How to get good sleep if you do shift work

This article explains why shift work can hurt your sleep and gives tips on what to do if you do shift work.

If you work a non-traditional shift like the night shift or rotating shifts, you may be missing out on more than daylight and watching your kids’ soccer games. You could be missing out on sleep and better health.

Night shift workers who have trouble sleeping may have a condition known as shift work sleep disorder.

“Working non-traditional shifts interferes with the body’s circadian rhythms,” says sleep expert Tina Waters, MD. “Most of us are awake during the day because our body’s internal clock is keeping us awake. So no matter how tired you are after working all night, your awakening signals will conflict with your desire tosleep.”

Fortunately, there are some lifestyle changes that can help. But first, let’s look at the problems this disorder can cause.

Why shift work sleep disorder can be hazardous to your health

Studies have shown that lack of sleep can lead to other health issues. Some people develop gastrointestinal distress or metabolic disorders, such as diabetes. Others may develop heart disease.

“There was also a large study done on nurses who worked the night shift in which they were found to have a higher prevalence of infertility and even cancer,” Dr. Waters says.

From a non-health perspective, working alternate shifts can make it difficult to lead a balanced life. “If you’re a spouse or a parent, there are things going on during the time you need to be sleeping,” Dr. Waters says.

Do you have shift work sleep disorder?

Not all shift workers will develop shift work sleep disorder.

If you’re having trouble sleeping and you think this disorder could be the culprit, expect your doctor to first run some tests to rule out other underlying sleep disorders, such as sleep apnea or narcolepsy.

“It’s also a good idea to keep a sleep diary of which shifts you worked and what hours you slept,” says Dr. Waters. A sleep diary can help your doctor identify the problem and monitor its progression over time.

What you can do to get a good ‘night’s’ sleep

Practice good sleep hygiene. If you’re diagnosed with shift work sleep disorder, one of the most important things you can do to make sure you are getting enough sleep is to practice ‘good sleep hygiene.’ which includes:

• Establishing a regular bedtime routine and sticking to it
• Making your environment conducive to sleep (e.g., keeping your bedroom dark, cool and quiet)

Go straight to bed after work. Dr. Waters also recommends going home and sleeping as soon as your shift is over. “One of the triggers that keeps people awake is light, so it helps to decrease your light exposure at least 30 minutes before trying to sleep,” she says. “One way you can do that is to wear sunglasses on your way home, even on a cloudy day.”

Cut back on caffeine. Another thing you can do to help you get a better ‘night’s’ sleep is to reduce yourcaffeine intake. “If you’re drinking caffeine to stay awake, try not to drink any within four hours of the end of your shift to give your body time to metabolize it,” Dr. Waters says.

Set boundaries. It’s also a good idea to let people know what hours you’re working and when you will be sleeping, so they know when to leave you alone.

Get help from your doctor if you need it. If behavioral techniques aren’t helping you sleep, your doctor may prescribe melatonin to induce sleep, medications to promote wakefulness, or prescription sleep aids.

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Medications for shift workers show little effectiveness

A review of medications shift workers take both for alertness and to help them sleep have little effectiveness.

Shift workers are taking drugs to help them stay awake or get to sleep despite weak evidence for their benefit, according to a new Cochrane review. The authors of the review found only small numbers of trials testing over-the-counter and prescription drugs used by shift workers, and the results suggest that for some people they might do more harm than good.

In most developed countries, at least 10% of the workforce is involved in some form of shift work. European statistics suggest that as many as three quarters of the population have 'non-standard' working hours. Disturbances to normal sleeping and waking patterns increase the risk of accidents and affect shift workers' health. It is therefore important to avoid shift work where possible and improve shift work schedules to help shift workers achieve more normal sleeping and waking patterns. In jobs where shift work cannot be avoided, such as health care, the police force or the military, drugs can potentially offer short-term benefits.

The review included 15 trials involving a total of 718 people. In nine trials, the over-the- counter hormone drug melatonin helped shift workers sleep for around 24 minutes longer during the night or day, compared to placebos. However, it did not help them get to sleep any quicker. Data from only one trial of the hypnotic drug zoplicone was available. The drug was no more effective than placebos for helping shift workers sleep during the day.

The remaining trials focused on caffeine and two drugs, modafinil and armodafinil, that are prescribed for sleepiness during night shifts. In one trial, caffeine reduced sleepiness during night shifts, when workers also napped before shifts. Modafinil and armodafinil, used by shift workers in one and two trials respectively, increased alertness and reduced sleepiness. However, they also caused headaches, nausea and a rise in blood pressure in a substantial number of people. Due to the limited benefits and frequent side effects, neither of these drugs is approved for shift workers in Europe.

