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Are you one of the 30 percent of nurses who work the night shift? If you are, are you frequently tired or do you often find yourself fighting off sleep? Do you have difficulty falling or staying asleep? Do these sleep problems disrupt your social, family or work life? Have these sleep difficulties been present for at least one month?

If you answered yes to any of these questions, then read on, because you may have shift work disorder, a type of circadian-rhythm sleep disorder that can adversely impact not only your job performance, but also the quality and even duration of your life. The good news is that by following a few simple recommendations, you can improve your health and well being and get your life back on track again.

What is shift work disorder? The human body naturally follows a “circadian” or approximately 24-hour period of wakefulness and sleepiness, with the desire to sleep strongest between midnight and 6 a.m., and between 2 p.m. and 4 p.m. Your circadian sleep-wake rhythm, which is linked to nature’s cycle of light and darkness, is regulated by an internal biologic clock located in the suprachiasmatic nuclei of the hypothalamus. Shift work disorder and its consequences occur when you try to stay awake when your internal biologic clock is telling you to sleep, or when you try to sleep when your internal clock wants you to be awake.

What are the major symptoms of shift work disorder?
It should come as no surprise that during the night shift, when your internal clock is saying you should be asleep, you would feel excessively tired, fatigued and less alert. It should be just as easy to understand why you would also have difficulty falling and staying asleep when your body’s sleep-wake rhythm demands you be awake. Thus, the major symptoms of shift work disorder are hypersomnia, or excessive sleepiness, and insomnia.

What are the consequences of shift work disorder?

• Shift work disorder typically results in a decrease in total sleep time of one to four hours and an “unsatisfactory” or non-restorative sleep quality.
• Excessive sleepiness, a consequence of both cumulative sleep loss and decreased circadian alertness, can result in difficulty staying alert, concentrating, remembering things and making decisions, as well as problems with eye-hand coordination, headaches, decreased attention span and increased reaction times.
• In 2005, Kenshu Suzuki, MD, and colleagues reported in their sleep study of nurses that those who were excessively sleepy during the night shift were more likely to make drug administration errors, have needle stick injuries and operate medical equipment incorrectly—mistakes that can impact both patient and nurse. Surveys of medical workers have demonstrated that 41 percent admit to making fatigue-related errors; 19 percent reported that their error worsened a patient’s condition. These findings are consistent with studies demonstrating that experiencing only two hours of sleep loss has the same effect on performance as drinking three alcoholic beverages.
• Individuals with shift work disorder also have increased absenteeism; gastrointestinal and digestive problems such as heartburn and indigestion; heart problems, including an increased risk of heart attacks and hypertension; carcinoma of the breast, uterus and colon; menstrual irregularities; colds and flu; and weight gain.
• Shift workers have more automobile accidents, especially driving to and from work, probably because they’re more likely to drive while fatigued and almost twice as likely to fall asleep at the wheel. In fact, two-thirds of shift workers report driving drowsy after a shift. In addition, associated irritability, impatience and mood disorders such as anxiety and depression can ruin job and family relationships and spoil social activities.

Do you have Shift Work Disorder? Take our quiz. To learn more about shift work disorder and get some tips on how to trick your body into sleeping (when the rest of the world is awake), read all of our Shift Work Disorder Articles series!

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When you don’t get enough of it, you suffer. Big time.

No, we’re not talking about money, we’re talking about sleep. And if you’re among the third of working nurses who work the night shift, you probably don’t have the luxury of setting a typical sleep schedule. Sleep expert (and fellow nurse) Terry Cralle helps you identify whether you have what is called “shift work disorder,” suggests ways for night shift nurses (and their managers) to ensure a safe working environment, and offers up the following tips to help you get some shuteye.

Here are 19 things you can do at home to ensure you’re getting the sleep you need:

