According to the Bureau of Labor Statistics, nearly 15 million Americans work the night shift. Factor in rotating and on-call shift work, and the number of people working non-traditional schedules balloons to 22 million. This is nothing shocking: In industrialized nations around the world, as many as 20 percent of workers fall outside the nine-to-five. They’re nurses, doctors, firefighters, police officers, factory laborers, security guards — the people who keep society running while day-shifters sleep.
But shift work comes with its fair share of costs to the body and mind. The risks range from drowsiness to heart disease; in 2007, the World Health Organization declared the night shift’s sleep-disrupting effects to be straight-up carcinogenic. This is scary stuff, but it’s not hopeless. Whether you’re a novice or veteran shift-worker, you can take steps to minimize health risks and achieve good sleep.
The night shift’s main effect on your body — the one problem that leads to all the others — is its disruption of your circadian rhythms. Generally speaking, the human body wants to wake up when it’s light out and go to sleep when it’s dark. Light suppresses production of melatonin (which causes sleepiness) and triggers production of cortisol (which causes wakefulness, among other things). Steer clear of light, especially the low-wave blue variety, and your brain releases melatonin, signaling the approach of bedtime.
These rhythms fluctuate throughout the day, causing dips and spikes in alertness that naturally affect mood as well. The night shift requires workers to combat their natural internal clock, a battle with consequences that reverberate beyond shift-workers themselves — from truck drivers to everyone else in traffic and nurses to patients.
Dr. Robert S. Rosenberg, a board-certified sleep medicine physician and author of "The Doctor's Guide to Sleep Solutions for Stress & Anxiety," recommends that shift workers keep their circadian rhythms in sync with a disciplined schedule.
“Try to keep the same sleep-wake schedule on your days off,” he said, adding that it’s essential to make use of the sleep-controlling effects of light. A shift worker, per Rosenberg, must gravitate toward bright lights — “especially at the beginning of their shift” — and wear wraparound sunglasses or blue-blockers as they head home.
At home, the bedroom should be a bastion for sleep. “Make your daytime bedroom a dark, quiet zone,” he suggested, noting that if you live with your family, it’s important to set boundaries together. For instance, you don’t want your kids running up and down the halls or slamming doors on a Saturday afternoon.
Naps are particularly important for shift workers, too. Rosenberg recommends taking two — one before the shift begins, and one during the worker’s break to stay alert.
“A brief, 20-minute nap can increase your alertness for up to four hours,” he said, “and will not cut into your sleep the following day.” Unsurprisingly, Rosenberg suggests laying off caffeine towards the end of your shift, as “it will only make it that much harder to fall asleep."
For those workers who take all these precautions and still have trouble sleeping, Rosenberg suggests a few remedies. One is taking a low dose of melatonin — consult a doctor to figure out how much is appropriate for you — to coax you into sleep. The other is light therapy, which entails exposing your eyes to bright lights, and is often used to treat seasonal (and nonseasonal) depression.
“Bright light, or even a light box during the first five hours of the shift can be very beneficial,” said Rosenberg. “In fact, some sleep labs use light boxes to help their sleep techs stay awake and alert during the night.”
These tactics work — most of the time. But there is always the sobering possibility, Rosenberg cautioned, that some people just won't be able to adjust their natural circadian rhythms.
“If after several months you either cannot sleep at least six hours during the day, or cannot stay awake at work, night shift work may not be for you,” he said.
Unfortunately, not everyone has the luxury of choosing when they sleep, and this is the truly dark side of the night shift. Sleep deprivation is more than just a health hazard, especially in our most critical professions. For doctors, firefighters and ambulance drivers, it can be a public health hazard. To condemn them to sleeplessness is to condemn everyone around them as well.