Shift Work

Shift work – Working under the moonlight

Imagine this. It’s nighttime and you’re tired. You are ready to hit the sack. But instead of putting on pajamas and getting ready for bed, you have to put your work clothes on, your shoes on, prep up your hair and go to work. Before heading out, you also have to tell your spouse and kids goodbye. This is the life of a shift worker.

We have become a 24/7 society. We like to see our local burger joint open 24 hours a day, or at the least into the late hours of the night. It is estimated that 15 million Americans work some sort of shift work, such as evening shifts, night shifts or rotating  shifts, according to 2004 Bureau of Labor Statistics’ data.

It is not an easy task, yet millions earn their living while you sleep in your warm bed. Pilots, doctors, nurses, police officers, factory workers, gas station employees and taxi or commercial drivers are part of this workforce.

Our bodies are designed to function around sunshine and sunlight. When the sun is out, we are awake and motivated to do things. The sun goes down, and we want to retire. Our body has its own biological rhythm and clocks.  Shift work hours work in opposition to that rhythm. The body can suffer.

Shift work is tough for most people partly because a shift worker must function mentally and physically against his or her own internal clock and environmental cues. When their families are asleep, they are working, and when they are home, their families are out working.

Individual differences determine how night shift work is tolerated.  Few individuals –the “night owls” — find the late shift is better suited to their needs. But most people would rather be in bed than working at 3 in the morning. Shift workers are sleepiest around 4 am, so this is when they need to avoid tedious work because it might make it potentially dangerous with jobs such as driving or operating certain machineries.

Many shift workers experience sleep problems such as sleepiness and fatigue during working hours. Then, they have difficulty falling asleep and poor quality or restless sleep when they finally get to bed.  A recent Italian study looked at nurses who work the night shift. They suffer from irregular sleep schedules and their shift work places a burden on their families and children. Many shift workers suffer from chronic illnesses such as cardiovascular disease and gastric problems. The Exxon Valdez accident is blamed on human fatigue.

A young nurse came to my office complaining of not being able to sleep at night. She works the second shift: 3 p.m. until midnight. She gets home around 1 am. Soon after, she goes to bed, but she just cannot fall sleep. She is tired but feels wide awake. She then sits up in bed and uses her laptop for a while. After struggling, she finally falls asleep at 4 a.m. She can only get 4 hours of sleep. No surprise, she feels exhausted. The hospital environment is full of stimulating activities, and it is a well-lit environment. So at 11 pm or midnight, when she should be unwinding, her brain thinks it must be daylight – not time to sleep.

Both she and I worked together to make positive changes. Now, she can get 6 hours of sleep and she feels better with it.  We talked about “winding time” before bedtime; this is a buffer zone that creates a little separation between work and sleep. I advised her to stay in her living room for two hours after she gets home with no TV, computer or texting. Instead, I advised her to listen to soft music (classical is good and slow) and to read with a low light environment. These routines have a purpose: to help her racing and active mind to slow, and to send the right signals to her brain that things are winding down and it is time to sleep.

Tips for coping with shift work

–         When you come home from work in the morning hours, go right to bed. Do not run errands; you will wake yourself up and make it more difficult to fall asleep. Make your room as dark as you can with curtains and an eye mask. Consider ear plugs to block out street noise.

–         Get plenty of outdoor light after you wake up (typically  around noon). It will ward off the fatigue.

–         Take a brief nap few hours before heading to work. The reason for taking it early is to give yours self time to recover from the grogginess that some people may experience after napping. Even if you experience grogginess, you are still getting the benefit later when you get to work.

–         When you are at work, maintain a well-lit environment.

–         Avoid the temptation to eat at night. Often, workers eat to compensate for sleepiness. This habit can lead to rapid weight gain. If you get hungry, go for a salad. Avoid carbohydrates.

–         During the day, get exercise. Eat a balanced diet. Both will keep you healthy and provide you with extra energy.

–         Avoid alcohol. You can develop a tolerance for it, and it affects the quality of sleep.

–         A cup of coffee when you get to work is fine, but don’t overdo it. It will only make you jittery when you are sleep deprived and will make it harder to sleep well at home.

–         Avoid long commutes to reduce your risk for accidents.

–         If you continue to suffer from difficulty with coping with your shift work, consult a local sleep medicine specialist. In certain individuals, sleeping aids and wake-promoting agents might be needed occasionally.

–         Help is on the way. There are efforts around the globe to change workplace policies to allow brief naps or other means to make shift work more tolerable. You can reach out to support groups and be an advocate for healthy change.


–         Niu SF, Chung MH, Chen CH, Hegney D, O’Brien A, Chou KR. The Effect of Shift Rotation on Employee Cortisol Profile, Sleep Quality, Fatigue, and Attention Level: A Systematic Review. J Nurs Res. 2011 Mar;19(1):68-81.

–          Palombo L, Federico B, Indigeno P, Capelli G. Health risks associated with night shifts: trasversal study in a sample of nurses at the Cassino hospital. Prof Inferm. 2010 Apr-Jun;63(2):77-85. Vgontzas AN