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Week of 12 September 1997

Vol. I, No.3

Health Matters

Working at night: how to stay awake and alert

I have started working the graveyard shift and constantly feel tired. Is there anything I can do?

For more than 11 million Americans, the workday begins after 6 p.m., when most people are heading home. While working night and early morning hours can make the commute easier, it can upset sleeping patterns and cause other health problems. In addition to sleep problems, shift workers (including workers on floating shifts, which change every few days or weeks) commonly suffer from lowered alertness and gastrointestinal problems, says Dr. Robert Swotinsky, director of Occupational and Environmental Medicine at Boston Medical Center and assistant professor of medicine at Boston University School of Medicine. While adjusting to shift work is difficult, the transition can be eased by changing dietary and sleeping habits.

Fluctuations in the body's physiological and psychological processes, called circadian rhythms, are the prime culprits of sleep deprivation. Your heart rate and short-term memory, which usually peak at midday and reach their nadir in the middle of the night, are among the many circadian rhythms that wax and wane during a 24-hour period. Since most of these processes are at their peak during the day, the body is most productive during the daylight hours. Shift work counters your body's rhythms by requiring high-level production when the body is least prepared.

But some strategies can soften the harsher effects of shift work. Sleep in a dark, cool, sound-insulated bedroom and use ear plugs. Shut off your phone and tell your household of your sleep schedule. The early morning hours are the most difficult for sleeping, so try to sleep later in the afternoon and evening. The best hours to sleep for the night-shift worker are between 2 and 9 p.m., but if you cannot manage this schedule, split your sleep, making time for a nap in the evening. Sleeping pills may serve as a temporary aid, but avoid them over the long run.

While researchers do not completely understand the effects of circadian rhythms on digestion, you should probably avoid eating large meals during working hours and eat only a small meal in the evening. If you have diabetes and are beginning shift work, consult your physician.

Obviously, your employer has control over your work schedule, but you might try to arrange for naps during your shift or ask about rotating shifts, which might offset some of the effects of shift work. Diabetes and certain sleep disorders might medically disqualify a person from shift work.

Swotinsky advises that anyone with sustained problems that clearly result from shift work should ask his primary care physician to recommend a doctor specializing in occupational medicine.

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about sleep disorders or other health matters, call the BMC Health Connection at 638-6767.