Night Shift Nursing: Savvy Solutions for a Healthy Lifestyle

8/22/2019 Night Shift Nursing: Savvy Solutions for a Healthy Lifestyle

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252 Night Shift, Fatigue, and Sleep

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26 Nig-Shift Nursing

Although it isnt always our preerence, working nights is oten the na-ture o the jobparticularly or nurses. As a typical night shit beginsbetween 7 p.m. and 11 p. m., night-shit workers must sleep during theday, when most people are awake.

One o the biggest challenges or nurses who work the night shitis getting enough sleep. Research indicates that individuals workingnights and rotating shits rarely obtain optimal amounts o sleep. Inact, an early objective study showed that night-shit workers obtain1 to 4 hours less sleep than normal when they were working nights(Rogers, 2008). In addition to being shorter in duration, daytime sleepis oten lighter than nighttime sleep because o outside environmentalnoise that makes it dicult to initiate and maintain sleep (Roszkowski& Jae, 2012).

The sleep deprivation and atigue experienced by nurses on thenight shit have real ramications. As noted by Rogers, Sleep loss iscumulative and by the end o the workweek, the sleep debt (sleep loss)may be signicant enough to impair decision-making, initiative, in-tegration o inormation, planning and plan execution, and vigilance(2008). Compounding the problem is the act that most people arenot accurate judges o how impaired they are by atigue or sleep loss(Rogers, 2008). Indeed, research indicates that although perormancecontinues to decline during several weeks o chronic partial sleep de-privation, subjective ratings level o, making sel-assessment o atigue

and perormance unreliable, much in the same way that occurs ollow-ing alcohol consumption (Lockley et al., 2007).

You might assume that adjusting your sleep cycle to sleep duringthe day and work during the night would be a simple matter. I only it

were that easy! The act is adjusting your sleep cycle is hard. As notedby Wong, Our 24-hour sleep wake cycle is naturally programmedand wired or our bodies to wake up during the day and all asleep at

night (2012). Indeed, sleeping while its light out and working whenmost o the world is sleeping is challenging or just about everyone.Fortunately, this chapter provides a wealth o inormation and adviceon this topic rom the literature, colleagues, and experts in the eld.Read on to see hownotto lose sleep over working the night shit!


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Yu ant un a hsita withut th night shit! Smn has

t wk it. Why nt yu?

Sle SceDespite decades o research, scientists have yet to discover why we sleep.Some believe that organisms sleep to conserve energy. Others posit that

sleep is what enables organisms to rejuvenate what is lost in the bodyduring waking hours. Whats clear, however, is that sleep is vital.

Generally, a circadian rhythm dictates peoples sleep cycles. Circa-dian rhythms are physical, mental, and behavioral changes that occurover a 24-hour cycle, responding to light and darkness in an organismsenvironment (National Institutes o Health, 2008). The circadian cycle,named ater the Latin term circa dia or around the day, regulates the

physiological and behavioral rhythms that control the waking/sleepcycle, body temperature, blood pressure, reaction time, levels o alert-ness, patterns o hormone secretion, and digestive unctions. Accordingto Shochat, Under normal conditions, circadian rhythms are entrainedto the environmental light-dark cycle and are synchronized with it.

Thus, time-o-day eects demonstrate increased sleep propensity andreduced alertness and perormance capacity in the early morning hours,corresponding to the minimum in core body temperature, the peak omelatonin secretion and the timing o the habitual sleep phase (2012).

As Smith and Eastman put it, Millions o years o evolution have madeus diurnal animals, programmed to be sleepy at night (2012).

Sleep cycle is also aected by the homeostatic drive or sleep. Thisdrive, which leads to an increased propensity or sleepiness, increasesthe longer one is awake. In addition, internal (endogenous) actors andexternal (exogenous) actors infuence our bodies rhythms (Marino,2005). Endogenous actors are what we think o as the biologicalclock. In contrast, exogenous actors are environmental actors, suchas changing seasons, the change rom day to night, and environmentalstimuli orzeitgebers(German or time givers or synchronizers), suchas noise, ood, sunlight, and social and physical activity (Marino, 2005).

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Finally, melatonin, which is secreted in low amounts during the dayand substantially increases by evening, plays a role in the sleep cycle.

