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Better Sleep for Shift Workers

If you’re a shift worker - or know someone who is - you probably already know how bad it can be for sleep. Studies find that 10% to 38% of shift workers are struggling with insomnia. Some research even predicts as high as 74%, depending on the industry! And quality of life aside, the annual cost of shift work has been estimated at $120 billion.


Male-appearing person in white doctor's coat sleeping at work with alarm clock

In one of the first trainings I ever did in sleep disorders treatment, the instructor said, the best advice you can give shift workers is, "quit your job." Sorry, I know that’s not very helpful. Or practical. Or maybe not even the slightest bit possible. Maybe you even love your job and wouldn’t want to quit even if you won the lottery.


The good news is, if you're a shift worker struggling to sleep well now, it doesn't mean there isn't room for improvement.


First the bad news

7 alarm clocks of different sizes, shapes and colours

Let's get that out of the way.

One of the cornerstones of good sleep involves going to bed and getting up at the same time each day. It helps keep your circadian rhythm (your body’s 24-hour biological clock) strong. Another is getting lots of daylight (outdoor light is ideal) and avoiding light at night. Of course, these are the things that are not always realistic when working night or rotating shifts.


Shift work is disruptive to the circadian rhythm (our body’s 24-hour biological clock), a major regulator of sleep and wake cycles. And this can impact health in all kinds of ways, including an increase in:

In fact, in 2007, the World Health Organization’s International Agency for Research on Cancer declared shift work a “probable carcinogen!


And even the increase in fatigue can wreak havoc on ability to function. Many horrific accidents have occurred during or following night shifts:

I know, I know, that’s enough to give anyone insomnia. Again, sorry. :(



But there is good news for shift workers too!


Better sleep for shift workers is indeed possible! Improving sleep for most people, shift workers or not, is often about changing the things we can control, then learning to accept the things we can't. This may be especially true for shift work.


Have you ever noticed that the harder you try to sleep, the more you fail? For anyone, striving for perfect sleep is a recipe for insomnia at the best of times. For shift workers, in particular, perfect sleep simply may not be possible. The best approach is to give yourself the best chance of better sleep (tips coming up!) and accept that you will be tired at times. The more you’re willing to put up with that reality of shift work, the less anxious you will be about sleep and the less insomnia you’ll likely experience. (But always prioritize safety!)


Given that shift work means some things simply are not within your control, it’s all the more important to take advantage of the other strategies that can improve the likelihood of better sleep – and thereby minimize the likelihood of inadequate sleep, which in turn may help reduce anxiety about not sleeping.


Strategies for Better Sleep for Shift Workers


Here are some important things that may be within your control:


Light & Darkness

  • When coming off a night shift, avoid light for at least 2 hours before your bedtime.

  • Consider wearing sunglasses (brown lens is better than black) or preferably blue light blocking glasses (clear lens is not likely sufficient; should be in the orange to red range) on your commute home from work

  • Keep your bedroom dark enough to develop film (blackout blinds, tape tin foil over your window, eye masks).

  • Light can be helpful for fatigue management.

  • Get as much light exposure as possible during your wake times and at work, but if using a bright light device, turn that off about 4 hours before your sleep time.

  • Artificial light will often have to do, but know that outdoor daylight is more powerful than indoor lighting (even on a rainy or overcast day).

  • Consider using a therapy light. Please consult with your physician as this is a medical device and may have unwanted side effects in some people (e.g. migraines, worsening of ophthalmologic issues).

  • Light too early or too late can have unintended effects. Discuss your particular shifts with your sleep specialist for specific recommendations.

Maximize “anchor sleep”

  • Try to stick to as close a routine schedule as possible

  • Are there any hours of the day or night when you are consistently free to sleep? Think of these times as your "home base". If you have the opportunity to schedule your sleep hours around that time, it can help to minimize the disruption of shift work on your circadian rhythm. Even a consistent time of one hour when you can always be asleep can help strengthen the body’s 24-hour biological clock and improve quality of sleep.

Naps

  • Nap strategically, for example before a shift when needed.

  • If you don’t have the opportunity for a 7 to 9 hour sleep window, aim for a 2 to 3 hour nap before your next shift.

  • Avoid napping or oversleeping on your days off so you can save up your sleep for when you really need it.

  • However, if napping will help your body clock adjust towards your next shift, this may be beneficial.

  • Always nap for safety reasons!

Relaxation strategies

Best to practice routinely when you’re not trying to sleep. Then these strategies will be more likely to help when you do want to sleep.

Light-skinned woman in yoga gear in meditation pose
Here are some common relaxation strategies:
  • Deep breathing

  • Progressive muscle relaxation

  • Guided imagery

  • Meditation

  • Yoga (not the energizing variety)

(If you haven't already, subscribe to our newsletter to receive our free handout on Why Relaxation Strategies can Backfire - and what to do instead).


