Barbra's Sleep Makeover

This night shift nurse found that taking small steps to get better sleep helped her to improve her overall health.

It's worth it to protect my sleep. It's hard to do, but it's better for me physically, mentally, and spiritually.
Barbra

Need sleep? The estimated 20 percent of our nation's workforce that work in shift schedules often do. This group is at serious risk for chronic sleep deprivation, which is something that interferes with how well they do their job, including critical medical or public safety work. But shift workers who get inadequate sleep also put their own health at risk. Increased rates of cancer, obesity, cardiovascular disease, and diabetes are associated with insufficient sleep. Barbra is one example of a worker at risk who decided to put her sleep first and improve her health.

According to the National Sleep Foundation, more than 15 million Americans are employed in shift work jobs.1 Shift work is common within the health care, communication, hospitality, leisure, and transportation industries. In many health care occupations, such as nursing, shifts often last 12 hours. The combination of having fewer hours that can be devoted to sleep, working during a time when your body is telling you to go to sleep, and trying to sleep when your body is predisposed to being awake is a perfect formula for sleep deprivation.

Barbra's Story

Barbra, an intensive care nurse at a community hospital in Boston has been working the night shift for two years. Her shift typically begins at 7:00 p.m. and ends at 7:00 a.m. In addition to feeling more tired than when she worked the day shift, she has gained weight, and she finds it difficult to follow a healthy diet and exercise regimen. After consulting a sleep physician, Barbra learns that not only is she sleep deprived (she averages 4.5 hours when she works the night shift) but her health concerns—weight gain, difficulty managing her high blood pressure, craving unhealthy foods—may be connected to her inadequate sleep.

Shift Work and Health

In fact, like Barbra, many shift workers do not get sufficient sleep, and the sleep they get tends to be of poor quality. Research on the health effects of shift workers' insufficient sleep has established that such workers have higher rates of migraines, stomach problems, and muscle and joint problems, and are at higher risk of developing cardiovascular disease, certain types of cancer, diabetes, and obesity.2 Additionally, some studies indicate people who are sleep deprived have abnormalities in the secretion of certain hormones affecting appetite in a way that may promote eating, resulting in weight gain.3

Shift Work and Safety

In addition to sleep deprivation’s effects on health, shift workers who do not get adequate sleep also put themselves and others at risk for accident or injury. In one study of hospital staff nurses working 12-hour shifts, 79.5 % of those who worked the night shift reported at least one episode of drowsy driving after their shift.4

But drowsy driving and motor vehicle crashes are not the only threat to safety. Nurses working shifts of greater than 12 hours report making 2 to 3 times as many errors as those working shorter shifts.5 Similarly, doctors in training have been found to make 36% more serious medical errors and 460% more serious diagnostic errors when working extended shifts of 24 or more consecutive hours, compared with when their shifts are limited to 16 hours.6 When you consider that as many as 100,000 patients die each year in the U.S. due to medical errors, long work shifts and lack of adequate sleep have a significant impact on patient safety and public health.7

Small Changes Make a Difference

Barbra decided that she needed to make a commitment to protecting her sleep time. She began sleeping longer, averaging seven hours before going to work, made changes to her sleep environment to block out light and sound, and told her friends and family not to call when she was sleeping. She is also making healthier food choices and has started exercising again, walking in the late afternoon before her night shift begins. Although these changes have not been easy to make, Barbra feels they are worth it, and that they will have a significant impact on her long-term health and well-being.

Learning from Barbra's Story: What You Can Do

  • Working when others are sleeping and sleeping when your body wants to be awake are difficult achievements, but not impossible. Night shift workers need to be even more vigilant about their sleep schedule and environment. Sleeping right after a night shift helps many shift workers sleep longer and more soundly. Avoiding exposure to light after completing a shift is also important. It is best to exercise before starting a shift at night. See Adopt Good Sleep Habits for more tips on how to improve your ability to sleep.
  • Sleep deprivation affects not only your health, but also your judgment, and the safety of others. Take the How Awake Are You? interactive challenge to find out how sleep deprivation affects reaction time.
  • Sometimes shift workers may suffer from sleep disorders, and are in fact at greater risk for obstructive sleep apnea (OSA). If this is a concern, see When to Seek Treatment in the Healthy Sleep module.
  • Even if you are not a shift worker, you put your health at risk when your sleep is inadequate. Improved cardiovascular health, better weight control, and lowered risk of diabetes are all connected to getting a good night's sleep on a regular basis. See Sleep and Health for more information.

References

  1. National Sleep Foundation, Strategies for Shift Workers, 2008.
  2. Knutsson, A. Health Disorders of Shift Workers, Occupational Medicine 2003; 53:103 – 108.
  3. Science Daily, Sleep Loss Boosts Appetite, May Encourage Weight Gain, Dec. 7, 2004.
  4. Scott, L., Rogers, A., et al., The Relationship Between Nurse Work Schedules, Sleep Duration, and Drowsy Driving, SLEEP, 2007, Vol. 30, No. X.
  5. Scott, L., Rogers, A. et al., Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety, AMERICAN JOURNAL OF CRITICAL CARE, January 2006, Vol. 15, No. 1.
  6. Landrigan, C, et al., Effect of Reducing Interns’ Work Hours on Serious Medical Errors in ICUs, NEHM. 2004; 351 (18): 1838 – 1848.
  7. Kohn LT, et al., eds. To Err is Human: Building A Safer Health Care System. Institute of Medicine; National Academies Press. 2000.

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This content was last reviewed on December 12, 2008