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Quick Fixes for Rapidly Rotating Shift Work

It’s your third night shift in a row. Your eyelids are growing heavy so you reach for another cup of coffee. Fast forward and you’re home in bed, tossing and turning. Here’s how to break this vicious cycle.

This information is intended for general educational purposes only and should not be taken as personalized health advice. It should not replace visiting your health professional.

In an ideal world, shift workers would have long stretches of nights to allow their bodies to adjust. But this isn’t reality. ER doctors often do a solitary night shift amid their days and evenings. Meanwhile, other healthcare workers are often rotating through a confusing series of days, evenings, and weekends. 

When you’re stuck on rapidly rotating shifts, there are some ways to prevent fatigued shifts and restless sleep. The effect of these measures is temporary for most people, so they will not completely help you flip your nights and days. (Permanent night-shift workers: read here to learn about reprogramming your internal clock!).


Quick Fixes to Stay Awake

Shift workers deal with sleepiness on nights in a variety of ways. Coffee and baked goods are a long-held tradition in most industries. But are there better ways to stay awake at night? Let’s review some common and evidence-based ways to help keep alert and on the ball at night. 

Caffeine 

Caffeine is a popular stimulant drug enjoyed the world over. It may improve night-shift alertness and performance. Unfortunately, for many, consuming caffeine too close to bedtime can also cause sleeping problems during the day, and then more sleepiness on the next shift. 

Tips:

  • Many night-shift workers recommend a small cup of coffee (or other caffeinated beverage) before work, or a small amount of caffeine early on in the shift. 
  • Some sources recommend small amounts of caffeine more often, rather than one large dose all at once. 
  • Try to avoid caffeine five to six hours before bed. If you’re having trouble sleeping, stop caffeine eight hours before bed.
 

Prescription stimulants

Prescription non-amphetamine stimulants have been studied since the 1970s for those struggling with shift work sleep disorder, as well as other specific sleep disorders, such as sleep apnea, narcolepsy, and hypersomnia.

Modafinil is a prescription stimulant that is approved for shift-work sleep disorder in Canada. Modafinil may help reduce sleepiness and improve work performance. Side effects include headaches, stomach or bowel upset, and an inability to relax. People who are or may become pregnant should not take modafinil. Also, to date, there are very few studies about the long-term safety of this drug.

Tips: 

  • If you are experiencing significant sleepiness due to shift work and nothing is working, speak to your doctor about a prescription for modafinil.
  • Everyone reacts differently to medication. It’s ok to gather anecdotal evidence when making your decision, but proceed with caution, especially if something sounds too good to be true.
 

Naps

Napping before or during a shift may provide a small improvement in alertness and performance. On the other hand, some studies show that napping during a shift may be a concern due to the phenomenon of sleep inertia. This is the grogginess that happens when we wake from a nap, and it is most severe at night. Some studies even show that performance immediately after a nap is slightly worse.

Tips:

  • During shift, if you are able to nap, try to keep it between twenty to forty minutes.
  • If possible, nap during the earlier part of the shift (ie, midnight to 3 a.m.). 
  • To combat the post-nap grogginess, try a caffeine nap! This is when you consume caffeine right before napping and sleep for about twenty to thirty minutes.
 

Bright light

Shining a bright light in your face can help you feel more awake and alert. Exposing yourself to light at the right time can also help you shift your circadian rhythm so that it better lines up with your night-shift schedule. So not only can it help you sleep better during the day, but it can also improve how you feel at work.

But be cautious with bright lights before bed—basking in bright sunlight or staring at a screen can make it harder to sleep.

Tips: 

  • There are lots of different light products on the market—try a light box or light mask.
  • Shift work sleep disorder experts recommend fifteen minutes of bright light exposure every hour during the first half of your shift.
 
 

Quick Fixes for Falling Asleep

We all know the frustration of lying awake, tossing and turning. Then multiply that by a thousand when it’s time to sleep but the sun is coming up and the birds are chirping. Here’s a review of some of the evidence for techniques to help you fall asleep faster after a long night shift.

 

Melatonin

Melatonin is a hormone naturally produced by our brains when it starts to get dark outside, and it tells us when to get sleepy and when to wake up. It is also sold as an over-the-counter supplement in Canada. Studies show that melatonin (at low doses) may help people who struggle to sleep during the day after a night shift.

On the other hand, many studies show that melatonin does not significantly improve sleep quality or quantity, and many night-shift workers are not able to cope with their schedule’s demands with melatonin alone.

Tips: 

  • Most sleep experts recommend low doses of melatonin (0.5–3 mg) to help shift the internal clock and to help with falling asleep. 
  • To optimize your sleep and circadian cycle adaptation to nights, take melatonin 30 minutes before sleep when you get home in the morning. 
  • Melatonin is a supplement, which means it is not held to the same standard as prescription meds. Talk to your doctor before starting melatonin to discuss its effects and possible side effects.
 

Sleeping pills

Sleeping pills (also called sedatives or hypnotics) may be prescribed to shift workers struggling to sleep during the day. Many doctors only recommend sleeping pills once all other avenues (like sleep hygiene and melatonin) have been tried.

Prescription sleeping pills can help some people fall asleep faster and increase the number of hours of sleep (however, this is not always the case). Unfortunately, many experience worsened sleepiness at work due to the sedating effects of these pills. Some sleeping pills can also impair workplace alertness and performance.

Tips: 

  • Speak to your doctor for more information on sedatives or sleeping pills.
  • Often, a short course of sleeping pills is best as they can become habit-forming.
 

Exercise

Exercise may help shift the circadian rhythm. Early morning exercise tends to move the circadian rhythm earlier (so you fall asleep earlier), whereas evening exercise tends to move the circadian rhythm later (so you fall asleep later). Short periods of exercise during night shift can help your internal clock line up with working nights.

Tips:

 

Restrict light

Just as bright light helps us feel more awake, darkness signals to our brains that it’s time to sleep. Exposure to bright light close to bedtime can push your circadian rhythm later, meaning you may fall asleep later than intended.

Tips: 

  • Avoid bright light later in the shift, if possible. 
  • Avoid bright sunlight on the drive home by wearing dark sunglasses with blue-light-blocking lenses (and don’t drive home if you feel very tired).
  • Ensure your sleeping space is as dark as possible, using black-out curtains or blinds and a sleeping mask.
 

Try combining some of these tips to maximize your wakefulness. Click here to learn about ways to optimize your sleep during the day, or here for ways to reprogram your internal circadian clock for working nights.

Last updated: 2024-01-15

Picture of Emma Farley, MD CCFP

Emma Farley, MD CCFP

On her journey to become a physician, Dr. Emma Farley worked many nights shifts caring for patients while balancing a heavy study workload. As a medical writer and editor at Night Shift Wellness, she creates practical and evidence-based articles for readers.

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