Coping with Shiftwork

Welcome to Night Shift
Submitted by Jeannie Graham, ASN, BA, RNC

Working night shift brings with it its own special challenges. This booklet is designed to give some helpful tips for coping with these challenges. Based on the results of a variety of research studies and the advice of experienced night shift workers, this booklet includes information on the following topics:

· Effects of shiftwork
· Sleep
· Diet/nutrition
· Exercise/health
· Road safety
· Friends/family

At the end of the booklet you will also find a list of resources for services and information that can be helpful for people coping with shiftwork.

Effects of Shiftwork

The human body was not designed with a 24-hour workday in mind. Circadian rhythms refer to normal physical and behavioral cycles that our bodies follow over the course of a day. Our bodies follow several of these circadian rhythms which affect sleep/wakefulness, body temperature, blood pressure, and the production of hormones and digestion. (2)

Controlled by centers in the brain, these rhythms are strongly influenced by daylight. This is how these rhythms can program us to be awake during the daytime. It also explains why shiftworkers often encounter problems sleeping during the day and maintaining alertness and concentration at night. This also explains why shiftworkers have problems eating and digesting food during the night—when our digestive systems are essentially at rest.

Working at night means one has to go against one’s own body’s natural tendencies. This can lead to some negative consequences. During nighttime hours (and to a lesser extent during early to mid-afternoon) most human activities are impaired. Manual dexterity, mental arithmetic, reaction time, and reasoning abilities all are measurably lower at these times.(2)

Working off shifts or irregular hours can have the following effects:

· Disrupted sleep/wake cycles
· Disruption of other daily body rhythms
· Decreased quality sleep (1, 2)

All these effects combined can impair alertness and judgement putting nightworkers at risk for making errors. To minimize these risks and to help nightworkers stay healthy, there are some strategies that can be beneficial.

The Health Effects of Shiftwork

Sleep

The most direct impact of shiftwork is felt on your ability to sleep. First, the normal ups and downs of the circadian rhythms boost alertness in the morning, making it difficult to get to sleep and/or to obtain long, uninterrupted blocks of daytime sleep. Second, while you are sleeping the rest of the world is awake and noise, sunlight, and friends and family often interrupt sleep or cut it short.

Shiftworkers commonly end up getting 2 or more hours less sleep than the average dayperson—5-6 hours of sleep after night shifts compared to the normal 7+ hours.(2) Along with decreased quantity sleep, shiftworkers also have poorer quality sleep.(1,2) They spend less time in the deeper, restorative stages of sleep critical for recovery from physical fatigue.(2) They also receive less Rapid Eye Movement (REM) sleep, which has been shown through research to have a negative effect on mental health.(2)

Digestion

Shiftworkers also suffer from 2-3 times higher rates of digestive problems, including constipation, diarrhea, excessive gas, abdominal pain and heart burn than typically seen in dayworkers.(2) More serious problems, such as peptic ulcers, are also seen occurring at a more frequent rate in shiftworkers than dayworkers.(2) But these problems are not unavoidable consequences of working at night; they can often be avoided by improving several basic health habits such as diet, sleep, and exercise and the avoidance of caffeine and nicotine.

Mental Health

A number of studies have also found that shiftworkers have more complaints of mental health symptoms such as nervousness, chronic fatigue, anxiety, restlessness, and irritability.(1, 2) Some studies have also linked shiftwork to an increased risk for depression (for example a French study of retired ex-shiftworkers showed an incidence rate of depression of 29% compared with a rate of 17% seen in former dayworkers).(2)

Risks to Women

Some recent studies have also looked at possible connections between shiftwork and women’s reproductive health. While these studies suggest possible links between shiftwork and decreased fertility, increased risk of miscarriage, premature birth, and high blood pressure during pregnancy, research is still inconclusive.(2)

What does this all mean?

While this list of problems related to shiftwork might seem alarming, it’s important to keep it in perspective. Not all of the research is conclusive. Factors including the number of people studied, variations in schedules worked, and a variety of cultural issues can mean that these studies are meaningless for you as an individual.

It is also important to remember that these problems are not unavoidable. By doing all the right things—understanding your body’s rhythms, making sleep a priority, eating a healthy diet, and getting regular exercise—you can drastically reduce your risk of developing problems as a result of working nights.

