A pathway to a healthier you

Sleep strategies for shift workers

Guidelines on sleep for shift workers, including midwives and nurses, were released early in 2023.  

Published in academic journal SLEEP, the Healthy Sleep Practices for Shift Workers research paper outlines 18 clear guidelines to ensure healthy sleep patterns, whether on permanent night shift or a rotating roster. And they have the consensus of sleep experts around the world.

Adapt sleep advice for you – everyone is different

Lead author of the research and CQUniversity PhD candidate Alexandra Shriane, a former paramedic for Queensland Ambulance Service and shift worker herself talks with the NMHPA on how nurses, midwives and students can adapt these strategies for their own use. 

“I think it’s important to normalise the struggle of getting adequate sleep and experiencing fatigue when you’re a shift worker – there is this culture of pushing through. We need to have strategies so that we don’t just soldier on, so that we can be a safe practitioner. 

 “The strategies are based on a huge wealth of scientific evidence and will work for most people – but everyone is different, and we hope the guidelines adapt around workers’ different shift schedules, lifestyles, and commitments,” she said. 

Until now, there has been inconsistent advice to help shift workers sleep, and many have been trying to adapt standard advice to their non-standard sleep/wake patterns, Ms Shriane said. 

“We acknowledge there’s no silver bullet or big ticket item to sleep and shift work. It’s one of those things that’s outside the control of shift workers. But you can implement half a dozen strategies that help to reduce the burden of fatigue from shift work.” 

Practice better sleep from the start of your career 

While most of the feedback from nurses and midwives on the guidelines so far is that they are common sense, the resource is particularly pertinent for students, and early career nurses and midwives, Ms Shriane said. 

“The research is about joining the dots and condensing the expert knowledge. It is a good resource for those entering the workforce and exposed to shift work and night duty for the first time. So that it doesn’t take them five years through trial and error to work out what works for them. These suggestions can help students and early career nurses from the outset.”

Follow these useful tips 

Some useful tips in the guidelines, according to Ms Shriane: 

Reassess ideas about caffeine 

People are surprised that we recommend that it’s ok to drink caffeine at night. Caffeine is demonised for those in the traditional sleep/work pattern. The literature suggests not to have caffeine in the afternoon. But for night shift workers, it is a useful fatigue management tool - if it keeps you alert and safe, then use it. 

Try napping

The literature advises people in traditional sleep/work patterns not to nap during the day. For shift workers, however short naps (15–20 minutes) can boost alertness and performance, while longer naps (90 minutes) can reduce sleep debt. Some trials/organisations have experimented with ‘napping rooms’ while doing night shift. But you do need to consider sleep inertia.  

Understand sleep inertia

On waking, shift workers may experience sleep inertia - a period of grogginess, where alertness and performance are impaired. This feeling typically lasts 15–30 minutes after waking but can last up to two hours. This can be a dangerous time for nurses and midwives if they’re groggy after waking. 

Add up hours of sleep

Research consistently shows shift workers get less quality sleep than the rest of the population, with many only managing less than 6 hours a day. Shriane says the evidence shows people need 7-9 hours. We know that some nurses and midwives push through on 4-5 hours but the evidence is overwhelming – 7-9 hours is what we need. But you can make it up in multiple sleeps you don’t have to do it in one go. You might sleep for 4 hours and then have a couple of naps. And it’s the number of hours asleep not the time you spend in bed.  

Choose medications that suit your routines

The advice is to use medications under medical or other health professional guidance. There are newer classes of medications now such as Stillnox which are much better in terms of safety profile. 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. If you don’t have a supportive GP, it might be time to consider finding another GP – we really need to be paying attention to the health of shift workers and realising they have different lifestyles to the general population. 

Think about foods and amounts

There’s no specific advice on what people should eat, as cultural factors also come into play. The advice is around timing and calorific intake. Research shows that fasting on night shift is beneficial in terms of offsetting the risk of diabetes and obesity. Restrict your calories to 500 or less but for those who work longer night shifts this might not be feasible - we don’t want people collapsing. Try to maintain your energy levels with healthy snacks to mitigate metabolic syndrome. Don’t go to bed hungry or it will disrupt your sleep. Instead, choose a lighter meal that leaves you feeling satisfied but won’t cause indigestion or discomfort. 

Avoid alcohol

Avoid alcohol as part of your bedtime routine. Some people feel that alcohol helps them fall asleep and will have a couple of drinks before they go to bed. But it’s a trap. Drinking alcohol close to bedtime, even in small amounts, interferes with your sleep quality. You might drift off to sleep easier but it limits your REM sleep which means you have a lighter sleep and nowhere near the restorative sleep required. 

Relax into the ‘struggle’ - it’s individual for you 

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

“What we need is people to feel ok with struggling and know they can do something about it. Some people have genes that help them adapt better to doing shift work, others struggle. It’s important not to feel failure if you can’t adapt [to shift work]. 

While guidelines focus on the individual, Ms Shriane said all stakeholders need to come to the table including governments and employers to acknowledge and discuss strategies for the health and wellbeing of shift workers. 

“Buy in from employers will see increased productivity and increased job satisfaction and retention of staff. At the end of the day, the responsibility for health and safety of staff doesn’t stop when they walk out the door. We need to invest in better health and wellbeing for staff for their safety and that of the public who they care for.” 


Alexandra E Shriane, Gabrielle Rigney, Sally A Ferguson, Yu Sun Bin, Grace E Vincent, Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology, Sleep, 2023;, zsad182, https://doi.org/10.1093/sleep/zsad182