So that night shifts do not harm: how to build a schedule correctly

Many people have to work at night for one reason or another. Some deliberately choose this mode of work. Others have ongoing work schedules or shift work.

Professions employed at night include medical workers, rescue workers, police officers, security guards, workers in 24-hour institutions, and workers in large enterprises with a continuous production cycle.

Regardless of the circumstances, working at night has its own characteristics and consequences for human health and socialization.

The human body is a complex mechanism that has developed certain biorhythms . It is they who predetermine for people an active lifestyle during daylight hours and a passive pastime at night. Even dividing people into “larks” and “night owls” does not change the situation. Disruption of thousand-year rhythms can negatively affect human health.

Pros of working at night

Working in the dark has a number of positive aspects:

• Work on the night shift is paid higher than similar work during the day (this norm is enshrined in law).
• For students who have classes during the day, working at night is a great way to earn extra money.
• Some few individuals are actually more energetic at night and are unable to lead an active life during the day. For them, getting a job in the dark is almost the only possible option.
• Working at night allows people to free up daytime time to care for their families and visit government agencies and shops. True, such a rhythm of life cannot be maintained for a long time. The body needs rest, and this way of life does not allow the body to rest.
• One of the positive aspects of working at night is the lack of supervision at the workplace.
• Night shifts help avoid conflicts in the family . Most people work during the day and by evening the whole family gathers in one place. Leaving for work at the same time as avoiding controversial issues in a family environment.

Establishing a regime

ATTENTION! The need for rest is an individual parameter. Some people need eleven hours, others need five.

On average, you spend 6 – 8 hours a day sleeping. To get quality rest, you need to set your own norm.

To do this, choose free time, about 2 weeks. It's best to take a vacation. They always go to bed at the same time, preferably at 9–10 pm, and turn off the alarm clock. During the first week, the body makes up for the lack of sleep. In the second week, you notice how much you spend on sleep. Observed for several days.

For example, if you fall asleep at 22:00 and wake up at 7:00, then the norm will be 9 hours. This is exactly how much sleep should be spent every day, regardless of how busy you are.

Next, the mode is formed:

1. On weekends they always go to bed at the same time.
2. At work, they take half an hour to sleep, if this is allowed by the internal regulations of the organization.
3. When working all night, the norm is divided into sleep before and after the shift. Before starting work, sleep for 2 hours. If the duty is half of the dark time of the day, then it is better to stay awake until the shift. When they get home, they fill up the missing time. If the norm exceeds 9 hours, then the rest time before work is increased, and after - reduced.
4. If possible, exclude one-and-a-half shifts and a flexible schedule. That is, they work only 24 hours, night or 12 hours. Then they have a day off.
5. Make time for sports. Physical activity promotes adaptation of the nervous system. But it is important not to overload the body when it is already exhausted.

Even if you follow these rules, recovery will still be difficult. But these recommendations help create at least some kind of regime. This will make it easier to fall asleep and wake up.

Disadvantages of night work

Despite some advantages, working at night has a number of negative aspects:

• Human activity is tied to daylight hours , and an intense lifestyle during the dark period of the day will inevitably lead to health problems. The damage to the body is comparable to the harm from drinking alcohol and smoking. To minimize negative consequences, it is recommended to take tonic herbal teas (but not drinks of artificial origin), drink multivitamin complexes, walk in the fresh air, and use all opportunities for relaxation.
• Night work can cause the collapse of family life . If spouses work different shifts, then they have practically no opportunity to spend time together. Gradually, the couple moves away from each other, feelings fade away, and family life ceases. Pregnant women are contraindicated to work at night, as in this case the risk of miscarriages or pathological conditions increases by 50%.
• A constant lack of proper rest will lead to irrational use of daytime and making mistakes at work at night. This is especially true for early risers.
• Constant activity in the dark part of the day disrupts the process of producing the satiety hormone . This awakens an increased appetite at night, which leads to rapid weight gain.
• Impaired insulin production and the occurrence of diabetes mellitus of the first degree are also the result of working at night.
• Ignoring natural biorhythms provokes irritability, nervousness, problems in the cardiovascular system and hypertension.
• Night work increases the risk of cancer (breast, rectal, prostate cancer) by 40%.
• Working in the dark for long periods of time leads to constant distraction. Statistics show that the number of errors at night is many times higher than during the day.
• People who have worked at this pace for many years develop a tendency toward grumbling, quarrelsomeness, and even aggression.

