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.
Ahmed BaHammam, FRCP, FCCP
Professor of Medicine
Director, Sleep Disorders Center
College of Medicine, King Saud University
Associate Editor, Ann Thoracic Med
