How to stay healthy while working on a night shift
Working late hours can turn even a dream job into a health nightmare.
For Ravi (name changed), a software engineer, working remotely for international companies was a dream coming true. However, the irregular work timings with late nights to match the time zones of his clients soon began to take a toll on his health. Besides growing increasingly dependent on caffeine to stay awake through the night, he was also experiencing migraines, anxiety, and mood swings.
Studies suggest that night shift workers are at around 30% higher risk for mental health conditions, such as depression and anxiety, which in turn can affect their personal and professional life. Several studies also show that a nocturnal work schedule increases the risk of developing physical ailments such as diabetes, obesity, and heart disease.
Moreover, rotating night shifts with inconsistent work schedules can even cut your life short.
A case in point is an extensive 22-year study showing a higher risk of death from cardiovascular diseases and cancer in nurses who worked rotating shifts for at least five years. The study also found that those working for over 15 years on rotating night shifts had a 38% higher risk of dying from heart conditions, 25% from lung cancer and 33% from colon cancer death than the nurses who only worked during the day.
So, how bad is the night shift for your health? Well, so much so that the World Health Organization has even classified shift work as a likely carcinogen.
Yet, for many – especially those in essential work such as healthcare and law enforcement –. working nights is mandatory. Also, in today’s competitive job market, even acquiring a job requires many to upskill themselves during the day while burning the midnight oil at work or in part-time night shift jobs to pay off debt, make ends meet, or afford a better lifestyle.
Research shows that one out of five workers globally is now involved in shift work.
Night shift work is typically a shift between sunrise and sunset or one outside the regular 9 am to 5 pm period.
So, is the night shift good for health in any way at all? While some folk claim to be more creative in the wee hours of the morning, research shows that our mind is not “designed” to work after midnight.
Moreover, night shifts particularly disrupt our 24-hour internal “body clock”, also known as the circadian rhythm. This body clock tells our brain when to get up for the day and when to call it a night and sleep. This schedule also helps us regulate our body temperature, heart rate, and digestive system.
Night shifts disrupt this circadian system by going against our natural sleep patterns. As a result, there is a greater risk of developing serious health issues such as shift work sleep disorder (SWSD).
“Working non-traditional shifts interferes with the body’s circadian rhythms,” says sleep expert Jessica Vensel Rundo, MD, MS as reported by Cleveland Clinic. “Most of us are awake during the day because our body’s internal clock is keeping us awake. So no matter how tired you are after working all night, your awakening signals will conflict with your desire to sleep.”
SWSD is a circadian rhythm sleep disorder that affects people who follow non-traditional work hours. Effects of SWSD include excessive sleepiness or insomnia during sleep times.
Treatment of SWSD includes lifestyle changes, melatonin, CNS stimulants, light therapy, and medication.
Besides SWSD, night shift health effects include:
· Depressed mood
· Substance use
· Impairments in cognition
· Suicidal ideation
On physical health
· Risk of heart attack and heart disease
· High cholesterol levels
· High blood pressure
· Above normal sugar levels
· Risk of diabetes
· Risk of peptic ulcers
· Risk of nausea, diarrhoea, and constipation
· Risk of cancer
Studies show that shift work can also result in a higher risk of complications during delivery as well as premature and low-weight babies, fertility issues, endometriosis, and irregular and painful periods.
Here are some tips on developing certain habits to make the most of their work schedule:
· Follow a diet
A recent study reveals that eating only during the day may reduce the health risk associated with night shifts. The researchers found that eating after waking up at night negatively affected insulin levels during the night shift schedule, but eating during the daytime did not. This is a great find to keep insulin levels in check, as insulin signals cells to take in glucose and diabetes results from difficulties in processing insulin.
· Exercise at the right time
Shift work can reduce opportunities for physical activity. Moreover, for shift workers who can exercise, working out at unusual times can cause significant biological responses. Hence, besides exercising, when you exercise matters. Research reveals that exercise training before a night shift work can improve physical work capacity and reduce arterial stiffness.
