The Hidden Burden of Shift Work

Working the night shift can pose many problems. Unfortunately, working in a medical center means that many of us will need to spend time working the night shift at some point. The burden may vary, based on whether the assignment extends over a few days—or weeks—or, even months. The Shift Work Sleep Disorder can be associated with increased stress on physical and mental health. It can also be associated with a drop-off in work performance and an increase in workplace errors. Some are able to adjust quickly, but others find it difficult to shift their sleep-wake rhythms.

There are three major components to Shift Work Sleep Disorder. The first comes from the fact that we all have an inner, biological clock that allows us to sleep more easily at certain times and to maintain wakefulness at other times. Working nights means that we must shift this clock. This accounts for the fact that people working at night may find it difficult to get proper and efficient sleep during the day. Our bodies are capable of making the shift over time.  However, the transition is reversed on days off when many will try to follow the usual schedule of family and friends. This system is sensitive to our activity schedule and is most sensitive to bright light exposure. Establishing a routine of activity, sleep schedule and bright light exposure can be quite helpful.

Total sleep need is the second piece of the puzzle. It is important to remember that we each have a “sleep need” that extends over each 24-hour period. For most of us, this “need” is in the 7-71/2 hour range – for some, it is a little more; for others, it is a little less. For a variety of reasons, including problems adjusting to the “clock shift”, many shift workers start to accumulate sleep deprivation and acquire a sleep debt. The development of a routine sleep schedule, using naps and even pre-napping in preparation for a night shift may be helpful.

Finally, there is the piece that is often least appreciated. Working the night shift can lead to additional stress in our daily lives. Interacting with friends and family during the day may become challenging. The shift worker may experience a feeling of “jet lag” with an increase in irritability. An increased consumption of caffeine and similar substances during the work shift may also contribute to irritability and further problems with sleep during the day. All of this leads to an increased level of physical and emotional stress which, in turn, may lead to a greater disturbance in sleep.

What are the signs of a shift work sleep disorder?

  1. Do you have problems getting the sleep you need? Do you find it difficult to fall asleep during the day when you have scheduled your sleep time?
  2. Do you find it difficult to function at a high level when at work? Do you lose focus or concentration? Do you need to repeat tasks? Are you forgetful? Do you make more mistakes?
  3. Do you experience fatigue and/or sleepiness at work?
  4. Are you more irritable with co-workers, family or friends?

Helpful Hints:

  1. Whenever possible, prepare for shift work. Make sure that you get as much sleep on the nights prior to the nights on duty. If possible, a nap prior to the scheduled night shift can be helpful.
  2. If you plan to work on a particular schedule for a period of time (weeks or months) then it would be helpful to establish a fixed schedule. If possible, you should try to stick with the schedule on days that you do not work.
  3. Maximizing bright light exposure prior to a night shift and minimizing it after a night shift may also prove to be helpful. Bright light exposure is very important in the adjustment of our sleep clock.
  4. Make sure that you sleep setting lends itself to a night of comfortable sleep. Ideally, it should be cool, quiet and relaxing.
  5. Stimulants such as caffeine may be quite useful, but care should be taken to avoid caffeine too close to your desired bedtime.
  6. Relaxation techniques may be helpful when it is time to initiate sleep.
  7. Regular, routine exercise is also helpful—but, it should be avoided within 3 hours of sleep onset.
  8. AVOID DROWSY DRIVING! If needed, take a nap before driving home. If sleeping is still an issue, find an alternative means of returning home.
  9. If problems persist, consider a discussion with your primary care physician and, possibly, a referral to the Sleep Disorders Center at Boston Medical Center. At times, certain medications may also prove to be helpful.

The Sleep Disorders Center at Boston Medical Center

Boston Medical Center is fortunate to host a fully accredited Sleep Disorders Center. It is staffed by a group of Board Certified Sleep Specialists. The Center is fully prepared to handle all types of sleep problems and includes a group of sleep physicians, pediatric sleep specialists, surgeons specializing in procedures for sleep disordered breathing, psychologists offering Cognitive Behavioral Therapy for insomnia and psychiatrists. In addition, it features a fully equipped Sleep Laboratory. To discuss an appropriate referral, please contact the Sleep Center Coordinator, Marianne Kelly, RN at 617-638-7746 or