Pre-bed Tips

  • Avoid vigorous exercise 2 hours before bed. It can be too alerting. In fact, mild to moderate exercise is one of the suggested fatigue management strategies.

  • Restrict fluid intake too close to bedtime

  • Avoid alcohol especially within 3 hours before bed

  • While a night cap may seem relaxing at first, alcohol tends to disrupt sleep a few hours later.

Buffer Zone

  • So important! Whenever possible, invest in your sleep by having a nice unwinding period before bed. Give yourself time to “power down”. Although it might be tempting to rush to bed when you get home from a shift, consider the importance of investing in a wind-down routine. You know yourself best, but sometimes rushing to bed is a setup for insomnia and can backfire. Ideally, you want to give yourself a good hour (minimum 30 minutes) to transition from your work to your sleep time, to let your body relax and your active mind settle down.

  • Plan some nice routine pre-bed activities.

  • Having a consistent pre-bed routine can be surprisingly important to help cue your brain and body to relax and wind down before bed.

Minimize disruptive noise during your sleep time

  • Some noises are more disruptive to sleep than others (e.g. human language, birds, beeping, traffic, etc.) White noise is a constant and meaningless noise that can actually help to drown out the other noises and let you sleep soundly. Therefore, try a white noise machine (not nature sounds), or headband audio to play white noise. There are also white noise apps.

  • Silicon or wax ear plugs are also very helpful in addition to white noise.

  • Have ongoing conversations with family, asking for their support in keeping quiet during your sleep times. They may make more of an effort when they consider how much less irritable and more energetic their loved one will be with better sleep.

  • Arrange for deliveries when you don’t hope to be sleeping.

Avoid lying in bed when you can’t sleep

Counterintuitive as it may be, this is definitely one of the most important things in the

category of things where you do have some control. Consider this: while it might (or might not)

give you more opportunity for catching a few extra zzzz’s in the short term, over time, it is

more likely to prime you for insomnia. Called “conditioned arousal”, the more you lie in bed

trying to sleep, the more your brain and body become trained to associate the bed with

wakefulness (and possibly even frustration and anxiety about not sleeping).


Light-skinned woman in bed with hands over face appearing frustrated

Only you can weigh the short-term benefits of lying in bed trying to sleep with the long term

cost of (worse) insomnia. Generally speaking, people have significantly better sleep in the long run when they get out of bed any time they are still awake after 10 to 20 minutes Plan in advance things to do when you can’t sleep. They should be enjoyable, distracting and not too alerting.


Plan ahead

  • Start adjusting in advance to your upcoming change in shift when possible.

  • For example, if your overnight rotation is coming up, try to sleep later on your preceding days off (perhaps 3 am to noon).

7 cups of coffee of different sizes and colours

Caffeine

  • Use strategically at the beginning of shifts and start avoiding at least 4, but preferably 6, hours before the end of your shift.

  • Research suggests that anything beyond a maximum dose of 200 mg of caffeine (approx. 2 cups of coffee) every 3 to 4 hours is of no additional benefit – and may simply impact your sleep more than necessary.

  • To reduce the opportunity for developing tolerance and improve the chance of caffeine having more effect when you really need it, consider avoiding or minimizing on your days off.

Fatigue management strategies

  • In addition to above use of light and caffeine, stretch your legs and arms, go for a short walk, stay hydrated, get fresh air and take a break from mundane tasks if possible.

Cooling socks

  • Interestingly, the US military (talk about shift work!) suggests the use of cooling socks both sleep and fatigue. While not based on research, it might be worth a try.

Have ongoing conversations with your family and friends

  • Don’t assume they “get it”. Invite them to participate in brainstorming ways to include you in social activities and “normal” life in general.

  • Social isolation is common among shift workers. Be creative and proactive.

Do you have signs of sleep apnea?

  • For example, loud snoring?

  • Shift workers with obstructive sleep apnea are more likely to develop insomnia.

  • Take this quick self screening questionnaire and discuss with your doctor if you have signs of sleep apnea.

Are you on any medications?

  • That may be making you sleepy during the day? Or interfering with sleep at night?

  • Ask your doctor if dose or timing could be tweaked to minimize unwanted side effects.

Look after your health

  • Adenosine is a chemical produced in the brain that is literally our brains natural sleeping chemical. The longer we’ve been awake, the more adenosine is built up for bedtime. And activity levels help increase adenosine. So, not only is exercise great for both physical and mental health, it helps improve sleep!

  • As long as regular shifts are not your current reality, make an extra effort to improve your health, such as getting regular exercise and eating a healthy diet.


