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 Allah
created us to be night sleepers, not workers. We can if
necessary stay up and work during times when we should be
sleeping, but in general, our hormones and our rhythms are
geared for daytime wakefulness. However, modern civilization
has grown into an all-day-all-night operation, unnaturally
forcing many people to work at night. Two particular
sleep-related problems are associated with shift work:
difficulty sleeping during the day and difficulty staying
alert at night. Before we go into the details of shift work
problems, we should define the body’s circadian rhythm. The
body’s circadian rhythm is its alternating cycle of sleeping
and waking. In healthy adults, sleep tends to occur during a
particular phase of the circadian rhythm. This circadian
rhythm is set and maintained mainly by two external stimuli;
light and noise. Circadian rhythms are finely tuned phenomena
in which hundreds of body functions mesh with each other.
Those who work the night shift ought to sleep when their
bodies want to be awake, resulting in a contradictory
relationship between sleep time and circadian rhythm. When we
change work shifts, it takes time to reestablish that fine
balance. It usually takes at least two to three weeks before
we are fully adjusted to a total day-night reversal.
Consequences:
Shift work affects our lives in many ways. The average sleep
cycle for a night shift worker sleeping during the day is two
to four hours shorter than that of the day worker sleeping at
night. Day sleep is light, fragmented, and more likely to be
disrupted. Sleep deprivation and insomnia can be severe in
shift workers. In turn, this affects job performance, since
people are generally sleepiest between 2:00 AM and 6:00 AM,
even after years of working nights. Under these circumstances,
mood deteriorates and health suffers. For example, digestive
secretions follow a circadian pattern. If you eat while on the
night shift, you fill your stomach with food at the time when
it is not ready for digestion, and you leave it empty when all
the acid secretions occur. This is probably why night shift
workers have more peptic ulcers than daytime workers do. Shift
workers must also cope with a lot of family and social
problems. They have to work while the rest of the world is in
bed, and sleep while the rest of the world is at work and
engaged in leisure activities. These people complain that they
do not have enough time to spend with their family and
friends, make appointments and get engaged in leisure
activities.
There has been much concern about the dangers to the public
caused by workers being sleepy on the job. The three nuclear
disasters, Three Mile Island, Peachtree, and Chernobyl all
happened in the early morning. Human factor was cited as a
factor in all three. Was sleepiness a factor also?!
How to sleep better if you are doing
shift work:
It would be best if we do not have to shift work at all.
However, as it is unavoidable, here are few things you can do.
Initially, we have to differentiate between professions like
physicians who have to be on call at night where their sleep
is frequently interrupted and other shift workers. Also, some
people are better suited to shift work than others. As a
general rule, the older we get the more difficult it becomes
to work nights and rotating shifts. Several strategies may
help the shift worker sleep better.
Workplace conditions:
Shift work should be organized in way to help the shift worker
sleep better. That can be done by rotating clockwise from day
to evening to night. This approach is more natural and helps
the worker to adjust his/her circadian rhythm gradually. Short
breaks during working hours may help in increasing alertness.
It is better to have longer shift periods to allow the body to
adjust to the new shift (i.e., three weeks rotation is better
than one-week rotation). The workplace environment should
stimulate the worker’s alertness. Lighting level should be
bright enough. The temperature should be cool rather than
warm. Caffeine containing beverages should be available to the
workers. Both the employer and the employee should educate
themselves about shift work and its effects.
Sleep and home conditions:
Rotating shift workers should start adjusting their sleep
schedule at the end of their current shift to cope better with
the new shift. On the last few days of the current shift,
sleeping time should be gradually adjusted to be ready for the
new shift. For example, if your next shift will be the evening
shift, try to delay your sleeping time and hence your wake up
time 1-2 hours everyday to ease into the new night shift. If
your shift is at night and you have to sleep in the daytime,
simulate the night environment in your bedroom by making it
dark and quiet. White noise (constant low background noise
like a fan or air conditioner) may help block out external
noise. The worker should follow the sleep schedule of each
shift as strictly as possible even in the off days. Try to
work out a fixed time to spend with your family and friends
without significantly compromising your sleep schedule.
Workers who permanently work night shifts, should strictly
follow and defend their sleep schedule even during weekends.
Changing the sleep schedule during the weekend to cope with
the social commitments may upset the sleep schedule for the
whole week. Employees in jobs that require frequent awakening
at night like physicians may benefit from short naps in the
daytime.
Sleeping pills:
There is no good evidence that improving daytime sleep by
sleeping pills has a significant effect on alertness and
performance in the subsequent night shift. These pills have
side effects and overtime may result in dependency. Moreover,
this type of treatment does not address the actual cause of
the problem. I do not recommend the use of these medications
in shift workers.
Eating habits:
Food may play a role in good sleep. Shift workers should eat
meals that are high in protein and carbohydrates, and avoid
fried and fatty food. It is not advised to go to bed when
hungry or after a heavy meal.
Finally I wish you all a restful restoring sleep.
Dr. Ahmed BaHammam
Director Sleep Disorders Center
King Khalid University Hospital
Associate Professor, College of Medicine, King Saud University
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