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As noted by Shochat, Shit work imposes a continuous misalign-ment between endogenous circadian (24-hour) rhythms and the en-

vironmental light/dark cycle. Such desynchrony in physiological andbehavioral circadian rhythms has been shown to cause sleep loss andsleepiness, and to detrimentally aect mental perormance, saety andhealth (2012). In other words, because night-shit nurses must ght

the circadian rhythm, daytime sleep can be shorter and o lesser qual-ity. This aects their alertness when awake and working. In addition,their total sleep over a week may be less than those who work the stan-dard nine-to-ve schedule. Finally, The job-driven schedule o theshit worker also can aect the exposure to environmental time cuesthat entrain the circadian clock to the 24-hour day. Time cues, such as


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natural sunlight, are out o phase with the shit workers altered sleep-wake times (Roszkowski and Jae, 2012). Without conscious eorton the part o the night-shit nurse, adjusting to this schedule is hard(kerstedt, 1984; American College o Emergency Physicians, 2010;National Sleep Foundation 2011a; Weiss, 2004).

Ng Owl LarkBeore you tackle the issue o sleep, its helpul to know how your bio-logical clock runs. Oten, morning people, or larks, adjust poorlyto shit work (Roszkowski & Jae, 2012).

Want to know i you are a night person (night owl) or a morningperson (lark)? The Center or Environmental Therapeutics provides aree, 19-question test, called the Automated Morningness-EveningnessQuestionnaire (AutoMEQ), to help you determine whether youre a

lark or an owl. You can nd it here: http://www.cet-surveys.org/Dialogix/servlet/Dialogix?schedule=3&DIRECTIVE=START.

Research shows that regardless o whether they are larks or owls,Some individuals are phase tolerant in that ater working at nightthey have the ability to sleep reasonably well during the day despitethe act that sleep occurs at the wrong circadian phase (Smith &Eastman, 2012). However, middle-aged and older adults are generally

less phase tolerant than the young, and men are typically more phasetolerant than women.

Ajug Yur Sle PtrAlthough some say you cant ght Mother Nature, there are ways or

night-shit workers to improve sleep and circadian rhythms, as notedby Berger and Hobbs (2006) ater a thorough review o the literature.Clearly, good sleep hygiene is key! Some o their suggestions, along

with a ew others, are as ollows:


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Cmbinatins ths an th untmasus, suh as

naing an th us tain stimuants (isuss atin this hat), a gnay m tiv than an ini-viua untmasu imving night-shit atnss(Smith & Eastman, 2012).

* Establish regular patterns o sleep, work, and leisure.

* Set a permanent our-hour sleep anchor time that never var-

iesor example, rom 9 a.m. to 1 p.m. Then add three toour hours beore or ater that anchor time as needed. That is,ater working a shit, you might sleep rom 9 a.m. to 4 p.m.,but sleep rom 5 a.m. to 1 p.m. on your days o.

* Establish a regular sleep schedule when working nights andon nights o. Go to bed at a regular timeor example, 8:30a.m. and establish a regular wake-up timesay, 4:30 p.m.

Its particularly important that you maintain consistent bed-times and wake-up times on the shit you work most oten.

* Target your ideal wake time and shoot or it, adjusting indaily 15-minute increments. When you get there, stay there.

* The sooner you go to bed ater your night shit, the better.Your best bet is to avoid all activities that would delay bed-time, such as housework, shopping, child care, and even walk-

ing the dog (Smith & Eastman, 2012). Watching televisionmay be too stimulating or some, in which case it, too, shouldbe avoided beore bed (Wong, 2012).

* Develop a relaxation routine and sleep-preparation ritualto help you wind down. Choose a relaxation method to usein the hour prior to going to sleepor example, reading,listening to music, or meditating (Pronitis-Ruotolo, 2001).

That being said, Avoid time-sucking activities. Choose thingsthat you can put down when the time comes to go to sleep(Trimble, n.d.).

* Get enough sleep to eel rested. The National Sleep Founda-tion (2011b) recommends seven to nine hours, with six hoursbeing the minimum.

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* When sleeping during the day, make the room as dark as pos-sible. Block out the light with blinds or curtains and turn o

TVs, lamps, and other devices that emit light. Turn around(or turn o) all LCD clock displays. Alternatively, wear asleep mask over your eyes to block light.

* Put away your electronicscell phones, tablets, e-readers.Some have do not disturb settings that prevent incomingcalls, texts, messages, etc.

T nsu a u ba snt intut yu st, imitui intak t 8 uns b s.

* Eliminate potentially disturbing noises in the bedroom. Wearearplugs i necessary. Alternatively, try using a white-noisemachine to drown out noise.

* Keep cool. Maintain a room temperature o 65 to 72 degrees

Fahrenheit, use light bedcovers, and wear light clothing tobed. This is in keeping with the bodys circadian rhythm rela-tive to body temperature and the act that our temperaturelowers while we sleep.

Its itia t uat yu ins an amiy t h yugt th s yu n. Mak it a int t isuss yu

s ns with amiy an ins. I yuv t twk th night shit t nsu n ant is aways hmwith th hin, b su t ngtiat with yu susan hin t mak su yu gt nugh s. In a-tiua, b stit abut ngtiating an taking avantag va tims (b at shits wkns) whn

bth ants a hm s. As, hs sia ativi-tis wisy. That is, avi ativitis shu uing yutyia s tim.

