An increasing number of Filipinos work in shifts as part of their jobs. These include call center agents, security guards, casino operators, hotel employees and hospital personnel like emergency room physicians, residents, nurses and nursing aides. Police officers, firemen and emergency response paramedics also work in shifts to provide round-the-clock service for us. Yet, all of them are at risk for what has been termed shift work sleep disorder.

According to a policy resource education paper from the American College of Emergency Physicians, people with shift work sleep disorder are always tired, have excessive sleepiness and have difficulty sleeping.

There is also a higher rate of getting peptic ulcer disease, heart ailments, depression, and substance abuse. The incidence of obesity, the metabolic syndrome and diabetes have also been increasing in shift workers. The main problem has been linked to a disturbance in the circadian rhythm of our sleep/wake cycle.

Circadian rhythm disorders and diabetes
The circadian rhythm is our internal clock that determines when we sleep and when we wake. It is closely regulated by the light-dark cycle of day and night. Simply put, we fall asleep when it is dark and wake up when light shines through our windows during sunrise. When we work irregular shifts, especially the graveyard shift, we are forced to function optimally at times when our body has been naturally programmed to be asleep. This results in sleepiness on the job—unintended dozing, irritability, reduced performance and accident proneness.

Our circadian rhythm also prepares our body for different functions during the day, such as eating our meals and being physically active. The body programs when insulin is secreted to coincide with mealtimes.

Insulin is secreted much more during the day when our body anticipates more food intake, and the levels are lower at night when fewer meals are expected to be consumed. When shift workers eat heavy meals at night, the amount of insulin produced may not be enough resulting in relatively higher blood sugar levels. The type of food intake (especially if high in calories or carbohydrates) results in obesity. Consequently, this excess weight and elevated sugar levels result in the development of type 2 diabetes mellitus.

This theory was validated in one study wherein researchers woke patients up 4 hours later than the previous day for 8 straight days, essentially disrupting their circadian rhythms. They measured leptin levels, a hormone that signals the body to stop eating by triggering feelings of satiety or fullness. There was less leptin in these persons, thus promoting more eating. On the other hand, blood sugar, insulin and cortisol levels were found to be high. Cortisol is a hormone released during stress and this brings up the blood pressure and blood sugar. Higher insulin resistance and glucose levels lead to diabetes.

For those persons with previously well-controlled diabetes, working the night shift may potentially result in fluctuating blood sugar levels. Hyperglycemia (high blood sugar levels) may occur when eating inappropriately more at night. On the other hand, hypoglycemia or low blood sugar may develop when medications are not appropriately timed with meals.

Getting the body clock in sync
Night shift workers can potentially lower these metabolic risks if they can figure out a way to keep their circadian rhythms settled or at least, to get a good night’s sleep whenever possible. Here are some tips to improve your sleep quality:

1. Try not to work too many nights in a row. You become more sleep-deprived the longer you work nights. Avoid frequently rotating shifts but if you need to, go from dayshift to night rather than the other way around.
2. When working the night shift, expose yourself to a bright lamp when you wake up, then keep your workplace brightly lit to promote alertness.
3. Limit caffeine. Drinking a cup of coffee at the start of your shift can promote alertness but taking more caffeinated drinks the rest of the night can result in difficulty sleeping at the end of your shift.
4. Avoid heavy meals, alcoholic drinks and vigorous exercise before bedtime. Regular exercise should be maintained earlier in the day.
5. Wear dark sunglasses on the way home to keep the sunlight out and try to go to sleep straight from work. Hang dark curtains or blackout blinds on the windows to keep any light from filtering in your room while you sleep. Turn off your phone and ask family and friends to limit calls or visits during your sleeping hours.
6. Stick to a regular sleep-wake schedule as much as possible even on your days off. This helps to keep your circadian rhythm in sync with your work schedule.

Diabetics working the night shift need to adjust their medication schedules. Medications like sulfonylureas (glibenclamide, gliclazide, glipizide, or glimepiride) and rapid acting insulin have to be given before meals. For nightshift workers, this would be best before the shift starts. Meals also have to be eaten in regular intervals to prevent very low sugars or hypoglycemia. Other medications can be given after the heaviest meal of the night. Using small, portable glucose meters to monitor your blood sugar level is a good idea when starting a new shift so your doctor can help you adjust dosages and medication schedules.

Exercise should be incorporated in your schedule to help with your diabetes control. Nutritionists recommend eating small, balanced meals which include carbohydrates that are low in fat and high in fiber (like whole grain breads, fruits and low-fat milk). For snacks, bring crackers, light sandwiches, or popcorn. At the end of your shift, have a light meal before going to bed.

Working the night shift has its dangers but knowing how to overcome them will assure you a good day’s sleep!

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