Tips for Coping with Shiftwork

· Keep your sleep area dark. Never underestimate the effect light has on stimulating wakefulness. Use thick curtains, or double-curtains, try lining windows with aluminum foil, or try wearing eye shades for day sleeping. Some shiftworkers have found it helpful to convert an area of their basement into a sleep area. Basements usually have few or no windows to let in sunlight and they are often cooler (a nice added bonus for those sleeping during the day in hot summer weather).
· Avoid eating heavy, starchy, or greasy food during a night shift.(1,2,3) This kind of food can interfere with your ability to fall asleep after your shift and it can contribute to digestive problems.(2) Remember your body’s circadian rhythms mean your digestive system is not prepared to cope with food eaten at 2:00 am. What’s recommended instead? Try lighter foods such as soups, fruit, or toast.(1,2,3)
· Avoid consuming caffeine (in coffee, tea, sodas, or chocolate) within three to four hours of going to bed since caffeine can interfere with your sleep.(1,2,3) If possible it is good to avoid caffeine entirely but for hardcore coffee drinkers this is not always possible. If you have to have your Java—try developing a coffee routine (i.e. start off your shift with a cup and limit yourself to a second cup halfway through the night).
· While some people try an alcoholic beverage as an aid in getting to sleep this is not recommended. While the alcohol may seem to help in getting you to sleep, it reduces the quality of sleep and may lead to an interruption in sleep if you have to get up to use the bathroom.(1,2)
· Treat yourself to a first-rate, comfortable bed. Make climbing into bed a pleasure and not just a collapse from fatigue.
· Keep the bedroom cool (65-68 deg is good).(2) Normal circadian rhythms cause your body temperature to drop at night and rise during the day.(1,2) These normal changes in body temperature will still occur, even if you have been up all night, and they can interfere with restful sleep.
· If you are having trouble getting to sleep—try taking advantage of this temperature effect. Drowsiness can be induced by a drop in body temperature. If you have a problem getting to sleep, it may help to take a warm bath. The cooling effect that occurs when you get out of the bath often can help to induce drowsiness.
· Try and avoid exposure to bright sunlight in the hour or two before going to bed. Many experienced shiftworkers wear dark glasses for the drive home.
· When it is time to get up, you can help get yourself going by opening the drapes (if it is still light out) and letting the daylight help to get your body started. If you schedule your sleep so that you are getting up after sundown, turn on the lights to help get you going.
· Keep as regular a schedule as possible.
· Some nightworkers break their sleep into smaller batches. They will sleep 4 or 5 hours in the morning, get up for part of the day, and take a pre-work nap in the evening. This may be an option for shiftworkers coordinating schedules with the needs of a spouse and children.
· Develop a pre-sleep routine to help your mind and body gradually wind down and prepare you to sleep.
· If you have problems getting to sleep, try to keep your bedroom for sleeping only. Don’t read or watch TV in bed. Don’t be a clockwatcher—it can only add to your anxiety if you find yourself looking at the clock every fifteen minutes thinking, “I’ve got to get to sleep!” If you have lain awake more than 15 minutes try getting up and doing something non-stimulating and relaxing, like copying recipes or working on a crafts project like ceramics. If possible try to stay in an area that is not too brightly lit—remember the point is to relax, not to get yourself revved up.
· If you work alternate shifts, don’t wait until the last minute to prepare yourself for a nightshift. If possible, try to stay up late and sleep late a couple of days before you start the first night of a stretch.
· Eliminate NOISE, NOISE, NOISE! Before becoming a nightworker, make sure to talk to your family and friends and explain to them the importance of letting you sleep except in the case of emergencies. If the phone is a problem, turn the ringer off and/or use an answering machine. Earplugs may be helpful as well as “white noise” from a fan or a commercially-made “white noise machine”. Some nightworkers also find it helpful to listen to relaxation tapes at bedtime.
· Exercise regularly. (Yoga is a great way to get exercise, relieve stress, and aid relaxation.) Shiftworkers who exercise regularly usually report higher quality and quantity sleep than those who don’t.(1,2,3)
· If you find you are having a lot of gastro-intestinal problems try to eat a high-fiber diet.(1,2,3) Fiber-rich foods include cereals, potatoes, carrots, broccoli, cauliflower, peas, beans, apples, bananas, nuts, and citrus fruits. (2,3)

A particular hazard for shiftworkers is the drive home. Nightworkers run a high risk of falling asleep at the wheel putting themselves, and other drivers, in danger. Check out the fun and informative Audio Clips available on the The AAA Foundation for Traffic Safety Website!

