Analysis

How to survive night shifts: advice on protecting your health and well-being

Sleep expert Steven Lockley’s tips to help you establish good routines around night shifts

Sleep expert Steven Lockley’s tips to help you establish good routines around night shifts

  • Working nights disrupts individuals’ circadian rhythms, which can lead to health problems and fatigue
  • Why eating at night, relying on caffeine as a stimulant and using alcohol to get to sleep should all be avoided – and what to do instead
  • Find out the sleep hygiene habits that can counter some of the harmful effects of night shifts

Working night shifts is a fact of life for some 3.25 million people in the UK, according to a 2019 analysis by the Trades Union Congress (TUC), and this includes many nurses and nursing students.

Sleep expert Steven Lockley’s tips to help you establish good routines around night shifts

  • Working nights disrupts individuals’ circadian rhythms, which can lead to health problems and fatigue
  • Why eating at night, relying on caffeine as a stimulant and using alcohol to get to sleep should all be avoided – and what to do instead
  • Find out the sleep hygiene habits that can counter some of the harmful effects of night shifts
Picture: Annette Taylor-Anderson

Working night shifts is a fact of life for some 3.25 million people in the UK, according to a 2019 analysis by the Trades Union Congress (TUC), and this includes many nurses and nursing students.

But working through the night can be exhausting and can have short and long-term health impacts, affecting individuals’ circadian rhythms.

Which health and care staff are most likely to work night shifts?

Care staff account for the majority, according to the TUC report, with 432,000 working nights, followed by nurses and midwives, with the figure at 232,000.

What are circadian rhythms and how are they affected by night shifts?

Humans have a 24-hour body clock, controlled by the brain, that regulates our circadian rhythms. Circadian rhythms are 24-hour cycles that affect essential functions and processes, including eating, temperature, metabolism and immune function. One of the most important circadian rhythms is the sleep-wake cycle. Humans are diurnal, which means that the clock promotes activity and high performance in the day and sleep at night.

External factors or cues such as daylight, mealtimes, clocks and working hours help to regulate this sleep-wake cycle and play an important role in keeping our bodies in step with the world around us, says the Health and Safety Executive.

Shift work, particularly night work, goes against this natural cycle and can disrupt these rhythms – especially our ability to sleep – which can lead to health problems and fatigue.

3.25 million

people in the UK work night shifts

Source: Trades Union Congress

How much rest am I legally entitled to between shifts?

All workers, including nurses, are entitled to a rest period of at least 11 consecutive hours in each 24-hour working period and an uninterrupted rest of at least 24 hours in each seven-day period.

Rest is not the same as sleep when it comes to reducing fatigue, however. Getting at least seven hours’ sleep a day, every day, should be a priority, according to sleep expert Steven Lockley, from the University of Surrey’s Surrey Sleep Research Centre.

Steven Lockley

What are the health impacts of night shifts?

These can be broken into long and short-term impacts, says Professor Lockley, who is a vice-chancellor fellow at the University of Surrey.

Short-term risks are related to sleepiness, accident or injury and error – for example, increased risk of needle-stick injury at work or a driving accident on the commute home.

Sleepiness is thought to be the cause of up to one in five accidents on major roads in the UK and a significant contributing factor in about 3,000 road deaths each year, the HSE says. An RCN survey of almost 400 nurses published in April 2021 found that 74% feel unsafe to drive after a nightshift and 30% have had a near miss or accident while driving home.

There is also an increased risk of errors being made by staff who are tired, which ultimately affects patients.

‘Adjusting your body clock to sync with night shifts is rarely possible, given time off and family and social commitments, and so shift work will always have a negative impact’

Steven Lockley, vice-chancellor fellow, the University of Surrey’s Surrey Sleep Research Centre

There is some evidence associating long-term exposure to shift work with gastrointestinal problems such as indigestion, abdominal pain, constipation, chronic gastritis and peptic ulcers, cardiovascular problems such as hypertension and coronary heart disease, and increased susceptibility to minor illnesses such as colds, flu and gastroenteritis. It has been linked to reproductive problems in women and there is a possible link with breast cancer, the HSE says.

In addition, shift work may exacerbate existing health problems such as diabetes, asthma, epilepsy and mental illness.

‘There is no doubt that night shifts are harmful,’ Professor Lockley says. ‘While people talk about adjusting their body clock to sync with their night shift, it is rarely possible, given time off and family and social commitments, and so shift work will always have a negative impact.’

Picture: iStock
Visit our free well-being centre

What is the best way to sleep after a night shift?

Go to bed as soon as possible after you get home from a shift, before your circadian rhythm gives you a ‘second wind’, says Professor Lockley. Do not potter around doing household jobs or checking emails, or start watching television.

