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Ten Evidence-Based Countermeasures for Night Shift Workers

June 19, 2020

Written by Aaron Lacy

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To improve safety for patients and the health of night shift workers, implement these personal and institutional countermeasures.

Why does this matter?
We know that those who work night shift have worse daytime sleep, which can lead to major health consequences. Pairing this with fatigue that may affect patient care, it is crucial to make sure we are doing everything we can to mitigate risk to patients and ourselves.

Health > Wealth
The nature of emergency medicine means being staffed and ready 24/7/365, resulting in a large portion of our specialty that works the night shift. We know that the night shift is detrimental to our health, and often times employers offer shift differential as a loose form of ‘hazard pay’ to compensate for this. While there are many tips and tricks to better night-shift health, are they evidence-based or just anecdotal? Work with yourself and your institution to implement these 10 evidence-based countermeasures to improve health for night-shift workers.

  1. Schedule for circadian rhythm – if you have a rotating schedule, rotating in a clockwise fashion (phase delay) leads to better satisfaction, performance, and higher levels of alertness.

  2. Nap prior to night shift – napping before a night shift has been shown to reduce fatigue on shift.

  3. Maximize bright light on shift –exposure to light cues (particularly blue light) on night shift aids wakefulness and increases performance. Have your institution install blue light for night shift workers or bring your own.

  4. Nap on shift (if you can) –napping on shift increases performance, mental agility, and decrease total sleep debt.

  5. Utilize caffeine early in the shift – humans reach their lowest level of alertness and function between 3 and 4 am. Mitigate this by consuming 4mg/kg of caffeine* between 12:20 – 1:20 a.m.
    *Although it varies, an 8-10 ounce cup of regular drip coffee has about 100mg of caffeine. So, you could need 2-3 cups. Drink up!

  6. Avoid large meals – large meals cause surges in leptin, ghrelin, glucose, insulin and fat. These play a critical role in our circadian rhythm. Small snacks throughout the shift prevent large swings and disruption of this rhythm.

  7. Minimize light on the commute home – limiting exposure to bright and artificial light (especially blue light as mentioned above) towards the end of your shift and on the drive home prevents disturbances to circadian rhythm. Use dark or orange tinted sunglasses to both feel and look the best.

  8. Consider melatonin – while the data isn’t steadfast, melatonin has a low side effect profile and has been shown to reduce time to sleep and increase total length of sleep. No dose-response relationship has been reliably described.

  9. Sleep in a dark environment – to avoid circadian rhythm disruption use blackout curtains or a sleeping mask.

  10. Sleep in a cool environment – rapid decline in core body temperature and heat loss is associated with sleep initiation.

Top 10 Evidence-Based Countermeasures for Night Shift Workers. Emerg Med J. 2020 Apr 24;emermed-2019-209134. doi:10.1136/emermed-2019-209134. Online ahead of print.

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One thought on “Ten Evidence-Based Countermeasures for Night Shift Workers

  • I have found melatonin helps substantially with shift time changes. Also requesting that your scheduler line up your nights each month can help. A lot of people seem to take too much melatonin. The therapeutic dose is 100 to 300 mcg. They sell it commonly for 3mg to 10mg. Instead of throwing it away (after learning that) I take small nibbles of the 10 mg tab and let it dissolve sublingually 30 minutes prior to when I want to sleep. Also sleep apps can help. I use Insight timer.

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