The night shift is not for the faint of heart. It creates havoc on hormonal production and the body’s circadian rhythm and increases the risk for sleep deprivation and Shift Work Sleep Disorder (SWSD). Even so, it’s an essential part of healthcare, and the ability to provide 24-hour care is priceless. A study conducted by the US Bureau of Labor Statistics in 2004 on work schedules shows that 15 percent of full-time workers were doing some kind of rotational shift work involving a full- or partial-night shift schedule.I find the night shift to be an exciting transition into another dimension. Being a creature of the night, I appreciate the quiet hours of fewer interruptions, increased autonomy, and more focused patient care. However, skeleton staffing with less support can be stressful, especially in emergency situations. There are several reasons why we may find ourselves in the night shift realm (and sometimes even benefit from it):
- As a new grad, you need the experience and do not have the seniority yet to pick your preferred shift.
- You have other obligations (such as school, another job, or child care) that require your attention during the daytime.
- The pay may be better.
- You may be one of the Night Owls who actually prefers it.
Night Shift Challenges
The most difficult part of doing the night shift for me was the drive home. During the shift, I could keep myself busy when times were slow or, if it was a bustling night, comfortability run on a continuous boost of adrenaline. But the drive home was when all the fatigue and stress of the shift seeped out of its guarded confinement and consumed my body. There were scary times where I almost fell asleep at the wheel and had to pull over to make sure it was safe for me to continue driving. Ever seen a movie where the actor had to slap himself to stay awake? Yup...the struggle is real! A proactive (and less painful) coping strategy might be to take a short nap before you leave work. Phoning a family member or a friend (especially in another time zone!) to catch up and help you stay awake on the drive is another great idea. And nothing makes the last stretch home as worthwhile as seeing a spectacular sunrise - which can give you a quick gratitude boost, as well!Unfortunately, 10% of shift workers struggle with more than just the drive home and are diagnosed with Shift Work Sleep Disorder (SWSD). SWSD affects people whose job require an erratic sleep schedule. People with SWSD typically experience extreme sleepiness when required to be awake a night, and difficulty sleeping when needing to sleep during the day.One of the main reasons the body reacts that way is due to some of the leading hormones regulating your circadian rhythm called cortisol and melatonin. Inversely proportional to melatonin, cortisol levels are naturally highest when we wake in the morning and gradually decrease throughout the day. Cortisol is also one of the hormones released as a part of the body’s stress response, and is involved in managing blood glucose levels, blood pressure, sodium/water balance, anti-inflammatory response, and memory function; disruption in cortisol levels, due to long term stress exposure or change in circadian rhythm, is one of the leading causes of health challenges for night shift workers like Nurses and CNAs. Additional challenges night-shift workers may face include:
- Reduced social interaction due to scheduling challenges and conflicts which make making plans/commitments difficult.
- Abnormal routines. Difficulty doing typical daily activities like shopping, attending appointments or school events. Fortunately, 24-hour grocery outlets and online stores have made shopping manageable.
- Disturbance from outside sources like unscheduled visitors/phone calls or family members when you are trying to sleep.
- Ineffective patient care due to fatigue and sleep deprivation.
- Vitamin D deprivation due to lack of sunlight.
- Increased stress due to erratic schedule maintenance and lack of sleep. (For more information on how to prevent and manage stress, follow the link to 8 Ways for Nurses / CNAs to Manage and Prevent Stress.)
Tips for Surviving the Night Shift
It’s important to take care of yourself in order to take care of others. Self care strategies included proper stress management, rest and relaxation, exercise and nutrition. Read more about a Nurse’s and CNA’s Guide to Self Care.
Sleep is the way the body repairs itself. It plays a role in regulating mood and can impact judgment. But sleeping at nontraditional times of day can be tricky! A few ways you can guard your sleep:
- Aim for 7-9 hours of sleep, as studies show that chronic sleep deprivation can lead to many health concerns.
- Establish a sleep ritual and routine to help your body transition and adjust to a different rhythm. Start the ritual by wearing sunglasses when driving home post-shift to reduce your eyes’ exposure to sunlight - which suppresses melatonin and stimulates alertness.
- Keep your room at a cool but comfortable temperature.
- Use blackout curtains or an eye mask to block out sunlight to help signal that it is time to go to sleep.
- Use earplugs or a white noise machine to block out or reduce any possible noise disturbance.
- Take Naps. This can help you get over the fatigue hump when it is not time for regular extended shut-eye. Even a 20 minute nap before your shift, or during your shift break (discuss with employer first), can increase alertness as well as reduce fatigue and possible work error. If you are not able to do it all in one sitting (or lying down), sleep in 2 sections (one section after your shift and one before the next) to help get the full 7-9 hours of sleep.
- Remember to turn off your phone, or turn on DND (Do Not Disturb), and set a special ringtone/call criteria for those who need to reach you in emergencies.
Group Shifts Together
Try to group the same shifts together as much as possible to assist with shift transition, maintaining a regular sleep schedule, and getting the most out of keeping a manageable routine.
Sunlight suppresses melatonin and increases your awake response. It also exposes you to Vitamine D which affects bone health. Be mindful of how long you’ll be outside and lather on sunscreen accordingly.
Exercise, Eat Well, and Stay Hydrated
Exercise has numerous health benefits, including stress reduction and increased alertness. Incorporate exercise after sleeping or naps to kickstart your level of alertness, and get you off the grogginess track. Eat healthy snacks which are high in protein and have a low glycemic index to avoid cravings and spikes in blood sugar. Limit fatty foods, which are difficult to digest and may cause drowsiness. Plan ahead by pre-packing snacks from home to avoid the ever-tempting vending machines.Limit caffeine to the beginning of your shift and opt to hydrate with water and/or herbal, non-sugary teas.
Stay Organized and Prioritize Your Time
Being organized can provide a sense of accomplishment and take the edge of trying to manage things when you are not around during the day. Plan in advance by incorporating a schedule and setting routines to make transitions easier. Involve the whole family and make sure to schedule quiet (including sleep) time for yourself!
Reach out to family and/or friends to help with:
- Grocery shopping.
- Pick up/drop off at school or activities.
- Chores around the house.
- Maintaining the organized schedule you just created.
- Arranging family time.
Focus on the Positive
Sometimes, when you're in the thick of it all, it’s difficult to see the benefits of the “downside up” schedule. However, night shift can have positive implications like:
- Opportunities to be available for kids’ schedules and events during the day.
- Ability to avoid peak hours - particularly considering high traffic geographics affecting commute time. And who doesn’t like having the big screen all to themselves at the movie theatre?
- Better pay possibilities.
- Less disruptions during the shift.
- Opportunities to enroll in school and career advancement classes, or participate in other activities of interest during the day.
Seek Professional Help
If you have established proper sleep routines and tried several coping strategies, but you are still struggling with night shift work, seek the help of a professional to talk about other alternatives and/or whether medical treatments, like medication, may be beneficial. It may also be a good time to consider whether night-shift work is right for you.Do you like the night shift? Let us know in the comments if you have additional tips and tricks!