“A life with night shift work and lack of sleep is like a marathon that we impose on ourselves to try to reconcile family life, work, and leisure, but which has immediate and long-term consequences on the mind and body.”
– Julie, a night shift nurse
“I stopped sleeping to take care of my son during the day because there was no daycare where we lived,” said Julie, a night nurse at the Jewish General Hospital in Montreal and a single mother whose son is suffering from ulcerative colitis. I was struck to realize that she chose to work at night, to which she responded, “It was not a voluntary decision,” because her motherhood dictated that schedule. “After I got divorced, I was alone to manage my son’s school, activities and his doctor’s appointments.”
While many of us end our day at sundown, packing up from the office, craving the comfy sofa to rest our heads on and release all the fatigue in one huge sigh, Julie’s workday – the work that is paid for – begins. Her schedule requires Julie to work during sleep hours and to sleep during wake hours. She leaves home at 6:30 p.m. to start her 12-hour shift in the ICU at 7:30 p.m. She returns home around 8:30 a.m. the next morning, still full of energy and her veins full of adrenaline. Later, she sleeps merely for four hours from 12 p.m. to 4 or 5 p.m., and then returns to work. “I can’t sleep more than that. It is impossible and if I try to sleep before noon, I have difficulty falling asleep.” This means that within less than four hours in the morning between 8:30 a.m. to 12 p.m., Julie must sprint to get her son ready for school, attend his doctor’s appointments, cook, clean the house and shop at the grocery store so that she can sleep at noon.
For Julie, it wasn’t always the same. Brimming with zest for life, she moved to Montreal after working as an emergency department nurse in France. Back then, after finishing her night shift and sending her son off to school, Julie would go roller skating or swimming, and then sleep. “Now that I am older, I don’t have to stimulate a lot to go to sleep. If I do sport, I can’t sleep,” said Julie, who is 52. Her son is now 24 and Julie has worked part-time for a year, which entails working for 3 nights per week. When asked if the part-time schedule benefits her, she said, “I was working full-time and did overtime to protect my son and to pay for our home. Now I am older, I have paid for my home, my son has grown up and so I am working part-time. Now, if I work more than three nights, I stop sleeping. It’s very bad. My body can’t understand the difference between night and day. This is new. My body has trouble adapting itself [to the new schedule].”
For someone who has worked full-time night shifts her whole life, the struggle to get a good night’s sleep on her nights off is understandable. This, for me who has experienced the frustration of endless tossing and turning at night, sounds more difficult than working a full-time night shift. With heightened concern, which seemed to be even more than Julie’s, I asked if she could sleep at night on an off day. “On an off day, I realized that my body needs to sleep during the afternoon for 1-2 hours and then at night early around 10 p.m. That’s very important for my body. If I take tea in the afternoon to not fall asleep and try to sleep at night, my body doesn’t understand what happened. Also, I can’t sleep all night. I sleep only three hours at night. When I wake up, I try to stay calm on the bed, I look at my iPad, read a book and accept that I can’t sleep.” During the evening on an off day, Julie’s brain is not exhausted, but her body is. This is because it is at this time that she would normally start her work. This is a clear barrier to having longer sleep at night.
When asked if she has sought for a doctor’s advice or has tried any remedies to improve sleep, she said, “Many of my friends have started melatonin and other sleeping pills and they have become dependent, they can’t sleep without it. I do not want to take pills. I don’t want the pills to control my sleep. I accept that I can sleep when my body needs to. I think we can do so many things to avoid pills. If I can’t sleep, I do something else.” Julie shared some habits which helped her get the sleep she needed. “Taking a very hot bath after coming home from work and eating less in the evening during off days to avoid waking my body up helps me a lot. To fall asleep, I watch something boring on the TV while in bed.” For her, it’s the news. “After work, I cover my eyes partly – not too dark, my body should know it’s the day. My cats’ purring helps me fall asleep,” she continued. Indeed, her three cats who bombed our Zoom call must be proud of their contribution to their mama’s sleep. Even though she sounded composed, Julie’s adaptation journey was long – it was a long haul learning about the body and listening to its needs. Julie had to adapt her sleep to a new schedule at the beginning of her shift work career, when she lost her parents, and when she changed to part-time work. In the future, she will have to adapt when she retires.
