Sleep Tips for Shift Workers in the Time of Pandemic

Heidi M. Lammers-van der Holst, PhD

Audra S. Murphy, BS

John Wise, BS

Jeanne F. Duffy, MBA, PhD

Division of Sleep and Circadian Disorders

Department of Medicine

Brigham and Women’s Hospital

Boston, MA USA

Sleep is more important now than ever. 

Getting enough sleep is a challenge for those who work nights even in the best of times, because our bodies are designed to be at rest during the night and awake and active during the day. Whether you are an experienced shift worker or new to shift work, the added stress from the COVID-19 pandemic has likely made sleep even more challenging over the past weeks. 

Sleep does more than just make us feel better the next day. It allows us to pay close attention, remember new information, and multi-task. Over the long term, insufficient sleep can also impair our health, weakening our immune system, increasing inflammation, and leading to increased vulnerability to viral illnesses. Given how important sleep is for our safety, health, and quality of life, the following tips are designed to help those who work at night sleep their best.

Sleep tips for night shift workers.

• Plan for sleep! Build time for sleep into your daily schedule, and try to keep your sleep schedule the same each day as you work a series of night, evening, or day shifts.  
• If you are on permanent nights, try to keep regularity in your sleep patterns even on days off.
• When working nights, try to shift your sleep so you wake up close to the start of the next night shift, rather than going to sleep as soon as you get home in the morning. Alternatively, split your sleep so that you sleep for a few hours when you get home in the morning and then take an extended nap that ends just before you have to go back to work the next night.
• Improve your sleep environment; keep your bedroom cool, dark, and quiet. Use an eye mask or blackout shades, and wear earplugs or try a white noise machine or app. If you live with family or roommates, let them know when your sleep times are so they can try not to disturb you.
• If you have to keep your phone with you while sleeping, avoid checking it if you wake during your sleep episode.
• If you are sleeping in a new environment, try to make it as comfortable as possible. Bring your pillow, favorite pajamas, slippers, etc. from home to make your new environment as comfortable and sleep-friendly as possible.
• Practice a soothing pre-bedtime routine, such as taking a warm shower or writing down stresses from your day; this will help you to unwind and tell your body ‘it’s time to sleep’.
• Use caffeine (coffee, cola, energy drinks) at the beginning of your shift, but avoid caffeine 3-4 hours before you want to go to sleep.
• Avoid alcohol before bedtime. While it might help you fall asleep, it will reduce the quality of your sleep and may make it more likely that you wake up early. 
• Melatonin may help promote daytime sleep, but should be taken carefully because at the wrong time it may worsen sleep problems. Seek the advice of a sleep specialist for when and how much melatonin to take, and where best to obtain it.

Sleep, alertness, and safety for night shift workers.

• Shift workers are at high risk for having a drowsy driving accident while commuting (especially when commuting home in the morning after a night shift). Consider taking a short nap in your car before heading home. If you are driving and begin to feel drowsy, pull into a rest area or parking lot and take a short nap before continuing.
• Be aware that if you are new to shift work, or you are working longer hours than usual, you may be more likely than usual to make an error or have an accident while at work.
• While you are at work, try using small amounts of caffeine every 1-2 hours to help remain alert. This can be more effective than a large amount of caffeine only once or twice per shift.
• A short bout of exercise can make you feel more alert for the next hour or so.
• If possible, take a short (15-20 minutes or so) nap during your break time.
• Try a “coffee nap”! If you are very sleepy, drink a coffee (or other caffeinated drink) and immediately take a short (15-20 minutes) nap. By the time you wake up, the caffeine will have had a chance to act, and combined with the nap it should keep you going for the next couple of hours.

Additional information and help.

• Shift Work Disorder, a kind of circadian rhythm sleep-wake disorder. You should seek help from a sleep specialist if your symptoms persist for 3 months or longer. Find a sleep specialist at http://sleepeducation.org/find-a-facility.
• Information on fatigue among healthcare workers from the CDC/ NIOSH can be found at the following link: http://blogs.cdc.gov/niosh-science-blog/2020/04/02/fatigue-crisis-hcw/ 
• General information about sleep health can be found here: http://healthysleep.med.harvard.edu/

The authors are supported by grant R01 AG044416 from the National Institutes of Health.

Cite as: Lammers-van der Holst HM, Murphy AS, Wise J, Duffy JF. Sleep tips for shift workers in the time of pandemic. Southwest J Pulm Crit Care. 2020;20(4):128-30. doi: https://doi.org/10.13175/swjpcc024-20 PDF 

Tips for Circadian Sleep Health While Working from Home

Robin K. Yuan PhD¹

Enmanuelle Pardilla-Delgado PhD^1,2 

Kirsi-Marja Zitting PhD¹

Jeanne F. Duffy MBA, PhD¹

¹Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School; ²Department of Psychiatry, Massachusetts General Hospital,

Boston, MA USA

Sleep is more important now than ever.

