Shift Work: How to Handle Sleep, Life

Got odd hours at work? Learn how to make your schedule work for you.

Medically Reviewed by Laura J. Martin, MD on March 02, 2010

Patricia Rose Brewster works the night shift. A fiber optics engineer in El Paso, Texas, Brewster, 50, has been clocking out and going to bed past dawn for the last 30 years. She wouldn’t have it any other way.

"I love working nights," she says. "People are friendlier, more laid back. You can get more work done at night than you can during the day...NO management at night. I would never work any other shift."

Brewster is one of the lucky ones. She says that despite her schedule she has never had any difficulty sleeping. Most people don’t have it so easy.

"We don’t see a lot of people who do fine on shift work," says Sally Ibrahim, MD, of the Cleveland Clinic’s Sleep Disorder Center. "They have trouble sleeping, trouble waking. And they’re drowsy when they’re awake."

Schedule Out of Whack

Working the graveyard shift forces the body to operate counter to its circadian rhythm, the internal clock that tells us when we should be sleeping and when we should wake. Few people adapt easily or completely to such schedules. It’s not uncommon for such people to suffer from shift work sleep disorder (SWSD).

SWSD is characterized by insomnia and excessive sleepiness. People with the disorder are more accident prone, irritable, and less able to concentrate – none of which will help win Employee of the Month status. Ibrahim says that lack of sleep is also linked to depression, anxiety, substance abuse, and other mood disorders.

Despite the toll that such shifts can take, somebody has to work them, from the waitress at the all-night diner to the on-call plumber, as well as police, firefighters, fiber optics engineers, and, of course, physicians and other hospital staff.

Karen O’Connell, MD, has worked from 11 p.m. to 7 a.m. in the emergency room at Children’s National Medical Center in Washington, D.C. for 2 1/2 years. She says she will never give it up, but she believes she’ll never fully adjust.

"It’s a very different lifestyle," says O’Connell, a 37-year-old mother of two young children. "A physician’s schedule doesn’t lock me in with what’s natural."

Handling Odd Working Hours

O’Connell and Brewster are night people. And night owls, Ibrahim says, thrive on the graveyard shift. For everyone else, it helps to have a few strategies to make working those odd hours easier. Here are five to try:

Shift Slowly: Any changes to your circadian rhythm should be made gradually, Ibrahim says. It takes at least two days – and perhaps as much as a week – to adjust to a major shift in schedule. Make sure your boss knows this. Ideally, Ibrahim says, your boss will give you two or more days to ease into your new hours. O’Connell says: "The human body doesn’t adapt to going back and forth" between schedules.

Resist Caffeine: The quick boost caffeine gives you is likely to raise your sleep deficit. Shift workers who rely on caffeine have more trouble getting to sleep after work, Ibrahim says. Brewster says she sticks with milk and water, and she sleeps just fine.

The Home Front: Your home life makes a huge difference when it comes to getting enough sleep. You need the support of those you live with, so that you can successfully manage kids, bills, and other priorities – not to mention having quality family time – without being robbed of rest. "Domestic factors can have a strong impact on coping with shift work," Ibrahim says.

Practice Makes Perfect: "You have to be smart about the amount of sleep you get," O’Connell says. "Sleep is a skill, and you have to be really savvy about where and how you sleep." Have a planned sleep period, and a very dark and quiet room at your disposal.

Get It in Writing: If the graveyard shift is causing you real problems, ask your doctor to write to your employer and explain your situation. "We’ve written to employers requesting shift changes for patients having significant problems," Ibrahim says. "The response has been very good." In some cases, a schedule change may be in everyone’s best interest. "I recently had a patient with narcolepsy," Ibrahim says. "I said, 'You can’t work nights in a hospital,' and we were able to shift his schedule."

"You see what fatigue does," O’Connell says of the toll that ER work takes on her and her colleagues. "When I’m in charge, we have time outs, to let residents take a break. There’s lots of give and take."

Still, she realizes that it is not for everyone.

"Some people don’t do well on the night shift, and we work that out among ourselves," O'Connell says. "But the night shift works for me and my family, and I’m getting better at it."

Show Sources


Patricia Rose Brewster, fiber optics engineer, El Paso, Texas.

Sally Ibrahim, MD, attending physician, Sleep Disorder Center, Cleveland Clinic.

Cleveland Clinic: "Shift Work Sleep Disorder."

Washington University Sleep Medicine Center: "Shift Work Sleep Disorder."

Karen O’Connell, MD, emergency room physician, Children’s National Medical Center, Washington, D.C.

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