Tired female night shift nurse looking at computer

During the hours when most people are sleeping, some are working through the night - and that includes night shift nurses. Consider the following:

  • Patients can arrive at the hospital at any time of the day
  • Admitted patients at healthcare institutions require continuous monitoring
  • Some medical cases may require emergency procedures during early hours

These are just some of the scenarios that show why nurses are always needed, even during non-standard work hours. However, there are some challenges involved in working night shifts.

Understanding Circadian Rhythmicity

Our body undergoes recurring physical, mental, and behavioral changes on a 24-hour basis, which is called the circadian rhythm. Circadian rhythms in our body are relatively stable, but as you may know, these rhythms are matched to environmental clues. This process is called entrainment, and daylight is the main factor that influences circadian rhythms.

In this article, we are specifically referring to the sleep-wake cycle. This explains why we feel energized seeing the sunrise in the morning, and begin to feel sleepy when it's dark out. Your eyes send information to the master clock, a structure in the brain called the suprachiasmatic nucleus. Then it tells your brain to produce more melatonin, which in turn, makes you feel sleepy.

Entrainment, however, takes time. In fact, entrainment is essential during early development. During fetal life, there is a time when the pathway between the retina and master clock is not yet fully developed. And melatonin from the mother is the only way that the fetal clock can be in-tune with the outside world.

If you suddenly become out of phase with the environment, there will be a lag time before your body starts adapting to changes. This lag time is called desynchronosis, and is also known as ‘jet lag' or ‘shift lag.' Since this article isn't about time-zone change, we will be focusing on the shift lag.

Desynchronosis in Shift Work and Its Effects

The term "shift work" can have different meanings depending on the context. Here, we will define it as employment that occurs between 7pm and 7am. Working on an irregular night shift or rotating schedules will result in a state called desynchronosis. Shift work requires you to change your normal sleep-wake cycle. The attempt to adjust may be complete or not, as it depends on the amount of successive night shift works you have done.

Certain factors can influence the impact on sleep disturbances and the body clock, as well as family and social life. These include:

Individual Differences

  • Gender
  • Age
  • Personality
  • Long or short sleepers
  • Morning or night type of person
  • Difficulty sleeping at unusual times
  • Difficulty sleeping at a different location

Organizational Differences

  • Availability and quality of rest areas for breaks
  • Psychosocial conditions at the workplace
  • Noise
  • Inclement weather

Situational Differences

  • Length of time in commute to and from work
  • Types of activities during rest periods (Ex. having a second job or a physically demanding leisure activity)

RELATED NIGHT SHIFT CONTENT:

Recommended Strategies for Managing Night Shift Work

In most cases, giving up night shift work isn't an option. Therefore, it's important to proactively adapt to your changing schedule. Here are some strategies to consider:

Sleep Management

Sleep management should be your top priority. Napping can be very effective, but only if you are doing it to prevent sleep debt rather than to catch up with sleep. Additionally, workers who nap before a night shift showed improvements in alertness and a stronger performance on cognitive tasks compared to those who do not.

Ambiance Modification When Sleeping

Another strategy that can help bring yourself to sleep is modifying your ambiance. You can minimize noise around your sleeping space by using earplugs or white noise machines. Furthermore, keeping your room at its darkest possible setting is beneficial – remember the main cue for circadian rhythm! You may also consider wearing eye masks while sleeping, and sunglasses on your ride home from work.

Phototherapy

A specific dose of bright light and the right timing of exposure can cause a significant delay in melatonin production. This delays the time it takes to feel sleepy!

Melatonin

Melatonin is a hormone produced by our bodies. While exogenous melatonin is available in the market and used to promote sleep, it is known to have no serious physiological adverse effects when taken. Studies show that melatonin helps prevent a decrease in the amount of sleep when sleeping at the "wrong" circadian phase. This sleep-promoting effect is beneficial before or after your night shift work.

Dietary Manipulation

Creating a schedule for your protein and carbohydrate intake could also be beneficial. In fact, a "jet lag diet" is often recommended to travelers crossing multiple time zones. Aim to eat protein-rich foods before times of activity and consume carbohydrates before the sleep phase.

Have you found a strategy that you can make use of during your next night shift? Make a reminder for yourself now!

Karen Cas-Alinas
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