* I you awaken during your rest, get up to use the bathroom. Iyoure hungry, eat a light protein snack in a dim or dark envi-

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ronment beore returning to bed.

* Put a note on the bedroom door, do not disturb or daysleeper, as a reminder to amily.

Avi binging stss wk wis int th bm.

* I sleep does not occur within 15 minutes o going to bed, getup and try again later. Repeat as needed.

Us yu b s an sxua ativity ny. Cgnitivassiatins an s a imtant. S th umingsiba, Cgnitiv Bhavia Thay an Insmnia (CBT-I), m inmatin.

* When you wake up, expose yoursel to lots o light as soon aspossibleoutdoor light i you awaken in the daytime or a light

box i its dark. (To nd out more about light boxes, search orresources or people with seasonal aective disorder.)

* Skip the snooze button. Get up the rst time the alarm goeso!

* At least three days a week, start the day with 30 minutes ormore o exercise to boost your energy or the day. Stop exer-cising three hours beore bedtime. For more on exercise, see

Chapter 5, Exercise Benets.* During your shit, take steps to stay ocused and awake. For

example, do a ew quick sprints down an empty hall or per-orm some other types o exercises, chat with coworkers, read,or do a crossword puzzle. Sitting idle will decrease your bloodfow and cause you to become sluggish (Wong, 2012).

* I your organization permits it, take a nap during your shit i

needed. (For more on napping during the night shit, see thesection Night-Shit Napping later in this chapter.)

* Wear dark sunglassespreerably the blue-blocker vari-etyto block light when driving home in the morning ater

working nights. Research indicates that daylight exposure in

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I am not a night nurse per se, but I do rotating shifts, as do

all the nurses on my unit. I am 49, and just began my nursing

career two years ago. I have found that when I have an up-coming night shift, I have to prioritize my sleep. Everyone in

the family knows this! I go to bed between 12 and 1 p.m. the

afternoon before, and I take a sleep aid to help me drift off

and stay asleep during the day. I aim for at least three to four

hours of sleep prior to a night shift. After my shift is over, I make

a beeline for home and my bed. I dont run errands, clean

house, or do anything distracting that is likely to keep me

awake. I take a sleep aid at this time as well, read a relaxing

book, and then wear both earplugs and an eye mask to keep

out light. If I do not have another night shift that evening, I will

set my alarm for noon so that I can get back to daytime living.

Ass Y sJn Dr PD, RN, rsr h ok cs ,

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FROM HE TReNCHE

the early morning hourscan inhibit the resetting o the cir-cadian rhythm to match the daytime sleep schedules o night

workers (Roszkowski & Jae, 2012).


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If I do have another night shift, I try to get at least six to seven

hours of daytime sleep before going back in to work. I stop

drinking anything caffeinated at least four to ve hours before

I plan to go to bed (day or night!); I nd that the older I get,

the more sensitive I am to caffeine.

On my off days, I go to my gym and do a vigorous workout of

light weights and aerobic exercise for about 45 minutes. Then

10 minutes in the steam room or whirlpool. My gym also offersfree gentle yoga classes twice a week, which I try to get

to as often as I can. I also walk the dog a couple of times a

week, sometimes jogging along, or at least keeping up a brisk

pace. As a wife and mother, I nd that by prioritizing my sleep

and health, I am better with my family than if I am an exhaust-

ed, grumpy mom.

I also try to think relaxing thoughts, focusing on all that I am

grateful for in life. I am so grateful for my home and family,

who make it all worthwhile. Im also grateful for my wonder-

ful career, even though it requires me to work night shift! With

careful planning and a fair amount of discipline, I have made

it work for me.

Anne-Marie Lillyman, BS, RN

Wrkle SluoIn addition to individual sleep solutions, changes can be made in the

workplace to benet the health and saety o night-shit nurses andtheir patients. While its true that we need 24-hour stang, there arebetter and healthier ways to accomplish it. For example, having per-manent night-shit assignments is healthier than rotating shit assign-ments. I thats not possible, scheduling shit rotations in a clockwiseashion, rom day to evening to night shit, is more in line with circa-dian physiology.


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Rgua tating shit wks shu miy thi istys

t aw atiiatin in sia ativitis xam,j in ing a hath ub that is n a ay insta j in ing aass that mts at a sii tim (Bg & Hbbs, 2006).

