Shift Work
Coping Strategies For Workers Who Sleep At Unusual Times

More than 22 million Americans are like you-working evening, rotating, or on-call shifts and facing sleep-related problems like trouble sleeping during the day and staying alert on the job. Shift work may cause you social and family problems, or even physical illness. Working a schedule different from most people’s can be challenging, but following the guidelines in this handout may make shift work easier for you to live with and safer too.

A main reason that shift work can be challenging to your health and lifestyle is the fact that your body is so sensitive to changes in circadian rhythms. “What are circadian rhythms?” you ask. Circadian rhythms are like “messages” that tell various body functions when to kick in. Things like temperature, alertness, sleepiness, hunger, and most hormones operate at different times during a 24-hour day. In healthy adults, sleepiness tends to occur during a specific phase of the circadian rhythm, with the strongest sleep urges between 2:00 A.M. and 5:00 A.M. If you work at night, you must fight your body’s natural rhythms by staying awake when you would normally be sleepy and by trying to sleep when you would normally be awake.

Some researchers believe that complete adjustment to permanent irregular shift work may take as long as three years to achieve. Others believe that a person never fully adjusts to an unusual sleep/wake schedule.
Whichever is true, shift workers tend to be continually sleep-deprived. If you are a night shift worker who sleeps during the day, your average sleep cycle may be two to four hours shorter than that of a day worker who sleeps at night. Your day sleep is probably light, interrupted, and less likely to make you fell well rested. You may even be experiencing sleep deprivation and insomnia. The sleep problems you face as a shift worker can be made worse if you already have some kind of a sleep disorder. If you suspect that you have a sleep problem, even if it existed before you started shift work, see your healthcare professional for advice and treatment.

How Can a Sleep Problem Affect My Life?
A main way sleep loss can affect your life is by lessening the quality of your job performance. Numerous laboratory and field studies show that sleepiness affects a person’s normal functions: memory, mental ability, motor skills, and moods.
 
There are many examples among night workers of serious accidents caused, at least in part, by sleepiness. Two such examples include the Three Mile Island nuclear power accident and the Exxon Valdez grounding. The cost to society of sleep-related accidents is huge.

Are there treatments for sleep loss related to Shift Work?
Since your work setting and tasks can vary greatly from other worker’s, whether they work shifts or not, it is necessary to explore a variety of solutions and treatments to help you overcome your problems. The ideal approach for someone who works in a hospital, for example may not be the best for someone who works on an assembly line. Also, some people are more naturally suited to working one kind of shift than another. “Night People” may adjust to the night shift better than “Morning People.” Older workers in general find it harder to work nights or rotate shifts. Several treatments appear to help with shift worker’s problem’s, but the approach likely to help you best depends on your individual needs and circumstances.

WORK SCHEDULES: The best work schedule is one that allows you to sleep when you are off duty and be alert when you are on duty. Of course, the best schedule for you may depend on the above mentioned factors as well as the job and position you hold. Work schedules that go along with your body’s circadian rhythm by rotating clockwise (from day to evening to night) are helpful. Studies have shown that changes in the work schedule that consider circadian factors are likely to lead workers to be more productive and feel more satisfied, and to reduce accidents. Your ideal schedule should be determined by your body’s natural sleep needs, by what feels “right” and helps your overall work-time alertness. Breaks during work hours may also increase you alertness. There is evidence that brief rest periods in certain types of jobs may reduce fatigue without reducing output: in fact, breaks may actually increase your productivity and job satisfaction. Ask your employer to work with you to determine a scheduling change that could improve your job performance and make you feel less tired.

SLEEP SCHEDULES: If you are a permanent night shift worker, you should keep a regular (day) sleep schedule seven days a week, even on your days off work. Going back to a typical day schedule during time off will only make it harder for you to sleep during the day when you return to your night shift work.
If you are someone who works rotating shifts, try to adjust your sleep schedule so that you will be able to adjust more easily to a new shift time when it happens. On the last few days of the evening shift, for example, bedtimes and arise times should be delayed by one to two hours. Then you can begin your night shift work already well on the way to being adjusted to the new schedule. Family and social responsibilities may, of course, make this difficult or impossible to do. Still, following this treatment approach may really improve your life, and indirectly help your family and social relationships.
If you are an on-call shift worker, you are probably aware that your sleep problems are somewhat different from those of night shift or rotating shift workers. Because on-call workers usually can’t predict work schedules far enough in advance to plan the right sleep/wake schedule that should try to be well rested at all times. Napping may be worth trying. Although there is some evidence that sleeping in one longer stretch than sleeping in several shorter periods, those of you who cant get all your sleep in one stretch may increase your total hours of sleep by napping. Napping is especially helpful when naps are taken off-shift, at an appropriate point in your circadian rhythm. Then napping can help offset the sleep loss associated with poor daytime sleep. On the other hand, brief naps taken during a work shift may only increase your alertness for the moment, since your job performance can be slowed at first as a result of sleep inertia (the body’s tendency to want to remain at rest for 15 minutes to an hour after awakening). You should seriously consider the effects of sleep inertia before you decide to use napping during the work shift (say, on a break), especially if your job required you to wake up quickly or react immediately to different situations. While naps are not a substitute for a regular schedule of normal sleep, they can help you reduce your sleep “debt” and improve your alertness, at least for the time being.

