Millions of Americans engage in shift work, including doctors, nurses, construction workers, police officers, pilots and commercial drivers. Shift work refers to any job that falls outside of a more "traditional" nine to five work schedule, affecting most people who start work before 6:30 a.m. or after 4:30 p.m. In the past few decades, we've lost focus on the 9-5 work schedule, in favor of a 24-hour society to maximize productivity in the electronic age.
Circadian rhythms biologically program us to stay awake during daylight hours and sleep at night. Shift work goes directly against what our bodies desire to do, and those that struggle with this may suffer from shift work sleep disorder (SWSD). Although many have no issue working shifts, a significant number of people find it to be an extremely difficult adjustment and develop SWSD.
SWSD is a complex problem with a number of commonly-reported symptoms. Those with SWSD often report excessive sleepiness during work times and insomnia during the off hours when sleep is desired. Other symptoms may include headaches, weight gain, gastrointestinal issues, fatigue, attention and concentration issues, work absenteeism, irritability and depression. They often miss out on family and social events due to work. Worst of all, shift workers are at a significantly greater risk for vehicular accidents and mistakes at work.
Although accidents and issues related to shift work and fatigue are gaining attention in the media, many companies are still not addressing ways to help alleviate work fatigue. The reality is, though, better sleep and appropriate rest for shift workers will only serve to improve productivity and reduce human errors.
Unfortunately, treatment is somewhat limited for SWSD and some never fully adjust to shift work. Successful intervention involves resetting the worker's circadian rhythms so they properly match the work-sleep schedule. The ideal situation is to have the worker maintain a steady sleep-wake schedule seven days a week, allowing for 7-8 hours of sleep. Although difficult to follow, it can be extremely helpful to help reset circadian rhythms. It can be especially tough on days off, when the shift worker wants to socialize in the daytime and maintain more “normal” sleep periods that others are following.
If an extended sleep period is impossible, experiment with two three- to four-hour sleep episodes during the day, then revert to a more “normal” nighttime sleep pattern on days off. One other option (which can be helpful to allow socializing time with friends/family) is to go to bed on nights off at a slightly later time than you would otherwise. For example on workdays, keep your normal schedule (e.g. 7am-3pm). Then, on days off, go to bed at 3 or 4am (as opposed to 11pm as you might want to do) and get up 7-8 hours later—this way, you're meeting your sleep pattern halfway and can be less disruptive overall.
Night shift workers should remain in bright light from early in the shift until two hours before the shift ends. At that point, switch to sunglasses for the commute home to block the light and prepare your body for sleep. That’s an easy one!
Take a brief nap before and, if allowed, during the work period to improve alertness. Don't drive home if sleepy—take a brief nap instead. Strategic use of caffeine earlier in the shift can prove helpful as well. Limit caffeine midway through the shift as you get closer to your desired bedtime.
If possible, avoid working overtime and extended shifts. Try to have rotating shifts move in a clockwise direction, therefore delaying the work schedule later and later each shift. For example, strive to work days, evenings, nights and then days again. Frequently rotating shifts can be an extremely difficult adjustment.
It is very important to protect your sleep period for sleep. Limit interruptions such as phone calls, housework or errands. Ask others to help keep your sleep time silent and undisturbed. The bedroom should be dark, cool and quiet, with blackout shades. Use a white-noise machine or earplugs as needed. If you can't sleep, get up, do something relaxing outside of the bed and return to bed only when sleepy—the bed is only for sleep and sex.
If behavioral changes don't work well, consult your doctor for other options. Newer medications are available to help promote wakefulness while at work and other medications can help with sleep during off-times. Although medications can be helpful, they usually need to be combined with behavioral options to achieve the biggest gains.
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