How to Survive the Night Shift
The night shift is no fun. Sleeping during the day and staying up all night is exhausting and turns you into a walking zombie! People start accusing you of being a vampire, and you are not sure, but you are pretty sure your retinas will light on fire if they see sunlight….
All jokes aside, the night shift is not only tiring but can be harmful to your health. That is why so many CNAs also hate it so much. Working nights disrupts your circadian rhythm, that internal “clock” in your body that tells you when you should be awake or asleep. This system is involved in regulating core body temperature, blood pressure, wakefulness or alertness, mental performance, and hormone secretions, in particular, melatonin, cortisol, prolactin, and growth hormone. A disruption in this system causes you to have less sleep and spend less time in REM sleep, that stage of sleep that helps you feel more rested when you wake. Less sleep disrupts your body’s hormonal balance, putting you at increased risk for obesity, cancer, ulcers, pregnancy complication, diabetes, heart disease and more.
The Circadian Rhythm
Circadian timing systems regulate the sleep/wake cycles throughout the animal kingdom, dictating when an animal should be awake and when they should be asleep. The circadian rhythm is regulated in the body by exposure to light and dark. Our body is trained to follow the sun, wake up when it’s light and go to sleep when it’s dark. This all makes sense, of course, when we were hunter-gatherers, but in today’s society of 24-hour service and artificial lights, this system can wreak havoc on our system.
Circadian rhythm disruptions are associated with many health issues. People who work night shifts have been shown to have lowered metabolism and impaired sugar and fat metabolism, even when the diet is identical[i]. Work performance is affected as well, where performance and reaction time is comparable to blood alcohol levels above the legal driving limit[ii]. Circadian disruptions are associated with increased blood pressures and inflammatory markers, reversed cortisol rhythms, and decreased insulin sensitivity, placing shift workers at higher risk for heart disease, diabetes, cancer, and other health problems.[iii]
One of the hormones involved in the circadian rhythm is melatonin. Melatonin is secreted by the pineal gland at night to signal the end of the day and help your body move into sleep mode. Melatonin is not only responsible for sleep but is also known to inhibit tumor growth, thus explaining the increased risk of cancers in shift workers. Melatonin secretion is regulated by the ganglion cells in your retinas in response to changes in light and dark. When light is waning, and the environment is getting darker, melatonin levels rise. If you try to sleep when melatonin levels are decreasing your sleep will be shorter and of lower quality. Likewise, if you stay up all night and expose your eyes to light when your melatonin levels should be rising you will have lower melatonin levels in your body, and thus less tumor growth inhibition[iv].
Many CNAs who work at night swear by taking Melatonin as a sleep aid. The research seems to support this; in one study participants given Melatonin 30 min before sleeping after a night shift had with an increase in the duration of sleep compared to those given a placebo. The Melatonin group, however, had similar fatigue and performance on the night shift, suggesting that while melatonin can help you sleep, it does not fully counteract the effects of circadian rhythm disruption[v].
Night Shift Strategies
There are ways to make the night shift easier and healthier for your body. While these strategies are not cures for the effects of circadian rhythm disruption they go a long way to keeping your healthier and happier while you are working the night shift.
Keep your Schedule
If your personal life allows it, try to maintain your sleep schedule, even on your days off. It can be very tempting to try to switch yourself to a daytime schedule when you are not working, but that just makes it harder for your body to adapt back to night shift. On your days off try staying up late (to about 3 or 4 am) and sleeping in as late as possible. This schedule still allows you to participate in social activities but maintains a near night shift sleep schedule. By keeping a similar sleep schedule on your days off, it makes it easier for your body to adjust to the night shift.
Avoid Rapid Rotation
Switching between days and nights is the time that is most difficult and more harmful to your body. If possible, try to limit switching between daytime sleeping and nighttime sleeping as much as possible by clumping your night shifts together without switching to days. Studies have shown that rapid rotation changes have a deleterious effect on your health and quality of life[vi].
Regulate light and dark
Since exposure to light is a significant factor in circadian rhythms, try to recreate a reverse schedule by controlling your exposure to light and darkness. When sleeping during the day use blackout shades and when driving home in the morning wear amber sunglasses to block out the blue light that inhibits melatonin production. There are many glasses on the market made to help shift workers mitigate this light/dark system, and studies show that wearing amber glasses two hours before sleeping resulted in close to normal melatonin production and therefore better daytime sleep. In one sleep study, subjects that wore blue-light blocking glasses for 2 hours at the end of their shift were able to fall asleep on average 34 minutes faster, improve sleep efficiency by nearly 5% and reduce sleep fragmentation by over 4%.[vii]
Conversely, exposing yourself to light when you are awake is just as essential to increasing wakefulness and alertness. When you wake up, try to expose your body (and retinas) to sunlight by going outside for a walk, or doing a little sunbathing. During your shift try to stay in well-lit areas as much as possible.