Getting enough sleep and maintaining a regular schedule for optimal circadian rhythm health is a challenge for most of us even in the best of times, but the schedule changes and added stress from the COVID-19-19,  pandemic has likely impacted your sleep schedule over the past few weeks. 

Sleep does more than just make us feel better the next day. It allows us to pay close attention, remember new information, and multi-task. Regularity of sleep and wake also maintains the health and optimal function of the circadian timing system (our internal biological clock). Insufficient sleep and irregular sleep-wake schedules can impair our health, weaken our immune system, increase inflammation, and even lead to increased vulnerability to viral illnesses. Given how important regular, sufficient, sleep is for our safety, health, and quality of life, the following tips may help to optimize circadian and sleep health in people now remaining at home.

Tips for optimal sleep and circadian rhythm health for those working from home. 

• The good news is that if you are working from home, you may now have extra time for sleep! Many of us usually sleep less than our optimal amount, resulting in a chronic sleep debt. Now that you don’t have to commute, use that extra time for sleep to pay off your sleep debt.
• Many of us habitually cut our sleep short on weeknights and “sleep in” on weekends, which both creates a sleep debt and disrupts our internal biological clock. Working from home may allow you the time and flexibility to keep the same sleep schedule 7 days a week. If you are a night owl and can do your daytime work on your own schedule, embrace the flexibility to sleep at your (later) preferred times every night!
• Get up around the same time every day. Your wake time is like an anchor to your day and night. Keeping a consistent wake time will help other parts of your day fall into a routine and help you sleep better at night.
• Get bright light exposure during the day, especially in first hour or two after waking. Morning bright light, when received around the same time every day, is a powerful time signal to our body clock. Bright light has the added benefit of promoting alertness, which is particularly important if you find it difficult to get going in the morning. Try opening curtains to let in direct sunlight as soon as you wake up, taking a short walk outside before breakfast, or drinking your coffee on your balcony or in front of a window. When you are working, try to sit near a window where you can get as much sunlight exposure as possible.
• Try to make your first social interaction of the day at the same time each morning. When you are following “social distancing”, interacting with others can be difficult, especially if you live alone. Try to have a phone or video call with friends or family at about the same time each morning. Even a quick “hello” and check-in is useful. The other person will probably appreciate the human contact too!
• Eat your meals around the same time each day, especially breakfast. Eating meals at the same time of the day serves as a time cue and supports a healthy biological clock, which is important for sleep.
• Exercise around the same time each day and avoid being sedentary for long stretches of time. If possible, exercise outdoors so you can get bright light exposure.
• Keep daytime and night-time different and separate. Our body clock benefits from keeping day and night clearly distinguished. During daytime, keep your living space full of light and keep active doing your work from home or organizing, cooking, cleaning, and exercising. In the evening, keep the lights dim, block blue light on electronic devices, and do less active things such as watching TV, reading, or a sedentary hobby. Keep a regular pre-bedtime routine to help you unwind and tell your body ‘it’s time to sleep’.
• Avoid using light-emitting electronic devices (like laptops, tablets, smart phones) for at least 1 hour before your set bedtime. A dim evening environment can help your body naturally produce melatonin and prepare your body for sleep.
• Make sure your sleep environment is dark and quiet. Use an eye mask or blackout shades, wear earplugs or try a white noise machine or app. If possible, leave your phone in a different room.

Additional information and help. 

• If you find yourself staying up later each night and sleeping later and later in the morning, you may be developing, a circadian rhythm sleep-wake disorder. You may want to seek help from a sleep specialist if this causes your problems with your work schedule or family.
• To block blue light from your electronic devices, turn the brightness of the screen to the lowest setting, and turn on apps such as f.lux (multi-platform) or Night Shift on iOSand Macs.
• General information about circadian rhythm health can be found here.

The authors are supported by NIH grants P01 AG09975 (RKY, KMZ, JFD), R01 AG044416 (JFD), T32 HL07901 (EP-D), F32 HL143893 (RKY), R01 AG054671 (EP-D), and the Milton Fund (KMZ).

Cite as: Yuan RK, Pardilla-Delgado E, Zitting K, Duffy J. Tips for circadian sleep health while working from home. Southwest J Pulm Crit Care. 2020;20(4):126-7. doi: https://doi.org/10.13175/swjpcc023-20 PDF