Few people would disagree that work in America is changing. Even before the pandemic upended the job market, the rise of the gig economy meant that more workers than ever before were working non-standard hours — often during the night when the rest of the world was sleeping.
From Uber drivers to emergency room nurses, nearly 15 million Americans work at night or rotate in and out of night shifts. Many more pick up extra hours for overtime or work a second job to make ends meet.
Although researchers are just starting to look at the impact of COVID-19 on shift work, it’s safe to say that in many industries — and most particularly in healthcare — shift work increased over the last year and a half. We’ve all seen stories of doctors, nurses, and other healthcare professionals working long hours into the night in crowded hospitals with COVID patients. Essential workers, from grocery store cashiers to police officers, also saw their hours increase — along with their risk levels.
Among the challenges that shift workers face is one that isn’t a problem for nine-to-five workers. It’s called shift work sleep disorder
(SWSD), and it affects between 10%-40% of shift workers. By working hours that are not in sync with their biological clock, shift workers experience poor quality sleep, leading to significant problems, both on the job and off.
What Is Shift Work Sleep Disorder
Your body has something called a circadian rhythm — sometimes known as your “biological clock.” This rhythm is your body’s natural timing device, and, among other tasks, it tells you when to go to sleep and when to wake up, as determined by the amount of available light. So, for example, when the sun goes down, your body starts preparing itself to get a good night’s sleep.
But if you work, for example, midnight to 9:00 a.m., this throws off your circadian rhythm. It’s programmed by your brain to prepare for sleep when you’re instead getting ready to go to work. Then, when it’s preparing your body to get ready for the day, you’re heading to bed.
This confusion leads to shift work sleep disorder, which has many symptoms. “Working long nighttime hours has been proven to increase a person’s risk of heart disease, diabetes, vitamin deficiency, sleep apnea, and many more serious conditions,” says Brandi Muilenburg, a registered respiratory therapist and integrative nutritional health coach who has experience with shift work.
Muilenburg notes that it’s not the night work itself that causes problems. “The real stress on the body comes from sleep deprivation — with the majority of shift workers reporting sleeping less than six hours a night on their days off and four hours or less on the days they work,” she says.
Other symptoms you may experience include the following:
- Insomnia: You may find that you have difficulty falling asleep or staying asleep. The average person with SWSD loses 1-4 hours of sleep a night.
- Excessive sleepiness: You may be fatigued while you’re awake or feel like you need a nap when you should be working.
- Difficulty concentrating: It may be hard for you to pay attention at work or to handle tasks that would normally not be difficult.
- Irritability: You may be short-tempered with family, friends, or co-workers. You may snap at people over minor things, even when you know they’re not important.
- Higher risk of errors and accidents: You may find yourself making mistakes at work or in your personal life. If you are in a high-risk job, this could be a major problem.
- Memory impairment: You may have difficulty remembering things, even if they happened recently.
- Hyperactivity: Conversely, you may have periods where you are “wound up,” and you feel like you can barely contain your energy level, or you feel agitated and unable to relax.
If you fail to address the issues of SWSD, you may find yourself more likely to experience long-term complications, such as cancer, cardiovascular disease, and gastrointestinal problems. You will be more susceptible to alcohol or drug addictions and may struggle with bad eating habits. You are also more likely to be involved in accidents, both at work and while driving.
Who is most likely to suffer from SWSD? If you are involved in one of the following professions, you may be at risk of this illness.
| Profession | Why you are at risk |
| Healthcare workers | Healthcare is a round-the-clock job, and nurses, aids, and other healthcare workers may be involved in nighttime shifts at hospitals, nursing homes, and other care facilities. These professions are growing faster than average, and much of that growth involves non-standard working hours. |
| Retail workers | Although most retail stores shut down at night, grocery stores and gas stations are often open 24/7. Job outlook increased during the pandemic, as grocery stores implemented delivery services and online shopping. |
| Transportation workers | Air traffic controllers, train conductors, truck drivers, and others involved in transportation may work at night when it’s easier to transport goods and passengers. |
| Network administrators | You expect your internet services to be available around the clock. That means that those who manage your internet services and ensure that servers are available are working throughout the night. |
| Factory workers | Whether in the U.S. or in developing countries, manufacturers like to keep their factories constantly running to get the most value out of them. That means workers are needed at all hours. |
| Emergency service providers | Police, ambulance drivers, 911 operators, and more need to be available at all times. If you have a heart attack at 2 a.m., you want to know that you’ll be cared for as quickly as possible. |
Strategies for Sleeping Better
So, how can you avoid SWSD? Your first step should be to take a look at some strategies that are easy to implement, which will allow you to get a better night’s sleep.
Ban blue light
Your devices emit blue light, which studies have shown disrupts your circadian rhythms. Putting your cell phone, tablet, and other devices away several hours before you go to bed may help you fall asleep more easily. “I decided to implement a blue light ban at least 1.5 hours before sleep,” says Will Peach, a fifth-year medical student who runs an online medical school guide. “As a result, I’ve noted [fewer] headaches and visual disturbances and more consistent deeper sleep.”
Restrict caffeine
Peach also recommends limiting caffeine intake for at least 12 hours before you expect to go to bed. Caffeine may help shift workers stay alert, but it’s important to cut back well before you sleep. Peach says that just by restricting caffeine and blue light, he and his partner are able to sleep well, no matter what time it is. “We’re definitely coping better,” he says.
Consider a natural sleep aid
Natural sleep aids include everything from a cup of chamomile tea to melatonin supplements. An alternative to drugs, natural aids are available over the counter and may help you regulate your circadian rhythms to get a better night’s sleep. They generally have few side effects, but you may want to check with your doctor before you start using them to be sure they won’t interact with any other medications you are taking.