Get into bed, with earplugs and an eye mask, in a bedroom that is as dark and peaceful as possible, he says. If it is noisy, a white-noise machine can help block out sounds.

‘Turn off your phone and make sure you get into bed – don’t fall asleep on the sofa,’ he says. ‘The longer you wait the harder it will be to get to sleep. You want to be as comfortable as possible and emulate your night-time sleep as much as possible, so that you get high quality sleep. Sleep for as long as you can.’

Professor Lockley also advises having a nap in the afternoon or evening before a night shift, particularly the first night shift in a sequence, to help maximise alertness during the night.

‘Get into bed for this one too and try to get 20-45 minutes of good quality sleep. It doesn’t have to be long to get some benefit.’

For those struggling to sleep during the day, taking melatonin can help. Melatonin is a hormone that helps to regulate the circadian rhythms. A synthetic version of it is non-addictive and relatively safe but requires a prescription, Professor Lockley says.

Picture: iStock

232,000

nurses and midwives in the UK on night shifts

Source: Trades Union Congress

Should I be eating lunch at midnight when I am on a night shift?

Humans have evolved to eat in the day, and the body digests food less well at night.

Professor Lockley says research shows that if a meal is eaten at 1am, it will lead to higher levels of fats, insulin and glucose in the blood than if the same meal was eaten at 1pm, including in shift workers.

This means that people who eat large meals at night regularly will be putting themselves at higher risk of cardiometabolic diseases, such as obesity, diabetes and heart disease. Sleep-deprived people also eat more and are drawn to unhealthy food when tired, increasing further the risk of eating at night.

While evidence on the best approach is still emerging, Professor Lockley suggests eating a good meal as early as possible before a night shift and avoiding eating at night.

‘Try and get the majority of calories earlier on in the waking period,’ he says. ‘If you have to eat in the middle of the shift, I suggest a high-protein, lower carbohydrate meal or snacks, such as protein bars. Then have a small high-protein breakfast before going to sleep, so that you’re not woken by hunger.’

Picture: iStock

What about caffeine consumption?

A cup of tea or coffee will be a part of many nurses’ routines to keep them going on a night shift, but caffeine is a strong stimulant that should be used cautiously when working at night, says Professor Lockley.

‘The caffeine you take at 10am is going affect your sleep that night,’ Professor Lockley says.

While the best approach is to avoid altogether, if you do want to consume caffeine, Professor Lockley says to avoid the urge to have a huge cup of strong coffee in one go before you start your shift.

‘The best approach is little and often,’ he says. ‘Small amounts of caffeine taken regularly, for example half a small cup of tea or coffee, or half a can of regular soda every 1-2 hours, is sufficient to maximise alertness. This keeps the caffeine level in your blood steady, while reducing the negative impact on sleep.

‘Caffeine has a long half-life, however, and so you should stop consuming it about six hours before you want to go to bed. Some people insist that caffeine doesn’t affect their sleep, but it will. Caffeine always affects sleep, even if you don’t realise it.’

11

consecutive hours of rest time in a 24-hour period is what workers are entitled to between shifts

Source: gov.uk

What about using alcohol to get to sleep?

Alcohol is sometimes used as a sleep aid, but this is not a good approach. Alcohol reduces deep sleep, leaving you feeling tired even after a long period of sleep, and will often make you wake up to go to the toilet.

Does lighting have an effect on alertness at work?

Research suggests that changing the light in hospitals, especially at the nursing station or in the break room, boosts alertness for night staff. The light should be bright, ‘cool-looking’ blue-enriched light (often described as having a higher colour temperature of 5000K or above).

A recent study by Professor Lockley showed that installing such lights reduced serious medical error rates in an intensive care unit by more than a third, although overall error rates were not changed.

‘This is an inexpensive, drug-free, safe and easy way to increase alertness,’ says Professor Lockley. ‘Many studies have shown the benefits of blue-enriched white light in offices, classrooms and other places where people need to be awake and alert.’

Care should be taken not to expose patients to this light at night, as it will disrupt their sleep. The increased alertness overnight might also make it more difficult for nurses to sleep when they get home, but will help them get home safely and make fewer mistakes at work, he added.

Finding the balance between staying safe overnight and getting meaningful rest during the day is difficult, Professor Lockley says, but by prioritising sleep and maintaining good sleep hygiene, some of the risks of shift work can be reduced.


Further information


Sign up to continue reading for FREE

OR

Unlock full access to RCNi Plus today

Save over 50% on your first three months:

  • Customisable clinical dashboard featuring 200+ topics
  • Unlimited online access to all 10 RCNi Journals including Nursing Standard
  • RCNi Learning featuring 180+ RCN accredited learning modules
  • NMC-compliant RCNi Portfolio to build evidence for revalidation
  • Personalised newsletters tailored to your interests

This article is not available as part of an institutional subscription. Why is this?

Jobs