What do medical workers, firefighters, police officers, and salespeople have in common? The majority of them have night work shifts. Night shifts can be difficult and health-damaging. In the U.S., taking into account the requirements of the modern world, about 18 million people work at night.
But active at night is unnatural and draught with multiple health risks: metabolic disorders, heart and digestive diseases, obesity, different types of cancer, DNA damage, and more.
Risks of night shifts
Night shifts challenge your biological clocks that regulate normal body processes. Just like when you come home from work, you should be resting when your body is set to stay awake.
Adults require not less than 7 hours of sleep. This time is needed to let the body restore its resources. But day sleep is much less refreshing due to the daylight and noise around.
Key points about shift work sleep disorder
Excessive sleepiness during night shift even after day sleep, excessive daytime sleepiness as a result of regular night shifts
Usually, within several months or years after the start of shift work
Shift work, poor day sleep, frequent night shifts
Based on a patient’s complaints, general medical examination, blood test and urine test to exclude inflammatory processes
Change of work place to quit night shifts, techniques to improve day sleep, sleeping pills, wakefulness-promoting medications Modafinil or Armodafinil
We have collected several proven ways how to better sleep for shift workers:
- Go to bed as soon as you get home. The more you stay up, the more complicated it will be to go to sleep;
- Eat a light meal prior to going to bed so that you won’t be hungry or thirsty and it won’t wake you up;
- Avoid drinking alcohol. It can make you sleepy, but will reduce the sleep quality;
- Sleep in a silent and dark room. Use earplugs and blackout curtains if needed. Light in the room may not wake you up but it will prevent melatonin production (sleep-promoting hormone).
- Talk to your family and ask them not to disturb your daytime sleep.
- Turn off your phone so that you won’t be woken up.
- Trick your circadian rhythms by regulating your light exposure. Studies show that people who work with a bright light at the night and wear dark glasses on the way home fall asleep faster and sleep longer than those who do not follow these simple tricks.
- When the body's circadian rhythms are disturbed, metabolism is also disturbed. People who work at night experience 29% more metabolic syndrome than people without such disorders. To prevent developing digestive tract diseases, obesity, and related complications, it is advised to stick to a healthy diet. It doesn’t mean you’re your diet should be very restrictive. You can eat bread and other carbohydrates but choose long ones, i.e. whole grain bread, pasta, rice, and so on. Eat lean protein such as fish, chicken or turkey breast, lean beef, dairy products, etc. Make sure you eat a lot of vegetables and fruits to receive sufficient vitamins. These products are the best choice for night shifts. Although you may feel cravings for fast food and sweets to indulge yourself, it is better to refrain from such foods to avoid long-term negative consequences. Night shifts are already stressful to the organism and when you eat unhealthy food at the night, it can accelerate the negative changes.
- Sleeping in the middle of the day helps to restore and even improve brain function. Short naps are proven to be a beneficial measure to cope with fatigue and even restore cognitive functions such as memory, speed of reaction, and so on. But keep in mind that naps that you have besides the 7-9 sleep a day should be 45 minutes or less or you can achieve a contrary effect.
- Most people drink a huge coffee cup before starting their work shift. But research suggests that using a different approach will give the best results. People who drink coffee in small portions (a quarter of a cup of coffee) but often stay awake longer, improve their cognitive abilities, and reduce sleepiness than those who do not drink coffee at all or drink 1 large portion per day.
Caffeine use should be discontinued six hours prior to going to sleep.
Worth noting, caffeine isn’t the best stimulant for shift workers. Wakefulness-promoting antinarcoleptic formulations such as Modafinil or Armodafinil are much more potent and safer than simple coffee. They are designed for extended use and were thoroughly tested for possible negative reactions. The formulation can be appointed for shift work sleep disorder, i.e. for individuals who suffer from severe sleepiness during night shifts and the day after. A single pill is taken one hour prior to a shift and makes a person awake and fully alert for 10 hours. The pills have a potent effect comparable to amphetamines but without the negative sides such as addiction, allergies, central nervous system damage, digestive tract dysfunction, heart dysfunction, and so on. If you often have night shifts, you can ask your healthcare provider to prescribe you Modafinil. Or, you can buy the drug online without an Rx but then make sure to check its contraindications to be sure that you have none and can use the drug without any harm to your body.
Most widespread sleep disorders and how to fight them
Quality sleep is crucial for our well-being, performance, social life, mood, and health in general. Most people experience short-term sleep disturbances during their lives, for example, due to stress or grief. Short-term insomnia is the most frequent sleep problem in people of all ages. However, sleep disorders can continue for an extended time, worsening both social life and general health. An individual with a sleep disorder may don’t even know they have it. But if you suspect it, you should definitely first visit your family doctor. The family doctor will conduct additional examinations and prescribe initial treatment. If necessary, he or she will send you to a sleep specialist.
Smart device apps measuring the duration of sleep and wakefulness cannot replace the recommended by a healthcare provider sleep diary or sleep tests if they are appointed.
A sleep diary is a scientifically based tool for assessing sleep patterns, lifestyle choices, and sleep disorders. Sleep violations are divided into six groups, which are diagnosed and treated in different ways. Below are descriptions of the most widespread forms of sleep disorders.
