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. 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. My Kingdom for a Nap Naps are often recommended, and frequently practiced, as an effective strategy for staving off sleepiness on the night shift. On the surface, napping makes sense. Many people nap, if they are lucky to have this rare privilege, to counter sleepiness at other times of the day. The National Sleep Foundation recommends "short naps breaks throughout the shift" for night workers, maintaining that napping can be essential for some shift workers. Short, restorative naps at night are widely believed to help reduce sleepiness and fatigue and increase alertness. In a small study, 10 of 13 critical care nurses who napped regularly during breaks reported improved energy levels, mood, vigilance, and decision-making abilities. In a larger, Internet-based survey, to which 536 critical care nurses in Canada responded, nurses were asked about their typical napping practices during the night shift napping practices. In this sample, 66% reported napping during their breaks, and 30% of those nurses believed that their care was safer after a nap. Most (80%) believed that napping was beneficial. Even though the primary reason for a nap might be sleepiness, nurses who are struggling to stay awake may also fear that without a brief nap they are unsafe to deliver patient care. More objective research, in both the laboratory and work settings, has yielded moderate support for the benefits of night shift-napping in terms of performance and self-reported measures of fatigue and sleepiness, even when the nap is short and the sleep is of poor quality. These findings have been fairly consistent despite varying nap durations. Sleeping on the job during the night shift may also partially compensate for the shorter daytime sleep at home among night workers. Why Not Nap? Many of the studies conducted to date identified a potential disadvantage of napping -- a phenomenon known as "sleep inertia." Sleep inertia is a period of disorientation and performance decrement that can occur immediately upon waking from a nap. If you have ever taken a nap in the middle of a night shift, you are familiar with this unpleasant, groggy feeling. Although sleep inertia is transient, some research suggests that the problem correlates with the length of the nap and recommends short naps, of 15-20 minutes. A meta-analysis of studies of napping as a countermeasure for fatigue concluded that sleep inertia, if present, was not a significant concern because it was counteracted by the beneficial effects of the nap. Despite widespread desire for the option of napping on the part of night-shift nurses, a few considerations argue against this practice. Carl Johnson explains why napping during the shift might be a bad idea for some workers. "In contrast to the usual situation of taking a mid-day nap when you are on a more typical daily schedule, taking a nap when your body is telling you it is "sleeptime" is likely to not only prolong the nap into a full-blown sleep episode (which will lessen alertness on the job after the "nap" is over) but also to make the phase-shift to a night-active phase even slower." In other words, if you are trying to truly adapt to night work and day sleeping, taking a nap at night is counterproductive. I'm Not Sleeping on the Job, I'm Napping on My Break! The benefits of napping have not led to universal adoption of this practice during the night shift by nurses or encouragement of this practice by employers. Barriers to napping include lack of designated nap facilities, patient care demands, understaffing, interruptions, and perceived lack of management support. Nurses are made to feel guilty for napping at night, and in some hospitals they are disciplined for doing so, even when the nap is taken during scheduled breaks. This guilt is not entirely unfounded. Most employers do not currently allow napping in the workplace, but this could soon change. The National Sleep Foundation maintains that napping can reduce fatigue-related accidents and workers' compensation costs, making a ban on napping a legal liability. Efforts to make workplace policies nap-friendly will be increasingly important. According to nurses, in addition to administrative support for napping, the following provisions would improve their ability to take a restful nap during the night shift: A quiet, safe, clean "nap room" that is close to the unit and has a private area for each user (eg, not a multiuse room or staff lounge used for other purposes); Comfortable napping surfaces, such as beds, sofas, stretchers, or reclining chairs; Blankets and pillows, or storage areas for staff to bring their own items; Low lighting levels, preferably with dimmer switches; Timers with audible alarms to awaken nappers at the end of the nap (20 minutes is ideal); and Relief from patient responsibilities during nap breaks. Still, whether napping should be a stop-gap measure to combat unanticipated sleepiness or part of a planned sleep-wake strategy to promote sleep health in regular night-shift nurses is not currently known. Nor is there much known about the effects of napping at night on subsequent sleep quality, or whether napping regimens can counteract the negative physiologic sequelae of working nights in the first place. Source