1. Make sleep a health priority, like diet and exercise.
2. Wear sunglasses if you’re commuting home in bright sunlight. Light is the most powerful zeitgeber, or influencer of the body’s circadian clock, and will negatively impact your ability to fall asleep. In contrast, once you wake up, go outside into the sun to cue your biological clock that it’s time to be awake and alert.
3. Only go to bed when you’re sleepy. Don’t go to bed just because it’s “time.”
4. Your body likes routines. Like light, your bedtime routine is a powerful zeitgeber. Establish a standard, relaxing, soothing bedtime ritual. Put on your pajamas, wash your face and brush your teeth to signal your brain you’re preparing for sleep. Play soothing music; take a warm bath for 30 minutes, one hour before bedtime; read a relaxing book or magazine. Allow enough time to unwind and relax, but try to go to bed as soon as possible after your shift, ideally within two hours. Don’t fall asleep in your recliner or sofa with a television blasting in the background.
5. Try to maintain a consistent and regular sleep schedule on work days AND days off/weekends. Keeping a routine helps your body know when to be alert and when to sleep.
6. Stop working at any task and attempt to resolve anything potentially stimulating, worrisome or upsetting one hour before bedtime. Writing down your emotional worries and thoughts in a journal may help release these concerns from your mind. Learn a relaxation technique, such as progressive muscle relaxation, and practice it in bed.
7. Use your bedroom only for sleeping and sex. Keep it stress and clutter-free. No paperwork, bills, unfolded laundry, TV, electronics or pets.
8. A darkened room signals your brain that it’s time to sleep. So keep your bedroom as dark as possible. Blackout shades, heavy curtains and eye masks can help. Standard window shades let too much light in. Cover an illuminated alarm clock, especially if you’re a “clock watcher,” or remove it, if necessary. If you need to get up, use a small nightlight instead of turning on bright lights.
9. Eliminate noise with earplugs, a fan or a white noise machine. Turn off or unplug the phone. Install carpeting or sound-absorbing curtains, drapes or shades.
   Keep your room well ventilated and the temperature on the cool side, ideally between 60 and 65 degrees (range: below 75 and above 54 degrees).
10. Invest in a good mattress. A poor or an old mattress can disrupt your sleep. The average mattress lifespan is about seven years.

More tips:

1. Make your sleep time sacred. Enlist the help of your family and friends and request that they respect your sleep. Put a “Do Not Disturb” sign on the front door, so friends and delivery people won’t knock or ring the doorbell. Have family and friends wear headphones when watching TV or listening to music. Ban vacuuming, dish washing, lawn mowing, loud games and any other noisy activity.
2. Tell your kids not to go into your room unless it’s an emergency, and be sure to specify exactly what is and is not an emergency. Schedule appointments outside of your sleep period.
3. Get at least 7.5 to 8.5 hours of sleep per day. Try to make up for lost sleep on days off.
4. Nicotine and caffeine are stimulants. Alcohol, while initially a sedative, causes arousals and awakenings, sweats and nightmares after it’s metabolized. Ideally, avoid caffeine-containing beverages and food such as coffee, tea, sodas and chocolate at least six to eight hours before bedtime. If you’re having problems falling asleep in the morning, avoid caffeine after midnight. Avoid cigarettes before bedtime and during awakenings, and alcohol at least five hours before bedtime.
5. Don’t go to bed too hungry or too full. Avoid eating two hours prior to bedtime. If needed, have a glass of milk or light snack before bed. Milk contains the amino acid L-tryptophan, which research has shown helps people fall asleep. Avoid consuming protein at bedtime, which may be harder to digest. Don’t drink excessive fluids prior to bedtime to avoid having to get up to urinate.
6. Don’t lie awake in bed for more than 20 minutes to avoid developing a negative association between your bedroom and sound sleep. After 20 minutes, leave the room and do something relaxing, such as reading, listening to music or watching television. Don’t return to bed until you feel sleepy.
7. Schedule 20 minutes of regular aerobic exercise and work it into your normal routine, but not within three hours of going to bed. Exercising raises the body temperature and can be alerting too close to bedtime. Walk or bike to work instead of driving; climb the stairs instead of taking the elevator. Consider exercising before work or during breaks to help you stay alert on the job. Keep a resistance band or hand weights at work for strength training. Find an exercise buddy to make exercising more fun and keep you motivated. Exercise will improve your sleep, energy level, mood, stress and cardiovascular fitness.
8. Address your partner’s sleep issues, if present. One partner’s sleep problem causes the other to lose, on average, nearly one hour of sleep a night.
9. Begin altering your sleep schedule three days in advance of a shift change. On the third day prior to the shift change and each subsequent day, postpone your bedtime and wake time by one to two hours compared to the previous day. By the time you begin the new shift, your circadian sleep-wake rhythm will be reoriented. For example, if you’re on a 5 p.m. to 1 a.m. shift and moving to an 11 p.m. to 7 a.m. schedule, do the following:

• Three days prior to your shift change, rather than sleeping from 3 a.m. to 11 a.m., postpone your bedtime to 5 a.m. and sleep to 1 p.m.
• Two days prior to the shift change, sleep from 7 a.m. to 3 p.m.
• One day prior to shift change, sleep from 8 a.m. to 4 p.m.
• On the day of the shift change, sleep from 9 a.m. to 6 p.m.

To learn more about shift work disorder and what you can do to make your work environment safer and more productive, read all three parts of our Shift Work Disorder series!

Image: Hemera | Thinkstock

We all know that a sleepy nurse is a potentially dangerous nurse. We’ve helped you identify whether you have shift work disorder, and have given you the tools to trick your body into sleeping when you need it to sleep.

