Trying to figure out the best way to conform to the night shift? Sleep on it.

Sleep is like air: it is taken for granted until there is not enough of it. This is not news to many of the estimated 22 million Americans working evening, swing, rotating, or on-call shifts, where lack of traditional sleep patterns can create very real problems.

Known as shift work sleep disorder (SWSD), the common set of symptoms brought on by working “off” hours is characterized by excessive sleepiness during the evening’s work shift, coupled with insomnia during the hours reserved for rest.

According to the American Academy of Sleep Medicine’s International Classification of Sleep Disorders-2, SWSD is suspected when these symptoms associated with the shift-work schedule persist for at least 1 month.

How much is enough?
So just how much sleep is required to avoid SWSD? The short answer is “it depends.” Most sleep experts agree the average adult requires between 7 and 9 hours1 of sleep in order to maintain an adequate level of alertness.

During this time, the body rests, rebuilds, and restores—and the brain gets busy, using the physical dormancy as an opportunity to recharge. Typically, individuals will cycle between REM stage sleep and four stages of non-REM sleep every 90 minutes. Stages 3 and 4 of non-REM sleep are typically referred to as slow-wave, or delta, sleep. It is during these phases of deep sleep that the biggest benefits are realized.

Without it, the body suffers and the ramifications extend far beyond simply dozing off in front of a monitor. Sleep deprivation is linked to a myriad of health concerns, including obesity, high blood pressure, and gastrointestinal diseases.2

“Studies also show an increased risk for stomach ulcers and sleepiness-related accidents,” says Muhammad A. Sayed, MD, medical director, Cascade Valley Sleep Disorders Center, Arlington, Wash. “Shift workers can suffer from short-term memory disturbances, decreased overall mental ability, and headaches, as well as poor overall sleep quality.”

It also takes a toll emotionally. According to the National Sleep Foundation, ongoing fatigue can decrease productivity and bring on negative moods and behavior—feelings that can be compounded by a sense of segregation.

“You start to feel so isolated from the rest of humankind, because the world is going on without you,” says Theresa Shumard, North American manager of sleep strategic planning for DeVilbiss Sleep Therapy, Longmont, Colo, and a veteran of the night shift. Shumard recommends making time for social events for the sake of sanity. “It’s a day-shift world so it’s important for night techs to network; it helps them to feel part of that community.”

Making Due
Addressing the physical consequences is not as easy. In most cases, SWSD can be completely eliminated only by reverting back to a “work days, sleep nights” schedule. For those whose jobs rule out the option of working days, hope is not lost.

“Improving the overall environment at your workplace is instrumental,” says Sayed, who recommends installing bright lights and maintaining a cool atmosphere throughout the night. Such minor changes are often achievable by coordinating with an employer and coworkers. “We don’t want to freeze anyone, but cooler is better because when you feel warm, you want to go to sleep.”

Maintaining Continuity
“If you work a night shift 5 nights a week, you don’t want to change your sleep schedule during the weekend,” Sayed advises. “Otherwise, you basically end up having to readjust to the night shift every week.”

Shumard agrees. “After I had completely turned into a night shift person and was getting the proper amount of rest, I kept that schedule all the time, staying up as late as possible while still having a family life.”

She admits the conversion to being a “night shift person” did not come easy, and sleeping during the day presented a unique set of challenges.

“It was like an obsession to get darkness into my life,” Shumard recalls. “I had darkening shades and those didn’t work. I’d put up foil on the windows ... I’d see one little crack of light coming through and it would bother me.” To help combat constant distractions, Shumard recommends employing eyeshades, which can also aid in blocking out noise. “When I started using those, I managed to be asleep before [any noise] started, and then it wouldn’t wake me up.”

Repetition Helps
Just as personal hygiene is important in the care and maintenance of our bodies, sleep hygiene holds many of the same benefits. A consistent bedtime routine—whether it be light reading or a warm bath—signals to the brain that it is time to gear down and prepare itself for rest.

“General sleep hygiene will maximize sleep quality,” Sayed says. “Go to bed only when you feel sleepy, do not sleep outside the bedroom, and use your bedroom for sleep only.” Sayed also advises against the consumption of caffeine, nicotine, or alcohol within 6 hours of bedtime.

These techniques should help diminish the adverse side effects felt when initially adjusting to a new schedule; however, if SWSD symptoms are severe or do not recede, consulting with a sleep specialist could help rule out a more serious, underlying health condition.

“First, you need to get a diagnosis, then decide if you need to do something more than the basics,” Sayed says. “We highly discourage any over-the-counter approaches, because it is never a good idea to just diagnose and treat yourself.”

By working with a medical professional, it is possible to address the situation methodically. Beyond the standard sleep hygiene techniques, other measures such as bright light therapy—an attempt to “reset” the biological clock with artificial light—or pharmacological stimulants can be initiated to regulate the sleep/wake cycle.

Not Just for Toddlers
When dealing with SWSD or any sleep disorder, one irrefutable fact must be acknowledged: there is no substitute for sleep. But that does not mean it has to come in a single stretch.

“The power nap can make a real difference,” Sayed says. “Sleeping for 20 minutes to a half hour helps a lot.”

Think napping is the sole domain of tantrum-prone 2 year olds? Guess again. British statesman, prime minister, author, and nap-enthusiast Sir Winston Churchill once said, “Don’t think you will be doing less work because you sleep during the day. That’s a foolish notion held by people who have no imaginations.”

It has been said that during World War II, Churchill would rarely sleep an entire night, instead taking several naps throughout the day. Other famous nappers include Leonardo Da Vinci, Albert Einstein, and Thomas Edison. Yet, modern society disdains the concept, often judging those who partake as lazy and ineffective, despite evidence to the contrary.

Sara Mednick, PhD, a research scientist at the Salk Institute for Biological Studies, La Jolla, Calif, concurs that a 20-minute nap can increase alertness, improve physical dexterity, boost stamina, and lower stress.4 Studies show naps can reduce crankiness and enhance brain performance. Additional benefits include improved heart function, increased alertness, and strengthened memory retention.

Reap the most nap rewards by resting at the same time each day and limiting the session to 30 minutes (or less). Longer periods allow the body to lapse into deep sleep, from which waking is difficult.

“Napping is very critical, and we’re so against it in this country that we deny ourselves,” Shumard says. “We let ourselves use the restroom, have lunch and other necessities, but we don’t allow for our most basic need: sleep.”

Dana Hinesly is a contributing writer for Sleep Review.

References
1. National Sleep Foundation Web site. Available at: http://sleep foundation.org/hottopics/index.php?secid=10&id=94. Accessed June 3, 2005.
2. National Sleep Foundation Web site. Available at: http://sleep foundation.org/hottopics/index.php?secid=9&id=33. Accessed June 3, 2005.
3. National Sleep Foundation Web site. Available at: http://www.sleep foundation.org/sleeptionary/index.php?subsection=basics&id=20. Reviewed by Christopher Drake, PhD, on April 6, 2005. Accessed June 3, 2005.
4. Metronaps Web site. Available at: http://www.metronaps.com/about/science_faq.php. Accessed June 3, 2005.