Your shift work survival guide: Expert tips to sleep and function better

Clinical careers are challenging enough. Add shift work into the mix, and stress levels mount, energy dips, and health can take a hit.

Shift work is, unfortunately, common. According to the Bureau of Labor Statistics, 16% of the US workforce is on the clock at inconsistent hours.^[] Among that 16%, 6% work evenings and 4% work nights. The remaining 6% work rotating shifts, split shifts, irregular schedules, or some other arrangement.

It’s no surprise that shift work is taking a toll on healthcare professionals (HCPs) who work this way.

How shift work affects sleep

Erin Flynn-Evans, PhD, is a circadian physiologist and spokesperson for the American Academy of Sleep Medicine. According to Flynn-Evans, shift work disrupts a central function of our sleep-wake cycle.

This conductor orchestrates biological functions including hunger, digestion, sleep pressure, and wakefulness. Under conducive circumstances, the conductor leads all of these functions harmoniously. But when we change our schedule, the conductor can’t keep time.

“When you become circadian-misaligned—which is what happens when you do shift work—basically everything is thrown off,” Flynn-Evans said.

The classic manifestation of circadian misalignment among shift-working HCPs is feeling tired on a night shift, and later being unable to sleep during the day. Beyond the immediate effects of somnolence and insomnia, there are also long-term implications.

Effect of shift work on health

A 2020 PLoS ONE research article analyzed 48 reviews on the effects of shift work and long hours on cancer, cardiovascular diseases, metabolic syndromes, pregnancy complications, depression, hypertension, and injuries.^[]

Evidence was inconclusive for other conditions, with the researchers citing a need for further studies.

They wrote that while shift work is inevitable in certain industries such as hospitals, employers should be cognizant of the increased healthcare costs that may come with it.

“Workers should be informed of the risks associated with these jobs and the evidence-based screenings and interventions that might mitigate the risk,” researchers wrote.

Shift work disorder

If your employer hasn’t apprised you of the health risks of shift work, consider yourself informed—although your constant search for coffee, inability to wake before noon, and difficulty sleeping during conventional hours probably told you all you need to know.

But for a certain subset of HCPs—those with shift work sleep disorder (SWSD)—this information is cold comfort. Common SWSD symptoms include:^[]

• Trouble sleeping

• Excessive sleepiness

• Trouble concentrating

• Headaches

SWSD can increase the likelihood of irritability, poor social functioning, and substance dependency. Perhaps most troubling for HCPs, it also increases the likelihood of accidents and errors at work.

The good news is that there are steps HCPs can take to sleep better and mitigate the risks of SWSD if they work non-traditional hours.

How shift-working HCPs can sleep better

Flynn-Evans offered multiple evidence-based tips that HCPs can use to improve their sleep:

Stay consistent

On days off, and on days when your normal hours are reversed (day instead of night, or night instead of day), try to keep your sleep schedule as consistent as possible. The key words are as possible. There will be days when your shifts are so divergent that this just won’t work.

Let’s say you typically work days, but you’re scheduled for a night shift. During these shifts, Flynn-Evans suggested exposing yourself to bright light in the blue spectrum, which mimics daylight.

“You can help to shift your circadian rhythm a little bit during the night to reduce some symptoms of fatigue during the night shift and then improve sleep quality during the day,” she said.

Use caffeine strategically

You may be tempted to guzzle that extra-large coffee at the beginning of your overnight. But hold off.

If you’re working a long stretch of time overnight, keep it to no more than 50 milligrams of caffeine per hour. That’s the equivalent of a weak cup of coffee or tea.

“Having a huge amount of caffeine is going to saturate the receptors that receive that caffeine, and then it's going to cause a big crash,” she said.

Also, try to cut off your caffeine consumption about 6 hours before going to sleep. Even if you metabolize caffeine well and can fall asleep, chances are the stimulant is disrupting deeper sleep stages, Flynn-Evans said.

Finally, if you have a long commute after your night shift, factor this into your caffeine schedule. Drowsy driving can be deadly.

Nap (wisely) when necessary

If you’re a physician working a 30-hour shift, you’re going to need to nap. Caffeine won’t replace sleep, Flynn-Evans said. And neither will bright lights.

Nap duration will depend on the extent of sleep deprivation, Flynn-Evans said.

Of course, a full sleep episode is going to give you benefits, she acknowledged, “but if you have no choice but to work a 30-hour shift, then you’re going to be much better off taking a nap than not.”

Optimal nap duration also depends on sleep inertia, the feeling of grogginess upon waking. Flynn-Evans said sleep inertia can be especially strong after a night nap, and can contribute to medical errors.

“If a person is taking a nap and a pager call comes and they have to wake up and immediately act, that’s concerning because performance immediately upon waking can actually be worse than, say, being awake for 24 hours,” she said.

Under ideal circumstances, nap—but build in time to wake up before making complex decisions.

Check and cross-check

“Medicine can actually take a lot of cues from aviation,” Flynn-Evans said.

The aviation industry adheres to strict fatigue risk-management protocols, she explained. These protocols make sure pilots get sufficient sleep and that critical processes and procedures are cross-checked, minimizing the risk of error for 19-hour flights.

We see elements of these protocols in medication ordering systems and pre-surgical time-outs. The more medicine incorporates these systems, Flynn-Evans said, the better.