Coping with Shiftwork

Think about the last time you were really sick.  You know, that kind of stomach cramping, head throbbing, shivering episode that made you feel like you were being turned inside out.  What’s the one thing, more than anything else, you wanted to do?  That’s right – go to bed, and get some sleep.  It’s the natural thing to do, and your body was craving sleep’s restorative powers. 

For those who are afflicted with disease more severe than a bout with the flu, long, effective periods of sleep are even more crucial.  But as many as 56% of the patients that arrive at the hospital are seriously sleep deprived by the end of their first day at the facility.  And for those who are in the Intensive Care Unit (ICU), the commotion and activity level makes it even more difficult for them to sleep.  It seems that the patients who need the most sleep, get the least.

We all need about 7-8 hours of sleep.  Older people seem to need a little less, but they don’t always get enough of the right kind of sleep.  The same applies to sick people.  To understand how the right kind of sleep is important to the human body, it is important to discuss the various dimensions of sleep.  We know that there are two main types of sleep:  REM (Rapid Eye Movement) and non REM sleep. We travel through all the stages in about 100 minutes, and throughout the night we slip in and out of the stages as if on an escalator.   

In non REM sleep, there are four stages.  Stages 1 and 2 are light sleep, and serve as the relaxation and transition period from being awake to being in deep sleep. Stages 3 and 4 are called “delta” sleep, with Stage 4 being the deepest sleep.  This is when growth hormone is released into our bodies.  Growth hormone promotes protein synthesis, tissue repair, bone growth and red blood cell production.  It also promotes epithelial cell growth, regenerates some of our brain cells, and also helps to generate bone marrow and cells in our gastrointestinal tract.  Wow!  Sign me up for more delta sleep, please. 

Even with a normal sleep pattern, only about 20% of our sleep is delta sleep.  Sixty percent of our sleep occurs in stages 1 and 2, and another 20% is REM sleep, which is characterized by those periods that we remember as dreaming.  REM sleep is important for cognitive function.  When we don’t get enough REM sleep, we are more irritable, restless, and confused.  In severe cases, we could lose emotional stability, have poor impulse control, and suffer from paranoia.  Yikes. 

Getting back to the ICU, some folks in the health care industry are finally addressing the fact that patients need prolonged periods of sleep in order for them to undergo all the critical stages that are necessary for body and mind regeneration.  This of course is the delta and REM sleep we’ve discussed.

So what is being done in hospitals for this to happen? 

First of all, sound levels are being muted during the night.  It has been shown that noise (besides interrupting sleep) raises blood pressure, causes irritability, and generally works against healing.  Additionally, health care providers working under noisy conditions experience the same symptoms!

Other improvements to the hospital environment include the overall layout – the central station location, traffic flow, and individual temperature control for patients’ rooms are designed to promote patient’s comfort.  Unnecessary noises (such as emptying trash containers, etc.) are reduced, and the lighting levels are subdued at night.  Conversely, lighting levels are bright and cheery during the day as patients are awake.  It has been found that keeping the circadian systems of patients on an even keel promotes healing and well being of all involved. 

These measures describe what progressive, “smart” hospital administrators are implementing.  There are still many who refuse to break free from the dark ages, but as more and more evidence suggests the miraculous healing powers of sleep, it should make sense for them to respond accordingly.

What does this mean for shiftworkers?  I think the answer is obvious, and at the risk of redundancy, we should all remember, shiftworkers or non shiftworkers, that getting enough sleep is crucial – actually, critical – for a lifetime of fulfillment, enjoyment, and good health.  It’s one of the most important things we can do for ourselves.  Shiftworkers must carve out large portions of their non-working hours to getting prolonged sleep.  

What are some of the ways that we can get those prolonged periods of sleep where we undergo the critical REM and delta patterns?  Well, I’m glad you asked.  Here is a review of some of the things we’ve discussed in previous articles, and they apply to shiftworkers and non-shiftworkers alike:

1. Keep your bedroom dark and quiet when you sleep.
2. Use your bed only for sleeping and sex.
3. Maintain a consistent sleep schedule as much as possible.  On your days off, try to sleep at times as close as possible to those of your working days.
4. Maintain a consistent exercise routine.  Don’t exercise immediately before going to bed.
5. Subject yourself to bright light after waking up, and to low lighting levels before you go to sleep.
6. Keep your work area bright to promote alertness.
7. Eat only small meals and healthy snacks if you’re working nights.
8. Take naps to supplement sleep loss.  Don’t nap for more than an hour, and not within four or five hours of your main sleeping period.
9. Stay hydrated, and stay away from caffeine and nicotine for four to six hours before trying to sleep.

Sources:

Christiane M. Dives-Kalinowski, “Promoting Sleep in the ICU.”  Dimensions of Critical Care Nursing, 1995. 

Anonymous.  “Shhhh – Healing Zone.” People’s Medical Society Newsletter, Allentown PA.  June 2001.

Kris Wetherbee.  “The Strain of Sleeplessness.”  Town and Country.  July 2001. 

Mechelle Williams.  “Critical Care Unit Design – A Nursing Perspective.”  Critical Care Nursing Quarterly.  November 2001.

Danielle Argenti, “Mastering Your Circadian Rhythm,” American Fitness, Jan/Feb 2002.