Eat a small snack
While you want to avoid eating a big meal too close to bedtime, a small snack that keeps your stomach from rumbling may help you get to sleep. Consider a few whole-wheat crackers with cheese or a slice of turkey, which contains tryptophan, an amino acid that helps encourage sleep.
Take a bath or shower
Studies have shown that taking a warm bath or shower before bed helps you fall asleep more quickly and stay there without tossing and turning. This is especially true if you are older. It can also help relax you and put you in the right frame of mind for sleep. Avoid vigorous scrubbing, which may be stimulating, and just enjoy the experience of the warm water on your skin.
Lifestyle Changes That Can Help You Cope
In addition to making the small tweaks that we’ve suggested above, consider some lifestyle changes that may help you in the long term.
Ensure your bedding is sleep-ready
Is your mattress comfortable? Does your pillow support your head without causing neck or shoulder pain? How about your sheets? They should feel soft and cool, allowing you to be comfortable without overheating. It’s worth spending a little money to find the right mattress for you and to ensure that your bedding doesn’t hinder your ability to get or stay asleep.
Control light
It’s one thing to go to sleep in a room that’s dark because it’s nighttime. It’s another to try and keep your bedroom as dark as possible during daytime hours. If you are a shift worker, consider purchasing blackout curtains that turn day into night. A lower-cost option would be an inexpensive night mask.
Minimize noise
Unless you live alone, you may have to cope with the noise of daily life around you. You can ask people to be quiet when you’re trying to sleep, of course, but that’s not always possible — especially if you have children. Consider investing in a pair of earplugs that shut you away from ambient noise.
Plan a sleep ritual
A sleep ritual can help trigger your brain to understand that it’s time to sleep, while also relaxing you. Your sleep ritual might be 15 minutes of meditation or listening to calming music. There are a number of sleep apps, like Calm and Headspace, that can help as well. Even taking a few minutes to review your day may help you to relax so that you can sink into slumber peacefully.
Incorporate exercise into your schedule
A brisk walk, jog, or cardio routine during the day (or night) can, surprisingly, help you to sleep. Exercise boosts melatonin, which tells your body when to prepare for rest. Just watch your timing: Avoid strenuous physical activity for several hours before you go to bed, which can be stimulating rather than relaxing.
Staying Safe At Work
It’s easy to see why poor sleep quality could have an impact on your work. SWSD may cause memory loss, a higher risk of errors, and more, which can all negatively impact your job. A single mistake can have disastrous consequences if your job is in a high-risk profession, such as construction.
Consider this: The near-meltdown that occurred at Three Mile Island Nuclear Station in 1979 was determined to have been caused by an error made by a shift worker sometime around 4:00 a.m. Your own job may involve stakes that aren’t quite that high, but at the least, you don’t want to have a poor performance review because you’ve been too tired to do your job properly.
If you suspect that you are suffering from SWSD, it’s a good idea to have a check-in with your doctor. They can help you determine the best way to handle it. You will also want to talk to your work supervisor or manager or your HR department, especially if you feel unsafe while at work. If possible, bring a note from your doctor explaining your symptoms and diagnosis when you talk to your supervisor.
If your manager is sympathetic, perhaps you can tweak your work schedule to allow you a more normal day of work. Even just standardizing your hours so that they don’t switch from week to week can help your body to adjust to its sleeping schedule.
Mental Health Support
If you suspect you have SWSD or are a shift worker who is struggling with sleep, you should know that you’re not alone. Thousands of others who work at odd hours and with lengthy, exhausting shifts have a hard time sleeping. The following resources may help you.
| Resource | What it Offers |
| SleepEducation.org | Run by the American Academy of Sleep Medicine, this website offers reliable information about sleep and sleep disorders. It can help you find a sleep center and has a blog full of articles for shift workers. |
| Circadian Sleep Disorders Network | This nonprofit organization aims to increase awareness of circadian sleep disorders such as SWSD, encourage research, and advocate for accommodations in education and employment for those with these disorders. |
| National Alliance on Mental Illness | NAMI is a grassroots organization that works to build a better life for those with mental illness, which can often be related to sleep difficulties. They offer a helpline (800-950-NAMI), educational resources, and support groups. |
| American Nurses Association | The largest support group for the nation’s 4 million RNs, who are often shift workers. Nurse fatigue is one focus of the organization. It offers education, mentoring, and support for all member nurses. |
| Plain Language About Shiftwork | This online booklet, a joint production of the CDC and NIOSH, is a wealth of information about the health and safety of shift workers, coping strategies, and improving the shift work experience. |
| Help With Sleep Disorders | The American Psychiatric Association’s webpage for those with sleep disorders offers blog postings, a Q&A, and a Find-A-Psychiatrist feature. |
It’s Worth the Effort
If you’re a shift worker, you would probably agree that it’s not all bad working at odd hours. Shift workers often receive additional pay to compensate for the late hours, for example. But few would deny that there are challenges to shift work, and a big one is the extra effort it takes to get a good night’s sleep. Our tips and strategies, from buying a good, comfortable mattress to starting an exercise program, can help make it less of a challenge.
And if your problems persist, remember that there are organizations and individuals out there to help you balance your life and regain a healthy, satisfying sleep schedule. It may take a little effort, but it’s worth it to be able to enjoy a good night’s sleep every night — no matter what time of the day it is.
References
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Cleveland Clinic. Shift Work Sleep Disorder. February 25, 2021. Accessed August 9, 2021.
National Institute of General Medical Sciences. Circadian Rhythms. January 21, 2021. Accessed August 9, 2021.
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