Insomnia is understood as trouble falling asleep, night awakenings, and early awakening. Trouble falling asleep is considered a natural response of the human body to any adaptation or stress and can accompany many other diseases. In some individuals, insomnia continues for a longer period of time, becoming a separate chronic illness. Proper sleep patterns are important to treat long-term insomnia. For this, psychological therapeutic methods are used and, if necessary, the use of sleeping pills is recommended. If insomnia persists, a healthcare provider may decide to further investigate other possible causes.
Breathing disorders during sleep
Breathing disorders during sleep can be manifested by night snoring and respiratory arrest. These disorders are called apneas with obstructive sleep apnea (OSA) being one of the most widespread. These phenomena make sleep interrupted, diminishing the oxygen content in the blood, which the sleeper may not feel at night. The first manifestations of breathing disorder during sleep can be daytime sleepiness, drowsiness, and cognitive functions drop (i.e. memory, ability to focus, speed of reaction, etc.). The risk of OSA is associated with excess weight, certain peculiarities of facial structure and respiratory tract. For instance, it can be caused by the deviated nasal septum, nasal polyps, excess fat storing at the neck, and others. In turn, the lack of OSA treatment can result in severe diseases such as hypertension and metabolic disorders, as well as accidents at work caused by drowsiness and fatigue. Diagnosis of sleep-related breathing disorder usually requires additional sleep tests. Treatment may include adjusting your lifestyle (losing weight), surgery (for nasal polyps or septum curvature), using a mouth guard while sleeping, or a CPAP device that will prevent airways from closing during sleep. To cope with sluggishness during the day while the main cause is treated, wakefulness-promoting drugs such as Modafinil or Armodafinil are prescribed. These drugs were initially developed for narcolepsy, a disorder in which an individual suffers from unbearable daytime sleepiness, but was subsequently approved by the FDA for OSA too.
Movement disorders during sleep
Movement disorders during sleep may occur even before falling asleep. For instance, symptoms of restless legs syndrome often begin in the evening, manifesting as unpleasant feelings in the legs or arms and provoking their movement. Sometimes the discomfort can be relieved by standing up and walking or by massaging the limbs. The causes of movement disorders during sleep can vary depending on age and health status. For further diagnosis, blood tests and additional tests at a doctor’s discretion are needed. Treatment can be very different - from iron preparations to special medications (antiepileptic drugs, sedatives, antidepressants, or others depending on the diagnosed cause).
Excessive sleepiness can manifest itself as too long a night's sleep (> 11 hours), and short daytime sleep, after which the person does not feel rested. Narcolepsy is the most severe, but also the rarest form of excessive sleepiness. The causes of excessive sleepiness are determined by clarifying examinations, which should be followed by appropriate treatment.
Disturbances in the rhythm of sleep and wakefulness
They are found in people whose biological clock does not coincide with the daily cycle, and therefore it is difficult for them to sleep during the period of time that is considered normal, generally accepted sleep time. Disturbances in the rhythm of sleep-wakefulness can be caused by environmental and social factors. The most common cause of such disorder is shift work. Working many years at night, people develop this violation of circadian rhythm and find it hard to adapt to the normal biological rhythm of life.
These are sleep behavior disorders and other short-term symptoms that appear during sleep, such as bad dreams, sleep paralysis, and others.
Normal sleep parameters
Sleep and wake-up times are hereditary and individual. From the age of 18, the following regime is usual:
- Sleep time - night;
- Sleep time 6.5 - 11 hours, on average - 7 - 9 hours;
- Going to sleep: from 21:00 - 1:00 AM;
- Waking up between 6 AM and 10 AM;
- The difference in the duration of sleep and wakefulness (increase or decrease) can reach 3 hours (within a 2-week observation period);
- Falling asleep within 30 minutes;
- Average 1 - 2 times of episodes of awakening during sleep
- Starting from the age of 55, daytime sleep of 30 minutes.
The above standard sleep duration is not valid for shift and night work people.
Fatigue can have various causes, but fatigue can also be a manifestation of poor quality sleep. Many of the habits of daily living affect the quality of sleep. To support your health and overall performance, it is advised to find out the causes of your bad sleep. Maybe it is because of your night shifts, or you go to bed too late and sleep less than seven hours, you eat heavy meals before bed, and so on.
Finding out the main cause of insufficient or poor sleep will help you work on its elimination. And at the meantime, in case of severe daytime sleepiness (or sleepiness during night shifts) and drop of your cognitive functions, you can use Armodafinil, a safer alternative to caffeine that doesn’t cause addiction and has a more potent effect. The usual dosage is a single 150 mg pill taken once in the morning. Or, you can start using half of the dosage and see whether it is suitable for you or not. If you don't have any negative effects from the pills, you can either use the same lowered dosage or take a whole pill next time if you think that the effect was insufficient. But keep in mind that the pills should be taken not less than 12 hours before going to bed or you will have insomnia.
You can find all information that you need about the drug: cost per pill, explanation of the effect, potential adverse reactions and how to prevent them, recommended dosages and time of intake, and so on, on the product page. You don’t need a prescription but if you are worried about the suitability of the medication for your case, you can consult our pharmacists who will provide you professional advice.
Post by: Emma Ager, MD, Copenhagen, Denmark