Southwest Journal of Pulmonary, Critical Care and Sleep

Heidi M. Lammers-van der Holst, PhD

Audra S. Murphy, BS

John Wise, BS

Jeanne F. Duffy, MBA, PhD

Division of Sleep and Circadian Disorders

Department of Medicine

Brigham and Women’s Hospital

Boston, MA USA

Sleep is more important now than ever.

Getting enough sleep is a challenge for those who work nights even in the best of times, because our bodies are designed to be at rest during the night and awake and active during the day. Whether you are an experienced shift worker or new to shift work, the added stress from the COVID-19 pandemic has likely made sleep even more challenging over the past weeks.

Sleep does more than just make us feel better the next day. It allows us to pay close attention, remember new information, and multi-task. Over the long term, insufficient sleep can also impair our health, weakening our immune system, increasing inflammation, and leading to increased vulnerability to viral illnesses. Given how important sleep is for our safety, health, and quality of life, the following tips are designed to help those who work at night sleep their best.

Sleep tips for night shift workers.

Plan for sleep! Build time for sleep into your daily schedule, and try to keep your sleep schedule the same each day as you work a series of night, evening, or day shifts.
If you are on permanent nights, try to keep regularity in your sleep patterns even on days off.
When working nights, try to shift your sleep so you wake up close to the start of the next night shift, rather than going to sleep as soon as you get home in the morning. Alternatively, split your sleep so that you sleep for a few hours when you get home in the morning and then take an extended nap that ends just before you have to go back to work the next night.
Improve your sleep environment; keep your bedroom cool, dark, and quiet. Use an eye mask or blackout shades, and wear earplugs or try a white noise machine or app. If you live with family or roommates, let them know when your sleep times are so they can try not to disturb you.
If you have to keep your phone with you while sleeping, avoid checking it if you wake during your sleep episode.
If you are sleeping in a new environment, try to make it as comfortable as possible. Bring your pillow, favorite pajamas, slippers, etc. from home to make your new environment as comfortable and sleep-friendly as possible.
Practice a soothing pre-bedtime routine, such as taking a warm shower or writing down stresses from your day; this will help you to unwind and tell your body ‘it’s time to sleep’.
Use caffeine (coffee, cola, energy drinks) at the beginning of your shift, but avoid caffeine 3-4 hours before you want to go to sleep.
Avoid alcohol before bedtime. While it might help you fall asleep, it will reduce the quality of your sleep and may make it more likely that you wake up early.
Melatonin may help promote daytime sleep, but should be taken carefully because at the wrong time it may worsen sleep problems. Seek the advice of a sleep specialist for when and how much melatonin to take, and where best to obtain it.

Sleep, alertness, and safety for night shift workers.

Shift workers are at high risk for having a drowsy driving accident while commuting (especially when commuting home in the morning after a night shift). Consider taking a short nap in your car before heading home. If you are driving and begin to feel drowsy, pull into a rest area or parking lot and take a short nap before continuing.
Be aware that if you are new to shift work, or you are working longer hours than usual, you may be more likely than usual to make an error or have an accident while at work.
While you are at work, try using small amounts of caffeine every 1-2 hours to help remain alert. This can be more effective than a large amount of caffeine only once or twice per shift.
A short bout of exercise can make you feel more alert for the next hour or so.
If possible, take a short (15-20 minutes or so) nap during your break time.
Try a “coffee nap”! If you are very sleepy, drink a coffee (or other caffeinated drink) and immediately take a short (15-20 minutes) nap. By the time you wake up, the caffeine will have had a chance to act, and combined with the nap it should keep you going for the next couple of hours.

Additional information and help.

Shift Work Disorder, a kind of circadian rhythm sleep-wake disorder. You should seek help from a sleep specialist if your symptoms persist for 3 months or longer. Find a sleep specialist at http://sleepeducation.org/find-a-facility.
Information on fatigue among healthcare workers from the CDC/ NIOSH can be found at the following link: http://blogs.cdc.gov/niosh-science-blog/2020/04/02/fatigue-crisis-hcw/
General information about sleep health can be found here: http://healthysleep.med.harvard.edu/

The authors are supported by grant R01 AG044416 from the National Institutes of Health.

Cite as: Lammers-van der Holst HM, Murphy AS, Wise J, Duffy JF. Sleep tips for shift workers in the time of pandemic. Southwest J Pulm Crit Care. 2020;20(4):128-30. doi: https://doi.org/10.13175/swjpcc024-20 PDF