1. Shifts Happen

2. Night Owl Nursing: Pro’s Autonomy Fewer interruptions Strong camaraderie Salary differential Easy commute (and parking!) Flexibility with family schedules

3. Physiology of Night Shifts Melatonin follows a circadian rhythm Highest melatonin synthesis at night Light exposure inhibits melatonin

4. Physiology of Night Shifts Cross-sectional study of 354 nurses and midwives age 40-60 rotating night to day shift. > 8 night shifts/per month had lower levels of melatonin metabolites (Peplonska et al., 2012)

5. Physiology of Night Shifts Adjusting to circadian rhythm changes is cellular “Clock genes” Light-at-night (LAN) disrupts the clock genes Cellular oxidant-antioxidant balance with the generation of oxidative stress is upset Lower levels of Vitamin A and E found in premenopausal women rotating shifts. (Gromandzinska et al., 2012)

6. Night Shift Risks Type 2 Diabetes Every 5 year increase of rotating nights shifts - 5% elevated risk of diabetes - adjusted for BMI Why? Circadian misalignment - increases glucose and insulin - increases post-prandial glucose response Diabetes known association with sleep disorders

7. Night Shift Risks Breast Cancer “Clock” genes are tumor suppressors Sun exposure may be protective Lower melatonin results in higher circulating estrogen OR = 2.6 for long term day-night rotating shifts (Hansen et al., 2012)

8. Night Shift Risks Skin Cancer 10+ years of rotating to night shifts - 14% decreased risk of skin cancer - 44% decrease risk of melanoma

9. Night Shift Risks Premature Labor Menstrual Irregularities Obesity 2,086 nurses Night shift rotation associated with obesity (Zhao et al., 2012)

10. Night Shift Risks Sleep Disturbances Sleep Quality Sleep Quantity Day nurses mean sleep = 8.3 hrs Night nurses mean sleep = 4.8 hrs

11. Night Owl Nursing: Survival Tips

12. Night Survival: Light At work: 34 nurses exposed to bright light during two break times for 4 weeks Bright lights suppressed nighttime melatonin, increase body temperature, improved alertness (Zamanian et al., 2010)

13. Night Survival: Light After work: Wearing sunglasses before leaving after a night shift may help circadian rhythm from being triggered During sleep: Room-darkening, blackout shades, sleep mask

14. Night Survival: Sleep Sleep hygiene: High quality mattress, pillow, covers for comfort Cool room Follow sleep schedule off shift Consistent bedtime routines Sleep in one episode Nap before going to work Reduces sleep pressure during subsequent sleep periods Nap at work!

15. Night Survival: Diet At work: High-protein, lo-fat Frequent snacks Lots of water! Caffeine Onset of effect 30 min Peak at 4 hours Duration 6-10 hours Eat main meal around 0100 After work: To sleep: milk, carbs No caffeine

16. Night Survival: Activity  Regular activity  Adequate sun exposure  Good communication with friends and family  Limit night schedule to two in a row  Always rotate forward: days to evenings-evening to nights  Be aware of your breast health

17. Night Survival Shift Work Tolerance 322 new and 427 experienced nurses Age related to higher tolerance for shift work Hours per week and caffeine related to intolerance (Saksvik-Lehouillier et al., 2012)

18. Questions?