"For lots of people who do shift work, it would be really useful if they could take a pill that would help them go to sleep or stay awake at the right time," said lead author of the review, Juha Liira, who is based at the Finnish Institute of Occupational Health in Helsinki, Finland. "But from what we have seen in our review, there isn't good evidence that these drugs can be considered for more than temporary use and some may have quite serious side effects."

Most of the data reported in the review was from small, low quality trials. In addition, trials tended to be carried out in specific settings, such as health care or oil rigs, so their results may be less relevant for workers in other types of roles.

"It's curious that there's such a clear gap in the research," said Liira. "It may well be that studying the effects of these drugs or others drugs in properly designed trials would be seen as unethical because workers should not need drugs to get along with their work. So the studies just haven't been done or if they have, our review has not been able to identify relevant data."

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Health consequences of sleep disorders

This article discusses the different health consequences of sleep disorders and issues with an internal clock.

Ulcers, hyperglycemia, diabetes, hypertension, gastric intestinal problems are not always caused by diet - they could be linked to a disrupted internal clock.

Working a job that requires shift-work or experiencing chronic jet lag disrupts your circadian rhythm. It results in countless consequences to your body that simply can’t be fixed by counting sheep.

“Stimulants such as caffeine can disrupt a patient’s circadian rhythm but also irregular sleep habits, jet lag, Delayed Sleep Phase Disorder, which is common in teenagers, Shift Work Sleep Disorder and Advanced Sleep Phase Disorder, which is common in older people,” says Dr. Baqhar Mohideen, the medical director of the Center for Sleep Medicine at Porter Regional Hospital.

“A quarter of American workers are on shift-work – 10 percent of which experience Shift Work Sleep Disorders.”

Delayed Sleep Phase Disorder is when patients fall asleep late and have difficulty waking up in the morning. Shift Work Sleep Disorder affects patients who work nights or rotating shifts. Advanced Sleep Phase Disorder is when patients go to bed early in the evening but wake up very early in the morning around 3 a.m., for example.

Our bodies work on a 24-hour cycle called circadian rhythm or internal clock. The main function of our internal clock is to determine when we sleep and when we wake. Unfortunately if a circadian rhythm is disrupted it affects many biological conditions in the body such as digestion, the release of certain hormones, body temperature, etc.

“Because your hormones are all mixed up, there are lots of consequences – ulcers, chronic fatigue, insulin resistance, glucose intolerance, diabetes, etc.” says Mohideen, who is a Diplomat of the American Board of Sleep Medicine.

Glucose intolerance is an umbrella term for metabolic conditions which result in higher blood glucose levels known as hyperglycemia.

Dr. Muhammed Najjar, sleep specialist at the Franciscan Healthcare Sleep Disorders Center located in Munster, agrees there are consequences for a disrupted circadian rhythm caused by Shift Work Sleep Disorder.

“Daytime functions shouldn’t be at night. When there’s a misalignment between the patient’s internal clock and the outside world, it’s not good for the body,” says Najjar. “Shift work causes stress to the body so blood pressure gets elevated, which is why this disorder can cause hypertension. Treating circadian rhythm disorders can help lower blood pressure.”

Najjar says besides patients experiencing the side effects of a disrupted circadian rhythm there are side effects to sleep deprivation also.

Sleep deprivation affects hormones as well which can lead to body weight and body mass index issues. Gastrointestinal tract problems can surface and it can also cause insulin sensitivity which can lead to diabetes. A patient’s body can also become resistant to treatment.

“Many patients are sleep deprived because when they do sleep, it’s not adequate sleep. This affects their level of alertness and they can become accident-prone,” says Najjar. “If a patient’s shift work schedule rotates, or they sleep with a different pattern on their days off, it’s like having continual jet lag —the circadian system never gets the chance to fully catch up.”

The process of adjusting the internal clock with cues from the environment is called entrainment. Light is a stimulant and can effectively re-align one’s circadian rhythm.

Mohideen says some patients take medication or melatonin to assist in the readjustment process.

Melatonin is a body clock hormone that chemically causes drowsiness and lowers the body temperature in preparation for sleep.

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What should I know about circadian rhythm sleep disorders?

This article details what everyone should know about circadian rhythm sleep disorders. People can have complaints of insomnia or excess sleepiness, depending on the problem with their life. - JR

When we think of sleep disorder, we tend to think of insomnia, but there are other sleep disorders that can affect a person's ability to work, attend school or live a normal life.