But watching your own rest and enjoying some R & R when you’re a shift nurse may not be enough. It’s about continually monitoring yourself and your fellow nurses. And it’s about being aware of the cues (be vigilant at 4 a.m!) that can set the stage for errors.

Here are 16 tips to help ensure that your work environment is safe and productive:

1. Get 7.5 to 8.5 hours of sleep prior to coming to work, the average amount of sleep an adult requires. Starting a night shift when you’re sleep-deprived increases fatigue and decreases alertness. If you don’t get this amount from your daytime sleep period, take 10- to 30-minute naps. They will make you feel more alert and enhance performance. Naps longer than 30 minutes can actually make you feel groggier. The best time for a nap is eight hours after you awaken or right before your work shift. Try to make up for lost sleep on days off.
2. Recognize fatigue and know what signs to look for in others: yawning, blinking, blank stare, head nodding, difficulty concentrating and communicating, poor decision making, confusion, delayed reaction times, poor eye-hand coordination, giddiness, irritability.
3. Develop a buddy system to help monitor each other for signs of fatigue.
4. Recognize that the most vulnerable time during the night shift is between 4 a.m. and 6 a.m. Complete challenging tasks before 4 a.m.
   Between 4 a.m. and 6 a.m., double and triple check medications and other important decisions
5. Eat healthfully and avoid having one large, heavy meal during your shift. Instead, have several quick, healthy snacks. “Brown bag” it. Remember that your body’s normal digestive rhythm can also be disrupted by shift work, resulting in indigestion and heartburn, which can awaken you and keep you up when you’re trying to sleep.
6. If you’re sleepy, and it’s possible, take a 10- to 30-minute nap during breaks.
7. If you can’t nap, try to be active/exercise during breaks (climb stairs, walk, do jumping jacks). Exercise can improve your energy and mood.
8. Use moderate amounts of caffeine to maintain alertness. But remember, if you’re sensitive to its effects, caffeine might make it more difficult to fall asleep after you get home. Ideally, drink caffeinated beverages before and during the early hours of a work shift. If possible, avoid caffeine six to eight hours before your usual bedtime.
9. Avoid extended working hours, long shifts and overtime. These practices will decrease time available to sleep and participate in family and social activities. Don’t be afraid to communicate with your coworkers about time you need to enjoy your off-duty hours.
10. Avoid a long commute, if possible, since it will delay and decrease the opportunity to sleep.
11. The most dangerous part of a shift is the late-night or early morning drive home from work. Do not drive drowsy. If necessary, take a 10- to 30-minute nap before driving home. Consider arranging for someone to pick you up, or take a cab, bus or other form of public transportation.
12. Discuss issues and exchange ideas with your co-shift workers on ways to cope with the problems of shift work. Organize a support group.
13. Don’t promote overtime.
14. Provide vending machines with healthful food choices and put a microwave oven in the break room.
15. Encourage the use of carpools, public transportation, rested drivers and taxis for the early morning drive home from work.
16. Educate management and get them involved. If your hospital administration knew that a 26-minute nap doubles productivity and decreases work-related errors, injuries and accidents in shift workers, they might be much more likely to make naps an approved policy. Useful workplace interventions to minimize the adverse effects of shift work include:

• Installing bright lights to keep the work environment as bright as possible. Bright light is the most powerful natural zeitgeber, which means “time giver.” A zeitgeber is a brain cue for your body’s biologic rhythms, such as sleep. By signaling your body that it should be awake, bright light promotes alertness. It will also help your body adjust to the shift work schedule.
• Developing a napping policy. Provide a sleep-friendly space and time for scheduled naps. A 10- to 30-minute nap is all that’s needed.

Appropriate shift scheduling:

• Have a new shift start later than the last one (work clockwise). If a worker is on a 3 p.m. to 11 p.m. shift, he will be more alert and sleep better if his next shift is an 11 p.m. to 7 a.m., rather than a 7 a.m. to 3 p.m. shift.
• Have less frequent rotations. Have workers rotate shifts every three weeks rather every week. It’s more difficult for the body to adapt to rotating shifts than to work the same shift for longer periods of time.
• Decrease the number of shifts worked in a row, with at least 48 hours off in between a string of shifts. For an eight-hour night shift, limit the number of shifts in a row to five or less; for a 12-hour night shift, limit work to four shifts in a row. Fewer consecutive night shifts allow more time to recover from the progressive sleep deprivation associated with night-shift work.
• Plan enough time between shifts to allow employees (and yourself) to get enough sleep as well as attend to their personal life. Rest and relaxation are essential for returning to work feeling rejuvenated and ready to function at peak performance.

To learn more about shift work disorder and get some tips on how to trick your body into sleeping (when the rest of the world is awake), read all three parts of our Shift Work Disorder series!