Shift Work

Ten of the Most Common Mistakes Shift Workers Make

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The root of our problems: a lack of good information

Have you ever received formal training on how best to cope with shift work?

I would wager the majority of shift workers have not. I’ve had one short information session since starting in this line of work – and that was over ten years ago. Not only that, but the information provided was lacking, dated, and in some cases just flat out wrong. Unfortunately I didn’t know this at the time.

It’s common knowledge that shift work comes with a greater risk of poor health. The unnatural schedule leads to increased incidence of cardiovascular disease, gastrointestinal, metabolic, and reproductive dysfunction, obesity, and cancer.

Shift workers are also more susceptible to errors in the workplace – errors which put themselves, coworkers, patients, etc. at greater risk.

In light of this, why isn’t training that teaches us to lead healthy lives and better manage our schedules mandatory? Or, at the very least, why isn’t training more common?

Almost every occupation with known risks requires formal training before workers are allowed to perform their duties.

Let’s take working at heights for example. No responsible employer puts a new hire on the job without first providing fall-arrest training. And while the risks of shift work are less obvious, and the consequences more delayed, they are no less real. The evidence is so strong that the World Health Organization has classified shift work as a probable carcinogen.[1]

In the absence of employer-provided training, new shift workers must resort to advice from others with shift work experience; advice that is not always very helpful, or healthful.

Let’s take a look at some of the top mistakes shift workers make, along with examples of poor advice to watch out for.

1. Not prioritizing sleep

Solid sleep is often hard to come by for shift workers, but if you don’t even give yourself the opportunity for adequate sleep, you’ve already lost.

The nature of shift work means missing out on a lot of social events and other activities. To keep the schedule from interfering too much, many try to compensate by sacrificing sleep; embodying an “I’ll sleep when I’m dead” mentality.

I was guilty of this when first starting shift work. I’d regularly stay out late with friends on weekends. This despite the fact I was the only one who worked the next day – and a twelve-hour shift at that. I’d also try to fit far too much in the time between night shifts; such as a round of golf.

Increased responsibilities (and age) restrain me from that sort of behaviour these days. And although I’m not immune to Netflix’s ability to delay sleep times, I now make much more time for sleep.

Sleep deprivation and increased health risks

There is no magic number that applies to everyone, but most scientists consider sleep deprivation as anything less than seven hours. Even just a single night of sleep loss causes a number of problems:

Reduced concentration
Reduced learning ability and memory
Irritability
Anxiety
Reduced reaction time
Increased risk of accidents and injuries
Increased risk of infections such as colds and flu

And when you regularly sacrifice sleep, you increase your risk of many health issues, including:

Cancer
Alzheimer’s disease
Heart disease
Stroke
Depression
Poor fertility
Weight gain
Diabetes

Simply put, there is no aspect of our health that isn’t negatively impacted by a lack of sleep.

Allowing enough time for sleep every day is the first step to minimizing these risks.

2. Eating around the clock

Along with neglecting sleep, this is another one I was guilty of, I just didn’t know any better. Given the nature of shift work, it’s easy to see how round-the-clock eating happens.

Many people eat breakfast as soon as they get up, simply because it’s what they’re accustomed to. Shift work, unfortunately, often comes with extremely early start times, forcing people who begin their day with food to eat earlier than normal. I recently spoke with one such shift worker whose breakfast habit has him eating at 4:00am before each dayshift.

The increased use of twelve-hour shifts also leads workers to delay dinner time, so they can share the meal with their families.

Night shifts result in longer eating windows as well. I’ll use my past behaviour as an example:

Eat “breakfast” around seven before going to bed.
Eat again upon waking (usually around two in the afternoon).
Proceed to eat a big meal and multiple snacks throughout the night.

This is the extremely unpopular 7/17 diet for anyone familiar with intermittent fasting.

What’s even worse, I’d often feel hungry during the night (or day) and find myself unable to sleep. This resulted in a trip to the kitchen, where I’d eat a banana or protein bar before returning to bed.

