Shift work is hard! As a nurse I know what it is like to work 12-hour night shifts and try to have a normal life on my days off. There were plenty of times I stayed awake for over 24 hours so I wouldn’t be missing out on events with friends or family the day after working a night shift. Even now that I’m working 12-hour day shifts, I still struggle to make it to events and time my meals so I’m not eating at 9 at night and going to bed soon after. Don’t get me started on how tired you are after working a stretch of shifts or even 1 chaotic 12-hour shift. You know, the one that turned into a 16 + hour shift that felt like an eternity in hell that drains you so much mentally and physically that you are pretty much worthless for anything productive the next day. Add on the external stressor that most shift workers (nurses, EMTs, firefighters, police officers, etc.) have like sleep deprivation, irregular eating habits, etc. and we begin to tax our adrenal system even more. Night shift is especially hard though because it can really take a toll on our natural circadian rhythm and how our body regulates cortisol and melatonin.
In a balanced system, cortisol starts to rise in the early hours of the morning as melatonin drops. This signals our blood sugar to rise so we have energy for our bodies to awaken and prepare for the day. Throwing off that natural circadian rhythm is what puts night shift workers at a greater health risk than shift workers in general. What seems like a simple process can lead to a cascade of issues when it is out of sync. Imbalances in cortisol and melatonin can lead to insulin resistance, depression, metabolic problems, higher incidences of diabetes, coronary artery disease and cancer.
So, what can we do about this?
While quitting your job or adjusting to the same schedule everyday (always staying on a night shift schedule) isn’t feasible for most anyone, don’t give up hope! There are several things you can do to reduce stress on your body and help regulate your circadian rhythm.
Meal planning and prepping
This doesn’t mean you have to plan gourmet meals either. Just focus on quality ingredients and whole foods. Having healthy meals that are accessible reduces the mental stress of “nothing is open, what the hell an I going to eat…I guess this bag of chips and/or candy bar will do.” Healthy meals also reduce the physical stress that processed foods have on your body such as the lack of nutrients/empty calories, bad fats and blood sugar spike and drop you’ll experience with them. Having an apple (or celery) with nut butter (ideally nuts & salt only) as a snack takes no time at all and it is balanced with protein, carbs and fat. Another simple option is organic sting cheese with some almonds or cashews. Again, hardly any prep. Need a quick and easy meal? Buy a pre-cooked rotisserie chicken. You can either pair it with a couple cups of roasted veggies or buy a pre-made bagged salad. Shred some of the chicken and put into Tupperware so you can add it to the salad when you’re ready to eat it. Add some extra nuts, seeds and/or avocado and it’s a pretty balanced meal. Ideally look at the ingredients in the salads because they are not all created equal. But honestly, if it is between most any of those salads and a processed meal, the salad should out weight the latter. A lot of times you can find salads on clearance at the store which is a bonus if you are going to eat them right away. Those are just a few examples. If you do make large meal at home, make extra and put it in the freezer in individual portions so you have a quick grab and go meal later down the road when you don’t have time to prep.
More Food tips…
Limit processed foods and chose products with real food ingredients.
An easy way to build a meal is starting with a quality protein, 2 cups of veggies (1/2-1 cup of starchy veggie and 1-2 cups non-starchy veggie) and add healthy fat like avocado, EVOO or grass-fed butter.
Erratic eating schedule can disrupt the gut microbiome, add stress to your body and blood sugar dysregulation. Time restricted eating can normalize this (eating your meals within a specific time frame). Add probiotic rich fermented foods & drinks like kombucha, kvass, kimchi and flavored krauts.
Be sure to pair carbohydrates with healthy fats to help prevent blood sugar spikes and crashes.
Carb cycling can help you regulate your cortisol levels. This involved eating lower carbs when you first wake up and the heaviest carb meal in the evening or vice versa if you are working.
If work at night, eat your biggest meal 1-2 hours before your shift. Lots of protein and healthy fat, not too carb heavy.
Eat a balanced light meal snack when at work
If you worked that night eat your breakfast 1-2 hours before bed with protein and fat and healthy carbs. The carbs will lessen the strain on your adrenals and help lower your cortisol levels before going to bed.
