Coping with Shiftwork

DIMINISHED 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. The cost to society of sleep related accidents is huge.

SOCIAL EFFECTS

People often complain about having a difference schedule to their friends and family. People also report feeling unable to ‘get things done’ as their work lives don’t coincide with normal business hours. All of these obstacles can lead to feeling ostracized and detached from the rest of society.

TREATMENTS FOR SLEEP LOSS DUE TO SHIFT WORK

There are many different factors that can be looked at to determine the best treatment for you:

• Where do you work? Are you working with people? Machinery? What skills do you employ when you’re at work?
• Are you a night person or morning person? “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 problems, 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, taking into account the above factors.

WORK WITH YOUR OWN CIRCADIAN RHYTHM

Work schedules that go along with your body’s circadian rhythm by rotating clockwise (from day to evening to night) are helpful.

Your ideal schedule should be determined by your body’s natural sleep needs, why what feels “right” and help your overall work time alertness.

TAKE YOUR BREAKS

Breaks during work hours may increase your alertness.  There is evidence that 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.

ROTATING SHIFT WORKERS

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 time 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.

ON CALL SHIFT WORKERS

If you are an on-call shift worker, you are probably aware that your sleep problems are somewhat different from those of a night shift or rotating shift worker. Because on-call workers usually can’t predict work schedules far enough in advance to plan the right sleep/wake schedule, they should try to be well rested at all times.

SLEEPING PILLS

Shift workers often use sleeping pills (also known as hypnotics or sedatives) to override the time of day and make themselves able to sleep, however there are several disadvantages:

• Results in only partial alertness
• You may develop a dependence and reduce effectiveness if used long term
• Only partial improvement in alertness and performance
• 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 aids is not the best choice to help you sleep since many of them cause drowsiness for several hours after you awaken, which can be unsafe.

NAPPING

Although there is some evidence that sleeping in one longer stretch is better than sleeping in several shorter periods, those of you who can’t get all of your sleep in one stretch may increase your total number of sleep hours by napping.

Napping is especially helpful when naps are taken off-shift, at an appropriate point in your circadian rhythm.  Napping in this case can help offset the sleep loss associated with poor daytime sleep.

NAPPING DURING YOUR WORK SHIFT – BEWARE OF SLEEP INERTIA

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 (ie. on a break), especially if your job requires 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.

ALCOHOL

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 for you to return to sleep.

STIMULANTS – EG: CAFFEINE

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.

ALTERNATIVE THERAPIES

BRIGHT LIGHT THERAPY

Bright light therapy is being studied as a way to shift the circadian system and reset the body’s clock. Properly timed exposure to bright lights may help advance or delay the sleep cycle.

Evening exposure to bright light can be used to treat ASPS by shifting the circadian clock to a later hour. Morning exposure to bright light is used to treat DSPS by shifting the circadian clock to an earlier hour.

If you think you suffer from one of these disorders, seek specific advice about this from your healthcare professional.

SUPPLEMENTAL MELATONIN

Melatonin is a naturally occurring substance that increases in the bloodstream during the night. Although this form of treatment is experimental, it is believed to help promote sleep onset and rest the biological clock in some situations.

SLEEP HYGIENE

• Sleep in a dark, quiet room
• Use the bedroom only for sleep and sexual activity (not for watching TV or balancing the checkbook)
• Keep your bedroom temperature cool and comfortable
• Only go to bed when you are relaxed
• Have a regular routine for preparing to sleep (brush teeth, put on pyjamas etc)
• Try to have dark curtains for the bedroom windows or to wear eye shades for sleep
• Use “white noise” to block out other noises
• Disconnect – Turning off the phone, disconnecting the doorbell or putting up a “Do Not Disturb” sign can also help you sleep.

OTHER MEASURES

WORKPLACE CONDITIONS

There are some factors at work that can affect your alertness, including:

DIET

Diet may 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 hungry or going to bed immediately after eating a large meal.

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