Over the years, Julie has found a sleep schedule which suits her. However, as a researcher in the field of sleep loss, I am aware that irregular sleep, sleep deprivation or sleeping during the day not only affects sleep health but also impacts quality of life, cognitive functions and bodily functions. “With time I realized that there is a big effect on my life without good sleep.” An important observation she made was the change in her eating habits. “I gained a lot of weight. It is because when I am exhausted, I eat. When I am not sleeping, I am eating more.”
Night shifts affected her ability to remember the occurrence of events, i.e. episodic memory. She gave the example of her visit to The AURA Experience at the Notre-Dame Basilica of Montreal. “I had worked the night shift. I came home, tried to sleep in the afternoon as usual and then went to the Aura. A few days later I went there again, but on an off day. I was shocked because I felt like it was the first time I saw it! I feel that throughout my day I sleep many times without realizing it. My brain is not in the present when I do something. My body is here, but I am not here. It looks like I am functional, but I am not.” She added, “I suffer from memory loss, chronic fatigue and I have physical problems for many years,” she said in despair.
Just as her body’s habituation to the night shift work affects her sleep-wake schedule on the off days, her habituation to the off days affects her night shift work. She shared that during the night shift, she finds it hard to stay awake around 10 p.m., as that is her usual bedtime on her off days. “So, I eat less during our evening break to signal my brain that it is time to work,” she said. I was surprised that, as opposed to most of her colleagues, Julie chooses not to drink coffee to stay awake on the night shift. “It’s aggressive for my body.” Instead, she keeps herself functional at night by taking a nap during her night break of an hour.
I asked if napping at work makes it easier, to which she responded, “We got a room dedicated to nurses’ sleep. We have 4 beds and 2 blankets, and we have around 22 nurses. It’s not enough. Some people don’t sleep, and some people sleep on a chair. Since the nap room is adjacent to a busy passage, people’s traffic and many call bells can be heard. There is a conference room and a kitchen which can be used for napping at night as it’s quiet at night.”
“Do you think you need more or quieter nap rooms?” I asked.
She exclaimed, “Some of my friends don’t sleep at night because they are no longer functional after. We are in the ICU; we must be vigilant. Everyone must find their balance. If it is hard for someone to stay awake at night, they probably must change shift or drink coffee.”
Listening back to this interview made me curious about whether it is indeed easy to change shifts, or choose shifts, especially for early career nurses. Is this one of the factors contributing to the current lack of nurses? Relevant to this issue, Julie shared a funny yet insightful anecdote about a new, young nurse who was appointed on rotating shifts and didn’t have a choice to switch to a day shift.
“One night, this new nurse on the rotating shift took the night break at 2 a.m., while all of us were unaware of where she was. She was not in our unit or kitchen or conference room. So, we had to call overhead, and we still did not know where she was. Finally, she was found in another unit where she slept for 4 hours until 6 a.m. This happened twice. She realized that her sleep is not good with the rotating shift.” The ICU department lacked one nurse during those nights. This could have had implications had there been a serious situation. But the question is, is it fair to blame the nurse for succumbing to the biological need for sleep? While some may doubt her competency, the issue at hand isn’t necessarily about her abilities as a nurse, but rather the challenges in managing sleep and coping with sleep loss.
Julie and I agreed that organizations could guide their employees towards attaining better sleep, improved quality of life and effective coping mechanisms, including introducing the right place to seek help. Organizations should recognize the sleep issues of people like Julie or the young nurse who involuntarily did rotating shifts, who has family responsibilities, and who like any other human being wishes to live a fulfilling life – all of which are impacted by sleep. Moreover, synergistic effects can surface when situations around us change like menopause, demise of parents, caregiving responsibilities or single parenthood. Through organizations’ support or listening to others’ stories, individuals can accelerate their coping and adaptation process which, as we learnt from Julie, may take years.
Behind this insightful discussion on Julie’s sleep, life and work, I witnessed an enthusiastic, zealous and passionate person. She said, “During my full-time night shift, people called me crazy because I prioritized doing many activities for myself over my sleep. I knew that it affected my sleep. But for me, it was my happiness to give time to myself and my family. Now with part-time, I can do so many things quickly and well, I can appreciate life, I am here, in the present.”
For Julie, preparation has been a key. Preparing the mindset to sleep in the afternoon and night, preparing her body to nap at work during her break and preparing her mindset for retirement. “I must help my body and brain to understand that in ten years you will retire. You must prepare now for a different schedule.” She has dedicated the last three decades of her life to working night shift and she loves her work despite all its effect on sleep. When asked about how she feels about retirement in ten years, she said, “It’s too soon for me.”
