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Sleep guidelines for shift workers

Stop trying to adapt standard sleep advice to your non-standard sleep and wake patterns. The Healthy Sleep Practices for Shift Workers guidelines explain how to achieve healthy sleep patterns, whether on permanent night shift or a rotating roster. 

Lead author of the research Alexandra Shriane, a former paramedic for Queensland Ambulance Service and shift worker herself, suggests that nurses, midwives and students of the professions can adapt these strategies for their own use. 

“… there’s no silver bullet … to sleep and shift work. But you can implement half a dozen strategies that help to reduce the burden of fatigue.” 

It takes practice (shift work can be hard)

Ms Shriane advises student and early career nurses and midwives to put the guidelines into practice as you enter the workforce and experience shift work and night duty for the first time. 

Shift work is demonised but people love their jobs and we need people to do shift work, says Ms Shriane. 

“What we need is people to feel ok with struggling and know they can do something about it…It’s important not to feel failure if you can’t adapt [to shift work].”

Guideline 1. Make sleep a priority

Reschedule social activities and household tasks where possible, and tell friends, family, and neighbours of your sleep schedule. 

Guideline 2. Aim for 7–9 hours of sleep per 24 hours 

Some nurses and midwives push through on 4 to 5 hours sleep, but research shows we need 7 to 9 hours. It can be made up in multiple sleeps – you might sleep for 4 hours and then have a couple of naps. (Only hours asleep count – not the time you spend in bed).  

Guideline 3. Develop a sleep schedule

Schedule sleep on your roster and lifestyle. Try to maintain a similar sleep schedule for each shift type (e.g. Bedtime A for day shifts, Bedtime B for afternoon shifts, etc.).  Add up your sleep to 7 to 9 hours total over 24 hours. 

Guideline 4. Develop a bedtime routine 

Find activities that help you wind-down and feel relaxed. Practise them before bed in a dimly lit and quiet environment. This can help you get to sleep.

Guideline 5. Plan your transition to days off 

When transitioning to a block of days off, particularly after working late/night shifts, try a short sleep in the morning then go to bed earlier than your usual bedtime. Some sunlight after waking in the morning can help your body clock realign to the day-night cycle. 

Guideline 6. Try napping

Short naps of 15 to 20 minutes help you stay alert. Longer naps of 90 minutes can reduce sleep debt. Naps less than 15 minutes are of little benefit, while naps longer than 20 minutes may make you groggy (see ‘sleep inertia’). Avoid longer naps in the 4–6 hours before your main sleep or you may struggle to get to sleep. 

Guideline 7. Consider sleep inertia

This is a period of grogginess immediately after waking. You are not fully alert and your performance can be impaired. This feeling lasts 15 to 30 minutes typically, but can last up to 2 hours. Avoid high-risk tasks (e.g. driving, operating machinery) during this time. 

Guideline 8. Create a comfortable sleep environment

Aim to sleep somewhere that is comfortably cool (16–20ºC), ventilated, dark and quiet. Some people find white noise helpful. 

Guideline 9. Use your bed for sleep and intimacy 

Avoid mentally stimulating activities in bed such as playing video games or working on a laptop. Sharing your bed with others (e.g. pets) may disturb your sleep. 

Guideline 10. Limit light exposure 

Exposure to bright light before bed can impact your sleep. Try to limit exposure where possible. Wear sunglasses on the way home after night shift, or turn down device screen brightness. 

Guideline 11. Consider caffeine intake 

Caffeine can help to improve alertness and performance before and during your shift. However, the effects of caffeine can last for several hours, often longer than you think, and vary greatly between people. Keep in mind that caffeine too close to your bedtime may impact your sleep. 

Guideline 12. Consider nicotine consumption 

Avoid nicotine entirely, or limit nicotine intake in the 6 hours before bed. 

Guideline 13. Avoid alcohol at bedtime

Avoid alcohol as part of your bedtime routine. Some people feel that alcohol helps them fall asleep. However, drinking alcohol close to bedtime, even in small amounts, limits your REM restorative sleep.

Guideline 14. Understand the effects of medication 

Some medications are stimulants. If you can, avoid taking them near bedtime. Some natural substances, like melatonin, can be helpful for shift workers experiencing sleep problems. Sleep-inducing medications (i.e. sleeping tablets) should usually only be used for short-term or intermittent relief of sleep problems. Find a supportive GP who understands the lifestyle and health of shift workers. 

Guideline 15. Consider food intake 

Where possible, limit food intake during night shifts, and if you do eat, opt for smaller, lighter meals. Don’t go to bed hungry, as this may negatively impact sleep, but choose a lighter meal before bed that won’t cause indigestion or discomfort. 

Guideline 16. Consider fluid intake 

It’s important to maintain hydration by drinking plenty of water; however, avoid too much fluid before bed, as this may lead to sleep disturbances to use the toilet. 

Guideline 17. Exercise regularly 

Exercise around your shift schedule and lifestyle. Research shows that exercise at night doesn’t disrupt sleep for most people; however, it’s also important to spend time winding down before bed. 

Guideline 18. Develop strategies for sleep problems 

If you’re unable to sleep, get out of bed and do something relaxing in a quiet, dimly lit environment. Try to limit screen time and clock-watching and go back to bed once you’re feeling sleepy. If sleep problems occur more than 3 times/week for several weeks in a row, seek advice from a healthcare professional.

References 

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