By Joelle Y. Jean, FNP

For nurses, the night shift is either a choice or a requirement. The night shift, also known as shift work, has significant effects on nurses’ mental and physical health. These effects include physiological derangement, which leads to:
•Cognitive impairment
•Metabolic disorders
•Cardiovascular disease

How sleep works

Sleep is controlled in the brain by the SupraChiasmatic Nucleus (SCN) found in the hypothalamus. This “clock” regulates the production of melatonin, a hormone that induces sleep. It is recommended healthy adults sleep seven to nine hours a night.

The circadian rhythm-internal clock- runs in the background to carry out essential functions and processes:
•Hormone secretion
•Core body temperature
•Sleep-wake cycle

Signals from your environment — especially light — influence your sleep-wake cycle. For night shift nurses, when the sleep-wake cycle is interrupted, this can cause sleep deprivation. It can also cause mental and physical health problems.

Sleep Deprivation

Sleep deprivation (SD) is defined as obtaining inadequate sleep to support adequate daytime alertness. Risks for SD include:
•Longer shift hours
•Irregular sleep patterns
•Increased light exposure which suppresses melatonin

SD has also been linked to decreased alertness, memory, and learning. It can affect patient care as well as driving. Night shift nurses are at risk for SD, especially if they stay on nights long term.

Depression

Nurses suffer depression at twice the rate of the general population. Working the night shift can have an effect on mental health. Depression is one of them. Signs of depression include:
•Negative thoughts
•Need for isolation
•Despondency
•Sadness
•Fatigue
•Insomnia
•Trouble concentration
•Anxiety
•Considerable fear
•Guilt
•Changes in sleep and appetite

The link between working nights and depression needs to be studied further. However, night shift nurses may be suffering from depressive symptoms and not even know it.

Physical health

Night shift nurses have a higher chance of developing physical health issues. Due to the constant interruption of the circadian rhythm, night shift nurses can develop:

• Obesity
  •Type 2 Diabetes
  •Breast Cancer
  •Cardiovascular disease
  •Worsening sleep apnea

Obesity and Type 2 Diabetes

Circadian disruption and poor eating habits are linked to obesity and Type 2 diabetes. Working nights can cause an inability to regulate glucose metabolism. Studies suggest that shift work is an independent risk factor for type 2 diabetes mellitus.

Breast cancer

Studies show working nights is linked to breast cancer. Although more research is needed, one study reported a 9% increased risk for every 5 years of night-shift work. Another study reported a 16% increased risk for every 10 years of shift work.

Cardiovascular disease

Higher levels of triglycerides are associated with those who work at night. High triglycerides can lead to cardiovascular disease. Researchers from Brigham and Women’s Hospital and Harvard Medical school report that women who work more than 10 years of rotating night shift work had an increased risk — 15% to 18% —of developing coronary heart disease. Coronary heart disease can cause serious complications, such as:
•Arrhythmias
•Heart failure
•Cardiogenic shock
•Sudden cardiac arrest

Sleep apnea

Working the night shift can worsen sleep apnea. Dr. Scott Danoff, D.M.D. of New York, is double board-certified in sleep apnea and has extensive training in sleep medicine. He says to be diagnosed with sleep apnea, you must first obtain a sleep study. According to Dr. Danoff, “sleep apnea can cause sleep disorders such as restless leg syndrome, insomnia, and other respiratory disturbances.”

If diagnosed with sleep apnea, there are options to treat it. Dr. Danoff says wearing a CPAP machine with severe sleep apnea is the gold standard. He also suggests getting fitted for an oral appliance or a mandibular advancement device for mild to moderate sleep apnea. Dr. Danoff tells Capsol, “a mandibular advancement device:
•holds the jaw forward,
•opens the airway, and
•moves the base of the tongue forward
This creates a lot of free space to get more air. 80% of patients continue to use it after 5 years.”

Tips for nurses to improve sleep

There are many ways to improve sleep for night shift nurses and reduce the chances of developing mental and physical health problems. Here are some tips:

• Exercise 20 to 30 minutes a day— a few hours before going to bed
  •Avoid caffeine, smoking, and alcohol before going to bed
  •Avoid lying in bed if you aren’t tired
  •Use smartphones or wearable devices to track your sleep
  •Melatonin can help with the timing of your sleep
  •Adjust your bedroom’s temperature to around 65 degrees Fahrenheit and wear socks to draw out the heat of your body
  •Meditate or create a relaxing bedtime routine
  •See your doctor if your sleep doesn’t improve

Night shift can have adverse effects on a nurse’s health. The longer a nurse works night shifts, the effects increase. Night shift nurses must understand the importance of sleep and improve sleeping habits by maintaining healthy routines.

Are you a night-shifter? What tips and tricks do you use for a healthy sleep-wake cycle? Tell us in the comments.