· Some road tips to keep in mind: if you feel drowsy the best thing to do is to pull over and park. Take a nap in the backseat. If you are worried about being hassled by a traffic cop—I am sure if you explain why you pulled over they would much prefer that you napped and then drove safely rather than risk causing an accident.
· Keep your eyes moving while you drive; don’t fix your vision on that hypnotic yellow line. Keep the radio on if it helps keep you awake.
· Some nightworkers find it helpful to have a pick-me-up snack before the drive home.
· Take advantage of carpools—you have less driving to do and there are other people in the vehicle making sure the driver is alert and that everyone is safe.
· Invest in a cell phone or carphone. No one likes to have the car break down on the way to work but it can be even worse if you have to deal with car trouble at 11:00 pm. With a cell or car phone, you can always get help if you need it.

Although many night workers choose their shift because it helps solve childcare problems, working nights can also create some challenges on the home front. If possible it is best to think ahead and try to solve potential problems before they occur.

Keep communication open. Talk about the changes in your schedule with your family in advance and get them to help you problem solve any trouble spots. Remember—you are not the only one in the house who will be affected by this change in your schedule
· Post a calendar with your schedule in an open area (like the kitchen) so that your spouse and/or children will know your schedule.
· Having problems finding “quality time” to spend with spouse/children when you are going to work when they are going to bed? Plan “dates”, even if it’s something simple like dinner out, or sitting down together to watch a video.
· Don’t try to dramatically flip your sleep schedule back and forth as you come on and off stretches of nights. Allow time for recovery days. If you work a stretch of four or more nights in a row, plan to spend at least one full day after the stretch as a recovery day. Your body will need to re-adjust to daytime living just like it had to adjust to being up all night. If you can schedule family outings on days after you have had a recovery day, then you are more likely to enjoy the outing (and your family is more likely to enjoy you!).
· Develop friendships and socialize with other shiftworkers. Your families will be able to connect with their families (who share similar challenges) and you may be able to work out helpful childcare and/or carpooling arrangements.

Hopefully you will find these tips helpful in making the adjustment to a nightshift schedule. If you have been working nights for a while and are still having problems, don’t hesitate to ask for help.

You can reach the Employee and Family Assistance Program (for FAHC employees) at 847-2827 or you can call the FAHC Wellness Center at 847-2278.

For sleep problems that do not seem to improve, try talking with your primary care provider or contacting the Sleep Disorders Center at 847-5338 or on the web @ VT Regional Sleep Center Website .

For more resources and information on coping with shiftwork go online at:

Canadian Center for Occupational Health & Safety (http://www.ccohs.ca/oshanswers/work_schedules/shiftwrk.html )
Circadian Technologies (http://www.shiftwork.com/)
The Night Shift Initiative (http://www.nightshift.com/)
The Shift-Work Benchmarking Institute (http://shiftwork.org/ )
Shift-Work Resources (http://www.shiftwork-resources.com/ )
Shift-Work Solutions (http://www.shift-work.com/ )
The Sleep Disorder Channel (http://www.sleepdisorderchannel.com/shiftwork/ )
SleepNet.Com (http://www.sleepnet.com/shift2000.html )

These websites include newsletters, access to brochures and books on coping with shiftwork, as well as the opportunity to communicate with other shiftworkers.
References:

(1) Moore-Ede, M. & Levert, S. (1998). The Complete Idiot’s Guide to Getting a Good Night’s Sleep. New York: Macmillan.

(2) Circadian Learning Center (1999). Shiftwork.Com [On-line] http://www.shiftwork.com/learning_center/

(3) Voron Communications (1999). The Night Shift Initiative [On-line] http://www.nightshift.com/archives.htm