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Shiftwork/Nightshift Sleep Disturbances

Shiftwork occupations account for approximately 20% of the American work force.  It is very important for individuals working changing shifts or nightshifts to understand the importance of maintaining good sleep habits.  Proper sleep hygiene is very important for one’s health and feeling of well being.

It is not uncommon for people who work night shifts or changing shifts to experience difficulty sleeping at desired times, restless, light and easily disrupted sleep, and frequent, often prolonged awakenings.  Other problems such as fatigue, malaise, muscle aches, joint pains, moodiness, difficulty concentrating or difficulty paying attention may also occur.

These problems occur when a person’s internal clock is not synchronous with their sleep-wake schedule.  Your internal clock is influenced by cues from the environment such as daylight and darkness, meals, and even sounds such as the much dreaded alarm clock.  Your internal clock is important in that it influences your body temperature, hormone production, and many other important restorative bodily functions.  By not following proper sleep hygiene guidelines, individuals working nights or changing shifts may disturb this very important synchrony of their internal clock and sleep-wake cycle.

Below are some sleep hygiene guidelines to consider in an effort to develop sleep habits which would fit the work and social demands for individuals working nights or changing shifts:

1.  Minimize abrupt changes in sleep onset and awakening times. Keep a consistent sleep schedule, going to bed and awakening at about the same time each day. Changing bedtime or awakening time by more than 2 to 3 hours may result in poor sleep.

It is especially important to maintain consistent sleep patterns during weekends and days off.  It is common to change sleep habits on days off, especially in shiftworkers, but minimize these changes to follow proper sleep hygiene.  If this is unrealistic based on your schedule, then consider delaying your usual bedtime by 3 to 4 hours, but then attempt daily naps with minimal changes in sleep patterns for the remaining days off.

When work involves changing work schedules, maintaining consistent sleep patterns is much more difficult.  It is best to minimize changes while working a specific shift, then delay your sleep onset time by as few hours as possible when your work schedule changes.  This assumes your work schedule rotates to later start times.  If your work schedule start times rotate to earlier shifts, or are irregular in scheduling periods, sleep onset and wake up times may need to be altered more drastically.  For these individuals, scheduled naps should become a routine during scheduled time off, and short courses of sleeping pills under a physician’s guidance may be appropriate.

2.  Allow yourself to get enough sleep.  Although the quantity of sleep may vary among individuals, most adults require 7-8 hours of uninterrupted sleep per night.
3.  Limit naps. Naps are very beneficial.  Typically they should be limited to less than 30 minutes, but may need to be longer when adapting your sleep-wake schedule to a changing work schedule which results in sleep deprivation.

4.  Exercise regularly.  Avoid strenuous exercise at least six hours before bedtime.

5.  Do not eat or drink heavily for 3 hours before bedtime.  In addition to potentially contributing to heartburn, eating before bedtime may result in difficulty falling asleep. When hungry, limit meals near sleep onset to light snacks.

6.  Use the bedroom for sleep or sex only.  Avoid other activities such as watching TV in bed, pondering work or social stresses, or performing work or exercise prior to bedtime.

7.  Assure a quiet peaceful environment for sleep.  A place to sleep must be quiet, dark, and not too cool or too warm.  Repair noisy heating or air conditioning systems, avoid bedrooms near car or train traffic, sleep separate from a loud snoring or restless bedpartner, and remove ticking clocks.  You should not fall asleep with a television or radio left on.  You may consider white noise in your bedroom such as a quiet fan, humidifier or a fish aquarium.  Especially if sleeping during the day, minimize any light exposure by using dark shades and thick drapes.  Lastly, choose a comfortable firm mattress and pillow.   

8.  Do not rely on stimulants to maintain an alert state.   Beverages containing caffeine (coffee, tea, hot chocolate, cola beverages) should be limited and should not be taken 6 hours before bedtime.

9.  Avoid alcohol before bedtime.  Although it may initially help you fall asleep, alcohol typically causes early awakenings, restless and light sleep, and difficulty falling back to sleep if awakened.

10.  Avoid smoking before bedtime.  The nicotine in cigarettes is a stimulant that may result in difficulty falling asleep and staying asleep.  Although it is best to quit smoking altogether, you should at least limit this activity near bedtime.

11.  Learn to wind down a few hours prior to sleep.  Stress and worry can result in difficulty falling asleep as well as cause light restless sleep with frequent and prolonged awakenings.  Avoid worrying about problems or discussing stressful issues prior to sleep.  Set aside time to deal with these worrisome thoughts.  Avoid reading job-related materials before bedtime.  Do not plan your next day just before going to sleep.  Concentrate on relaxing thoughts or peaceful imagery.  Bedtime rituals such as reading an enjoyable book, taking a warm bath or listening to soft music can be helpful.

12.  Get plenty of light exposure while awake.  Of all factors, light probably has the strongest influence on one’s internal clock.  Exposure to bright light upon awakening will help adjust your internal clock to match your sleep-wake cycle.