This was actually in line with advice I got from the only employer-sponsored education on shiftwork-health I’ve ever received. I was told to keep crackers by the bedside in case hunger interfered with sleep.

Not only are crackers one of the most nutrient-devoid foods you can buy, but this pattern of eating is a direct contradiction to modern literature on circadian rhythms and fasting.

The solution: Time-restricted eating

I first discovered the health risks associated with this pattern of eating through the work of Satchin Panda. Panda is a professor at the Salk Institute for Biological Studies and one of the world’s leading experts on circadian rhythms.

For good metabolic health, Panda recommends eating all calories within a set window of time each day; typically eight to twelve hours. This is referred to as time-restricted eating (TRE). And while twelve hours is the suggested maximum, smaller eating windows may offer greater health benefits, especially for individuals who are already unhealthy.

Smaller eating windows allow more time for the body to rest and perform critical repair processes.

To date, most of the proven benefits of TRE have come from animal models, but evidence for benefits in humans is mounting.

Benefits of time-restricted eating

Lower blood cholesterol
Lower fasting blood sugar
Lower body weight
Lower body fat
Lower levels of inflammation

Improved cardiac function
Improved sleep
Improved endurance
Improved motor control
Improved energy expenditure

Panda’s studies also revealed that most people aren’t even aware of their eating window length. While most participants claimed to eat everything within twelve hours, collected data showed the average window to be around fifteen hours.

If you would like to begin tracking your eating/fasting windows, I urge you to check out the mycircadianclock app. Through this free app, which also offers feedback, you can participate in Satchin Panda’s ongoing study on TRE in humans.

Participants in the study report losing weight, sleeping better, and feeling more energetic during the day.

3. Delaying sleep following night shifts

A former coworker once rationalized this by saying “you don’t go to bed as soon as you get home from dayshift, so why would you go to bed immediately after a night shift?”

I never did take his advice. I was so tired after most night shifts that I couldn’t imagine forcing myself to stay up any longer.

Though I thought it sounded reasonable at the time, this is a bad idea for a couple of reasons.

First, delaying sleep following a night shift causes sleep to occur at an even more inappropriate time.[2]

People who fly all over the world know they experience more jet-lag the more time zones they cross. Postponing daytime sleep by three hours is the equivalent of crossing three time zones – and these are in addition to the nine or so you already “crossed” by working night shift.

Secondly, the goal of this strategy – assuming you have a goal – is to delay your circadian clock, so sleep occurs closer to work start times. But postponing sleep also leaves you with increased exposure to morning light. Bright light at this time of day has been shown to advance circadian rhythms. This is the opposite of what you’re trying to do and will make quality sleep harder to come by.

Family life may force you to compromise on this. I’m not suggesting you neglect such responsibilities. Just know that the longer you delay sleep, the greater the circadian disruption.

Note: If you work a permanent night shift schedule, and your circadian rhythms have fully adapted, delaying sleep may actually be a viable strategy. However, full circadian adaptation is unlikely. I cover this in greater detail here: Permanent night shift: Is it better than a rotation?.

4. Neglecting social life

This is the one I’m currently most guilty of. Although I make lots of time for family, other social activities often take a back seat. With work schedules limiting opportunities for social events, it’s easy to lose touch.

A limited social life may seem inconsequential compared to other items on this list; but research has shown relationship quality to be an important predictor of good health.

A lack of social support and poor relationship quality significantly increases your risk of depression.[3] Social isolation has also been shown to increase risk of illness and early death.[4] Strikingly, this increased risk is on par with other known risk factors such as high blood pressure, obesity, lack of exercise and smoking.[5]

Married life and children

Shift work can also cause strain on family life. US researchers published a 2004 paper that looked at 3476 married couples.[6]

In the absence of children, couples appeared to cope with shift work schedules quite well. But with the introduction of children, the risk of separating increased significantly.