Aministats shu uat thi sta abut th basiinis iaian hythms an th bnits ay-

ing thm t sta shus.Here are a ew more suggestions or organizations seeking solu-

tions (Berger & Hobbs, 2006; Enger, Nelson, & Walsh Starr, 1995;Nursing Organizations Alliance, 2007; Ruggiero & Pezzino, 2006):

* Decrease the number o shit changes or employees, allow-ing better adaptability. One can adapt better with a consistent

shit rather than having to alternate between nights and days.* I possible, identiy those sta members who are best able totolerate night-shit work and schedule accordingly. Provid-ing more opportunities to schedule shit workers based on

whether they are larks or owls can help.

* Because morningness tends to increase with age, it mightwork to hire young nurses or the night and rotating shits.

Its more practical. For the most part, the night shit seemsto be a young nurses game. This isnt to say that all owls areyounger and larks are older, but it seems to hold or the ma-jority. In a 2005 review o the literature on sleep and atigue,Muecke conrmed that the negative eects o night shit in-crease ater the age o 40.

* Increase shit-worker job satisaction and reduce eelings oisolation by ensuring that sta meetings, education, and de-

velopment are held during all shits. As noted by Smith andEastman (2012), Overtime and morning meetings should notbe tolerated by shit workers, and managerial and administra-tion sta should not ask shit workers to remain on site aterthe night shit ends.

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* Oer shits rom 3 p.m. to 3 a.m. to prevent the bright-lightexposure that occurs when night-shit workers leave or homeat the end o the shit.

Cnsi instaing ag ight bxs at nusing statins annuag night nuss t sn as muh tim na thmuing th ist six hus thi shit as thi wkaaws. This an h k nuss ngiz (Smith & East-

man, 2012). F a ist ight-bx manuatus, visithtt://www.stb.g.

* Schedule night-shit nurses or a maximum o three consecu-tive shits per week, with at least two days o in a row when

working an alternate shit.

* Cultivate a culture that encourages nurses to avoid workingwhen atigued.

* Give night-shit nurses adequate time or sleep breaks andprovide a comortable place or them (perhaps with sot mu-sic and a massage chair). Sleep breaks, or naps, are discussedin the next section.

* Give night-shit nurses access to ree or aordable exerciseacilities (or example, in the cardiac rehabilitation depart-ment, which is most likely empty during the night shit). Thismay help decrease atigue and increase well-being.

* Reduce the number o shit-work rotations and attempt tohire more permanent night-shit workers. I the organiza-tion is unable to hire more permanent night-shit workers,use orward rotationmorning to evening to night, in thatorder, to go with the circadian rhythm rather against itintwo-week intervals. Research indicates that rapid rotations

and counterclockwise rotations are less-tolerated work shitsdue to their adverse impacts on the quality, duration, and totalamount o sleep (Roszkowski & Jae, 2012).

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Several relevant organizations have also chimed in on the issue oatigue. For example, in the same Sentinel Alert that addressed atigue(reer to Chapter 1, "Advantages, Challenges, and Risks o Night

Work"), the Joint Commission suggested actions in the workplace tohelp reduce the risks (2011). These include the ollowing:

* Assess the organization or atigue-related risks such as o-shit hours and consecutive shit work, as well as assessingstang levels.

* Examine processes and procedures or patient handos to en-sure patients are adequately protected. Handos are a time o

high risk, especially or atigued sta.* Invite sta input into designing work schedules.

* Create and implement a atigue-management plan. Thisshould include scientic strategies or ghting atigue, such asengaging in conversation, physical activity, strategic caeineconsumption, and short naps.

* Educate sta about good sleep habits (sometimes calledsleephygiene) and the eects o atigue on patient saety.

Wk with yu ntinuing uatin atmnt t hwith iving this inmatin t yu sta. It u b inth m int matias, an nin aning mu, anin-sn ass.

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* Have sta express concerns about atigue and take action toaddress those concerns.

* Encourage teamwork. For example, use a system o inde-pendent second checks or critical tasks or complex patients.

Although this doesnt help with atigue per se, it does help tominimize some o the risks associated with it.

* Consider atigue a potential contributing actor when review-ing all adverse events.

* Organizations that allow sleep breaks should assess the envi-ronment provided or those breaks to ensure it ully promotessleep.

The U.S. Department o Labor, Occupational Saety & HealthAdministration (OSHA) is another organization that has taken steps toaddress these hazards. Specically, OSHA (n.d.) recommends the ol-lowing to mitigate atigue when employees need to work longer than

eight-hour shits:* When possible, managers should limit the use o extended

shits. Working shits that are longer than eight hours otenresults in reduced productivity and alertness. Rather thanhaving employees work shits that are longer than eighthours, managers should distribute employees hours by in-creasing the number o days employees work.

* Managers should plan or requent and regular breaksthroughout the work shit. I shits run longer than the nor-mal work period, managers should provide additional breakperiods and meals. Along those lines, managers should keepadequate personnel available to ensure workers can takebreaks, eat meals, relax, and sleep.

