Shift Work Sleep Disorder: How to Stay Healthy When You Don’t Work 9-to-5

Nearly 25% of American workers have sporadic schedules. Here’s what the experts say about the risks of shift work and how to mitigate related health concerns.

Medical worker napping at hospital.
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No disrespect to Dolly Parton, of course, but when she wrote and recorded the song “9 to 5,” she unwittingly left out 25% of working Americans: shift workers.

Shift hours generally fall outside the typical 9-to-5 workday. That might mean you’re working nighttime hours, very early mornings, long shifts, sporadic schedules, or a mix of all of these.

Shift workers hold essential jobs that help keep the world running (including firefighters, police officers, emergency room doctors and nurses, pilots, and many roles in the service industry), but research shows that unusual sleep patterns and a lack of routine can put your health at risk.

When you go to bed as the sun comes up, or regularly change up your sleep schedule to accommodate 12-hour shifts, you disrupt your circadian rhythms, or the natural cycles that govern how our bodies respond to day and night and light and dark.

“Circadian rhythms govern virtually all processes in the body,” explains sleep neurologist and advisor Dr. Chris Winter. “When that schedule is ‘off,’” he adds, “all of these processes are off. Your immune system, digestive system, cardiovascular system — they can all become problematic when you engage in shift work. Even cancer risk goes up.”

But it’s not all negative. We promise. Sleep science has your back. There are science-backed strategies to minimize the impact shift work has on your health, so that you can thrive in these important jobs and get the sleep you need to be at your best.

Here is some expert advice on how to minimize the impact shift work has on your sleep and your health.

What is shift work sleep disorder?

Circadian rhythms are sensitive to even subtle shifts, like when 9-to-5 workers stay up later than usual on the weekends. So the dramatic sleep schedule deviations experienced during shift work can have an even bigger health impact.

Misaligned circadian rhythms due to atypical work hours can lead to something called shift work sleep disorder. Atypical hours might look like a 12-hour truck driving schedule or an emergency room nursing shift that is from 5 p.m. to 5 a.m. one day and 7 a.m. to 7 p.m. a couple days later.

Shift work sleep disorder symptoms may include difficulty falling asleep or staying asleep, trouble concentrating, fatigue, and more.

According to research published in the Journal of Sleep Medicine and Disorders, shift work sleep disorder also increases the risk of having the following health concerns:

  • Breast cancer
  • Cardiovascular disease
  • Chronic pain
  • Cognitive decline
  • Gastrointestinal issues
  • High blood pressure
  • Infections
  • Mental health conditions
  • Migraine
  • Metabolic syndrome (high triglycerides, low HDL “good” cholesterol, high blood sugar, excess abdominal fat)
  • Obesity
  • Stroke
  • Traffic accidents
  • Type 2 diabetes

If you work in a highly stressful environment or have a physically demanding shift job, you may be even more likely to develop shift work sleep disorder. For example, research indicates that shift work sleep disorder is prevalent among airline industry workers, including pilots and flight attendants.

Stress is correlated with shift work sleep disorder, in part, because it is also linked to insomnia, according to research in the Journal of Sleep Medicine and Disorders.

You’re also more at risk for the disorder if you have less social support or already have a mental health condition, like anxiety or depression, according to the same research.

How circadian rhythms work

Why is it so hard to adjust to a different sleep schedule? Our circadian rhythms are geared toward daytime light exposure and nighttime darkness. Flipping the switch, as with nighttime or early-hour shift work, or a constantly rotating schedule, upsets the delicate workings of our circadian clocks.

Though everyone is slightly different — think night owls versus early birds — most adults experience peak sleepiness between midnight and 7 a.m. But your exact circadian rhythm timing will depend on your photic history, or your exposure to light throughout a 24-hour cycle, according to research published in the journal Somnology.

Photoreceptors in our retinas react to sunlight and then send signals to our suprachiasmatic nucleus, or SCN. Think of the SCN as the body’s grandfather clock. It’s what controls your circadian rhythms. The SCN, located in the brain’s hypothalamus, is also involved in many other physiological processes, including metabolism, hormonal function, and body temperature. It affects nearly every cell, so you can see why confusing it might lead to health concerns.

Research confirms that light exposure in the morning, particularly to natural light, sets a process in motion that helps us get enough quality sleep at night, while light experienced later in the day delays the onset of sleep.

Plus, exposure to light and dark affects the secretion of the sleep-promoting hormone melatonin and the mood-boosting neurotransmitter serotonin.