Night shifts can disrupt sleep, time with loved ones, meal timings, and more. All of which can cause extreme stress on both physical and mental health. Research shows that positive coping from stress can include problem-focused methods such as time management strategies. Managing stress could also include emotion-focused methods such as mindfulness, relaxation, and seeking emotional support from colleagues or friends.
· Take naps and breaks
Research shows that a prophylactic nap or a nap for a few hours before the night shift, followed by caffeine intake, helps improve nocturnal alertness and performance. A particular study on the health of nurses on night shows that restorative napping during night-shift breaks helps improve energy, mood, decision-making and vigilance.
· Maintain a social life
It is no secret that a good social life can benefit our physical and mental health. Several studies show consistent evidence that links poor quantity or quality of social ties with health conditions such as the development and worsening of cardiovascular disease, recurring myocardial infarction, atherosclerosis, high blood pressure, cancer and delayed cancer recovery, and even slower wound healing.
· Set boundaries
Yes, developing a healthy social life is essential, but so is purposefully spending time alone with the intention of self-care. It’s about finding the right balance. Hence, it’s also a good idea to let people in your social circle know when you are available and when you are not. Moreover, you could also request family members or roommates to assist you in getting better sleep by reducing noisy household activities such as vacuuming or watching TV on high volume to a later time. While it may take time to set boundaries, the overall benefits to your mental and physical health are worth the effort when you are a shift worker.
· Develop healthy sleep habits
Even limited exposure to light during the day can disrupt sleep patterns. A study found that nurses in a workgroup prone to sleep issues associated with shift work used effective coping strategies such as installing light-darkening shades and using telephone-answering machines and white noise to facilitate better quality and quantity of sleep.
While it would be ideal for everyone to work during the day and have a good night’s sleep, saying no to the night shift is not possible for everyone. The good news is that there is growing research to reduce the negative health issues associated with shift work.
If you or someone you know needs assistance to stay healthy while working a night shift, reach out to a mental health professional. You can browse our directory of treatment centres across India here.
Chellappa, Sarah L; Qian, Jingyi; Vujovic, Nina; Morris, Christopher J; Nedeltcheva, Arlet; Nguyen, Hoa; Rahman, Nishat; Heng, Su Wei; Kelly, Lauren; Kerlin-Monteiro, Kayla; Srivastav, Suhina; Wang, Wei; Aeschbach, Daniel; Czeisler, Charles A; Shea, Steven A; Adler, Gail K; Garaulet, Marta; Scheer, Frank A J L (2021) Daytime eating prevents internal circadian misalignment and glucose intolerance in night work. Science Advances. https://www.science.org/doi/10.1126/sciadv.abg9910
Chellapa, Sarah (2020) Circadian misalignment: A biological basis for mood vulnerability in shift work Wiley Online Library https://onlinelibrary.wiley.com/doi/10.1111/ejn.14871
Gu, Fangyi; Han, Jiali; Laden, Francine; Pan, An; Caporaso, Neil E; Stampfer, Meir J; Kawachi, Ichiro; Rexrode, Kathryn M; Willett, Walter C; Hankinson, Susan E; Speizer, Frank E; Schernhammer, Eva S (2015) Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts. American Journal of Preventive Medicine. https://www.ajpmonline.org/article/S0749-3797%2814%2900623-0/fulltext
Schäfer, Christine; Mayr, Barbara; Müller, Edith E; Augner, Christoph; Hannemann, Juliane; Böger, Rainer H; Schönfelder, Martin; Niebauer, Josef (2020) Exercise training prior to night shift work improves physical work capacity and arterial stiffness. European Journal of Preventive Cardiology. https://academic.oup.com/eurjpc/article/27/8/891/5924925
