How to Be a Overnight Shift Warrior

Annie Lu, Simmons Dietetic Intern

For many people, sleep is often an overlooked, but essential part of our health and overall wellbeing. Getting
enough quality sleep is hard enough for those of us who work a typical nine-to-five job, but for overnight shift
workers, it is even more challenging. 

The overnight shift is undoubtedly a difficult time to work because our body is naturally programmed to be asleep.
Then when we get home the next morning, our body is trying to keep us awake during the day, which makes it
hard to get enough deep, restorative sleep. A few days of working overnight shifts without getting enough sleep
during the day leads to sleep deprivation and in the long term can lead to shift work sleep disorder (SWSD), which
is a circadian rhythm sleep disorder characterized by excessive sleepiness, insomnia, or both.

What are circadian rhythms?

A main challenge of overnight shift is being forced to sleep against the internal master clock in our brain. Every
organ and tissue in our body has its own clock and they are synchronized by the master clock. The organs and
tissues follow circadian rhythms or cycles that regulate important body processes on a daily schedule:

• Sleep-wake cycles
• Eating habits 
• Digestion
• Hormone release 
• Body temperature

Circadian rhythms help keep our body’s processes in tune like how a conductor keeps an orchestra in tune. These
rhythms are set by our exposure to sunlight in order to keep the clocks’ timing close to the night and day cycles. In
response to darkness at night, our brain makes a hormone called melatonin to make us sleepy; conversely, daylight
signals our brain to keep us awake. Learning how to adapt to the opposite sleep pattern is an obstacle that
overnight shift workers must overcome.
Why do we need sleep?

Getting enough quality sleep is important for both physical and mental health. When we sleep, our heart
and blood vessels are being repaired. Additionally, our blood pressure goes down when we sleep, so
when we’re sleep deprived our blood pressure stays higher for longer, which puts us at risk for heart
disease and stroke. 

Sleep also maintains a balance of the hormones that make us hungry (ghrelin) and full (leptin). When we
don’t get enough sleep, our level of ghrelin goes up and our level of leptin goes down, making us feel
hungrier than when we’re well rested. 

Another hormone affected by sleep is cortisol, which is a hormone made by the hypothalamic pituitary
adrenal (HPA) axis and is best known as the stress hormone. Cortisol is produced alongside our sleep and
wake cycles; it is highest about an hour after we wake up and lowest around midnight. However, when
our circadian rhythms are disturbed during overnight shift, so is cortisol secretion. Poor sleep increases
the activity of the HPA axis, which increases cortisol levels, and as a result increases blood sugar.
Frequent and long term cortisol elevations inhibit insulin production, make our cells insulin resistant,
and can lead to type 2 diabetes.  

While we sleep, our brain is preparing for the next day by forming new pathways to help us learn, make
decisions, and problem solve. Therefore, lack of quality sleep may reduce our alertness, impair our
judgement, and make it hard for us to control our emotions and behaviors. These can all lead to loss of
productivity at work and increased accident rates. Sleep deficiency has also been linked to mood
disorders such as depression. When we are on a reverse schedule from the people we care about the
most, we may feel disconnected from them. It can be hard to manage social activities or even motivate
ourselves to be social after a few overnight shifts.
Are overnight shift workers doomed for poor health?

Our body is adaptable and with some planning, we can train it to adjust to an overnight schedule, similar to how we adjust to
a different time zone. There are a variety of strategies to get enough restorative sleep, but finding the approach that works for
you depends on your individual needs and your job requirements. 

Our body prefers routine, so overnight shift workers should try to stay on the same sleeping schedule everyday, including
days off in order to align our body clock with our sleep pattern. It is essential to get as much sleep as you can prior to a night
shift. Shift your sleep schedule so you wake up close to the start of your next night shift. OSHA recommends 7-9 hours of
uninterrupted sleep, but if this is not possible, split it up so that you sleep when you get home in the morning and take a nap
before you go back to work the next night.

Depending on your living situation, you may have to tell your family or roommates about your work hours and sleep times in
order to reduce disruptions to your sleep. Make your bedroom an environment that promotes uninterrupted sleep by: 

• Blocking out light using black out curtains or wearing an eye mask
• Drowning out noise using a white noise machine, fan, or ear plugs 
• Setting the thermostat to a cool, but comfortable temperature (near 65℉)

Practice good sleep hygiene by having a relaxing pre-bed routine such as doing some light stretching, meditating, or listening
to relaxing music. Avoid looking at a screen at least half an hour before bed because the light from the screen decreases
melatonin production.