In addition to the obvious disadvantages of working at night, there are contraindications to working in the dark. It is not recommended to work at night:

1. Pregnant women.
2. After a heart attack.
3. For coronary heart disease.
4. For heart failure.
5. For gastrointestinal ulcers.
6. Other diseases, if there is a risk of severe exacerbations.

Only absolutely healthy people can work at night. Night owls find it easier to adapt to a night schedule than early risers.

Features of the organization of sleep, wakefulness and nutrition when working on the night shift.

Key points:

• Working at night disrupts the circadian rhythm and can lead to increasing sleep deprivation, as well as deterioration in performance and health.
• Full adaptation of circadian rhythms to night shift work is impossible in the short term
• Night shift workers should be aware of decreased performance and productivity when performing difficult tasks and on the way home

Sources and selection criteria

The authors selected published guidance on sleep and shift work from the UK National Institute for Health and Care Excellence (NICE) and the Royal Colleges of Physicians and Anesthetists. The authors then searched the PubMed and Cochrane databases (accessed May 2020) for observational and randomized controlled studies, meta-analyses, and systematic and narrative reviews examining the health effects of night shift work. The authors also searched for information on each method proposed for regulating sleep and wakefulness (shown in Table 1). Preference was given to randomized controlled trials and meta-analyses, but given the interdisciplinary nature of sleep and night shift work research and the quality of the evidence base, the authors additionally considered observational studies and non-indexed publications from the fields of aviation and heavy industry, as well as published expert opinions.

Night shift work occurs during the period of the sleep-wake cycle (“circadian phase”) that is reserved for sleep. Concentration, cognitive function, psychomotor coordination and mood reach their minimum between 3 and 5 am [1]. Night shift workers must rest during a circadian phase that is less conducive to sleep [2], which causes fatigue and can lead to chronic sleep disturbance [3]. A recent systematic review found that working night shifts increases the risk of insomnia, work-related accidents, obesity and weight gain, type 2 diabetes, coronary heart disease, and breast, prostate, and colorectal cancer [4]. ]. In a 2020 survey of 2,231 UK trainee anaesthetists, more than 70% indicated that fatigue affected their physical and mental wellbeing. 57% had an accident or near-accident when returning home after a night shift [5].

The efficiency of night shift work decreases with age, and recovery time increases [6, 7]. This is important to consider in hospitals seeking to provide 24-hour consultative support. Both the organization and its employees are responsible for maintaining the health and performance of their employees, but the purpose of this article is to describe ways in which an individual can manage their sleep patterns.

The evidence base for sleep patterns offered to night shift workers

Two recent Cochrane reviews of sleep patterns offered to night shift workers found a lack of sufficiently powered and well-designed randomized control trials, and the generally low quality of the evidence generated [7, 8]. Sleep and performance are complex, difficult to measure, and difficult to control, and it is unlikely that one specific way of regulating sleep will act as a panacea. Because of these limitations, the most effective approach to combating the negative consequences of night shift work is likely to be personalized and multifactorial. Given the complexity of the problem, the authors suggest that night shift workers independently develop a suitable sleep regime and select methods for regulating it among those that have proven their effectiveness experimentally (ideally, in randomized controlled trials). In this review, the authors present strategies that have proven effective in clinical trials, as well as expert opinions.

Sleep regulation capabilities

Minimize sleep deprivation before night shift

During the first night shift, a worker experiences both “homeostatic stimuli” (the increasing need for sleep) and “circadian stimuli” (the normal sleep-wake cycle) that encourage sleep [1]. The duration, timing and structure of sleep varies from person to person: a retrospective study of more than one million people aged 30 to 102 years found that eight hours of sleep was sufficient for most people (52% slept less than 7.5 hours and 4% slept less than 6.5 hours in day) [10]. Differences in susceptibility to sleep deprivation have also been observed [11]. Performance is impaired when a person sleeps two hours less than he needs, and with increasing sleep deprivation, performance deteriorates more and more [12]. Thus, a logical first step would be to minimize sleep deprivation before starting night shifts, allow yourself to sleep in (without setting an alarm) the night before your first night shift, and increase your total sleep time by napping during the day (due to circadian rhythms, the time between 14 and 18 hours, known as the "circadian dip", are best for naps). In a randomized controlled trial of 53 night shift workers, a short nap (followed by caffeine) reduced objective and subjective measures of night shift sleepiness compared with controls [13]. In a laboratory study, a nap of 60–90 minutes was shown to complete both slow wave and rapid eye movement (REM) sleep. Also, in a study setting, short-term naps provided some cognitive benefits, but this approach has yet to be tested in practice [14].

