Shift Workers

The Problem

One quarter of the work force in industrialized countries perform some sort of shift work.  Millions of
Americans are considered shift workers, including doctors and nurses, pilots, bridge-builders, police
officers, customer service representatives, commercial drivers, and others.

Sleepiness is common among shift workers, especially during the night shift:

 80% of shift workers feel tired during their night shift.

 60% believe they doze off at work about once per week.
 20% fall asleep on the night shift.
 Sleepiness in shift workers is similar to that seen in primary sleep disorders, such as sleep apnea
or narcolepsy.

Reasons for sleepiness in shift workers include:

 Shift workers often do not get enough sleep before their shifts.
 Sleep after the shift is usually shortened (by an average of one-third).
 Even if adequate in duration, sleep near shifts is usually fragmented.
 The day-night cycle (circadian rhythm) of the brain and the body may get disrupted when
working different shifts.
 Shift workers may have other primary sleep disorders independent of their work
schedule.

Consequences of sleepiness can be hazardous to the worker’s health and may cause decreased
work performance:

 Near-crashes when driving after night shifts are common.

 Shift workers are at increased risk for a variety of chronic illnesses such as
cardiovascular and gastrointestinal diseases.
 Shift workers often complain of insomnia, disrupted sleep schedules, reduced
performance, difficulties with personal relationships, and irritability/depressed mood.
 Sleepiness effects are similar to that of moderate alcohol consumption.
 Several disasters, such as the nuclear meltdown at Chernobyl and the Challenger space
shuttle disaster, have been attributed to poor performance related to shift work.
 Caffeine is a stimulant that starts working 30 minutes after consumption.  Its effect peaks
at 2 hours and lasts for about 5 hours.  Problems associated with its use include
disruption of subsequent sleep, tolerance, and a diuretic effect that may be dehydrating
or becomes a nuisance.

The Solutions

There are several strategies that may help a worker cope with the sleep-wake cycle disturbances
resulting from working different shifts.  If your sleep-wake cycle does not adjust perfectly with your work
schedule, it may be useful to control your shift schedule and your environment, instead.

 The number of shifts worked in a row has not been shown to be an important factor in sleepiness.
 Direction in which shifts rotate may be important.  Shifts that rotate forward are better tolerated 
(see Table 1).
 Duration of shifts contribute to the ill effects, the shorter shifts being better tolerated.
  Exposure to bright light (more than 2000 lux, such as the light of 5 standard fluorescent tube
bulbs) increases alertness by inhibiting the secretion of a natural hormone called melatonin. 
Melatonin promotes sleep and its secretion increases in darkness.  It is best to maximize light
exposure early in a shift and avoid it 6 hours before bed time.
 Strategic napping is one way of getting enough sleep before a shift, and during the shift (if
feasible).  A nap of no longer than 30 minute can restore functionality. Longer naps tend to lead
to sleep inertia or grogginess with awakening.
 Phase shift is another way to manage rotating shifts, as one may intentionally move bed time
towards the anticipated shift end time.  This can be done if there are a few days off between shift
switches.

In some cases, your doctor may prescribe medications such as the following:

 Sedatives (hypnotics) may be used to improve sleep after a shift, but their effect on shift work is
unknown.
 Melatonin (sleep rhythm aid): may be used to modify the sleep phase to a new sleep schedule,
especially when combined with strategic light and darkness exposure.
 Modafinil (Provigil®): has been shown to improve vigilance in night shift workers, but to a limited
extent.

Theses treatments are not well studied and a physician should supervise their use.

Tips for Coping with Shift Work:

 Keep to the same sleep schedule when your shifts are constant, even on non-work days.
 Have as much exposure to bright light as possible when you need to be alert, and avoid light
exposure in the morning after night shift.
 Protect your sleep by eliminating noise and light from your sleep environment (use eye masks
and ear plugs).
 Avoid using caffeine close to bedtime.
 Avoid drinking alcohol since it disrupts sleep, even though it may seem to help in falling asleep,
initially.
 Nap before work, and if possible on breaks during the shift since any sleep is better than no
sleep.
 If you still have problems, contact your physician, or a Sleep Specialist.

Table 1
Forward (Clockwise) Rotating Shifts
Day/Shift 7 am – 3 pm 3 pm – 11 pm 11 pm – 7 am
Mon ////////////////////////////
Tues ////////////////////////////
Wed ////////////////////////////
Thu
Fri ////////////////////////////
Sat ////////////////////////////
Sun ////////////////////////////
Table 1: Shows weekly schedule of a shift worker where the shifts (shaded areas) proceed along with the
clock: 7 am to 3 pm, followed by 3 pm to 11 pm, followed by 11 pm to 7 am, and so on.  

Table 2: Shows the weekly schedule of a shift worker where the shifts proceed against the clock: 3 pm to
11 pm, followed by 7 am to 3 pm followed by 11 pm to 7 am, and so on.  The top shift schedule is better
tolerated than the bottom one.

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