make. It is important that your health does not suffer. Help is available, please reach out sliiip.com.
Sleep well, my night warriors. Thank you for your service.
Are there any thoughts you would like to share? Please feel free to leave a comment. Happy to continue this conversation.
Written by Dr. Avinesh Bhar
About the author – Dr. Avinesh Bhar our online sleep doctor
Dr. Bhar is fellowship-trained and board-certified in sleep, critical care and pulmonary medicine. He has been in practice for over seven years and established a telemedicine practice founded on high-value and personalized, convenient, and cost-effective sleep and pulmonary care. At Sliiip, we offer pulmonary and sleep telemedicine that allows you to receive video consultation, diagnosis, and follow up care from the comfort of your home. Our physician, Dr. Bhar, believes that high-quality care only comes from a trustful physician-patient relationship. To find out more about our services, and our products get in touch with us today by visiting our website, or calling 478-238-3552.