Among men with children, who had been married less than 5 years, working nights made separation or divorce more than six times more likely relative to working days.

Among women with children married more than 5 years, working nights increased the likelihood of separation or divorce by three times.

I offer two possible explanations for this. First, the addition of children places an even greater strain on the already handicapped sleep of shift workers. Second, the presence of children makes it more difficult to carve out time for the couple – time that is crucial to maintaining communication and fostering the relationship.

The bottom line is this: make time for family and friends. It is important for both your well-being and the well-being of your family.

The National Sleep Foundation provides some good strategies for this here: https://www.sleepfoundation.org/shift-work-disorder/shift-work-you/how-manage-shift-work-and-your-social-life

I also recommend coupling social with other important activities, such as exercise, for more efficient use of time. Joining a recreational sports team is one good example. Which brings us to the next common mistake…

5. Neglecting physical activity

Shift work schedules generally limit opportunities for exercise, particularly participation in sports and other time-of-day dependent activities. And for those who work a rotating shift schedule, creating a routine around physical activity is an even greater challenge.

Sleep deprivation among shift workers is another factor; exercise seems much less enticing when you’re constantly tired.

With all these obstacles to overcome, it’s easy to let physical activity fall by the wayside.

The benefits of regular physical activity

The benefits of exercise are well established. As shift work is associated with poorer health, physical activity is a key part of reducing your risks. Many of the benefits are direct counters to the negative risks of shift work:

Helps control weight
Reduces your risk of heart disease
Helps manage blood sugar and insulin levels
Improves your mental health and mood
Helps you maintain cognition as you age
Reduces your risk of some cancers
Improves your sleep
Increases your chance of living longer

There is also some evidence that individuals who regularly engage in physical activity are better able to tolerate the stresses of shift work.

Regular physical activity can improve the sleep quality and duration of shift workers.[7], [8] One way it affects sleep quality is by increasing the amount of slow wave sleep (SWS).[9] SWS is thought to be important for brain restoration and recovery.

How to fit exercise into your shift work schedule

Exercise doesn’t have to consist of daily, hour-long gym sessions. There are many ways to incorporate physical activity into your day without disrupting your schedule too much. Any amount of exercise is better than none.

Make efficient use of your time with 20-30 minutes of high intensity interval training (HIIT).
Try to incorporate walking into your work day and take the stairs instead of the elevator.
Do bodyweight exercises, such as pushups and body squats, randomly throughout the day when you have time.
Workout at home instead of the gym. The money saved over a gym membership will quickly pay for the equipment needed, and the time saved not travelling to and from the gym will increase your adherence.
Check out the book Body by Science. It details and prescribes the minimum effective dose for exercise: a weekly, twelve-minute, high-intensity strength training session.

The wrong time to exercise

I would advise against exercising at a time that leads to further disruptions of your circadian rhythms.

For example, if you have to get up extremely early for a dayshift, don’t get up even earlier just to fit in a workout. Same for exercising after a night shift (see mistake #3). Also, try to exercise at least three hours before sleep, allowing time for your body temperature and heart rate to come down.

6. Not having a basic understanding of circadian rhythms

Although I was familiar with circadian rhythms when first starting shift work, I didn’t have much of an understanding of the science.

Every organ, tissue and almost every cell in the body follows a circadian rhythm. Through this fact alone, it is clear that some basic knowledge can greatly improve our ability to navigate our schedules.

There is an ideal time of day for almost everything. Although shift workers are disadvantaged compared to someone working nine to five, there are many actions we can take to minimize circadian disruption.

But in order to know what actions to take, we must first understand the activities and environmental cues that affect our rhythms.

Regulating our circadian rhythms

Light/dark exposure (light has the most power to synchronize/shift circadian rhythms)
Sleep/wake patterns
Food intake
Ambient temperature
Physical activity
Social interaction
Medications

It’s important to know how timing changes the way each of the cues affects our rhythms. For example, exposure to bright light in the first half of the night delays our rhythms, whereas exposure during the latter half advances them.

