Living with Shift Work

It’s no secret that working night shifts does a number on your body.

From increased risks of cardiovascular disease, diabetes, and cancer, to excessive alcohol consumption and worsened nutritional intake, shift work is associated with a whole host of nightmarish health effects.

The simple solution would seem to be to get rid of jobs that put people on work schedules that are brutal to their well-being. But society needs 24-hour emergency and healthcare workers to function, which means night shift work is here to stay.

It’d be great if there was a pill you could take to erase shift work’s negative effects. Unfortunately, there’s not much in the way of pharmacological solutions that work for shift workers at present. There is hope, however: non-pill solutions, like changing shift timings and light therapy, can offer relief to shift workers. In this blog post, we’ll cover what we know about what works for shift workers.

Changing shifts

There are three main ways you can change a shift: 1) by making it longer or shorter, 2) by changing when it happens, and 3) by changing the amount of rest workers get, both during and between work shifts.

Changing from an 8 hour shift to a 12 hour shift has been found to improve sleep and decrease blood pressure in a majority of studies, but has also been found to worsen sleep and correlate with an increase in BMI in others.

Changing the order and timing of shifts can help. This is most often tested in rotating shift work, where the hours you work change according to a prescribed schedule. Sometimes, these schedules have a forward rotation, which means your shifts get progressively later (days to afternoons to nights). Others have a backward rotation, where your shifts get progressively earlier (nights to afternoons to days). In most cases, moving from a backward rotation to a forward rotation has been found to yield better sleep, though at least one study observed an increase in blood pressure with a move to a fast forward-rotating schedule.

Adding a short rest period during work seems to help, as does increasing the amount of time off between night and morning shifts. This improvement applies not just to sleep, but also to blood lipids when nurses and nurses’ aides are given an extra day after the night shift.

In summary, both forward rotating schedules, and more time off after a night shift, seem to help shift worker health.

Changing behaviors

If you just provide people with information about how to sleep better, their sleep doesn’t change very much. But if you combine sleep education with cognitive behavioral therapy, you see improvements in sleep.

Targeted behavioral interventions, including consulting with a physical therapist, motivation interviewing, and making healthy meals more available at work, also led to decreased BMI, decreased blood pressure, increased physical activity, and better sleep.

In other words: With the right behavior changes, shift worker health can improve.

Changing light

When we talk about changing light exposure, there are two sides to the coin. One is getting bright light when light is useful to your body. The other is avoiding light when it’s actively confusing your body. You can get bright light with light boxes, or simply by sitting near a window when it’s bright outside. You can avoid light by putting on blue-blocking glasses, installing blackout curtains, or just making your environment as dark as possible.

Interventions that expose shift workers to timed bright light have largely found that people get more sleep, fall asleep faster, and feel better about the sleep they got (though one study found a decrease in sleep duration on the first night on a shift that was counteracted by longer sleep on the second night, while two found no significant effects).

But here’s a neat thing: In a review of interventions for shift workers, every trial that combined both seeking bright light at some times and avoiding it at others was found to improve at least one sleep outcome, be it increasing sleep duration, improving sleep quality, or reducing sleep interruptions.

Light therapy that combines blocking light at some times and boosting it at others holds significant promise for making the lives of shift workers better.

The Future is Personalization

But why isn’t there a perfectly clear picture on what works? A lot of it has to do with the fact that people can differ by a huge amount, both in how disrupted their circadian rhythm is and in how sensitive they are to interventions designed to correct that disruption. If you’re not personalizing a lighting intervention, for instance, you risk telling someone to get light at a time that might be bad for them, but good for their coworker.

Exciting emerging work in this direction has shown that personalizing work schedules to match whether someone is a night owl or a morning person can help improve their sleep and quality of life.

At Arcascope, our bet is that by tracking your circadian rhythms, we can go a step further: designing a lighting and behavior intervention specifically for you, to improve your sleep and get you feeling better faster after a shift. We’re working on an app to do exactly that. Interested in learning more, or participating in our private beta? Sign up at the link below:

This blog post gets a lot of its sources from “Non-Pharmacological Interventions to Improve Chronic Disease Risk Factors and Sleep in Shift Workers: A Systematic Review and Meta-Analysis” by Crowther et al. in Clocks & Sleep. The authors of that review weren’t involved in the making of this blog post, but we would like to thank them for putting together an excellent resource!