Palm Beach Gardens Fire Rescue
Health & Wellness

Frequently Asked Sleep Questions for Shift Workers

My shift schedule changes on a predictable basis and I am expected to spend several weeks on day,
evening, and night shifts. How do I best transition from one schedule to another?

It can be difficult to make the transition from day to night shifts, but there are strategies that will help. First, plan your sleep and develop a consistent sleep schedule. Some workers find that sleeping immediately after getting home from an overnight is best for them. Others may preserve part of the day for life tasks while businesses are open and choose instead to sleep later, such that they wake up at a time proximal to their next work shift. Choose what works for you and stick to it. Consistency is very helpful in adapting to your new schedule.

Once you have identified your planned sleep period, avoid activities that promote wakefulness immediately prior to your planned sleep. The half-life of caffeine is about 6 hours. While you may perceive coffee to be unimportant to your sleep, it is best to avoid it for several hours prior. In general, exercise is great for your sleep. If you find that exercise too close to your planned bedtime keeps you up, try to fit it in a little earlier. Rich meals should be avoided prior to bed. The effects of alcohol on sleep can be deceiving. Alcohol may facilitate sleep onset but results in lighter, more fractured sleep over the course of the sleep episode. Higher quality sleep is achieved in the absence of alcohol.

Create an environment that facilitates sleep. A dark, quiet, cool environment is often best. You may find it worthwhile to take extra steps to eliminate light sources from the bedroom, for example, hanging blackout shades or wearing an eye mask. Earplugs help to block outside noise. Included in this environment is your phone or tablet. While you may need it nearby, try not to go to sleep while looking at your phone. The light from the device can make it more difficult for you to sleep. Even a small amount of light prior to or during sleep can have an impact. Consider adjusting the wavelength of light emitted from the device as well. You can use apps such as Night Shift or f.lux to easily reduce the blue light which most affects your internal body clock. When you wake up, get as much light exposure as you can to adjust your clock to your new wake-time.

Gradual transitions in sleep and wake times are easier than abrupt ones. When possible, try to ease into your new schedule by incrementally adjusting your bedtime a couple of days in advance. Blue light systems, such as those sold commercially to treat a seasonal affective disorder can also be utilized. Exposure to blue light upon awakening will help your body adapt more quickly.

I mostly work day and evening shifts, but occasionally need to cover a night shift. How do I prepare for the night shift, and how can I best adjust afterward?

There are several strategies to approach these situations. The goal is to maintain alertness throughout the shift without shifting your internal clock. Let’s outline a scenario where you are working an early shift, say 7a-3p, and you will be covering that night from 11p-7a. Ideally, you would plan to nap for 2 hours prior to the shift, perhaps from 8p-10p. Then after the shift, nap again for 2-3 hours. This approach will help with fatigue and will allow you to sleep at your normal bedtime that night. If you feel alert after the shift, you could stay awake until your normal bedtime, or go to bed somewhat earlier for additional time to recover.

One thing to avoid, if possible, is sleeping for the entire day for Better Work and LifeHealthy Sleep BRIGHAM SLEEP HEALTH INSTITUTE when you get home from work. This will make it difficult for you to maintain your normal schedule and make you feel less alert the next day. Furthermore, repeatedly shifting your body clock in such a way leads to a disconnect between your physiological drive to sleep and when your body clock will help you to sleep. This state of misalignment between the two systems can result in both sleepiness and insomnia.

Sometimes I find out at the last minute that I need to work longer than expected. What should I do?

Ideally, the workplace and nature of your work will allow you the opportunity to take a short nap when you feel sleepy. Take advantage of this if you can. Even a 20 minute nap can be helpful in restoring alertness. The traditional remedy, caffeine, can also be effective, but the way many people use caffeine is not ideal. If you know you will be forced to stay awake, you should take smaller doses of caffeine at regular intervals before you feel sleepy, tapering off as your shift goes on. You may find it to be much more effective. We suggest 60 mg every 2 hours when needed for alertness. This is about 1 oz espresso, 4 oz of brewed coffee, or an 8 oz black tea. There are also some over-the-counter medications that contain caffeine. Another way that caffeine can help is to use it less casually and more as a tool. Only use caffeine when you need it to stay awake and decrease your usage on your days off. You will lower your tolerance over time and increase the effectiveness when you need it. Be wary of sugary drinks for the powerful crash you may feel shortly afterward.

