Sleeplessness at night and daytime sleepiness are the expected reactions of the body to shift work. Human is a daytime “animal”. We are biologically adapted to be wake when the sun is up and sleep when it is down. So people who have night working shifts can have problems with drowsiness and insomnia at inappropriate times. This phenomenon even has a medical term – shift work sleep disorder (SWSD). It is an official condition for which certain medications are approved. But before we discuss the treatment methods, let’s talk about the risks and manifestations of SWSD.
Short information about shift work sleep disorder
Insomnia, difficulty falling asleep or waking up, sleepiness during the shift, daytime sleepiness, difficulty focusing, headaches
Night shifts, irregular shifts
Quitting job with night or rotating shifts, sufficient intervals for rest between shifts, clockwise turning shifts (i.e. day, evening, night shifts going in a sequential order)
Melatonin, sleeping pills, Armodafinil, Modafinil (wakefulness-promoting drugs)
5–10% of night and rotating workers
The risk of SWSD
Work at night breaks a "habit" that is hundreds of thousands of years old. For a while, the body's reserves are sufficient to recover from night shifts, feel good during the daytime, and sleep well on those nights when there is an opportunity to sleep. But these resources are not eternal. If you are now working a shift schedule and have trouble sleeping, then your reserves are most likely depleted. Or close are to it.
We understand that you would like to see some simple recommendations or medications that will help you "pull" your well-being to an acceptable level so that you won't have to quit your job. But the primary way to restore sleep in SWSD is to change the job. It is the only way to return to your body the possibility to sleep and wake in accordance with nature - and sleep with a high probability will return to normal.
Of course, you are now thinking that this option is unacceptable for you. If so, then there are recommendations that will help alleviate your condition.
Try to create the work schedule in the following way:
- So that you do not have "one and a half" shifts when you work day, night, and next day. It is much healthier to work only a day (24 hours) or 12 hours, and then rest.
- So that shifts when you work at night alternate with day shifts, not chaotically, but in a certain manner. For instance, one night shift, three-day rest, or one night shift - rest - two daytime shifts.
- Rotate the schedule "clockwise". Example: one day work during the daytime, one in the afternoon, one at night. This will make it easier for the body to adapt.
Before the shift
- If you are going to have a night shift, ensure you get a sufficient night's sleep the previous night.
- Do not drink alcohol on the day before your shift.
- Prepare your own food prior to going to work so that you can have a quick snack before going to sleep when you come home.
- If you have to work all night or even the night and the next day, it is advisable to sleep at least one hour in the evening before going to work.
During the shift
- It is best not to eat after ten o'clock in the evening; the digestive organs are not tuned to vigorous activity at night. If you allow yourself to snack, avoid heavy, fatty foods.
- If eating at work, do not do it on the run. Sit down and eat slowly. Otherwise, there is a great risk of eating more than planned unnoticed, and this will aggravate the consequences of a sleepless night.
- Caffeinated foods and drinks are allowed only in the morning. Stop taking them 6 hours before your expected bedtime (that is, about 5 hours before the end of the shift), as it may prevent you from falling asleep after returning home.
- If near the end of the night shift you want to sleep, but you can no longer have coffee, use other methods to invigorate: exercise, go out into the fresh air, wash your face with cold water, do some kind of focused activity, etc.
- Drink water throughout the night shift (0.7-1L per night) to prevent dehydration, which aggravates the effects of circadian rhythm disturbances.
After the shift
- On the way home after a night shift, wear sunglasses to allow melatonin, the sleep hormone, to be produced.
- If you are far away from home, use transport rather than walk as walking you will lose time that you could spend on sleep, and because walk promotes wakefulness and it would be harder to fall asleep.
- If, due to night work, you slept less than 5-6 hours in total per day, go to sleep after it.
- Do not fall asleep on the way home; sleep after the night shift should not be interrupted, it is better to sleep once and for a rather long time than a few times a little because you won’t get sufficient rest but can suffer from trouble falling asleep when coming home;
- Ensure you have good conditions for rest: good darkening of the bedroom, silence, change in comfortable clothes before going to bed, and turn off your phone and other devices that can wake you up. If necessary, you can use an eye mask and earplugs.