For rotating shifts, it’s easier to adjust to a schedule that rotates clockwise instead of a schedule that rotates counterclockwise
or has a random pattern. For example, work day shift one day, evening shift the next night, and night shift the following night.
If time permits, take a nap before reporting for night shift to make you more alert on the job. Since it’s not possible to keep a
regular sleep schedule, your sleep time will need to be adjusted before a shift change. For example, if you work evening shift
for two nights then night shift the third night, delay the times you go to bed and wake up by one to two hours each day to give
your body time to adjust to the new schedule. 

It might take some time for your body to adjust to an overnight shift schedule, so be patient with yourself. Whether you have a
fixed shift or rotating shifts, it all comes down to making sleep a high priority and using strategies that work best for you and
your schedule.
Okay, but what about food? 

Overnight shift workers face the challenges of lack of food options at night and being too tired to think about
what to eat. You may wonder should I even be eating so late at night? What if I’m not hungry? 

There is a common misconception that eating at night will cause weight gain. Night time isn’t the only
problem though. Studies suggest that circadian misalignment coupled with poor food choices and irregular
meals impair energy metabolism. This disruption also raises ghrelin and lowers leptin, which leads to an
increase in hunger. Eating while we’re supposed to be sleeping sends mixed messages to our digestive system,
which is less efficient at night. It disrupts our normal rhythm for glucose metabolism and impairs glucose
tolerance. It’s a vicious and complex cycle.

On top of that, there are limited studies on dietary interventions used to improve the health of overnight shift
workers. Esther Lopez-Garcia, PhD, MPH, MhPharm, a professor of preventive medicine and public health in
the School of Medicine at Spain’s Universidad Autónoma de Madrid advocates for dietary patterns that consist
of minimally processed foods, high-quality fats, with low amounts of added sugars and salt. The
Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH), the Healthy Eating Index, and plant-
based diets follow this way of eating. She says, “In addition to the important nutrients they provide, these
diets are digested slowly, which leads to a gentle rise in blood sugar and insulin. This produces fewer peaks of
hunger, less deprivation, and less production of stress hormones. All of this also has a beneficial impact on
sleep.”
Fuel to thrive

It is important that overnight shift workers have enough energy throughout the
night. Even if you don’t feel that hungry, try to eat a small meal before you start
your shift. This first meal mimics breakfast and will boost your energy levels.
Avoid big meals to minimize further disruption of the circadian rhythm. As the
night goes on, eat small snacks if you’re hungry such as: 

• Carrot sticks with hummus

Prepare these snacks ahead of time at home or stop by a grocery store before
work to pick them up. Our brain runs on carbohydrates as its main fuel source,
which is why when we are tired late at night we are more likely to reach for
high energy foods such as sugar and starch which provide quick energy. But
eating only carbohydrates causes our blood sugar to spike and drop quickly,
causing us to “crash”. To prevent this, we need to eat carbohydrates with
protein or fat to keep our blood sugar steady and keep us full. 
To cook or order out?
If you have time, try meal prepping before the start of the week. Experiment with slow cooker or pressure
cooker recipes and refrigerate portions for easy access when you don’t have the energy to cook. If you are
unable to cook, here are some tips for making healthy food choices when ordering takeout as your main
meal:
• Look for these words: grilled, sautéed, roasted, steamed, baked, poached
• Choose a protein: lean beef or pork, chicken, turkey, seafood, eggs, tofu, beans, lentils
• Pick a starch: brown rice, whole wheat bread or pasta, baked or sweet potato
• Prioritize vegetables: broccoli, side salad, double lettuce and tomato on your burger
• Ask for sauce and dressings on the side
• Add a finishing touch: fresh fruit or fruit-based desserts, yogurt parfait 
If the portions are too big, save some food for another meal. Stay hydrated and drink plenty of water
throughout the night to prevent fatigue. Limit caffeine intake three to four hours before the end of your
shift, since caffeine is a stimulant and can prevent you from getting the deep, restful sleep you need. Also,
avoid drinking alcohol too close to bedtime since it suppresses melatonin and reduces sleep quality. 
When you get home, try to eat a light “breakfast” or snack before going to bed since it can be hard to sleep
if you’re too hungry or too full. This also helps you avoid waking up hungry. Eating foods that are high in
carbohydrates and lower in protein and fat can make you sleepy. Some examples include orange juice, toast
with jam, and cereal. 
It is okay and normal to have a treat every once in a while for comfort or to help you unwind, but if you find
yourself regularly reaching for calorie dense foods (high in sugar, starch, fat) in large portions, you may be
eating for emotional reasons. Pay attention to how you feel at night (tired, stressed, lonely) and find other
ways to deal with these emotions, such as taking some deep breaths, going for a walk, or talking to a fellow
coworker. 
Just like how we can adapt to a new sleeping schedule, we can adapt to a new eating pattern. With the right
preparation, routine, and habits overnight shift workers can adjust to their unique schedule while taking