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 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.
