Help Me Make it Through the Night (Shift)

Laura A. Stokowski, RN, MS

Disclosures

January 24, 2012

In This Article

How to Survive the Night Shift

The extent to which human circadian rhythms can adapt to a night shift is not known. Nor is it known whether such adaptation would negate the health consequences of working the night shift. However, the findings of such studies as that conducted by the Vanderbilt team suggest that on some level, at least some nurses can adapt to working nights.

A member of the Vanderbilt research team, Carl Hirschie Johnson, spoke with Medscape about the practical implications of the study. "With respect to adaptation, the best strategy is staying awake at night, and sleeping during the day, even on your days off, if your family obligations allow you to do that. To entrain yourself, you have to simulate a reverse day. Sleep in a very quiet, very dark room (or use a blindfold). At work, seek out brightly lit areas. You need bright light exposure, but most indoor lighting is insufficient. Don't nap during your shift. If you can't stay on this schedule (and fewer than 5% of nurses in the study did), the next best strategy is that of sleeping late before your first night shift, rather than going without sleep."

Some nurses seem to be unable to adapt to working nights, no matter how hard they try.[27] Suggestions for mitigating the effects of shift work and fatigue include the following[25]:

  • If you work 8-hour rotating shifts, rotate clockwise (days, then evenings, then nights);

  • Avoid rapid rotation (eg, working different shifts in the same week);

  • Follow a regular sleep schedule regardless of which shift you are working;

  • Use room-darkening or blackout shades in your bedroom;

  • Spend as much time as possible in brightly lit rooms;

  • Wear sunglasses to block blue light when driving home in the morning;

  • Don't schedule appointments or activities during your routine sleeping hours;

  • After your last night shift, sleep for 4 hours;

  • Avoid eating large meals within 4 hours before sleeping;

  • Avoid caffeine and nicotine before sleeping; and

  • Seek exposure to bright light after waking.

Many other measures have been assessed for their value in helping workers adapt to shift work, including supplemental melatonin, chemical sleep aids, use of stimulants, and physical exercise.[41] With the exception of physical exercise, all of these measures have potential drawbacks. However, a regular exercise program can benefit night-shift workers not only by helping them tolerate the night shift but also in reducing the somatic symptoms associated with poor sleep and working nights.[41]

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