Expert Review by Ronee Welch, Sleep Coach and Owner of Sleeptastic Solutions
June 29, 2021
If you work outside of the traditional 9-to-5, you might have noticed that staying awake at night and getting yourself to sleep during the day can be challenging. Some people are able to adapt to an unconventional sleep schedule, but many are not.
Those who are not able to adjust and continue to have difficulty sleeping are likely living with shift work sleep disorder (also known as shift worker syndrome).
Shift work sleep disorder is the result of the difficulties in adjusting your sleep schedule to your work schedule. Shift work is defined as anything from graveyard or night shifts to swing shifts, and even shifts that fall out of the typical 9 am to 5 pm schedule.
Nearly 20 percent of full-time American workers are involved in shift work, and an estimated 10-40 percent of these shift workers are affected by shift work sleep disorder.
Sleeping after a night shift can be difficult because a nighttime work schedule goes against the workings of humans’ innate internal clocks.
Circadian rhythms are 24-hour rhythms that coincide with daytime and nighttime. The primary circadian rhythm responsible for sleep depends primarily on two hormones, cortisol and melatonin. Melatonin releases at nighttime to prepare the body for sleep, and cortisol production generally peaks in the early morning to wake the body up and prepare for the day.
Shift work schedules are in conflict with the hormones that regulate the internal clock, making sleep difficult.
Even a schedule that is technically during the daytime, such as a 6 am to 2 pm schedule, can cause sleep problems in some individuals. This is because internal clocks vary from person to person. So-called “night owls” may adjust well to a night shift but struggle to stay alert when they must consistently wake up early.
Additionally, sleeping during the day when melatonin production is not at optimal levels for sleep can impact the body’s ability to enter Stage 3 sleep or REM sleep. Stage 3 sleep is a period of deep sleep that is essential in cellular repair and immune defense.
Not getting enough Stage 3 sleep can cause feelings of grogginess, and those woken up during Stage 3 sleep exhibit decreased mental performance. REM sleep is likely involved in learning and the consolidation of memory, and a lack of REM sleep can cause headaches or migraines.
Accidents caused by excessive sleepiness are the most obvious risks of shift work sleep disorder. In fact, about 20% of serious car accidents resulting in hospitalization or death involve a drowsy driver.
Putting aside the risk of accidents resulting from sleep deprivation, there are also long-term health risks associated with sleep deprivation and misalignment of circadian rhythms.
A study of melatonin onset in hospital night workers found that, after a week of night work, some of the workers’ melatonin secretion adjusted completely, while others experienced no shift. In addition to hindering the ability to sleep, changes in melatonin secretion and circadian rhythms are responsible for other hormones and health outcomes.
For those with rotating shifts, the difficulty presented by the shift in melatonin onset could mean feeling constantly out of alignment with their internal clocks.
Peptic ulcers are more prevalent in shift workers than those who work the traditional 9-to-5.
One known cause of ulcers is Helicobacter pylori (H. pylori) bacteria. While this type of bacterial infection is common, it can sometimes irritate the digestive tract, which causes the ulcer to develop.
While more research is needed, studies suggest that the long-term stress and sleep loss associated with shift work may increase gastric acid secretion and reduce mucosal defense, making it more likely for the bacteria to colonize and cause irritation.
However, ulcers can also develop from frequent use of anti-inflammatory drugs including aspirin and ibuprofen, smoking, and excessive alcohol consumption.
Research suggests that shift workers are 29% more likely to become overweight or obese. While the causes vary from individual, this link between shift work and obesity is likely because shift workers have fewer waking daylight hours to exercise, tend to eat less healthily, or feel isolated from social networks as a result of their working hours.
Cardiovascular disease among shift workers is a concern, but it can be difficult to study the full impact of shift work on the risk of developing cardiovascular disease.
This is likely because shift work is defined differently from study to study. While one study found that shift workers were 40 percent more likely to develop ischemic heart diseases than those working the standard day shift, a review of 16 studies was unable to determine a causal link between shift work and cardiovascular disease.
A longitudinal study in the UK found that, over a period of five years, shift workers who slept less than 6 hours a night were 2.1 times more likely to be taking blood pressure medication at the end of the study compared to those who did not work shifts.
It is worth noting, however, that for shift workers sleeping upwards of 7 hours per 24-hour day, there was no significant difference in the likelihood they were taking blood pressure medication compared to non-shift workers. This coincides with the fact that some individuals are better able to adapt their sleep schedules to shift work, but for those who are unable to, there are potential consequences such as increased blood pressure.
