Shift Workers: Solutions for Sleep Problems
Millions of Americans are shift workers who struggle to stay awake while they perform their jobs and then battle with insomnia and other sleep-related problems once they return home. Here are some tips for getting a good night or day's sleep.
You stand at the bathroom sink, yawn, and splash cold water on your face. You glance at the clock—it's 10 pm. Instead of putting on pajamas and crawling beneath the covers, you're dressing for work. You fill a thermos full of coffee and stumble out the door. On the drive to work, you rub your eyes and roll down the window a bit to keep from falling asleep at the wheel. You have trouble concentrating on your work and you struggle to stay awake throughout the night. Finally, it's quitting time and you can go home to bed. Just when you're about to drift off, a neighbor cranks up a lawn mower, the birds seem to chirp louder than usual, and you can't ignore the sunlight seeping in around the corners of the drawn shades.
The lifestyle of a shift worker can be pure agony. The lack of sleep can lead to many problems, including depression, lower job productivity, health problems, and marital and family discord. It can also lead to accidents, both on the job and on the highway. The National Sleep Foundation (NSF) cites a frightening statistic: In a recent study, the foundation found that 72% of shift workers admitted that they had driven while drowsy and 41% said they had dozed off at the wheel.
A 24-hour Society
If shift work creates so many problems, why not just stick with a daytime routine? While that seems like an easy answer, it's not a possibility for many workers. Shift work is essential in our 24-hour society. Many people who make their living at odd hours provide crucial services, such as emergency care and police and fire protection. There's also a demand for 'round-the-clock workers in the transportation and manufacturing industries. Our bodies, however, are regulated by a different clock.
Internal Circadian Clock
Humans are regulated by an internal body clock that causes them to be active or sleepy based on different phases of each 24-hour day. For most people, the desire to sleep is greatest when it is dark outside, and the need to be alert and active is greatest when it's daylight.
"Sleep [for shift workers] is ineffective because it occurs out of synchrony with the endogenous circadian rhythm that organizes sleep and activity," says Wolfgang Schmidt-Nowara, MD, of the Sleep Medicine Institute at Presbyterian Hospital of Dallas. "The worker must sleep at a time when the body expects to be active, while work occurs at the usual sleep time. Sleep, therefore, is often short or interrupted. During a work week, sleep deprivation accumulates and sleepiness becomes worse. Time off from work can be used to get extra sleep, but conflicting demands of family and other social responsibilities prevents a full payment on sleep debt. The result is fatigue and stress," he says.
Swing shifts present even more challenging problems to workers. Just when they get adjusted to the hours of one shift, they spin off to another schedule. Terri Lynn of Waldorf, Maryland used to pull a swing shift as a police officer. "We worked three shifts: six days of 7:00 a.m. to 3:00 p.m., two days off, seven days of 3:00 p.m. to 11:00 p.m., two days off and then seven nights of 11:00 p.m. to 7:00 a.m. followed by four days off," says Lynn. "I was grouchy and fought with my husband. I'm sure it contributed to our divorce. I couldn't make any permanent plans for weekly meetings, clubs, etc, because of the shift changes."
"The biological clocks cannot adapt to frequent and large changes in the timing of sleep from one day to the next," says Karl Doghramji, MD, Director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia. "Optimally, sleep times should not be changed by more than one hour counterclockwise or three hours clockwise from one night to the other," he says
Strategies for Getting Some Shuteye
If you're working a shift and having trouble sleeping when you get home, here are some strategies for getting some much-needed rest:
- Keep a regular sleep schedule, even on weekends
- Create a quiet, peaceful environment for sleeping
- Wear eye shades if the sunlight disturbs you
- Wear ear plugs if daytime noise keeps you awake
- Run a fan or create other white noise to help lull you to sleep
- Turn off the ringer on your phone
- Put a "Do Not Disturb" sign on your front door
- Exercise regularly, but not within four hours of bedtime
- Avoid caffeine near bedtime
- Avoid alcohol
- Consult a physician about the use of prescription or over-the-counter sleep aids
A Short Snooze
When you can't get enough sleep, you may find it beneficial to take a nap. Even a short nap can recharge a person and improve job performance, alertness, and mood. The National Sleep Foundation says studies show that naps at the workplace are important and effective for employees who need to keep a high level of alertness in order to make quick decisions. Naps at the workplace are also helpful for people working a double or a 24-hour shift.
Time for a Change?
If you're experiencing severe symptoms related to sleep deprivation, it may be best to consider a job change, or at least a shift change. "There are some individuals who simply cannot handle shift work," says Dr. Doghramji. "As we age, the ability to withstand the effects of shift work also diminishes. Therefore, if symptoms become severe and begin to interfere with daily life, and especially if individuals begin to fall asleep during dangerous situations, such as driving, they should consult a physician."
American Academy of Sleep Medicine
National Sleep Foundation
Circadian Technologies Inc. website. Available at: http://www.circadian.com/.
Dement WC, Vaughan C. The Promise of Sleep: A Pioneer in Sleep Medicine Explains the Vital Connection Between Health, Happiness, and a Good Night's Sleep. Delacorte Press; 1999.
Sleep strategies for shift workers. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/publications/shiftworker.html#1.
Last reviewed August 2007 by J. Thomas Megerian, MD, PhD, FAAP
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