Rsah shws that sht baks nt ny imv -man an u subjtiv atigu, thy a tivin nting th aumuatin isk assiat withng task man (.g., 2 hus sustain wk)an sinss (Rgs, 2008).

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* I possible, workers should perorm tasks that require heavyphysical labor or intense concentration at the beginning othe extended or unusual shit.

* Managers and supervisors should learn to recognize the signsand symptoms o health eects associated with extended andunusual work shits. Employees displaying these signs orsymptomsparticularly atigueshould be evaluated. Man-agers may opt to direct these employees to leave the activearea and seek rest.

* Employees should not work extended shits or more than aew days, especially i those shits involve heavy physical ormental exertion.

In 2006, the American Nurses Association (ANA) Board o Di-rectors issued a position statement on the matter, entitled AssuringPatient Saety: The Employers Role in Promoting Healthy Nursing

Work Hours or Registered Nurses in All Roles and Settings. It readsas ollows:

It is the position o the American Nurses Association that allemployers o registered nurses should ensure sucient sys-tem resources to provide the individual registered nurse in allroles and settings with:

1. a work schedule that provides or adequate rest and recu-

peration between scheduled work; and2. sucient compensation and appropriate stang

systems that oster a sae and healthul environ-ment in which the registered nurse does not eelcompelled to seek supplemental income throughovertime, extra shits, and other practices that con-tribute to work atigue.

The ANA continues: Institutions that persist in policies support-ing a culture where overwork, understang, and underpay are thenorm may ultimately nd themselves acing extensive accountabilityor their short-sightedness. This accountability may include legal im-


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plications, due to the act that nurses mental and physical atigue maycontribute to errors in patient care.

As noted by Czeisler and Fryer (2006), We now know that 24 hourswithout sleep or a week o sleeping our or ve hours a night induces animpairment equivalent to a blood alcohol level o .1%. We would neversay, This person is a great worker! Hes drunk all the time! yet wecontinue to celebrate people who sacrice sleep or work. The bottomline: Its in the best interest o nurses, patients, and health care organi-zations as a whole to reduce nurse atigue.

Ng-Shft NpgNapping, particularly napping on the night shit, seems a little likeFightClub:The rst rule o napping on night shit is you dont talk aboutnapping on night shit! But the act is researchers have ound napping

during the night shit improves alertness or night-shit workers.

For example, the National Sleep Foundation (2011a; 2011b) reportson research examining the impact o napping and caeine on sleepi-ness among night-shit workers. Both were ound to be eective, with acombination o the two being most eective. In addition, a 2008 articleby Linda Beattie reports on a qualitative study o napping experiences,preerences, perceptions, and barriers. According to the study, not

everyone ound napping helpul; or those who did, however, benetsincluded increased alertness and energy. This carried over to the drivehome at the end o the shita very risky time or night-shit workers.

When discussing how to improve the experience and alertness onurses who work the night shit, people requently mention napping.

The problem is, despite support rom the literature and recommenda-tions by experts, accommodations or napping on the night shit are not

widespread. Nurses do it, but oten eel they have to do it on the sly.Indeed, many nurses are araid to ask whether napping during a breakis okay, and some nurses share that they help each other to nap duringbreaks while watching out or management.


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Th is, untunaty, a stigma assiat with

naing, n that sahs an wits, suh asGi Asah (2008), nuag us t gt v. Its timt mba naing n th night shit!

Discussions about night-shit napping must be brought to the ore-ront. Organizations must establish policies that support napping, ar-range breaks or napping, and oer acilities or napping.

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We have a nursing retention committee at our hospital, and

they continually look for ways to retain the nurses we have.

One of the nurses mentioned the idea of being able to nap

during the 12-hour shift. They went to the literature and found

evidence that napping can be benecial, especially for indi-

viduals working the night shift. Our policy and procedure was

updated, and more comfortable furniture was purchased for

the lounges on each unit. Key points from the policy include:

* Night-shift staff are permitted to take their scheduled 30-min-

ute power nap only in the designated nursing lounge during

their shift.

* Each employee is responsible to begin and end their break

times, returning to work alert in a timely fashion.

* If possible, the night-shift staff member should nap around

the same routinely scheduled time frame each shift worked.

Ideally, this nap time would be scheduled at the time the

employee is often the most tired during their standard shift.

* Each employee will clean up their linens and any other re-

fuse after themselves.

* Coworkers should be considerate and quiet when someone

is napping.

FROM HE TReNCHE


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Naps are also benecial when taken at home prior to a shit, 3090minutes beore leaving or work. Berger (2006) recommends a nap

just prior to going in or the night shit. That way, youll have no morethan 18 hours beore going to sleep again.

