Depending on your point of view, night and shift work can be a boon or a curse. On the plus side, working nights or unsociable hours gives you the time to do your own thing away from the crowds. But chronic tiredness, health and relationship problems are all common complaints from the bleary-eyed. We examine the problem and offer some advice on how to cope.

HEALTH PROBLEMS ASSOCIATED WITH SHIFT WORK

Night workers can find it hard to get decent quality and quantity of sleep during the day for a number of reasons. First our natural circadian rhythm (the body's highs and lows during a 24-hour cycle) boosts alertness in the morning, making sleep difficult1,2.

Distractions like outside light and noise mean you spend less time in a really deep sleep and don't wake up refreshed. It's tempting to stay up when the family's around, then lose sleep yourself. It can lead to a constant feeling of tiredness, dropping off at work1 - even car crashes3.

Many shift workers suffer stomach problems, including ulcers1,4 and Crohn's disease4. They're also more likely to have digestive problems associated with poor diet, disturbed sleep and stress. These include constipation, diarrhoea, heartburn, and wind2. Heart problems, including coronary heart disease and ischaemic heart disease, have been linked to shift work by several studies1,2,5 - although others question it2,6,7.

Women shift workers could find it more difficult to get and carry a pregnancy to full term, studies have shown2,5, although more research is needed to confirm this association. Depression has also been linked to shift work, although it seems to affect only those people who are already vulnerable to it1,5. There is a stronger association with increased anxiety and stress levels1,2.

MAKING SHIFTS WORK FOR YOU

SLEEP WELL

Lack of sleep is at the heart of many shift-related problems. There are lots of things you can do to improve your chances of getting enough rest:

-- wear sunglasses on the way home during sunny weather, so the brightness doesn't stimulate your brain

-- avoid alcohol and caffeine because they can act as stimulants and affect your quality of sleep

-- avoid heavy, greasy food before bed as your body will find it difficult to digest - try soup, fruit and toast

-- even if it feels odd when everyone else is getting up, adapt a normal pre-bed routine like having a light snack, a bath, brushing your teeth and perhaps reading - and don't be tempted to nap on the couch

-- install black-out blinds in your bedroom, or put blankets over the windows

-- block outside noise with a fan or a 'white noise' device or wear earplugs

-- turn off the doorbell and 'phone. Buy a pager so close friends and family can contact you in an emergency

-- if you really can't sleep in the morning, try in the afternoons before work instead, but make sure you leave yourself enough time, though

"Don't be tempted by tranquilisers," says BUPA's associate medical director, Dr Sally Cubbin. "They might help in the short-term but not as a way of coping with shifts because they're addictive."

"If your shifts jump around, give yourself at least one quiet day to recover after coming off one shift pattern," Dr Cubbin advises. "If the hours are regular, keep a similar routine on days off by sleeping in late, going to bed late and/or sleeping part of the day. It's less of a strain on the body that way," she says.

EAT AND DRINK SENSIBLY

It pays to keep to a regular eating schedule, even if your working hours change from day to day. Try and have breakfast at breakfast-time, for example, even if you're just coming in from work. It's light enough for your body to digest - and a small amount of food will stop excess acid from circulating in your stomach2.

Avoid heavy meals after midnight on night shifts. They not only make you feel drowsy, the body naturally slows down then so your body won't digest the food properly. Avoid fatty, spicy and high fat foods overnight, for this reason. Try pasta, rice, potatoes, soup, wholegrain bread, chicken, fish, tofu and low fat dairy products. Avoid caffeine and alcohol. Water is least likely to irritate the stomach.

BE CAREFUL ABOUT MEDICATION

Always tell your doctor you work shifts before they prescribe medication because it might make you drowsy. If you're on antibiotics or other treatments which must be taken regularly, work out with them the best way to proceed. BUPA occupational health physician Dr Jenny Leeser says: "Anyone on long-term medication should consult their doctor before starting shift work. If you're a diabetic taking regular insulin, for example, it could cause real problems."

MAKE TIME FOR FRIENDS, FAMILY - AND YOURSELF

One of the keys to making shift work a success is ensuring friends and family appreciate how important it is you get some sleep. At home, make sure the family keeps the noise down and doesn't disturb you unless it's an emergency. Also:

-- try and eat breakfast with them and meet the children from school before you go to work

-- little things like ringing the kids from work to bid them goodnight reminds them you care

-- keep a family calendar/notice board to keep you in touch with each other's movements

-- make a real effort to mark special days like birthdays and anniversaries and ask for days off/shift changes well in advance so you can be together

-- if you can't be around, ask the family to record special events with a camcorder

Use email and answering machines to keep in touch with friends. Cultivate friendships with others working unsociable hours. They're more flexible, so it's easier to enjoy hobbies and sports together when it suits you and others are at work. Take advantage of day-time cinema screenings.

Evening classes are no longer the only way to broaden the mind - so there's no excuse! Try day-time classes, correspondence and web-based courses. And you'll feel a lot better all-round if you're physically fit. Take advantage of the cut-price membership most gyms offer during the day.

Last but not least, don't forget how lucky you are to be able to avoid the queues when you shop and go to the bank. If you still don't feel inclined to spend your free time this way, use online grocery shopping and 24-hour banking.

WORKING TIME REGULATIONS

The Working Time Regulations contain several measures to protect the rights of shift workers. Full details of these are on the Department of Trade and Industry website but the main points relating to night workers are:

-- they should work no more than an average eight hours in 24

-- they have the right to free health assessments

-- if problems are caused or made worse by night work, employers should transfer the worker to day shifts if possible

-- special consideration should be given to pregnant women and young workers

-- some sectors are excluded from the directive (eg road, sea, rail and air workers and junior doctors)

KEEP LIFE IN PERSPECTIVE

Working shifts doesn't mean the end of 'normal life' - but planning ahead to incorporate rest as well as a social life is vital. Just because shift workers are statistically more likely to suffer some ailments doesn't mean you will. Many of them are related to lack of sleep, lack of fitness and an unhealthy diet, which can usually be overcome by following the tips above.

If you still feel shift working's not for you, don't do it. Research carried out among nurses found people seem to know instinctively whether they're physically or psychologically equipped to cope - and they're usually right8. This was a relatively small study and therefore not conclusive, but it's worth bearing in mind.

Paul Sellers, policy officer for the Trades Union Congress (TUC), says employers can be quite willing to let you switch from night work if it doesn't suit. "Not only do they want to hang on to quality staff, they're also concerned about the health and safety aspect," he adds. "They don't want accidents at work through tiredness or ill-health, or stress claims to contend with. The bottom line is, look after yourself."

References:

1. BMJ editorial "Working long hours and health". 1994; 308;1581-1582 (18 June)

2. Circadian Learning Center www.circadian.com, a US research and consulting firm specialising in optimising a 24/7 workforce

3. JAMA Vol 283 No4, Jan 26, 2000

4. PMID: 2210450

5. PMID: 11072299

6. PMID: 10615298

.7 PMID: 2381175

8. Humm C (1996) The relationship between night duty tolerance and personality. Nursing Standard. 10, 51, 34-9

This article comes from BUPA, a UK medical health insurance company