What You Need to Know About Shift Work Disorder

by Nachole Johnson, MSN, APRN, FNP-BC

 

Millions of people work hours other than the standard 9 to 5, Monday through Friday and, unbeknownst to them, their health may be severely affected because of it. Shift work (defined as working anything other than the traditional 9 to 5) was designed to cover industries that operate twenty-four hours per day. Hospitals fall into that category and need staff coverage at all times, leading to employees that are more prone to a condition known as shift work disorder (SWD).
Although mainly an issue for those who work overnight shifts, SWD can cause problems for those who regularly work longer than eight hours per day, too. Working twelve hours at a time, day or night, can cause problems for some people. Nurses are particularly affected by SWD due to the nature of hospital working conditions.

The American Academy of Sleep Medicine (AASM) identifies those who work early morning, evening, overnight, and rotating shifts as the ones most affected by SWD. Aside from excessive sleepiness, shift work can lead to difficulty falling asleep or staying asleep, decreased energy, difficulty concentrating, headaches, and poor mood and irritability.
Dianne Jones, RN, has experienced the effects of working odd hours firsthand. “When I worked 3 pm – 3 am in my first ER position, I had difficulty sleeping,” she says. “It was made worse by the next job when I worked 7 pm – 7 am.”

Jones’ problem is all too common among those who work overnight shifts. The human body has a natural circadian rhythm that sets sleep and wake patterns over a 24-hour period—and working the overnight shift disrupts that cycle since the normal circadian clock is set by a light-dark cycle. Jones describes the feeling of this disruption after working a night shift as follows: “Once my eyes were exposed to daylight as I left work, I felt as if I became almost manic…my body was telling me it was time to be awake and active.”

Those who work dayshift can also be affected by SWD, not necessarily because of working a non-traditional shift, but mainly because of quick returns. Quick returns, or working back-to-back shifts, are a practice all too common among nurses. A study on nurses who worked various shifts found that quick returns of day shift nurses were just as strongly correlated with SWD as those who worked strictly night shift. Quick returns—just like shift work in general—cause disruptions in the circadian rhythm. The mismatch in the natural circadian rhythm eventually leads to sleep/wake disturbances and internal desynchronization.

Jones noticed that the amount of time she slept varied with the length of her shift and the stress associated with her job at the time. “When working twelve-hour shift in the ER, I slept about 5 hours max. With an eight-hour shift at a less stressful job, I slept about 7 or 8 hours.”
Jones, who has worked nearly every shift imaginable as a nurse, has finally settled into a day shift position after spending a considerable amount of time working evening and overnight shifts in her 10-year nursing career. She believes that nurses who work 12-hour shifts in high acuity areas can burnout over time: “I think most nurses can maintain a high level of stress on the body and mind for a while, but it does begin to take a toll and may lead to errors, substance abuse issues, or burnout.”
Shift work can cause many health issues, some with longstanding effects. The AASM attributes SWD to work disturbances such as work-related injuries, vehicle accidents related to drowsy driving, and substance abuse (to improve sleep). Many serious medical conditions, including hypertension, diabetes, obesity, and an increased risk of breast and bowel cancer have also been attributed to SWD.

Certain risk factors can predispose some people to developing SWD when working alternative shifts. Those who are older, have comorbidities, drink alcohol, smoke, or have had previous sleep issues in the past are at highest risk.
There are ways to combat the symptoms caused by SWD, but for some, a change in schedule may be necessary to reverse them altogether. Here are four recommendations for those who may be affected by SWD to help alleviate any sleep issues:

1. Have a consistent room temperature
Sleep experts recommend a room temperature of 68 degrees Celsius to help promote sleep, as it’s easier to sleep with cooler temperatures.

2. Keep the room dark
If working nights, using a blackout curtain during the day can dramatically improve sleep. Use eye shades if the room cannot be darkened enough for sleep. Along the same lines, wearing dark sunglasses on the drive home in the morning can blunt the impact the sun has on making you feel alert once sunlight hits your eyes.

3. Reduce noise
Reducing noise before bed and limiting screen time with the TV, computer, and cellphone will help your brain “wind down” for sleep. Silence your cellphone and unplug any landlines before you lie down. Heavy carpeting and drapes in the bedroom can also help dampen noise. Lastly, ask family members to respect your sleep time if others are awake when you plan to be asleep by limiting noise in the home.

4. Avoid large meals and caffeine shortly before bed
Large meals can cause indigestion and make it hard to sleep when your stomach is full. Avoid large meals at least 2 hours before bedtime. Ingesting caffeine can keep you amped up when it’s time to sleep.

Other ways to decrease SWD include working less shifts in a row, shortening your work commute by finding another job closer to home or moving closer to your job, and taking naps when possible. Another possible solution that may help some nurses is to switch from working twelve-hour shifts to eight-hour shifts. Symptoms related to working an alternative work schedule need to be present for at least 3 months for an official diagnosis of SWD, so it’s imperative to be evaluated by a provider if sleep issues are still a problem after implementing recommendations.

Nachole Johnson, MSN, APRN, FNP-BC

Nachole Johnson is an FNP who specializes in Health and Wellness and is the author of You’re a Nurse and Want to Start Your Own Business? The Complete Guide, available on Amazon. Visit her ReNursing blog for more ideas on how to reinvent your career.