B awa that th ist 1530 minuts at waking, b itm gua s m a na, may b haatiz byiminish man, mmny a s intia.Th is a tansitina i btwn th tim yu waku an th tim yu bain bms uy untina. This is

why yu nv want t mak an imtant isin as snas yu a suny awakn (Czis & Fy, 2006).

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Nappers may bring in ear plugs or eye masks to help promote

rest.

Breaks are based on patient care activity, and every nurse is ex-

pected to respond to the unit if an emergency occurs.

Barbara Brunt, MA, MN, RN-BC, NE-BC

Earlier in my career, I worked nights in a hospital where we were

given a 60-minute lunch break and required to leave the unit.

They had a room on the oor with 6 to 8 recliners that staff were

encouraged to use for nap time. The reason behind this forward

thinking was the medication errors had decreased on nights be-

cause nurses were allowed to take a quick power nap.

Jess Ramirez, MBA/MHA, RN, NE-BC

FROM HE TReNCHE


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Oten, your ability to sleep and to perorm while awake can be a-ected by your intake o ood, drinks, stimulants, and sedating medica-tions. In this section, youll learn what works and what to avoid. (Formore on ood and drinks, see Chapter 4, Healthul Eating.)


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Fo d Dk

Avoid eating a heavy meal in the three or our hours beore bed. In-stead, eat the biggest meal o the day ater waking. Protein helps with

wakeulness, so is best consumed beore or during the shit and not dur-ing the meal eaten beore going to sleep. In addition, make it a point toeat small portions throughout your shit. This will help you to maintaina regular sugar level and will also keep you eeling energized. Com-plex carbohydrates such as pasta, grains, bread, and vegetables are best.

Avoid oods loaded with sugar, such as candy bars, which are known tocause a sugar high, meaning you will eel energized and eel instantgratication, but you will crash later on. Symptoms o being sugarhigh are atigue, mood swings, and irritability (Wong, 2012).

I you eel chilled, which can happen due to hormonal changesthroughout the night, eat or drink something warm. (Avoid consumingcaeinated drinks, however, such as coee or caeinated tea, at least six

hours beore you go to bed. More on caeine in a moment.) In addi-tion, make it a point to drink plenty o water. Doing so helps to increasethe oxygenation o your blood level, which aids in increasing alertness.Besides, its hard to eel too sleepy i your bladder is ull!

To aid in sleep, several medications exist. These include theollowing:

* Melatonin. Melatonin is a hormone secreted by the pinealgland and is a major controller o the circadian rhythm(Pronitis-Ruotolo, 2001). Melatonin levels naturally rise be-tween one and three hours beore an individuals typical sleeptime, helping to make people sleepy. To aid in inducing sleepand improving sleep quality and duration, many night-shit

workers take melatonin or melatonin receptor agonists such asramelteon prior to daytime sleep. Indeed, immediate-release

oral melatonin, sustained-release or multiple doses o oralmelatonin, and daytime transdermal melatonin administrationater a night shit have been reported to modestly increasesleep quantity and quality (Smith & Eastman, 2012). Melato-nin receptor agonists have a avorable saety prole andcan be used long term (Zee, 2012). Note that you should use


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over-the-counter melatonin only i you are planning to sleepor at least six to eight hours.

* GABA. To acilitate sleep, some use gamma-aminobutyricacid (GABA), including benzodiazepines, such as furazepamand temazepam, and short-acting nonbenzodiazepenes, suchas zolpidem, zaleplon, and eszopiclone, all available by pre-scription only. Although they may be eective, these agentsare also associated with dependence, alls, and accidents, as

well as memory, cognitive, and psychomotor impairments

(Zee, 2012). With the exception o zaleplon, which takes eectwithin 30 minutes and can be used to obtain as little as ourhours o sleep, these medications require a seven to eight hour

window or sleep. Be aware that none o these agents shouldbe taken with alcohol (Zee, 2012).

In a recent review o literature ocusing on the ecacy o herbalremedies or managing insomnia (Antoniades, Jones, Hassed & Pi-terman, 2012), the authors ound that there is very little research oncommonly used herbal remedies. Studies related to the use o valerianrefected eectiveness in improving sleep quality, but not reducinginsomnia. Valerian in combination with hops appears to reduce sleeplatency. Other herbal remedies, such as chamomile and St. Johns

wort, do not have sucient research evidence to support eectivenessin managing insomnia. The authors recognize that many people use

herbal remedies and recommend that research be conducted to assessor eectiveness o these remedies.

Th U.S. F an Dug Aministatin has an avisystatmnt n th us kava-kava u t th isk hattxiity.

S mis shu b us with gat autin, as thymmis atnss, saty, an man. Its itiathat yu isuss th us any s mis, b thysitin, v-th-unt, hba, with yu imaya vi.

