Do you often feel tired or wiped out, even when you get a full eight hours of sleep? Is your job anything but the typical 9 to 5? Read on to learn more about why chasing sleep isn't the answer. Written by Jason Fritz, Night Shift Emergency Department Physician Assistant Frontline Experience for 6+ years You're Not Alone There are numerous jobs that require abnormal work hours, many of which might not immediately come to mind. This includes full-time night shift, 24-hour coverage, alternating schedules, swing shifts, or simply shift schedules with unpredictable hours. The most common occupations include law enforcement, fire safety, healthcare, food preparations, transportation, factory production, and maintenance. Shift work tends to require a sleep-wake schedule that conflicts with the normal, endogenous rhythm. As a result, many workers experience sleep disturbances, excessive sleepiness, and other ill effects. This causes decreased quality of life for many people, to the point that it has become an established condition in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Your Body Wasn't Built for Shift Work There's a reason why your body's "default mode" is to wake up with the sunrise and go to bed after the sun sets. And there's a reason why trying to circumvent that can be difficult. A commonly used term when talking about sleep is the "circadian rhythm" - your "internal clock". This refers to the rhythm between the "pressure" to sleep, and a circadian "alertness" signal that encourages wakefulness. This is controlled by a part of the brain called the suprachiasmatic nucleus, found in the front part of the hypothalamus. It affects many physiological processes such as blood pressure, body temperature, and hormone secretion including cortisol and melatonin. Circadian rhythm is largely maintained through external cues, such as sunlight and darkness. For example, melatonin production in your body is suppressed when light enters the eye. Its effects increase at night when there is less sunlight, quieting central nervous system activity and promoting sleep. When the sun rises the following morning, melatonin is inhibited again, which promotes wakefulness. Working Against Your Circadian Rhythm There is a lot of variation between shift workers. Some are able to adapt to a change in circadian rhythm, while others have a harder time with it. This might actually be partially explained by genetics, specifically alterations in a gene that affects sleep and circadian rhythm. Night shift workers need to sleep during the daytime, when the alertness signal from the circadian rhythm is strongest. This often leads to shorter, more fragmented sleep. At night when going back into work, this alertness signal is at its weakest. Between the weaker alertness signal and the aforementioned fragmented sleep, you may experience sleepiness and brain fog when you really need to be most alert. If you're a night owl, you may prefer working late or night shifts. Or maybe you're an early bird who prefers daytime hours. Unfortunately, many of us don't have much choice in the matter when it comes to shift work. If you're a firefighter that generally functions better during the day - sorry, you're still going to get woken up at 0300 for a lift assist. If you're a young physician or APP, you still might need to work night shift for a couple years to build your foundation. Circadian rhythm disturbance is probably the most significant factor that negatively impacts shift workers' sleep and chronic sleepiness. That said, there are plenty of other causes that can contribute. Other Factors Affecting Recovery Shift work can be immensely stressful and a lot of that can weigh on our minds after the shift, right when we are trying to fall asleep. Sometimes we finally fall asleep, only to be woken up abruptly by a vivid dream or nightmare. A particularly tough call at work, sad patient case, friend injured on the job, coworker with a life changing diagnosis. Nobody can say they haven't lost sleep at some time or another from these types of experiences, but unfortunately for many shift workers it can be a weekly or daily occurrence. To counteract the chronic exhaustion, many shift workers end up turning to caffeine, most often in the form of coffee or energy drinks. This can be an effective temporary fix, however it comes with caveats. If consuming caffeine too close to bedtime, the stimulant effects may result in fragmented sleep. If used daily, it may cause one to develop a physiological dependency on caffeine ,potentially even requiring increasingly higher doses to maintain the same benefits. Furthermore, when not consuming caffeine, one may experience negative symptoms such as brain fog and headache. Even when you're off duty, you still have to find a way to take care of the usual responsibilities that generally function on a daytime schedule. For example taking your kids to school, getting your car serviced, going in for an office visit with your PCP - these are all things you still have to make time for during a time of day you would usually be sleeping, and when you're most exhausted. Recovery That Actually Works There are many methods to optimize sleep and decrease negative daytime symptoms. These include improving your sleep environment, decreasing psychostimulants such as caffeine, consuming supplements, decreasing bright or blue wavelength light, and "anchoring" sleep. It's also important to maintain a healthy diet and physical exercise. It's important to be aware of these habits and, if not already done, work on improving them. Shift work is tough, but it's not wise to just "tough it out". This mantra can avoid and reinforce the underlying problems. This is one of the reasons that community and camaraderie is important for shift workers. We need to talk about these struggles with one another in order to learn about ways to cope with them. This is one of the reasons why we founded Cloudcraft - we're shift workers wanting to help other shift workers. At the end of the day, it's not just about "sleeping more". It's about actively working on sleep and recovery strategies designed around the reality of how you actually live and work. What Next? Stay tuned as we break down the science behind holistic recovery and maximizing your performance on and beyond the shift. References: “Shift Work and Shift Work Sleep Disorder” https://pmc.ncbi.nlm.nih.gov/articles/PMC6859247/#bib31  “Shift Work and Sleep: Medical Implications and Management” https://pmc.ncbi.nlm.nih.gov/articles/PMC5836745/  US Bureau of Labor Statistics https://www.bls.gov/soc/2018/  “The suitability of a caffeinated energy drink for night-shift workers” https://pubmed.ncbi.nlm.nih.gov/16574171/  “Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness” https://pubmed.ncbi.nlm.nih.gov/15164887/ 

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