Sleep and Shift Work Disorder in the Time of COVID-19

By Robon Vanek, APRN, CNP

With the stress of the Covid-19 pandemic, caregivers can experience both physical and emotional exhaustion. Restorative sleep as a means of caring for oneself fortifies one’s reserves. Both shift work and long shifts can be challenging in the best of times. With the added strain of our current environment, it is possible that even those who previously tolerated shift work and long shifts could develop shift work disorder. The American Academy of Sleep Medicine and sleep research provides us with some guidance on how to approach shift work. Here are some important recommendations to improve your sleep and wakefulness on the job.

Get 7 to 9 hours of sleep.

Prioritize consistently obtaining 7 to 9 hours of sleep every day. Six hours or less of sleep for the majority of people will lead to sleep deprivation. A National Health Interview survey identified that in all occupations, 30% of those surveyed were obtaining six or fewer hours of sleep each night. In the healthcare and social assistance industries, 52.3% of those surveyed had this amount of short sleep duration.1

Utilize strategic napping.

The highest level of recommendation from the American Academy of Sleep medicine is to use planned napping before or during the night shift to improve alertness and performance when working at night.2

When to nap: Before, during and prophylactic nap before driving home from work when needed are all great times to nap.

How long to nap: Before night shift, 90 minutes to three hours; during night shift or before drive home from work, 15 to 30 minutes.

How to nap at work: Consider this, caffeine before or directly after a nap can address sleep inertia (that groggy feeling when you wake from a nap), which is more likely to occur between 2 a.m. and 5 a.m. when we are at our coolest body temperature and also at our sleepiest.

What are the barriers to napping at work? Workload, unstable patients, lack of a comfortable place to nap and fear that management doesn’t support napping are the primary barriers. There may be nights when it is not feasible to nap, but none of these are insurmountable barriers.

Understand melatonin and light exposure.

So, what’s up with melatonin and blue light exposure? And why shouldn’t I look at my phone in bed? Light exposure to the eyes suppresses the secretion of the hormone melatonin, which is responsible for helping us to feel sleepy throughout the night. Use light exposure to promote alertness during your shift and avoid light exposure after work when you want to fall asleep. After a work shift if you are feeling sleepy, do not drive home immediately. Either take a short nap before driving or have a member of your household pick you up.

Food and medications can help.

To promote sleep: There are dietary sources of melatonin. Pistachios are one of the highest dietary sources of melatonin. Just seven nuts contain an equivalent to 1 mg of melatonin. There are also both short and sustained-release melatonin tablets available. The lowest effective dose is recommended. It is best to not exceed 3 mg to 6 mg.

Wake-promoting agents: Research shows that 100 mg of caffeine upon awakening decreases the time of sleep inertia, restoring reaction time more quickly when compared to placebo.3 Caffeine has an average onset of 30 minutes. And FYI, a 16-ounce Starbucks brewed coffee has 330 mg of caffeine. You can also see a sleep specialist if you are interested in prescription medications to help with wakefulness or sleep.

Create an environment for daytime sleep (if you work nights).

Use blackout curtains or an eye mask to block light. Use white noise or ear plugs to block noise disruptions. Post “do not disturb” signs on doors at home. Advise your family and friends of shifts that include working at night and ask them not to disturb you unless necessary during hours dedicated to daytime sleep. Set the do not disturb feature on your phone. You can identify favorites in contacts of those who can still call when this feature is activated, such as your children or their school. If you need to look at your phone, activate the blue light blocking feature on the iPhone or download the blue blocking app for the Android phone.

Practice good sleep habits.

Develop a routine that works for you such as drinking chamomile or another nighttime tea, having a light meal, taking a warm bath or doing progressive muscle relaxation. Research also shows that aroma inhalation therapy (such as lavender oil) can positively improve shift worker’s sleep quality.4

Ok, let me say this gently. Maybe Fifi or Fido should not be in the bedroom. Pets can be quite disruptive to sleep. If they can’t behave, they should not be in the bedroom. I’ve heard it all, my baby is old and needs to go outside a number of times each night, or he will just cry outside my door. Yes, they can be our “fur babies,” but be strong and discipline yourself. You are their support system, so you must take care of yourself. Do the best you can with this right now. Sometimes we do need that closeness in times of increased stress.

Two more resources.

You can actually earn CME credits and learn how to best approach shift work on the National Institute for Occupational Safety and Health (NIOSH) website. This is a great resource for information on sleep and wakefulness for people who work night shifts and longer shifts.5

For more ideas on how to fall asleep faster, read about natural remedies on Cleveland Clinic Health Essentials.

References

1. Luckhaupt SE, Tak S., Calvert GM. The prevalence of short sleep duration by industry and occupation in the National Health Interview survey. Sleep 2010; 33(2): 149-159.
2. Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007; 30(11):1445-1459.
3. Newman RA, Kamimori GH, Wesensten NJ, Picchioni D, Balkin TJ. Caffeine gum minimizes sleep inertia. Percept Mot Skills 2013; 116(1):280-293.
4. Kang J., et al. Sleep quality amonth shift-work nurses: A systematic review and meta-analysis. Applied Nursing Research. (2019); https://doi.org/10.1016/j.apnr.2019.151227.
5. Caruso CC, Geiger-Brown J, Takahashi M, et. al. NIOSH training for nurses on shiftwork and long work hours. DHHS (NIOSH) Publication No. 2015-115. Cincinnati, OH: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 2015. http://www.cdcgov/niosh/docs/2015-115.