Shift Workers: Solutions for Sleep Problems

You stand at the bathroom sink, yawn, and splash cold water onyour face. You glance at the clock—it's 10 pm. Instead of puttingon pajamas and crawling beneath the covers, you're dressing forwork. You fill a thermos full of coffee and stumble out the door.On the drive to work, you rub your eyes and roll down the window abit to keep from falling asleep at the wheel. You have troubleconcentrating on your work and you struggle to stay awakethroughout the night. Finally, it's quitting time and you can gohome to bed. Just when you're about to drift off, a neighbor cranksup a lawn mower, the birds seem to chirp louder than usual, and youcan't ignore the sunlight seeping in around the corners of thedrawn shades.

The lifestyle of a shift worker can be pure agony. The lackof sleep can lead to many problems, including depression, lower job productivity, health problems, andmarital and family discord. It can also lead to accidents, both onthe job and on the highway. The National Sleep Foundation (NSF) cites afrightening statistic: In a recent study, the foundation found that 72% ofshift workers admitted that they had driven while drowsy and 41%said they had dozed off at the wheel.

A 24-hour Society

If shift work creates so many problems, why not just stick witha daytime routine? While that seems like an easy answer, it's not apossibility for many workers. Shift work is essential in our24-hour society. Many people who make their living at odd hoursprovide crucial services, such as emergency care and police andfire protection. There's also a demand for 'round-the-clock workersin the transportation and manufacturing industries. Our bodies,however, are regulated by a different clock.

Internal Circadian Clock

Humans are regulated by an internal body clock that causes themto be active or sleepy based on different phases of each 24-hourday. For most people, the desire to sleep is greatest when it isdark outside, and the need to be alert and active is greatest whenit's daylight.

"Sleep [for shift workers] is ineffective because it occurs outof synchrony with the endogenous circadian rhythm that organizessleep and activity," says Wolfgang Schmidt-Nowara, MD, of the SleepMedicine Institute at Presbyterian Hospital of Dallas. "The workermust sleep at a time when the body expects to be active, while workoccurs at the usual sleep time. Sleep, therefore, is often short orinterrupted. During a work week, sleep deprivation accumulates andsleepiness becomes worse. Time off from work can be used to getextra sleep, but conflicting demands of family and other socialresponsibilities prevents a full payment on sleep debt. The resultis fatigue and stress," he says.

Swing Shifts

Swing shifts present even more challenging problems to workers.Just when they get adjusted to the hours of one shift, they spinoff to another schedule. Terri Lynn of Waldorf, Maryland used topull a swing shift as a police officer. "We worked three shifts:six days of 7:00 a.m. to 3:00 p.m., two days off, seven days of3:00 p.m. to 11:00 p.m., two days off and then seven nights of11:00 p.m. to 7:00 a.m. followed by four days off," says Lynn. "Iwas grouchy and fought with my husband. I'm sure it contributed toour divorce. I couldn't make any permanent plans for weeklymeetings, clubs, etc, because of the shift changes."

"The biological clocks cannot adapt to frequent and largechanges in the timing of sleep from one day to the next," says KarlDoghramji, MD, Director of the Sleep Disorders Center at ThomasJefferson University Hospital in Philadelphia. "Optimally, sleeptimes should not be changed by more than one hour counterclockwiseor three hours clockwise from one night to the other," he says

Strategies for Getting Some Shuteye

If you're working a shift and having trouble sleeping when youget home, here are some strategies for getting some much-neededrest:

• Keep a regular sleep schedule, even on weekends
• Create a quiet, peaceful environment for sleeping
• Wear eye shades if the sunlight disturbs you
• Wear ear plugs if daytime noise keeps you awake
• Run a fan or create other white noise to help lull you tosleep
• Turn off the ringer on your phone
• Put a "Do Not Disturb" sign on your front door
• Exercise regularly, but not within four hours of bedtime
• Avoid caffeine near bedtime
• Avoid alcohol
• Consult a physician about the use of prescription orover-the-counter sleep aids

A Short Snooze

When you can't get enough sleep, you may find it beneficial totake a nap. Even a short nap can recharge a person and improve jobperformance, alertness, and mood. The National Sleep Foundation saysstudies show that naps at the workplace are important and effectivefor employees who need to keep a high level of alertness in orderto make quick decisions. Naps at the workplace are also helpful forpeople working a double or a 24-hour shift.

Time for a Change?

If you're experiencing severe symptoms related to sleepdeprivation, it may be best to consider a job change, or at least ashift change. "There are some individuals who simply cannot handleshift work," says Dr. Doghramji. "As we age, the ability towithstand the effects of shift work also diminishes. Therefore, ifsymptoms become severe and begin to interfere with daily life, andespecially if individuals begin to fall asleep during dangeroussituations, such as driving, they should consult a physician."