Sleeping Tips for Nurses and Workers on the Night Shift

by Linda Martin, RN

If you are a “night owl,” nights is the shift for you. You’ll be awake and alert throughout your shift and feel that you are “stealing time” because everyone else is home asleep. Your patients will be lucky to have you, though.

The up side is that the pace might be a little slower, you might have more time to interact with your patients, most doctors will be home asleep so there won’t be a lot of new orders, and you will miss most of the “daytime drama” of the earlier hours. Your coworkers will most likely be motivated much as you are – to work during the night so you can get home to your “real life,” usually meaning your family and friends.

The downside is that the food in the hospital cafeteria (if there is any) will not be quite as tasty (or fresh), the doctors will not be close by if you need them, and you might have a major “sinking spell” at some point during your shift. And, the family you are rushing home to will probably be gone for the day by the time you get there.

You will soon learn what the old phrase “bone weary” means. Those of you who have worked this shift know exactly what I am talking about. Once you leave your shift and have to stay up to function during the day, you eventually feel that your bones are weary. But you will slap that blank smile on your face and go through the motions, counting the minutes until you can crawl into your big comfy bed. When you finally do settle in, exhausted, you are surprised to find that you can’t fall asleep. Sound familiar?

Night-shift workers are especially vulnerable to sleep problems, particularly the inability to sleep during the day. Our circadian rhythm is a biological force that controls our waking and sleeping cycles. Unfortunately for night-shift workers, these body rhythms are internally driven and keep us on an “awake in the day/asleep at night” schedule, even in controlled experiments of subjects isolated in darkness with no knowledge of time. Environmental factors such as sunrise and sunset may provide timing cues that alter the onset by several hours, but the rhythm instinctively follows its 24-hour cycle.1 Night-shift workers generally have difficulty adapting to their schedule because they are exposed to the usual outdoor light-dark cycle, which acts as a powerful cue. Night-shift workers who end their shift at 5 a.m. and go home in darkness have a better chance of falling asleep than those who leave at 7 a.m., after sunrise. I know this from experience.

Another challenge faced by night-shift workers is the readjustment to nights off, when they actually can sleep at night. Even though the nurse may stay awake during the day in anticipation of that “good night’s sleep,” there is no assurance that it will come easily. Usually after several days off, the nurse can adjust to a “regular” schedule, only

to return to work and have to readjust again. It is an endless cycle; one that is physically demanding.

Some of us, however, thrive at night and choose to work that shift. Many hospitals, aware of the potential for sleep deprivation and the effect it could have on patient care, limit the number of night shifts that can be worked in a row. In a way this is good, but it calls for more frequent readjustment of sleeping and waking schedules. Nurses who work alternative shifts, such as 7-on and 7-off night shifts, or weekend nights, have an entire week to readjust and probably prefer that schedule.

What can we do to help transition between the day schedule of our days off and the night schedule of our nights at work? One of the most important aspects to me was making sure I got enough sleep during the day to sustain me during the night. I was lucky; I could fall asleep easily enough during the day. My shift ended at 5 a.m., and I was able to get home before daylight. On days when I worked until 7 a.m., however, I could see a big difference. When the sun comes up, your body thinks it is time to “rise and shine,” even if you are dead on your feet (and many times you will be). That little burst of energy will help on the drive home because you will be more alert, but may ultimately cause real problems when trying to fall asleep.

Some helpful tips for successful “day sleeping:”2

* Keep the room as cool and as dark as possible with blackout shades or heavy drapes – the darker, the better.

* Use a fan, humidifier, or air cleaner to muffle the sounds of the day.

* Wear a sleep mask and use earplugs.

* Maintain a consistent sleep schedule, either immediately after or before work.

* Plan for at least eight hours of sleep.

You might also want to:

* Take a warm bath to wind down when you get home.

* Avoid nicotine and caffeine for the last several hours of your shift (easier said than done).

* Avoid heavy meals and spicy foods that might cause heartburn and gas.

* Limit what you drink several hours before your shift ends so you don’t repeatedly have to get up to go to the bathroom.

* Lie still, consciously slow your breathing, systematically relax your muscles from head to toe, and visualize yourself falling deeper and deeper into sleep.

* Use a short-acting sleep medication (if prescribed) as a last resort only.

Exercise is an important factor in the life of the night-shift worker. When you wake up from your day sleep, you might feel a little groggy, especially if you haven’t gotten your full eight hours, or if this is your second or third night shift in a row. A brisk walk or some sort of aerobic exercise will help you wake up, stay alert at work, and keep in shape.2

During your shift, if you start to “sink” (and you most likely will around 2:30 or 3:30 a.m.), walk up and down the hallway on your unit. On your meal break, take the stairs to the cafeteria to get that blood pumping. Most places of employment prohibit naps, and rightly so – you are taking care of patients. Your only alternative is to refresh yourself, and exercise is a good way to get back on track.

Times when you feel you can’t hold your eyes open one minute more commonly plague nurses working the night shift, especially if they are not getting adequate rest at home. These “sinking spells” are powerful and almost painful, but you can’t give in to sleep! Sometimes getting a cold drink, eating ice or a light snack, washing your face with cold water, or exercising will pull you out of it. Eventually they pass and you get that “second wind” that sustains you through the rest of your shift. Napping at home before work is sometimes a key factor in preventing a “sinking spell,” even if it is only for 20 to 30 minutes. When I worked nights, I called them my “power naps,” and if I could sleep long enough to have a dream, I was good for the shift. Especially on the first night back after several nights off, that nap would give me the extra rest I needed to get me through the night.

Sometimes the ride home is challenging to say the very least, especially if you have a long drive. You feel alert many times when you get in your car, but as you sit quietly behind the wheel your shift catches up with you. Keep the air system on cool and blow it in your face or open the window a little if you need to. Keep the radio or a CD playing and sing along as loudly as you wish, even if you don’t know the words. Talk to yourself and keep your mind on staying awake. Take a cup of that good crunchy “hospital ice” with you; call your family or a friend on the phone – anything to stay awake and get home safely. If you feel like you are just too tired to make it, pull over, get out of your car, and walk around, or pull over to a safe place and take a short nap. If you need to call a family member to pick you up, do it – better to be safe than sorry!

Working the night shift can be rewarding, both professionally and monetarily, as most hospitals offer shift differentials to reward you for your efforts. Whatever your motivation, if you have chosen night-shift work, you must be aware constantly of the importance of adequate rest. With sleep deprivation comes mistakes, and we can’t afford to make even one! Close attention must be paid to maintaining a healthy sleep pattern to prepare us to function at work and recognizing when our sleep requirements haven’t been met. Night-shift work is not for everyone, but if you feel that you are suited for it and keep yourself rested and healthy, you will surely flourish.

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