Increased performance during the night shift (Table 1)

A systematic review of 13 small studies with different designs found that short naps during the night shift improved alertness and performance [15]. However, a meta-analysis of randomized controlled trials showed the low quality of the available evidence [8]. The authors recommend sleeping no longer than 30 minutes during the night shift to avoid the slow-wave sleep phase, during which awakening is accompanied by confusion (“sleep inertia”) [16]. A systematic review of 12 randomized controlled trials found that caffeine consumption (versus placebo) during night shifts or jet lag was associated with improvements in several measures of cognitive performance, such as orientation, alertness, and reasoning [17]. Given the pharmacokinetics of caffeine (peak concentrations are reached 20–45 minutes after consumption and persist for 3–5 hours) [18, 19], it is advisable to avoid caffeine consumption for at least three hours before expected bedtime. A dose of 4 mg/kg taken 8 hours before expected sleep does not appear to interfere with subsequent sleep [20]. There is moderate quality evidence of the effectiveness of other stimulant drugs such as armodafinil and modafinil: three randomized controlled trials with a total of 755 participants showed that these drugs reduced sleepiness compared with placebo during night shifts [9]. However, both drugs can cause serious skin side effects, and the long-term effects of these drugs have not been established. Theoretically, exposure to bright light during the night shift may reduce sleepiness by suppressing the secretion of the sleep-promoting hormone melatonin, but studies have been inconclusive due to design issues [8, 21, 22]. In addition, it is believed that a decrease in the level of melatonin, which also functions as an antioxidant, may lead to an increase in the incidence of cancer among night shift workers [23]. Because there is limited evidence that such interventions can correct night-time psychomotor impairment, the authors suggest mitigating the risk for night shift workers and [instead of such interventions - approx. transl.] introduce control of the main stages of work, especially in the early hours of the morning, when physiological functions reach their minimum [24, 25].

When there is

Digestion follows its own circadian rhythm: gastric emptying, peristalsis, liver function, pancreatic activity, and glucose tolerance decrease overnight [26]. This makes it difficult to determine the appropriate time to eat for night shift workers: in two small studies of approximately 10 people each, participants who did not eat during a simulated night shift had less decline in performance than those who did eat [27, 28]. ]. However, not eating food resulted in hunger and an increased incidence of gastrointestinal disorders. Taking into account the data described above, the authors suggest eating the main meal immediately before the night shift, and then eating in quantities not exceeding that necessary to maintain comfortable well-being during the shift.

Between shifts

After a night shift, homeostatic stimuli for sleep will counteract circadian stimuli for daytime wakefulness. It has been shown that phase shifts of more than five hours cause desynchronization of the circadian rhythms of various body systems, since these systems adapt to the shift at different rates [29]. When traveling with jet lag, true circadian adaptation appears to take one day per time zone [30], but night shift workers face conflicting environmental cues on rest days (including light) and social environment. In the case of a constant shift in shift times, adaptation of circadian rhythms is impossible. Therefore, to compensate for the inevitable increase in sleep deprivation, optimizing sleep in the days between night shifts must come first. Sleep hygiene experts advocate several approaches to maximize sleep quality and duration. However, due to interindividual variability [31] and insufficient evidence from randomized controlled trials, no recommendations can be made that are suitable for all night shift workers. Most strategies are based on eliminating factors that can disrupt sleep. These include avoiding bright daylight on the way home (wearing sunglasses) and blue light from computer and phone screens [32]; sleep in the dark and in a quiet environment, which is provided by dark curtains, sleep masks, earplugs or white noise generators [33]. Coolness (relatively low temperature) [34] or a routine before bed, such as taking a bath, reading, or gentle muscle stretching, can help induce sleep [35, 36]. Avoid stimulants such as caffeine or nicotine for at least six hours before bed (due to their pharmacokinetic properties) [37]. The effectiveness of zopiclone or short-acting benzodiazepines is largely unproven [38], and in addition, taking these drugs can lead to dependence [39]. Endogenous melatonin coordinates circadian rhythms in various tissues of the body [40]. It has been shown that taking melatonin the morning after a night shift can increase sleep duration by approximately 24 minutes, but this data comes from seven randomized controlled trials with a relatively low quality of evidence [9].

