The Practical Challenges of Shiftwork

Our bodies crave sleep during the night.  Those who work nights- and fight this sleep instinct- face several challenges.

Staying awake during the night is the first challenge.  Naps before work- followed by 10-20 minutes to recover from sleep inertia- improve wakefulness. Bright light during the night may help.  Regular, small doses of caffeine provide benefits as well; a single large dose spikes behavioral effects and then loses alertness promoting effects rapidly.  In shift workers who remain tired despite these interventions, medications such as Provigil, with treatment guided by a physician, may be beneficial.  I caution all of my patients to pull over if drowsy.

Daytime sleep provides a second set of obstacles for shift workers.  Earplugs may help to block out noise, and face masks or blackout shades may reduce the effects of light upon sleep.  Melatonin- of which I prefer Trader Joe’s chewable version- may improve sleep. Sleep physicians sometimes provide sleeping medications to foster daytime sleep when other interventions are inadequate.

Decades of academic research have shown that under precise lighting conditions and precise sleep schedules people can adapt well to shiftwork.  However, these schedules generally do not allow “flipping” to day schedules.   Realistically, night shift workers want to “flip” at least partially to spend time with friends, family, and the rest of humanity.  Thus, in the real world, I encourage compromise.  I advise each shift-working patient to pick an “anchor period”- some period during which he or she will have an opportunity to sleep every single day, for instance, “8 am to noon.” An anchor period provides some regularity to sleep.   As in so much of behavioral sleep medicine, the consistency of the anchor period requires short-term discipline but provides long-term benefits.