(2020) Night Shift Work IARC Monographs on the Identification of Carcinogenic Hazards to Humans. https://pubmed.ncbi.nlm.nih.gov/33656825/
Brown, Jessica P; Martin, Destiny; Nagaria, Zain; Verceles, Avelino C; Jobe, Sophia L; and Wickwire, Emerson M (2020) Mental Health Consequences of Shift Work: An Updated Review. https://link.springer.com/article/10.1007/s11920-020-1131-z
How Do Nurses Cope with Shift Work? A Qualitative Analysis of Open-Ended Responses from a Survey of Nurses Int J Environ Res Public Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843180/
Tubbs, Andrew S; Fernandez, Fabian-Xosé; Grandner, Michael A; Perlis, Michael L; and Klerman, Elizabeth B (2022) The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology Frontiers in Network Physiology https://www.frontiersin.org/articles/10.3389/fnetp.2021.830338/full
Jyotirmayee, Bahinipati; Rajlaxmi, Sarangi; Mona, Pathak; Srikrushna, Mohapatra (2022) Effect of night shift on development of metabolic syndrome among health care workers https://journals.lww.com/jfmpc/Fulltext/2022/05000/Effect_of_night_shift_on_development_of_metabolic.17.aspx
Landis, Tullamora T; Wilson, Marian; Bigand, Teresa; Cason, Moriah (2021) Registered Nurses’ Experiences Taking Breaks on Night Shift: A Qualitative Analysis https://journals.sagepub.com/doi/10.1177/2165079920983018
Leso, Veruscka; Gervetti, Paola; Mauro, Sara; Macrini, Maria C; Ercolano, Maria L; Lavicoli, Ivo (2020) Shift work and migraine: A systematic review Journal of Occupational Health. https://onlinelibrary.wiley.com/doi/10.1002/1348-9585.12116
Schwartz; Jonathan R L; Roth, Thomas (2012) Shift work sleep disorder: burden of illness and approaches to management. Drugs. https://link.springer.com/article/10.2165/00003495-200666180-00007
Bonnet, M H; Arand D L(2007) The use of prophylactic naps and caffeine to maintain performance during a continuous operation. Ergonomics. https://www.tandfonline.com/doi/abs/10.1080/00140139408963714
McMillan, Diana E; Fallis, Wendy M (2011) Benefits of napping on night shifts. Nurs Times. https://pubmed.ncbi.nlm.nih.gov/22165560/
Torquati, Luciana; Mielke, Gregore I; Brown, Wendy J; Burton, Nicola W; and Kolbe-Alexander, Tracy L (2019) Shift Work and Poor Mental Health: A Meta-Analysis of Longitudinal Studies. American Journal of Public Health https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2019.305278
Umberson, Debra; Karas Montez, Jennifer (2010) Social Relationships and Health: A Flashpoint for Health Policy. Journal of Health and Social Behaviour https://journals.sagepub.com/doi/10.1177/0022146510383501
James, Stephen M; Honn, Kimberly A; Gaddameedhi, Shobhan; Van Dongen, Hans P.A. (2017) Shift Work: Disrupted Circadian Rhythms and Sleep—Implications for Health and Well-Being. Current Sleep Medicine Reports. https://link.springer.com/article/10.1007/s40675-017-0071-6
Fernandez, Renae C; Moore, Vivienne M; Marino, Jennifer L; Whitrow, Melissa J; Davies, Michael J (2020) Night Shift Among Women: Is It Associated With Difficulty Conceiving a First Birth? Frontiers in Public Health https://www.frontiersin.org/articles/10.3389/fpubh.2020.595943/full
(2020) How You Can Sleep Better If You Work the Night Shift. Cleveland Clinichttps://health.clevelandclinic.org/how-you-can-sleep-better-if-you-work-the-night-shift/
Prescott Dixon, Lisa (2020) The Impact of Spending Time Alone on Emerging Adults’ Mental Well-Being chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=1017&context=familyperspectives
Erren, Thomas C; Morfeld, Peter; Grob, J. Valerie; Wild, Ursula (2019) IARC 2019: “Night shift work” is probably carcinogenic: What about disturbed chronobiology in all walks of life? Journal of Occupational Medicine and Toxicology https://www.researchgate.net/publication/337585343_IARC_2019_Night_shift_work_is_probably_carcinogenic_What_about_disturbed_chronobiology_in_all_walks_of_life