Recovery after night shifts

After a few night shifts, there is a balance between eliminating sleep deprivation and returning to a normal sleep rhythm. One approach to eliminating sleep deprivation is to allow yourself to sleep for 1.5 or 3 hours (one or two full sleep cycles), and then switch to a daytime routine: go outside into bright daylight, talk to people, and try to get into bed as close to normal time as possible. However, further studies are required to determine the effectiveness of this approach [29, 33, 41]. A meta-analysis of 66 studies suggests that regular exercise leads to improved sleep duration and quality [42], but the optimal timing, duration, and type of exercise to improve sleep has not yet been determined.

This article is accompanied by an infographic that shows a suggested sleep strategy based on available evidence and the authors' expert opinion. You can view it using the link - https://medach.pro/media-post/1680

Table 1 | Ways to regulate sleep and wakefulness in night shift workers

PS: So, based on the knowledge gained, we conclude:

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Why does my head hurt after a nap: reasons, what to do?

If you have a headache at night, the causes of this condition may be disorders of both the physical and mental health of a person.
Any pain, including headaches, is a signal of a problem in the body. And if a single episode of headache at night can simply be eliminated by taking an analgesic, then recurring night headaches are a serious reason to contact a neurologist. The reasons for the development of headaches at night are very different. They can provoke cephalgia at any time of the day, and can develop specific night headaches. Let's look at them in more detail.

The main causes of headaches during sleep include the following:

• physical and emotional fatigue;
• mental stress;
• migraine;
• cervical osteochondrosis;
• diabetes;
• changes in blood pressure;
• cluster headache;
• brain tumors;
• stroke.

The peculiarity of headaches during sleep is that they are a signal of even the slightest defects in blood supply and innervation in the brain. This organ differs in its structure from other tissues of the body. It has no reserves of nutrients and oxygen.

Night headaches caused by great physical and emotional fatigue go away without special treatment. It is enough to take a tincture of valerian or motherwort, and proper rest will relieve your headache. You can take analgesics - Nurofen or Analgin.

Intense intellectual work during the working day can cause night headaches. The brain cannot switch off from processing information related to the work process and continues to work intensively, which becomes the cause of nocturnal cephalgia.

You can relieve tension and headaches with herbal tea with lemon balm or mint; one of the combination drugs, for example, Persen, can also help.

Migraine

Night headaches are characteristic of migraine, a disease in which pain is localized in one half of the head or in the frontal region. It is characterized by paroxysmal, sharp course, nausea and vomiting. Symptoms are aggravated by loud noises, bright lights, and even odors. The cause of night migraines is still not fully established.

There are hypotheses about a genetic predisposition to this disease, which affects women. To eliminate an attack, drugs based on sumatriptin are used. This is a specific vasoconstrictor substance that acts on the blood vessels of the brain. As a result of its use, a migraine attack is stopped.

Cervical osteochondrosis

Headache at night due to cervical osteochondrosis is relevant for many people. This involves working on computers in offices and at home. A sedentary lifestyle for many weeks and months leads to the development of degenerative processes in the spine.

The cervical musculo-articular apparatus of the spinal column is especially affected. The result is compression of the blood vessels and nerves passing inside it. The brain does not receive enough nutrition and oxygen - that’s why I get headaches at night after working at the computer for a long time.

Nocturnal cephalgia in this situation can be relieved with an antispasmodic or analgesic. But the cause of its development cannot be eliminated by these means. Comprehensive treatment by a neurologist is required with the use of chondroprotectors, physiotherapy, and manual therapy.

Diabetes

Why do people with diabetes have headaches at night? The presence of such a disease requires strict adherence to the dosage of the necessary medications. If you do not follow medical recommendations, a person’s sleep can be disrupted by a severe headache. Its causes in diabetes mellitus are:

• diabetic neuropathy, which causes headaches due to damaged blood vessels and nerves in the brain. The disease requires treatment only from a specialist;
• hyperglycemia. Cephalalgia is associated with the toxic effects of excess glucose in the blood on blood vessels. The patient experiences severe weakness due to developed intoxication. It is possible to normalize glucose levels in this situation only in a specialized hospital;
• hypoglycemia. The head begins to hurt due to low blood glucose levels. Such pain occurs along with symptoms such as acute hunger, profuse sweating, and confusion. The patient must be given immediate assistance by injecting him with a glucose solution or giving him sweet tea to drink.