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O course, the trick is not just getting a good nights sleep; its alsowaking upand staying upor your shit. To aid in this, many night-shit nurses drink caeinated coee, tea, or soda at the beginning otheir shit. Studies have shown that caeine, one o the most widely

used stimulants in the world, improves night-shit alertness and per-ormance (Smith & Eastman, 2012) compared to no intervention.

Rnt yas hav sn a iatin s-a ngyinks, with a ain ntnt anging m 50500 mg.Athugh it might b tmting t ink suh bvags u-ing a night shit, b awa that th aut an ng-tmts ngy inks n hath an man aagy unknwn, but that ts ain intxiatinsuggst that ths inks may inas bms a-in nn an withawa as w as us thug substans (Shhat, 2012).

That being said, Ingesting too much caeine or consuming it toolate in a night shit could urther exacerbate daytime sleep diculty(Smith & Eastman, 2012). In addition, habitual daily caeine con-sumption has been related to sleep disruption and sleepiness (Sho-chat, 2012), which is particularly problematic considering that caeineis also addicting. The bottom line? Moderation is key. A healthy

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intake o caeine ranges rom two to our cups o brewed coee a day,or 200 to 300 milligrams (American Osteopathic Association, n.d.). Inaddition, Caeine consumption should occur only at the beginningo a shit or about an hour beore an anticipated decrease in alertness(e.g., between 3 a.m. and 5 a.m.). To reduce the possibility o insomnia,caeine consumption should stop at least 3 hours beore a plannedbedtime (Rogers, 2008).

A W o Aol coW y m thk t kin ol i s, in , t

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s k thou t . A , bjcv s

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v ron o. An o, By c

, ol d v d r n ks qri

sd tn d lo n (ch, 2).

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b. (O o, vn bt i s b top

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Another way to improve alertness during a shit is to take modaniland the longer-acting armodanil, which are FDA-approved or thepromotion o wakeulness (Salgado & Jae, 2012). Modanil and ar-modanil, both non-amphetamine stimulants, are recommended by

the American Academy o Sleep Medicine or enhancing alertness dur-ing shit work. In addition to reducing excessive sleepiness, modanilhas been associated with small but signicant improvements in per-ormance (Zee, 2012). Also, ewer patients taking modanil reportaccidents or near-accidents during their commute home rom nightshits (Zee, 2012). For its part, armodanil, like modanil, has been


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shown to result in improved perormance on memory and attentionand reduced sleepiness during night shits both at work and in a labora-tory setting, and during the commute home (Zee, 2012). In addition,Armodanil was associated with signicant improvements in late-in-shit clinical conditions, wakeulness, and improvements in overallpatient unctioning. It can also acilitate improvements in measureso overall clinical condition, long-term memory, and attention (Zee,2012). Be aware that both modanil and armodanil are prescriptionmedications. Your primary care provider will want to know your medi-

cal history, including any history o angina, recent myocardial inarc-tion, and seizures (Salgado & Jae, 2012).

Sle-Assig Ap DveAlthough putting away your electronic devices is key to getting the

sleep you need during the day, there are various iPhone, iPad, and An-droid apps that can help improve sleep. By using some o these apps,you can evaluate your sleep and assess your drowsiness. Other apps pro-vide relaxation exercises, help with meditation, or play white noise orsoothing sounds to help with sleep.

Search the Web or reviews o apps or sleep and relaxation. Reviewsmay help you narrow down ones that would work or you. Searching

the market specic to your device should also yield a variety o results.The ollowing website provides inormation about apps or the iPhoneand iPad: http://appadvice.com/appguides/show/sleeping-aid-apps. Andthis website lists apps or Android users: http://www.androidauthority.com/best-android-apps-sleep-insomnia-90783/. Another approach is tosearch in the iTunes App Store or the Android Market.

In addition to apps, various devices are available that can evaluate the

quality o the sleep youre getting. Most work by tracking how otenyou move while you sleep. Although not quite the same as having yoursleep evaluated by a sleep expert, these devices can provide inormation

you can share with your health care provider. Searching the Web ordevices or evaluating sleep quality or or sleep devices should yield alist or you to check out.


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Because we love gadgets, here are some ideas to get you started iyou are so inclined. One device, the Zeo Sleep Manager Pro, evaluatesyour sleep quality and provides coaching or improving your sleep. Formore inormation, visit http://www.myzeo.com. They also have a sleepknowledge center and, or a ee, a sleep health risk assessment.

Another gadget that can address exercise and sleep is the FitBit.The FitBit, which is a device that you clip on to your clothing whileyou are awake, tracks the number o steps you take, the number ocalories you burn, how active you are, and the number o fights ostairs you climb. When you are ready or bed, you place the FitBit in aholder that goes around your wrist, and it evaluates your sleep by howoten you move. Check it out on the Web at http://www.tbit.com.

