Nurses Combating the Health Risks of Working Nights
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Industries that are required to be "open" 24 hours a day inevitably need people to work at night. Often, these people have careers that allow them to help those in need. While these workers are necessary, they encounter a number of health risks while working overnight shifts. Some of these risks include weight gain/obesity, circadian misalignment, sleep disorders, digestive problems, and increased depression and anxiety. They are also at risk for committing more errors and having more accidents than daytime workers. Although there is nothing that can completely eliminate the risks, there are some things that night workers can do to help with some of these problems.
When it comes to weight gain and obesity, night shift workers are at a disadvantage. Having a disrupted circadian rhythm, along with eating at night, can impair the ability of the body to process sugar (glucose)2. This impaired processing puts the affected person at higher risk for obesity, diabetes, and cardiovascular disease. One study completed in 2021 showed that eating at night increased blood glucose levels, while eating only during the day prevented the effect2. This presents both a solution and a problem for night workers, as they are typically asleep during the day and working (and presumably hungry) at night. One possible solution to this problem is to eat after work (in the morning) and before work (in the afternoon) and to keep any eating during the night to a minimum. If the worker needs to eat during the night, keeping sugar/carbohydrates as low as possible in the food consumed can help minimize increased blood sugar levels.
Another major risk factor associated with night work is circadian misalignment, which forces people's bodies to work against their natural sleep period. The circadian clock signals the body to release hormones at appropriate times and controls body temperature, alertness, and other daily cycle functions1. Sleeping during the day and working at night does not reverse the functions of the circadian clock; it just leaves a person with a misalignment between the clock and their actions. This misalignment causes sleep disorders, impaired decision-making, and decreased safety while performing activities such as driving.
There are a couple of options to address circadian misalignment, but neither is perfect, and both are difficult to accomplish and/or tolerate long term. The first option is to combat the symptoms of sleepiness and decreased alertness at night by using stimulants (most commonly caffeine) to stay awake and alert at night and then using some type of sedative to sleep better during the day1. This option is not ideal, but it does reduce some of the fatigue and excessive sleepiness that leads to errors and accidents. The second option is to attempt to adjust the circadian clock to better suit the night worker's schedule. This involves steps like exposing workers to bright lights at night, wearing sunglasses on the way home, and sleeping in a very dark room1 in order to simulate night sleeping. The adjustment takes about a week, and while this option does seem to work, it is very difficult to maintain, as the person would have to keep to this schedule both on work days and on days off. Most people would find it difficult to lead a completely nocturnal life. Going to sleep as late as possible on days off and waking up mid-day can help decrease this circadian misalignment while allowing the worker to have some daytime alertness on days off.
Another health risk associated with night shift work is gastrointestinal (GI) dysfunction or digestive disorders3. One study from 2010 showed a higher incidence of IBS (irritable bowel syndrome) in both night shift and rotating shift workers as opposed to day shift workers4. In addition, night shift workers reported more gas, diarrhea, indigestion, heartburn, and other GI symptoms5. While the exact cause of these problems is unknown, the GI system works by the circadian clock, and problems can arise if food is eaten at the times not preferred by the body (night). Also, fatigue can lead to stress, which can cause GI symptoms. By trying to minimize night eating, some of the symptoms may be alleviated. Another solution is to use medications to treat symptoms when necessary.
Depression among night shift workers is another serious concern. The lack of natural daylight and being exposed to bright artificial lights at night can lead to night workers developing a depressive state similar to seasonal affective disorder6. They may also develop depression for other reasons. Working night shift can negatively affect family and friend relationships6 due to the inability of the person to be available at the times when they are needed by loved ones. This can also lead to chronic stress and anxiety. Night shift workers should schedule some time to get sunlight as often as possible6, either in the morning before sleep or in the evening before work. This can help with depression and can also be an avenue to spend time with family or friends, such as taking a walk with the family in the afternoon before work or eating breakfast in the morning with family outdoors on the porch. If depression becomes severe or is having a significant impact, the worker should seek mental health services and possibly antidepressant medication.
While there are some options to help mitigate risk for people working the night shift, none of them lead to optimal health for the worker. For many people, the best option for health improvement may be to stop working the night shift as early in life as possible. If that is not an option, then utilizing the strategies presented here can provide some relief and possibly allow for better health outcomes in the long term.
References
1The risks of night work
2Daytime meals may reduce health risks of night shift work
3Effects of Shift Work: The Danger of Not Getting Enough Sleep
4The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses
5NIOSH Training for Nurses on Shift Work and Long Work Hours
6The Mental Health Effects of Working the Night Shift