Exercise
Exercise is also important in mitigating your health risks. This can even be a brisk walk 20-30 minutes a day. The time of the day when you exercise depends on how your body feels after working out. If it helps you unwind, and you feel relaxed afterwards then exercising after your shift may be best for you. If working out gets you revved up and alert, then it would be best to do it after you wake up and before going into work. As long as you find a time of the day that allows you to do it consistently (a few times a week) without disrupting your sleep is a win!
Sleep and Sleep Hygiene
Melatonin production for night shifters may be lower than normal due to this dysregulation of the circadian rhythm. It’s important when leaving work, if its light out, to have amber tinted sunglasses or ones that block blue light wavelengths. These wavelengths suppress melatonin production which we don’t want to do. These types of glasses can be purchased on Amazon. If you already wear glasses, you can get them with blue wavelength blockers built in. When sleeping at home, you should create the darkest space possible. Black-out curtains are a must and cover digital clocks or anything else that has a light. Remove anything from the room with lights that you can’t cover and also anything that may beep or make noise that could potentially wake you up. A sleep mask and ear plugs may be necessary depending on lights and sounds you cannot control (family members, pets, road traffic, etc.). A sound machine, fan or other type of white noise can also be beneficial as is keeping the room cool while you sleep. Avoid the use of electronics or bright screens before going to bed as well.
When you awaken
Get some sunshine. The moment you get out of bed, if the sun is up, get yourself outside (or in front of a window if it’s the arctic vortex) and soak up the sun. If it is dark, but you are getting ready for work, put yourself in a brightly lit room. You can also get yourself a light machine and sit in front of it for 15-20 minutes to increase cortisol. These lights can also be helpful with seasonal affective disorder. Talk to your provider about possible need of vitamin D supplementation. With the lack of sun and many health benefits of vitamin D, it may be beneficial.
Days off work
Some research suggests having a hybrid schedule on your days off. On your off days from work, go to sleep 6 hours earlier than you would on a work day to help transition your body’s sleep schedule. So, you would go to bed at 2am if you normally go to sleep at 8am after working a night shift.
Meditation, Yoga, Gratitude or some other stress reduction techniques
Doing these types of practices regularly can not only calm your system down at that moment but allow your body to react less to stressful situations in general. If you work in the ER or similar situation, you can’t control the outside stressors that are coming in. “Sorry sir, can you wait to have your heart attack or stroke until the next shift?”. There are combative patients, short staffing, family yelling at you, traumas, code blue...maybe all at the same time! This gets your adrenaline running (increasing cortisol and blood sugar) and you go into that sympathetic, fight or flight response, but if you train your body to be less reactive to those outside stressors you can shift out of that mode, back into a relaxed state more easily. Being able to get out of that sympathetic state decreases your cortisol levels, helps regulate your blood sugar better and decreases the inflammatory response on your body that chronic stress creates. I am really enjoying the Insight Timer app. It is free (unless you want to upgrade) and has a variety of meditations you can do in just 5 minutes! EFT (Emotional Freedom Technique) tapping is a quick and easy way to reduce stress and anxiety. It uses the same principles as acupuncture and you can learn and do this on yourself quite easily.
Hydration
Water is often the most deficient nutrient in our body. Staying hydrated allows our bodies and minds to perform optimally. Drink plenty of water between meals and less with your meals. Take your body weight in pounds and divide that by 2. That is how many ounces of water you should be drinking. So, if you weigh 150 pounds you should be drinking 75 ounces of water a day. Add a pinch of sea salt to room temperature water with fresh lemon and drink it when you first wake up. This will make your adrenals happy and kick-start your digestion. Try to limit caffeine consumption to 1 cup’s worth per day. If you’re the type that drinks a pot of coffee a day, start by weaning yourself down and avoid caffeine in the second half of your day.
By implementing these changes, you are adding more balance to your life, regulating your natural circadian rhythm and decreasing your risk of chronic disease. Making lifestyle changes sometimes takes time and can be a challenge. Whether you’re an all or nothing type of person or you like to take things slow and steady, these are all changes anyone can implement. Talk to your friends, family and co-workers and ask for their support. This will help give you accountability and hopefully a greater sense of community.
Some Outside References Used
https://experiencelife.com/article/the-cortisol-curve/
https://drjockers.com/7-ways-prevent-shift-work-disorder/
https://www.hindawi.com/journals/ije/2015/591729/
https://www.hindawi.com/journals/ije/2015/826249/
https://chriskresser.com/how-shift-work-impacts-your-health-and-what-to-do-about-it/
