This was a pretty good article about surviving night shift.
Night Shift Physiology
By Terri Kerner-Gore, BSN, RN, CNII
It is 4 a.m. and your patients are settled for the moment. Time to sit and do some charting. The medical chart is open before you, waiting to be completed, but your eyelids are falling to half-mast despite the interesting story a co-worker is telling. Fighting off that irresistible urge to sleep is becoming harder by the second. You’ve ingested enough caffeinated beverages to keep an elephant awake for a week, but each time you sit down for more than 5 minutes your eyes want to close.
You feel chilled and recall with a small chuckle the time it was quiet on the floor and, just for fun, the night shift staff kept an hourly recording of each other’s temperatures to prove body temperatures drop around 4 a.m. Deep in this thought, you nod off momentarily and then, with a small jerk, awaken to the muffled giggles of your co-workers. Although they understand, they still find it amusing that someone could fall asleep in the middle of writing a sentence.
But why is this happening? Yesterday, you had a good day’s sleep of about 6 hours and yet it seems impossible that you’ll ever make it to 7 a.m. when the next shift arrives to relieve you.
Rhythm of the Night
What is occurring has been referred to as “microsleep.” It’s a spontaneous episode of uncontrollable sleep that may last from 2 to 30 seconds. It can occur regardless of what activity the nurse is doing and become more frequent as the shift progresses. Inactivity, such as sitting, increases the susceptibility of falling prey to microsleep.1
Being more rested is the key to safety and increased productivity for night shift nurses. Mental functioning and alertness are affected by lack of sleep and the stress caused by fatigue. These are serious concerns for nurses who are responsible for drug administration and critical care of patients in hospital settings.
But does it have to be this way? It is important to understand why it is so difficult to stay awake at night so that adaptations made by night shift workers can be effective.
The difficulties of night shift workers primarily stem from sleep loss/deprivation that is tied to our circadian rhythm, which regulates our body’s cycles. It is a 24-hour cycle that is dependent on light, and is involved with hormone release, body temperature, and sleep/awake cycles. Humans are diurnal, meaning that we are at our best during the daylight hours with a natural dip in alertness in the mid-afternoon. The strongest urge to sleep occurs between the hours of 2 a.m. to 5 a.m.2,3,5
Our genetically obtained circadian rhythm dictates how well we function at a certain time of the day. No one has the exact same rhythm, which explains why some people are “night owls” while others are not. Even night owls are subject to the sleep disturbances associated with night shift work.
The circadian rhythm is associated with hormone production such as melatonin, cortisol, growth hormone, prolactin and seratonin, among others.6 Melatonin levels naturally increase at night and sleep is normally initiated during this rising phase. Temperature levels of the body are in decline during this time.3
Night shift workers go against this natural phasing by trying to sleep during the daytime hours when melatonin levels are lower and body temperatures are higher, which inhibits the ability to sleep for long periods of time. The average sleep time for night shift workers is 2-4 hours less than normal nighttime sleep. All this leads to work related sleep deprivation that increases stress on the body, both mentally and physically.6
Better Sleep
Nurses should be aware that while there may be no way to reset the internal clock, there are ways to combat these natural rhythms to get a more restful sleep.
A “power nap” is one way to combat the sleepiness encountered during work. During scheduled breaks, a nap as short as 15-20 minutes can be helpful. Many people say this makes them feel worse and believe that a nap isn’t helpful. This is not necessarily true. This feeling is referred to as “sleep inertia” and if you understand that it follows a power nap then goes away within 1-15 minutes, then the benefits of the power nap can be appreciated and will rejuvenate a tired worker. Although some research has reported up to 4 hours to recover from a power nap, the shorter recovery time seems to be more accepted. It is important to realize that the benefits of the nap may last for many hours, providing a more alert state and better work productivity.3,4
Eating, drinking and even exercising properly while working the night shift will also improve the ability to sleep during the day. While beverages containing caffeine can be helpful at the beginning of the shift, intake should cease by 3 a.m., as caffeine can linger for 15 hours or more in the body. Also, avoid junk foods while at work. Instead, eat foods low in fat and high in fiber. Light, frequent meals are healthier than large meals and keep blood sugar levels from fluctuating. Going to sleep on an empty or over-full stomach adversely affects sleep. If you exercise at work, do so at least 3 hours before attempting to sleep so that your body has time to cool off.