Optimize your sleep
Since sleep during the day tends to be lighter and shorter in duration try to create an environment that is most conducive to sleep. Invest in good blackout blinds or curtains to keep your room as dark as possible. Wear a face mask to block out even more light. Since most of the world is out and about during the day, everything tends to be noisier. Try wearing earplugs to block out as much noise as possible, invest in a white noise machine or have a fan in your bedroom. These things will block out the ambient noise, helping you sleep longer.
Eating and Drinking
Along with exposure to light, feeding and fasting cycles are also cues in circadian rhythms. Studies have shown that eating at inappropriate times disrupts the circadian rhythm and contributes to the adverse effects of shift work. High-fat meals have an even greater impact on circadian rhythm by blunting the feeding/fasting cycles. While it can be tempting to eat junk food on a night shift, try to eat small, regular light meals, timing your meals to when you would typically eat on a day shift.
Also, while caffeine can be great as a pick-me-up it can disrupt daytime sleep so try to avoid caffeine as much as possible on your shift. Studies have shown that caffeine can interfere with melatonin secretion, causing further disruptions to the circadian rhythm[viii]. Conversely, drinking caffeine has been shown to help adjust your circadian rhythm to a night schedule[ix]. If you do drink caffeine, drink it when you wake up and make sure to stop drinking it in the early morning (around 2-3 am) so it does not affect your ability to sleep during the day. Instead, focus on drinking lots of water to stay hydrated, but try to stop drinking at least 4 hours before sleeping to avoid waking up to go to the bathroom all day.
To Nap or Not to Nap
Many CNAs swear by taking a 20-30 min nap during the night shift on a meal break. While this practice is often discouraged by the administration a short nap during a night shift has shown to increase alertness and improve critical thinking and reaction times. Some people have concerns about something called sleep inertia, where a nap ends up causing more drowsiness for as much as an hour after waking. In one study, 30 min naps were allowed to nurses on a night shift. After napping, these nurses did not report any drowsiness and found naps to be extremely helpful in alertness for the rest of their shift and reducing sleepiness when driving home[x].
Working the night shift can wreak havoc on your social life. You sleep when everyone is awake, and you are awake when everyone is asleep! It is essential to prioritize your social time, even if you are tired. If you have a family, wake up early enough to enjoy the evening meal together. Schedule time with friends and family on your days off. It can be tempting to avoid going out when you are tired from night shift, but friendship is integral to your mental health. Maintaining a good work-life balance will help you get through those tough nights and keep you sane!
Working the night shift as a CNA can be difficult, hard on your social life, and can cause serious health problems. It is important to understand the physiology behind sleep and wakefulness to understand how to make night shifts easier and healthier for you. All of these things can be managed by these simple strategies to help your body cope and adjust to a nighttime sleeping routine.
[i] Lund, Arendt, Hampton, English, Morgan. (2001). Postprandial hormone and metabolic responses amongst shift workers in Antarctica. J Endocrinol. 171(3): 557-64
[ii] Dawson, Reid. (1997). Fatigue, alcohol and performance impairment. Nature. 388(6639):235.
[iii] Scheer, Hilton, Mantzoros, Shea. (2009). Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci. 106(11):4453-8.
[iv] Claustrat, Leston. (2015). Melatonin: Physiological effects in humans. Neurochirurgie. 61(2-3):77-84.
[v] Sharkey, Fogg, Eastman. (2001). Effects of melatonin administration on daytime sleep after simulated night shift work. J Sleep Res. 10(3):181-92.
[vi] Sonati, De Martino, Vilarta, da Silva Maciel, Sonati, Paduan. (2016). Quality of life, sleep, and health of air traffic controllers with rapid counterclockwise shift rotation. Workplace Health Saf. 64(8):377-84.
[vii] Sasseville, Benhaberou=Brun, Fontaine, Charon, and Heber. (2009). Wearing Blue-Blockers in the morning could improve sleep of workers on a permanent night schedule: A pilot study. Chronobiology International, 25(5), 913-925
[viii] Burke, Markwald, McHill, Chinoy, Snider, Bessman, Jung, O’Neill, Wright. (2015). Effects of caffeine on the human circadian clock in vivo and in vitro. Sci Transl Med. 7(305):305ra146.
[ix] Potter, Cade, Grant, Hardie. (2016). Nutrition and the Circadian system. Br J Nurt. 116(3):434-442.
[x] Geiger-Brown, Sagherian, Zhu, Wieroniey, Blair, Warren, Hinds, Szeles. (2016). CE: Original Research: Napping on the Night Shift: A Two-Hospital Implementation Project. Am J Nurs. 116(5):26-33.