In response to darkness, the pineal gland releases melatonin, giving you a case of the sleepies about two hours later. Night shift workers might feel drowsy, especially if they work outdoors or in a dimly lit environment. Alternatively, artificial light exposure, say from fluorescent lights and computer screens, can prevent or delay melatonin secretion. If you end your workday in the morning, when the sun is coming up, melatonin secretion is further inhibited, possibly preventing much-needed sleep when you finally get home.

A lack of natural light during the day — if you’re busy sleeping — can decrease serotonin production and secretion, according to a research letter published in The Lancet. Serotonin is crucial for regulating mood, but it also helps with sleep, digestion, immune response, and wound healing. Not getting enough serotonin can put you at risk for anxiety, depression, sleep issues, and more.

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Video Companion
Night Shift with the Fort Worth Fire Department | Sleeping Around with Dr. Chris Winter |

13 tips for adjusting to non-regular sleep schedules

What can you do to counteract the negative side effects of shift work? The suggestions below will help you adjust to a rotating schedule and get better sleep during the day if you work the night shift.

  1. Determine your chronotype, or natural sleep proclivity, and see if you can get on a set shift schedule that matches. Working with your chronotype will allow you to be on shift when you naturally feel the most energetic and alert, according to research published in the journal Nature Communications.
  2. If you’re required to rotate shifts, check with your employer about rotating schedules that follow a clockwise pattern. This is what a study published in the International Journal of Environmental Research and Public Health recommends. For example, going from a night shift to an early morning shift is easier than moving from a night shift to an early evening shift.
  3. According to a study in the American Journal of Nursing, incorporating a nap before your night shift or during your break can help you feel less drowsy, especially for tasks like driving home post-shift. Aim for about 30 minutes.
  4. Try for an extra two hours of sleep time after shift work, suggests research published in Endocrine Reviews. This may help realign your circadian rhythm.
  5. Drinking coffee at the start or middle of your shift can help, too, but avoid caffeine closer to your bedtime. You may need a five-hour buffer, since this is how long it takes your body to metabolize half the caffeine in your system, according to the book The Pharmacology of Caffeine.
  6. Melatonin supplementation before bedtime may help you fall asleep easier. In a study in Frontiers in Psychiatry, participants who were shift workers took 6 mg and found they had fewer sleep disturbances. But you might require less. Start with the smallest dose and see what works for you before increasing. Take melatonin about 30 minutes before you want to fall asleep.
  7. Use blue-light blocking glasses for two hours prior to sleep if you need to use electronic devices. According to research in the journal Endocrine Reviews, exposure to artificial bright light before bed can suppress melatonin production.
  8. Unjunk your sleep with blackout curtains, sound machines, and more to help prevent disruptions. Sleep disruptions can negatively affect health and cognitive performance, according to research in the journal Nature and Science of Sleep.
  9. Eating regular, well-balanced meals while you’re awake can also help, suggests research in Endocrine Reviews. But try to limit your eating window to 10 to 11 hours, and avoid eating large meals close to bedtime. These tips can improve your metabolic health, which is closely tied to your circadian rhythms. Your internal clock helps regulate glucose levels and hormone secretion, including insulin and cortisol. Over time, misalignment can lead to insulin resistance, Type 2 diabetes, and cardiovascular disease.
  10. Avoid alcohol, a known sleep disruptor, according to research in the Handbook of Clinical Neurology. Stop drinking at least three hours before bedtime to give your body time to metabolize what you’ve consumed.
  11. Engage in physical activity, which can help with both energy and sleep, but avoid strenuous exercise too close to your bedtime. Exercise may help prevent sleep disruption, but working out right before sleep could increase wake-promoting neurotransmitters like norepinephrine, according to research in Endocrine Reviews.
  12. If you regularly work nights, stick to sleeping during the daytime, even on your days off. This will help you adjust to and remain synced with your night shift schedule. Aim for some afternoon light exposure when you wake, which will serve as your morning light. According to research from the Centers for Disease Control and Prevention, this can help you maintain adequate melatonin release.
  13. Make adjustments to your sleep schedule a few nights in advance of your shift rotation. For example, if you’re switching from a night shift (11 p.m. to 7 a.m.) to an early morning shift (5 a.m. to 2 p.m.), go to bed one to two hours later each day, for two or three days leading up to the shift change. This helps you adjust in the sleep-friendly clockwise pattern mentioned above.

Balancing circadian rhythms with shift work

Unfortunately, detouring from a daytime work schedule can make getting quality sleep difficult, but not all is lost. With the above tips, shift workers can get the shut-eye their bodies need to stay healthy and the rest they need to stay awake and alert at work.

The above tips offer a mix of strategies for preventing shift work sleep disorder. They do this by helping to mitigate insomnia and sleep disruptors. Plus, they help reset your internal clock, even when you’re not in that “9 to 5” life.