If you are sleepy after your shift, try to take a nap before going home. If you are sleepy while driving, one option is to take a few minutes to stop for a nap with the car locked. Because our sleep patterns are affected by light, wearing sunglasses may help your body ease into sleep once at home. Another tip is to drink fluids while driving. Taking small sips helps keep you wake. Think about it, how many of us above the age of three can fall asleep while eating or drinking?
Night Shift Physiology
Day Sleeper
To help them sleep during daylight hours, some night shift workers use over-the-counter drugs like Benadryl, among others, and the hormone melatonin (which is not approved by the FDA). Some also resort to prescription sleeping pills. More studies need to be done in order to determine whether these drugs are helpful or if they are actually a detriment to night shift workers.
Meanwhile, family members need to understand how important sleep is for the night shift worker and that daytime sleep is not the same quality as nighttime sleep. Mood and emotions are adversely affected by fatigue and a feeling of being chronically tired is commonplace.
Without consideration from your family about the need to sleep, attempts at restful sleep may be futile.
Make sleep a priority. Socialization with family members often needs to take a back seat to sleep. Of course, most families don’t understand this, especially with extended families or families with small children. If a plan can be worked out with family members to respect the time you need for sleep, you will be better for it.
Family needs and commitments however, often take precedence over sleep. In social situations, sleep or the lack thereof, is often the primary topic of discussion by a night shift worker. It can become almost an obsession, which is not always conducive to great conversations or social life.
Setting aside time isn’t always the problem however. Often, the night shift worker lies in bed unable to sleep, suffering from insomnia. This can be most frustrating. Here are some helpful hints for better sleep:
· Develop a bedtime routine to prepare your body for sleep
· Sleep in a darkened room and use eyeshades if necessary
· Utilize ‘white noise’ or earplugs to keep noises from disturbing sleep
· If possible, maintain the same sleep schedule when not working to keep your body on a consistent cycle
· Avoid alcohol prior to sleep, although you may feel relaxed at first, it actually disturbs sleep
Arm Yourself
When it comes to trying to stay healthy, both mentally and physically, the challenges faced by night shift nurses are unique.
They cannot rely on “normal” strategies for getting sleep, and have the added burden of health issues, such as an altered circadian rhythm and hormone shifts that are not found in daytime workers.
The social issues of night shift workers are not easy to deal with, and must be worked out by each individual to reach compromises with family and friends that best suit his or her needs.
But armed with some knowledge of the dynamics and physiology of working at night, perhaps third shift workers can achieve a better balance, and of course, get a more restful sleep.
References:
1. Emeril Vernarec, ed. Linda A Perkins. ( 2001). Occupational hazards: Is the night shift worth the risk?. RN, 8: 65.
2. American Sleep Disorders Association. (1997). Coping with shift work. Wellness booklet.
3. National Sleep Foundation. (2001). Sleep strategies for shift workers. Retrieved Feb. 29, 2004 from the World Wide Web:
http://www.sleepfoundation.org/publi...hiftworker.cfm.
4. Mercola, J. (2001). Shift work dangerous to your health. The Lancet, 358, 999-1005. Retrieved May 25, 2004 from the World Wide Web:
http://www.mercola.com/2001/sep/29/shift_work.htm
5. Fermilab Accelerator Update. (2001) Coping with shift work. Retrieved May 3, 2004 from the World Wide Web:
http://www.fnal.gov/pub/news/history_shift.html
6. Labyak, S., Lava, S., Turek, F., Zee, P. (2002). Effects of shift work on sleep and menstrual function in nurses. HealthCare for Women International, 23: 703-714.
Terri Kerner-Gore is an OB/GYN staff nurse at Windham Community Memorial Hospital, Willimantic, CT.
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Night Shift Survival
Experience
feeling guilty when you need to sleep verses spending time with the little ones. If it is not quality time, wouldn't it be better to sleep and feel more rested so that you are not so upset? Your husband needs to help you find a balance as to what will work for your family! Good luck in whatever you choose to do!! Get some rest though. It is hard to think clearly when you are exhausted. 
Leave for work at 6:30p home by 8am Sunday. Sleep from 9 or 10 am-3pm, leave for work again, home by 8am Monday. Sleep from 9 to noon. Go to bed at 9pm that night.
