Nursing News

The Risks of Working the Night Shift


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Tips for a Sounder Sleep
  • Avoid caffeine—don’t consume any at least three hours before bedtime
  • Let your brain rest before bedtime—avoid watching TV
  • Adjust the temperature—cool rooms are more conducive to sleep
  • Darken the environment—use a sleep mask or room-darkening shades
  • Tryptophan-rich foods—drink milk or eat a banana about an hour before bedtime
  • Melatonin supplements—studies suggest it promotes sleep; ask your doctor
  • Aromatherapy—oils such as lavender, sandalwood or chamomile calm nerves
  • Naps—whenever you can squeeze one in to catch up on needed rest
  • Ear plugs—an inexpensive, simple way to quiet your surroundings

Above all else, doctors recommend that those who do not exclusively work nights should avoid scheduling more than three consecutive night shifts. This is the maximum that the body can handle effectively.

By David Sindel, staff writer

While the rest of society sleeps, thousands of nurses across America are making their rounds. Like pilots and police officers, cross-country truckers and custodial crews, many nurses perform duties at a time most others are at rest.

Working the night shift is a necessity in many fields, including health care. The need to tend patients and provide immediate medical care for emergencies shows no regard for time. While working the night shift does have its advantages—less traffic on the road for commuting, generally quieter conditions compared to day shift workers in the same positions—the work is fraught with far more downsides.

According to a March 2008 article in the Los Angeles Times (“Sleep Deprived Pay the Price for Shift Work”), night shift workers are known to be at a higher risk for accidents and sleep disorders, as well as psychological stress—a great deal of which is brought on due to non-work-related, daytime issues, such as family and other personal obligations that can interfere with what should be a night worker’s sleep time.

In addition, scientific evidence has shown that the disruption of circadian rhythms (an approximate 24-hour cycle in the biochemical, physiological or behavioral processes of living beings) may also lead to an increase in the likelihood of obesity, gastrointestinal disorders and, according to some studies, even cancer.

Scientists have found that nearly 15 percent of human genes function on a schedule, based upon oscillating periods of activity—a direct tie-in to the body’s circadian rhythms. These rhythms determine when certain body processes take place and, in night shift workers, some body functions continue to take place despite the person’s change in activity level.

For instance, the body releases a sleep hormone at night (melatonin) and a waking hormone in the morning (cortisol). Even though night workers are awake at night, their bodies continue to produce melatonin after dark and they continue to produce cortisol in the early morning, right when they are most likely trying to get some sleep.

The result is that disrupted circadian rhythms are causing night shift workers to get less and poorer-quality sleep because they are trying to get rest when their bodies are working to stay awake.

More chance of errors on the job

A research abstract from the University of Alabama at Birmingham (UAB), indicated nurses who work the night shift are more likely to have poor sleep habits, a practice that can increase the likelihood of committing serious errors that can put the safety of themselves as well as their patients at risk. The results showed that 56 percent of the nurses surveyed were sleep deprived.

According to researcher Arlene Johnson of UAB, who surveyed nurses while they were working on the night shift, the amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Sleep deprivation can result in poor psychomotor performance which, in turn, has been associated with an increase in errors and can be translated into an unsafe work environment.

What can nurses do?

A new study in the journal Sleep shows that the use of light exposure therapy, dark sunglasses and a strict sleep schedule can help night shift workers create a "compromise circadian phase position," which may result in increased performance and alertness during night shifts while still allowing adequate nighttime sleep on days off.

During light therapy, a subject is placed near a device called a light therapy box. The box gives off bright light that mimics natural outdoor light. Exposure to this light is thought to alter the body’s circadian rhythms and suppress the natural release of melatonin.

Vast amounts of research and testing continue to be done to find the best solution for those facing this affront to their normal body rhythms. Until an all-encompassing solution is found, doctors recommend that those faced with night shift duties concentrate on two specific concerns—diet and sleep.

According to sleep researcher Eve Van Cauter, professor of medicine at the University of Chicago, night shift workers not only have displaced work schedules, they also have displaced meal schedules. The liver, pancreas and digestive system function on circadian rhythms and are not expecting food at the hours that night shift workers are eating. Thus, Van Cauter stressed, it is important to watch what you eat and when you eat it. Avoid eating heavy meals before going to bed and keep intake of starchy, sugary foods to a minimum.

Experts agree that sugar or caffeine should not be used to combat fatigue. A candy bar can provide a “sugar high” but it is burned through quickly and your energy level ends up lower than before you ate it. Coffee and tea can get you “hyped” but may require something to bring you back down at the end of your shift so you can rest.

As for sleep, Ed Cobum, publisher of Working Nights newsletter and a consultant at Circadian Technologies in Cambridge, Massachusetts, said it is essential to get some sleep when you can. Do what you can to create as dark and quiet an environment as possible during daylight and get the six to eight hours of daily sleep your body requires. Augment that with a nap or two, if necessary. Even a 15-20 minute snooze on a break during work will have a significant effect on improving alertness.

According to the Bureau of Labor Statistics, 20 percent of American workers are night shift workers and the number is growing by about 3 percent per year. If you are currently one of those working while “the rest of the world sleeps,” you are definitely not alone.

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