Interactions between different cues is also something to be conscious of. The effect of supplemental melatonin, for example, is enhanced when light exposure is avoided (and can be completely negated when it’s not).

7. Not owning blue-light-blocking glasses

This one ties into the mistake above and understanding the huge effect light has on our circadian rhythms.

The increased health risks in shift workers are thought to be a result of nighttime light exposure and its effect on the biological clock. Unfortunately there is not much we can do to change our lighting environment. Shift workers have little control over workplace lighting and are regularly forced into opposition with the sun.

Experts on sleep and circadian rhythms, such as Matthew Walker and Satchin Panda, recommend limiting light exposure starting three hours before bed – and certainly during the last hour. This darkness is necessary for the body to start producing melatonin, the hormone responsible for the onset of sleep.

It is important to note, however, that these recommendations are for a typical dayshift schedule. Individuals working night shift may benefit from avoiding bright light for the entire second half of the night, preventing a circadian phase advance.

Blue-light-blocking glasses have emerged as a simple tool to protect yourself from the melatonin suppressing effects of blue light. They can help you adapt to a night shift schedule[10] and have been shown to increase sleep quality and duration.[11], [12]

All of the mistakes we’ve talked about so far require behaviour modification to correct. Anyone who has tried to break a bad habit, or form a good habit, is familiar with the struggle involved. Blue-light-blocking glasses, on the other hand, are an easy intervention and well worth the investment.

I’m a big fan of the BON CHARGE (Formerly BLUblox). They offer more protection than most brands as well as a wide range of stylish frames.

Note: Not all so-called blue-light-blocking glasses are effective when it comes to nurturing circadian rhythms. In fact, many have no effect at all. For information to help you pick glasses that actually improve adjustment to shift work, read Why every shift worker needs blue-light-blocking glasses.

8. Failing to plan for retirement

Although this is a growing concern for almost everyone, it is even more costly for shift workers. Shift work is associated with decreased life expectancy[13], and there is evidence to suggest tolerance for shift work goes down as we age.[14], [15]

As tolerance for shift work is highly individual, there is no specific age after which you should avoid night shifts. However, to minimize health risks, the earlier we stop working nights the better.

How exactly to accomplish this is beyond the scope of this blog, but you’ll want to place a high priority on saving and investing. Simply put, the more money you can set aside for retirement, the earlier you can retire.

Make an appointment with a financial advisor. They can tell you how much you’ll need for retirement and help you plan accordingly.

Improved finances can also enable a transition to a lower paying dayshift job; a great option for those who want to remain in the workforce without the rigors of shift work.

For some, delaying retirement may be less about finances and more about what to do with the newly found time. It’s important to have hobbies and interests outside of work to keep your mind and body engaged after retirement.

“A goal without a plan is just a wish.”

– Antoine de Saint-Exupéry

Instead of wishing you’ll be able to retire at a chosen age, make a plan and take action. And while you’re at it, plan what you’ll do in the absence of shift work as well.

9. Caffeine abuse

Caffeine is a great tool for coping with the struggles of shift work. It increases alertness, concentration, and mood, and can even help us adapt to night shifts.

But if you’re not strategic about its use, caffeine can cause more problems than it solves.

Shift workers are notorious for drinking coffee throughout their shifts. Some even have one final cup to help with the commute home. There are a couple of issues with this pattern of consumption.

Timing of caffeine intake

Caffeine remains in your system well after its energy boosting effects have worn off. With a half-life of five to six hours, you’ll want to avoid caffeine too close to bedtime.

One study found that even when administered six hours before bed, caffeine reduced total sleep time by more than an hour. As expected, administration closer to bedtime had even worse effects.[16]

What’s more interesting, with caffeine at six hours out, the participants didn’t even notice the negative effects. The fragmented sleep was only picked up by monitoring electrical activity in the participants’ brains.