SLEEP AIDES: Shift workers often use sleeping pills (also known as hypnotics or sedatives) to override the time of day and make themselves able to sleep. There are disadvantages to using these medications, including side effects in some people. You should avoid long-term use of medication because its effectiveness may wear off over time, and you may develop a dependence on the drug. Most important, however is the evidence that even if daytime sleep is improved with the use of sleeping pills, there will likely be only partial improvement in alertness and performance in the night shift following a worker’s dose of such medication. Although sleeping pills may offer relief, and may be appropriate with other treatment, they do not address the actual cause of your sleep problems. Sleeping pills cannot reset your internal clock. If you think sleeping pills could help you once in a while, talk with your healthcare professional. Over the counter sleep aids are not the best choices to help you sleep since many of them cause drowsiness for several hours after you awaken, which can be unsafe. Some people believe that alcohol helps them sleep, but that is only because of an initially sleepy feeling they might experience as a result of drinking. Alcohol is not beneficial to sleep. In fact, if you drink alcohol when you are already tired, and in the wrong circadian phase, the alcohol may have a rebound effect, waking you within a short period of time and making it harder to return to sleep.

STIMULANTS: Studies have shown that the occasional use of stimulants, such as caffeine, can reduce sleepiness and improve your ability to be alert on a night shift. However, you should avoid caffeine within four hours of your desired bedtime since it can actually cause difficulty falling asleep.
MELATONIN: Our brain’s natural production of a melatonin appears to affect our sleep/wake cycle. Melatonin is a chemical produced by the pineal gland in the brain at night, during sleep. Research has recently begun to explore the possibility of giving a synthetic (man-made) form of melatonin to night workers so they can sleep during the day and be awake at night. Further research is needed to determine the effectiveness of this treatment.
 
BRIGHT LIGHT THERAPY: Some recent studies have produced early evidence that timed exposure to bright light can help adjust the sleep cycle quickly. Just as the sun sets your body’s clock, exposure to bright light may actually shift the circadian phase, reversing your sleep/wake schedule so you are able to sleep during the say and be alert on the job at night.

SLEEP HYGIENE: The best treatment may be to follow the guidelines of good sleep hygiene, especially the need to sleep in a dark, quiet, room. Proper sleep hygiene requires using the bedroom only for sleep and sexual activity (not for watching TV or for balancing the checkbook), keeping the room temperature cool, relaxing before falling asleep, and having a regular routine for preparing to sleep (brushing teeth, putting on pajamas, and so on). It may also be helpful to buy dark curtains for the windows, or to wear eye shades for sleep. You may find it helpful to use “white noise”( produced by tuning a radio to the far end of the dial, or by running a fan) to block out other noises/ Turning off the phone (an answering machine can be used if necessary) and disconnecting the doorbell or putting up a “Do Not Disturb” sign can also help.

WORKPLACE CONDITIONS: Lighting levels, temperature, and job responsibilities in the workplace are among the factors likely to play a role in your alertness levels at work. Your workplace should be well-lighted and cool rather than warm. The setup of the workplace will determine how you can best control these factors to increase your alertness on the job. In general, you and your employer should educate yourselves about the effects of shift work in your workplace, and you should encourage safety and productivity.

OTHER MEASURES: Diet may also play a role in good sleep: shift workers should eat meals that are high in protein and carbohydrates, and should avoid fried or hard-to-digest foods, going to bed when hungry, or going to bed immediately after eating a large meal.
    How to Sleep Well:
  • These guidelines can help most people sleep better, as well as many individuals with different types of sleep disorders.
  • Maintain a regular wake time, even on days off work and on weekends.
  • Try to go to bed only when drowsy
  • If you are in bed and are not drowsy, and unable to fall asleep for about 20 minutes, leave your bedroom and engage yourself in a quiet activity somewhere else. Return to bed only when you are sleepy. Repeat this process as often as necessary throughout the night.
  • Use your bedroom only for sleep, sex, and times of illness.
  • If you have trouble sleeping at night, don’t nap during the daytime. If you do nap, try to do so at the same time every day and for no more than an hour. Mid-afternoon (no later than 3:00 pm) is best for most people.
  • Establishing relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or ten minutes of reading.
  • Keep a regular schedule. Regular times for meals, medications, chores, and other activities help keep the brain’s inner clock running smoothly, allowing you to sleep more easily and soundly.
  • Avoid large meals before bedtime.
  • Avoid caffeine (coffee, tea, soda pop with caffeine, cocoa or chocolate) within six hours of bedtime.
  • Don’t drink alcohol when sleepy. When you are sleepy, even a small dose of alcohol can affect activities like driving. Do not drink alcohol while taking sleeping pills or certain medications. Don’t use alcohol to make you fall asleep at night. While alcohol may help you to fall asleep faster, it severely affects the quality of sleep later in the night and may even keep you from sleeping through the night.
  • Avoid tobacco close to bedtime or during the night.
  • Sleeping pills should be used only conservatively.

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