- If you are hungry, before going to bed, eat a light meal, consisting of cereals, fruits, vegetables.
- Take a melatonin tablet 40-60 minutes before bedtime; it is an artificial sleep hormone with hypnotic and adaptogenic effects.
- Determine the optimal duration of "post-work" sleep, so that in a day you sleep approximately as much as your body usually requires. If you take a nap for a couple of hours before work, and then come home in the morning and sleep for another 8-9 hours, it is unlikely that it will be easy for you to fall asleep the next night. In such a situation, it will be better to limit your rest after a shift to 5 hours of sleep.
- When you fall asleep after your shift, set an alarm. Otherwise, you can oversleep, and this will further disrupt your already suffering sleeping schedule.
- The duration of sleep after work should be a multiple of the duration of one sleep cycle (it lasts 1.5 hours). This will help you wake up easily, without headaches, heaviness in the head, and drowsiness, and then you can spend the rest of the day fully.
- After waking up, take a shower, exercise, drink coffee to wake up faster.
- Discuss the specifics of your work with your family or roomates and explain that you need rest after shifts. Silence during your daytime sleep, planning important events for the moments when you will definitely be in good shape, helping with some everyday moments - all this is very important so that an uncomfortable shift schedule brings you as little discomfort as possible.
- On days when you are not working, observe a constant and correct routine: you must go to sleep and wake up at the same time.
- Exercise regularly, this increases the adaptive capacity of the body, improves the quality of sleep and overall well-being.
- Try to avoid stress as it exacerbates the circadian disturbance that occurs.
General tips for SWSD
To prolong your adaptive reserves, the best remedy is a healthy lifestyle. So ideally:
- Ensure you have proper nutrition;
- Move a lot, be in the fresh air more often;
- Normalize your weight if it is higher or lower than optimal;
- Eliminate existing health problems by visiting a doctor.
In general, we repeat, a person should not work at night. This is unnatural, difficult, and hazardous to health. It was discovered that a shift night work raises the incidence of hormone-dependent tumors, especially in women, and diabetes, especially in men. In general, all shift workers can be advised to look for alternatives.
If you do decide to change jobs - then you acted very wisely. In this case, help your sleep recover faster.
Follow these simple rules:
- Go to sleep and get up at the same time every day. On weekends, get up no more than 2 hours later than usual.
- Avoid excess alcohol consumption 4 hours before bedtime. Limit or stop smoking.
- Avoid caffeinated foods (tea, coffee, energy drinks, chocolate) 6 hours before bed.
- Avoid heavy, spicy, and sugary foods 4 hours before bed. A light dinner is preferable before bed.
- Exercise regularly, but at least 4 hours before going to bed.
- If you have a habit of sleeping during the day, then the daytime sleep should not exceed 40 minutes, and you need to wake up no later than 3 pm.
- Ensure comfort in the bedroom (mattress, pillow, bedding).
- Ensure good ventilation in the bedroom and maintain a comfortable temperature.
- Ensure silence and darkness in the bedroom.
- Use the bed only for sleep and sex. You should not read, eat, communicate there.
What medications are used for SWSD?
Those who work night shifts and cannot quit their jobs are recommended to use melatonin or sleeping pills before going to bed to cope with insomnia and use stimulants for wakefulness-promotion during the day (and during the shift if necessary).
The best combination of drugs is melatonin pills that act as a replacement of naturally-produced sleep hormone before going to bed and use of Armodafinil, a safe wakefulness-promoting drug. Armodafinil is a medication designed for narcolepsy that is also approved for SWSD because is it a safe, non-addictive, and effective stimulant with an effect comparable to amphetamines but with the lack of their negative effects. You can get a prescription for the medication from your physician or order it online from our drugstore. The daily dosage is just one 150 mg pill that is sufficient for 12 hours of wakefulness and vigilance. More about the product you can find out on the product’s page.
Post by: Natalie Keller, M.D. General Health Centre, Minneapolis, Minnesota