Young black man and woman wearing exercise gear standing on exercise mats

Talk to your employer

  • In an ideal sleep world, we'd all have regular routines with lots of access to daily light and limited light at night. But if that's not your reality, is there any possibility of modifying your current shifts to something with a bit less variation? Something that might permit more consistent "anchor sleep"? More hours of daylight? Consider making a request of your employer.

  • They may not have considered the potential for improvement in their "bottom line" when their workers are well rested: fewer accidents; more productivity; happier, healthier workers. Circadian.com is a company specializing in advising employers on how best to schedule shift work and optimize their most valuable asset, their workforce.



Safety!

  • Most important! Never drive or operate potentially dangerous equipment if you are feeling sleepy or drowsy.

  • Have a backup plan (get a ride, taxi, public transit, ride share, move closer to work if possible)

  • While napping at the wrong times can indeed sabotage sleep later, you will have to decide when to nap as needed for safety. For example, a 10-15 minute nap before your commute home after a shift can help keep you safer.


Improve your sleep with CBT-I for shift work


Of course, none of the above is a guarantee of perfect sleep every night. Instead, think of these strategies for shift workers as a "harm reduction" approach. No one has perfect sleep every night, not even people with very consistent work schedules. Remembering this can go a long way towards acceptance of an imperfect reality - for all of us. And that can go a long way in alleviating sleep-related anxiety.


Cropped image of light-skinned woman in a field on sunny day

The goal is to control what you can and find peace with the rest. However, if you have tried these tips and nothing seems to be helping, a sleep therapist with expertise to tailor a treatment may help you get the rest you need. "The most effective nonpharmacological treatment for chronic insomnia is cognitive-behavioral therapy for insomnia (CBT-i)." It's important that it be customized to the reality of your shift work. Remember, there are many different types of shift work schedules. One-on-one advice from a sleep therapist may help you sort out what kind of sleep schedule is best for you.


If you're among the 10% to 38% of shift workers struggling to sleep, perhaps you too could find yourself among the 62% to 90% who aren't.


Feel free to book a free 15-minute phone consultation if you're interested in gold-standard CBT-I to help get your sleep back on track.


References


1. Barger, L.K., Lockley, S. W., Rajaratnam, S. M., & Landrigan, C. P. (2009). Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Current Neurology and Neuroscience Reports, 9(2), 155-164.


2. Boggild, H., & Knutsson, A. (1999). Shift work, risk factors and cardiovascular disease. Scandinavian Journal of Work, Environment & Health, 25(2), 85-99. https://doi.org/10.5271/sjweh.410. Published online.


3. Cheng, P., Casement, M. D., Kalmback, D. A., Castelan, A. C., & Drake, C. L. 2021. Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic. Sleep, 44(4), zsaa258.


4. Culpepper, L. (2010). The social and economic burden of shift-work disorder. The Journal of Family Practice, 59(1 Suppl), S3-S11.


5. Drake, C. L., Roehrs, T., Richardson, G., Walsh, J. K., & Roth, T. (2004). Shift work sleep disorder: Prevalence and consequences beyond that of symptomatic day workers. Sleep, 27(8), 1453-1462.


6. Kalmbach, D. A., Pillai, V ., Cheng, P ., Amedt, J. T., & Drake, C. L. (2015). Shift work disorder, depression, and anxiety in the transition to rotating shifts: The role of sleep reactivity. SleepMedicine, 16(12), 1532-1538.



8. Karlsson, B., Knutsson, A., & Lindahl, B. (2001). Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27 485 people. Occupational and Environmental Medicine, 58(11), 747-752.


9. McHill, A. W., Melanson, E. L., Higgins, J., et al. (2014). Impact of circadian misalignment on energy metabolism during simulated nightshift work. Proceedings of the National Academy of Sciences, 111(48), 17302-17307.


10. Puttonen, S., Harma, M., & Hublin, C. (2010). Shift work and cardiovascular disease – Pathways from circadian stress to morbidity. Scandinavian Journal of Work, Environment & Health, 36, 96-108.


11. Schweitzer, P. K., Randazzo, A. C., Stone, K., Erman, M., & Walsh, J. K. (2006). Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. Sleep, 29(1), 39-50.


12. Scott, A., Monk, T., & Brink, L., (1997). Shiftwork as a risk factor for depression: A pilot study. International Journal of Occupational and Environmental Health, 3(Suppl. 2), S2-S9.


13. Straif, K., Baan, R., Grosse, Y., et al. (2007). Carcinogenicity of shift-work, painting and firefighting. The Lancet Oncology, 8(12), 1065-1066.

14. Ward, E. M., Germolec, D., Kogevinas, M., et al. (2019). Carcinogenicity of night shift work. The Lancet Oncology, 20(8), 1058-1059.


15. Zhang, Y., & Papantoniou, K. (2019). Night shift work and its carcinogenicity. The Lancet Oncology, 20(10), e550. https://doi.org/10.1016/S1470-2045(19)30578-9.



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