R

kerstedt, T. (1998). Shit work and disturbed sleep/wakeulness. Sleep MedicineReviews, 2(2), 117128.

Alspach, G. (2008). Napping on the night shit: Slacker or savior? Critical Care Nurse,28(6), 12-19.

American College o Emergency Physicians. (2010). Circadian rhythms and shitworkPolicy resource and education paper (PREP). Retreived rom http://www.acep.org/content.aspx?id=30560

American Nurses Association. (2006). Assuring patient saety: The employers role inpromoting healthy nursing work hours or Registered Nurses in all roles and set-

tings.NursingWorld. Retrieved rom http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/AssuringPatientSaety.pd

American Osteopathic Association. (n.d.). Making healthy caeine habits.AmericanOsteopathic Association. Retrieved rom http://www.osteopathic.org/osteopathic-health/about-your-health/health-conditions-library/general-health/Pages/caene.aspx

Antoniades, J., Jones, K., Hassed, C., & Piterman, L. (2012). Sleep. . .naturally:A review o the ecacy o herbal remedies or managing insomnia.Alternative andComplementary Therapies, 18(3), 136-140.

Beattie, L. (2008). Study nds nurses need their naps.NurseZone.com. Retrieved romhttp://www.nursezone.com/nursing-news-events/more-news/Study-Finds-Nurses-Need-Their-Naps_28834.aspx


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Berger, A., & Hobbs, B. (2006). Impact o shit work on the health and saety o nursesand patients. Clinical Journal of Oncology Nursing, 10(4), 465-471.

Center or Environmental Therapeutics. (n.d.). The Automated Morningness-Eveningness Questionnaire. Retrieved rom http://www.cet.org

Czeisler, C., & Fryer, B. (2006). Sleep decit: The perormance killer.Harvard BusinessReview. Retrieved rom http://hbr.org/2006/10/sleep-decit-the-perormance-killer

Drake, C. L., Roehrs, T., Richardson, G., Walsh, J. K., & Roth, T. (2004). Shit worksleep disorder: Prevalence and consequences beyond that o symptomatic dayworkers. Sleep, 27(8), 14531462.

Enger, J., Nelson, L., & Walsh Starr, J. (1995). Understanding circadian rhythms:A holistic approach to nurses and shit work. Journal of Holistic Nursing, 13(4),306-322.

Lally, R. M. (2009, March). Badge o honor or recipe or disaster: The importance oadequate sleep or nurses. ONS Connect, 24(3), e-12.

Lockley, S. W., Barger, L. K., Ayas, N. T., Rothschild, J. M., Czeisler, C. A., & Land-rigan, C. P. (2007). Eects o health care provider work hours and sleep deprivationon saety and perormance.Joint Commission Journal on Quality and Patient Safety,33(11), 718. Retrieved rom http://www.ncbi.nlm.nih.gov/pubmed/18173162

Marino, P. C. (2005). Biological rhythms as a basis or mood disorders. Retrieved romhttp://www.personalityresearch.org/papers/marino.html

Muecke, S. (2005). Eects o rotating night shits: Literature review.Journal of Ad-vanced Nursing, 50(4), 433-439.

National Institutes o Health. (2008). Circadian rhythms act sheet. Retrieved romhttp://www.nigms.hih.gov/Education/Factsheet_CircadianRhythms.htm?wvsessionid=wv6b1e07b629d45b6a320bd3795664e

National Sleep Foundation. (2011a). Napping / National Sleep FoundationInormation on sleep health and saety. The National Sleep Foundation. Retrievedrom www.sleepoundation.org/article/sleep-topics/napping

National Sleep Foundation. (2011b). How much sleep do we really need? / NationalSleep FoundationInormation on sleep health and saety. The National SleepFoundation. Retrieved rom www.sleepoundation.org/article/how-sleep-works/how-much-sleep-do-we-really-need

Nursing Organizations Alliance. (2007). Principles o atigue that impact sae nursingpractice. Retrieved rom http://ana.nursingworld.org/position/atigueprin

Pronitis-Ruotolo, D. (2001). Surviving the night shit: Making Zeitgeber work or you.American Journal of Nursing, 101(7), 6368.

Rogers, A. (2008). The eects o atigue and sleepiness on nurse perormance and pa-tient saety. In R. G. Hughes (Ed.),Patient safety and quality: An evidence-based hand-book for nurses. (AHRQ Publication No. 08-0043). Retrieved rom http://www.ncbi.nlm.nih.gov/books/NBK2645/

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Night Shift Nursing: Savvy Solutions for a Healthy Lifestyle