To alleviate the symptoms of shift work disorder and get better sleep, there are multiple lifestyle changes, supplements, and medications that may help.
Lifestyle changes are the first recommended treatment for shift work sleep disorder, as they can provide a significant benefit with few or no side effects. The first thing you can do to identify the issue is keep a sleep journal. Use it to record the time when you settle in for the night and when you wake up, along with how long it took you to fall asleep and your perceived sleep quality.
You can also use a sleep journal to record your work schedule and other daily habits like exercise and caffeine intake to help you see the connection between these factors and your overall sleep quality.
Keeping a sleep journal will also help keep you accountable to forming better sleep habits.
Establishing a sleep schedule and consistent bedtime routine that is maintained even on weekends and days off of work can also help signal to your body that it is time to go to sleep.
In addition to creating a sleep schedule, create an ideal environment for sleep each time you go to bed. This may include blackout shades, eye masks, or ear plugs, as well as reminders to those you live with to keep the noise down while you are trying to sleep.
If you work a night shift, try and minimize your exposure to light when returning home in the morning by wearing sunglasses and avoiding going outdoors as much as possible. The morning sun can activate your internal clock.
On the other hand, if you’re having trouble staying alert at work, you can try light therapy near the beginning of your shift to simulate sunlight’s natural effect.
Caffeine can be helpful to energize you in the beginning of a shift, but you should be careful not to ingest caffeine too close to when you plan to sleep.
According to the American Academy of Sleep Medicine, it takes 30-60 minutes for the effects of caffeine to reach peak levels. Caffeine has a half-life of 3 to 5 hours, which means that’s how long it takes to eliminate half of the drug from your body. The remaining caffeine can stay in your body for much longer—up to 10 hours.
While you don’t have to cut caffeine 10 hours before hitting the hay, you should stop consuming caffeine about 4 hours before bed (that includes sneaky sources of caffeine like soda, iced or hot tea, and chocolate—particularly dark chocolate).
If at all possible, avoid rotating shifts or adding hours to your shift. Working at night can be a difficult adjustment, but working rotating shifts can make the situation even worse as your body struggles to get used to an uneven sleep schedule.
In some professions, working rotating shifts is unavoidable. If that’s the case for you, try to rotate shifts from day to evening to night. This gradual clockwise shift rotation tends to work best for adjusting to an inconsistent sleep schedule.
Your body naturally produces melatonin to regulate the sleep/wake cycle. When it’s dark out, the brain releases more melatonin, signaling that it’s time to sleep. Unfortunately, for those working the night shift, that natural hormone production makes it more difficult to stay awake at night and sleep during the day.
The good news is that you don’t have to rely solely on your natural supply of melatonin. Melatonin is also available as a supplement, which you can take before bed to help you fall asleep.
Keep in mind, though, that while melatonin is generally considered safe for short-term use, more research is necessary to determine long-term risk. That’s why it’s best to only use melatonin when necessary, and discontinue use as your body adapts to your new sleep schedule.
If shift work is impacting the quality of your sleep and lifestyle changes are insufficient to help you get the sleep you need, a trained medical professional may prescribe sleep aids. Possible treatments for shift sleep disorder include hypnotics and sedatives like zolpidem and eszopiclone. While they can be effective sleep aids, these prescription drugs should only be used for a short period of time, according to FDA guidelines.
Another treatment, a drug called modafinil, can also be prescribed for shift work sleep disorder, as it promotes alertness. In clinical trials, modafinil reduced the amount of time it took for individuals to fall asleep, as well as decreased the frequency and duration of lapses of attention at night. In addition to the benefits of increased nighttime alertness, modafinil did not decrease the quality of sleep during the daytime.
It’s not easy to get a good night’s (or day’s) sleep after shift work. The bright sunlight, sounds of people going about their day, and your body’s own internal rhythms can leave you tossing and turning.
This restlessness can even end up putting your health at risk, which is why it’s so important to find a treatment that helps you get your sleep schedule back on track.
There are multiple options for shift work sleep disorder treatments, and you can work with your healthcare provider to find a strategy that works best for you. If you believe that shift work is negatively impacting your sleep, you can start keeping a sleep diary to track your sleep and create a consistent bedtime routine.
Sleep is important for focus, wellbeing, and overall health, and there are options to help you sleep better, even with a shift work schedule.