These findings demonstrate that, even for those who claim they can drink a cup of coffee and go right to sleep, caffeine near bedtime is a bad idea.

Excessive consumption

The other issue relates to the amount.

Regularly consuming large quantities of caffeine leads to increased tolerance and dependence. When this happens, caffeine no longer enhances performance and is instead necessary just to bring you back to baseline. A vicious cycle ensues where higher tolerance is fought with ever increasing amounts of (sleep disrupting) caffeine.

Limited ability to compensate for sleep loss

Caffeine can help you perform after a single night of poor sleep, but it can’t make up for chronic sleep loss.

This was demonstrated in a 2017 study where participants were sleep restricted for five days. They were then given a three day recovery period where they were allowed eight hours of sleep per night.[17]

Caffeine initially helped participants maintain alertness, but was no longer effective by the fourth day.

The researchers also tested caffeine’s effect on wakefulness. Multiple times a day, the participants were asked to lie down in a dark room, but try to remain awake. In this setting, caffeine’s ability to keep the participants awake was gone after just the second night.

Additionally, the caffeine group was slower to return to baseline during the sleep recovery period, further demonstrating caffeine’s negative effect on sleep.

If you want to experience caffeine’s positive effects, the less you use it, and the more calculated you are with timing, the better.

10. Believing alcohol is a sleep aid

In today’s health conscious environment, I would have thought this assumption to be a thing of the past. However, a 2017 study out of Australia reported that one in six shift workers use alcohol as a sleep aid, at least occasionally.[18]

As alcohol is a depressant, such an assumption is not unfounded – but it is harmful.

The consumption of alcohol leads to more fragmented sleep. This is a result of increased sleep disturbances in the later stages of sleep, as the alcohol wears off.[19] Alcohol also causes a decrease in REM sleep, which is necessary for emotional well-being and is believed to play a role in memory consolidation and learning.

There is also evidence that alcohol increases symptoms of sleep apnea, even in those who have no pre-existing condition.[20] This finding is especially relevent to shift workers, as the severity of obstructive sleep apnea is significantly higher during daytime sleep.[21]

For better sleep, avoid both the nightcap and the post nightshift drink.

Final thoughts

It’s not the training we shift workers so sorely need, but understanding these common pitfalls will help us to better navigate our abnormal schedules.

Featured photo by Javier Molina on Unsplash

References:

Thrive, No Matter What Your Schedule Looks Like

HealthShift is a weekly email offering the best physical, mental, and financial health resources for shift workers.

No Spam. No Fluff. No Charge. Unsubscribe anytime.

Disclaimer: This blog is for general informational purposes only and is not intended as medical advice. As shift work is a vague term that incorporates many different schedules, the content of the blog may not be applicable to an individual’s particular situation. Users should seek medical advice from a qualified healthcare professional for any medical condition they may have.

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Ten of the Most Common Mistakes Shift Workers Make

HealthShift is a weekly email for shift workers. Get the best physical, mental, and financial health resources delivered straight to your inbox.

The root of our problems: a lack of good information

1. Not prioritizing sleep

Sleep deprivation and increased health risks

Recommended reading

2. Eating around the clock

The solution: Time-restricted eating

Benefits of time-restricted eating

Recommended reading

3. Delaying sleep following night shifts

4. Neglecting social life

Married life and children

5. Neglecting physical activity

The benefits of regular physical activity

How to fit exercise into your shift work schedule

The wrong time to exercise

6. Not having a basic understanding of circadian rhythms

Regulating our circadian rhythms

Recommended reading

7. Not owning blue-light-blocking glasses

8. Failing to plan for retirement

9. Caffeine abuse

Timing of caffeine intake

Excessive consumption

Limited ability to compensate for sleep loss

10. Believing alcohol is a sleep aid

Final thoughts

References:

Thrive, No Matter What Your Schedule Looks Like

HealthShift is a weekly email offering the best physical, mental, and financial health resources for shift workers.