I feel sleepy all the time, even after I get a lot of sleep. What could be the cause?

There are a few things to consider. First, it is important to consistently get enough sleep for you. This amount varies for everyone, but healthy adults require, on average, 7-9 hours of sleep each night. If you are getting 6 hours during the week and 12 on the weekend, it is a sign you are not sleeping enough during the week. People who are sleep deprived sometimes take months to fully recover
from their sleep debt once they start sleeping an adequate amount each night.

You should consider the possibility that you could have a sleep disorder. About one in three people has a sleep disorder. Prevalence is higher among shift workers. Common disorders include insomnia, obstructive sleep apnea, and shift work disorder and there are over 90 sleep disorders in all. Estimates suggest that 80-90% of sleep disorders are un-diagnosed and untreated. A sleep lab visit is often not required for a definitive diagnosis, and treatment is highly effective.

I have difficulty falling asleep at the time when I would like to. What are the best solutions?

A first step is to make changes to your bedtime ritual to program your mind that it is time for bed. Be sure that you are avoiding large meals, nicotine and caffeine for several hours prior to bed. Consider that exercise too close to your planned bedtime could also keep you up.

As your bedtime approaches, dim all lighting and seek to cultivate a relaxed physical and mental environment. Turn off all electronic devices (e.g., television, phones, computers) an hour before bedtime. Consider keeping a bedside notebook to write down worries, lists or items which you want to remember in the morning. This can help to put your mind at rest.

Meditation and other relaxation techniques such as stretching, yoga, a warm bath, deep breathing exercises or guided imagery can be effective as well. When it is time to sleep, create a dark, quiet environment through use of an eye mask and ear buds, if necessary.

If you still struggle getting to sleep you should see your physician. Physicians often prescribe medications for short-term management of insomnia and treatment programs, such as online cognitive behavioral therapy for chronic insomnia, which have been proven to be effective.

I wake up at times when I need to be sleeping and toss and turn. What can I do?

It is easy to exacerbate the problem by feeling stressed about not being able to sleep. It may help to keep your alarm clock turned away from your bed to avoid the additional stress of watching the clock. Try not to look at your phone or watch television, as these activities can promote wakefulness through the light they emit, reminding you of the passage of time, and by piquing your interest. If you are not at all drowsy, try reading or playing soft, relaxing, instrumental music.

You can take some steps to prevent waking up before it happens. Drinking alcohol prior to bed will make it more likely that you wake up during the night, and can make it difficult for you to fall back asleep. Similarly, high levels of fluid intake prior to bed may cause you to wake up. Having a night light in your bathroom can be helpful as a less intense source of light if you are woken for this reason. The previously mentioned eye mask and ear buds can help prevent awakening by transient light or environmental noise.

The Takeaway

Getting enough sleep is objectively important. Many of us champion our ability to persevere with little sleep, but we lose the ability to accurately perceive how well we are doing on tasks when we are sleep deprived. Many people who are sleep deprived do not complain of sleepiness for this reason. We lose the ability to recognize our deficits, but the “new normal” isn’t quite as sharp.

Beyond that, insufficient sleep can wreak havoc on your diet and metabolism and present a formidable safety hazard. Drowsy driving is easily one of the most dangerous activities you may encounter. Drowsy driving increases the risk of a crash or near-crash 4-6 fold and is responsible for about 20% of all serious crash injuries. Be mindful of these risks and consider taking a brief nap at your workplace before driving home.

Alternative forms of transportation are preferred when you have been awake for a prolonged period.