Your circadian rhythm is your body's "internal clock," which signals when you should sleep and when you should wake, as well as other body processes. Normally, this clock runs on a 24-hour cycle, which echoes the Earth's pattern of night and day. We sleep at night; we are awake during the day. However, sometimes our circadian rhythm becomes disrupted, making it difficult for people to sleep during the night or be fully awake and functioning during the day.

Some common causes are going on shift work, pregnancy, time zone changes, medications and changes in routine.

Some common circadian rhythm disorders are:

Jet lag or rapid time zone change syndrome: This includes excessive sleepiness and lack of daytime alertness in people who travel across time zones.

Shift work sleep disorder: This sleep disorder impacts those who frequently have to rotate work shifts or often work at night. They may have trouble adjusting to sleeping during the day and working at night, and this can lead to insomnia.

Delayed sleep phase syndrome: This disorder affects the timing of sleep. People with DSPS tend to fall asleep very late at night and have difficulty waking in time for work, school or other appointments.

Advanced sleep phase syndrome: With this disorder, a person goes to sleep earlier and wakes earlier than desired.

Non-24-hour sleep-wake disorder: With this disorder, a person has a normal sleep pattern, but they live in a 25-hour day. Over time, their sleep cycle is affected by inconsistent insomnia that occurs at different times each night. They may fall asleep at a later time and wake up later, or fall asleep earlier and then wake up earlier.

How are sleep disorders treated?

Treatment options vary depending on the type of sleep disorder involved. One of the first steps is ruling out side effects from any medications, as well as any underlying medical conditions. Having the patient keep a sleep diary for one or two weeks is also important. Often, a combination of behavior therapy, light therapy and possibly medication is involved in providing successful treatment.

Behavior therapy: This usually involves having the patient maintain regular sleep/wake times and avoid naps. This will help "train" the body to the proper sleep time. Engaging in regular exercise is also key as it will encourage physical tiredness. Patients are also advised to avoid caffeine, nicotine and other stimulants, as well as any intense exercise within several hours of bedtime.

Those suffering from delayed sleep phase syndrome should minimize exposure to light during the evening and at night by reducing illumination in their home, and by avoiding the bright screens of televisions and computers. For those suffering from advanced sleep phase syndrome, the situation is the reverse, with light exposure needing to be increased in the evenings. Typically, patients are advised to keep lights on indoors for a longer period, or to spend more time outside in the longer daylight months.

Medication: Medications such as melatonin, or short-term sleep aids, may also be used to adjust and maintain the short-term sleep cycle in order to shift it toward the desired schedule. Melatonin is available over the counter and is a hormone that is found naturally in the body. It promotes sleep and can help with short-term sleep issues. The proper timing of melatonin use varies depending on the condition being treated.

Chronotherapy: A behavioral technique in which the doctor works with the patient to gradually and systematically adjust bedtime until the patient is on the desired schedule. This can take one to two weeks to achieve.

Bright light therapy: Sleep therapists use bright light therapy to help reset a body's circadian clock. The patient is exposed to a high-intensity light (10,000 lux) and the amount of exposure is typically for 30 minutes upon awakening.

We often joke about not getting enough sleep, but for those suffering from true sleep disorders, this is no laughing matter. A good rest, and being able to sleep and wake on a regular schedule, are keys to our being able to function successfully in the world. Lack of sleep, or lack of a regular sleep pattern, can lead to depression, substance abuse and other mental health issues. If you are suffering from a sleep disorder, do not self-treat. Consult with your physician. Treatment is available.

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Health Scan: Shift work could be hazardous to women’s health

Studies find working the night shift raises the risk in women of contracting type-II diabetes, overweight and smoking.

Girl sleeping Photo: Wikicommons

Working the night shift raises the risk in women of contracting type-II diabetes as well as overweight and smoking, according to two prospective studies recently published in the Israel Journal of Obstetrics/Gynecology.

The two US studies, conducted over long periods among nurses, were analyzed in the journal by Prof. Ido Sholat of the Technion-Israel Institute of Technology’s Rappaport Medical Faculty and Rambam Medical Center in Haifa.

Women who work for years on the night shift are more likely to be overweight, develop metabolic syndrome and smoke. Previous studies on the subject had been small and conducted on men, mostly in Japan. The journal article concluded that women who work late should be screened for such risks.

To blame is a disruption of the circadian rhythm, a roughly 24-hour cycle in the physiological processes of living beings, the researchers suggest.

Disruptions of the circadian rhythm involve a complex process in the sleep cycle, energy balance, body heat, cell cycles and the production of hormones. All of these also affect lifestyle, which is a major factor in type-II diabetes.

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