You see the symptoms and wonder: Your night shift colleague is irritable—more so than usual. She has been complaining for a while of an upset stomach and periods of dizziness. During report, she seems to have trouble concentrating and during her shift she can’t make simple decisions. What’s even more worrisome is that at the end of her shift, she heads out to her car to drive home—a walking zombie, soon to be behind the wheel.

Insomnia … Have you had it? Can you see it in others and intervene?

According to the recently released National Sleep Foundation poll, 40 percent of all U.S. workers—in the throes of working longer and harder—have trouble staying awake at their jobs.

About 63 percent sleep less than eight hours and 31 percent sleep less than seven hours (most experts agree that eight hours is optimum). For shift workers, most sleep only six hours or less.

To put the problem in perspective, various surveys from the late ’90s report that about one-third of American adults say they have sleep problems.

Half of those who say they have insomnia believe it is a serious problem.

For nurses who admit to an insomnia problem, they find that they are more prone to make errors. Some experience anxiety, depression and decreased productivity, as well as weight gain, higher blood pressure and greater susceptibility to the flu or colds.

High tolerance
"I don’t have trouble with insomnia," said Carolyn Wack, RN, a 31-year veteran of nights, who works in the ICU at Long Beach Memorial Medical Center in California.

"I’m one of those lucky individuals who can sleep anytime, anywhere, anyplace. I believe that people who work nights can tolerate night shifts better than others. I also think psychologically it’s easier if you are choosing to work nights—for example, for child care reasons—rather than if you are forced to work them," she said.

Even though Wack has long worked nights, she still considers herself a day person.

"On my days off, I get up at 6 a.m.," she said. "It’s my favorite time of the day. But I can switch automatically," Wack said. "Some of us truly can be night owls."

Donna Myers, RN, an oncology nurse at Scripps Mercy Hospital in San Diego who has worked nights for more than four years, has a similar tolerance for the night shift.

"I just don’t have a problem," she said. "For those of us who have no problem, we stay there. But I know from hearing [about] people who struggle with nights, you need to figure out if it’s caused by some isolated situation—like the kids were sick today so you were up—or if it is a chronic problem," she said.

Adaptation strategies
"I see that the ones who try to stay on nights give it an honest try to tolerate the schedule—say for three to five months," Myers said. "If they can’t overcome the insomnia, they usually have the option of spreading their days apart, moving to a day shift, or working registry or casual shifts," she said.

Strategies to quell insomnia focus on behavioral interventions, which studies show can be effective as much as 70 percent of the time.

The focus of most interventions is to optimize the natural sleep-wake cycle, the internal circadian clock.

With shift workers, the problem usually is not falling asleep but staying asleep, as well as overcoming sleepiness at night, according to James Walsh, Ph.D., executive director and senior scientist at the Sleep Medicine and Research Center at St. Luke’s Hospital in St. Louis. "Even if you sleep well during the day, you still can be sleepy on the night shift. The question is how to sleep better during the daytime and wake up better during a night shift," Walsh said.

To address the challenge of staying awake on a night shift, Walsh and his colleagues, as part of a CDC grant, are evaluating a strategy that combines a one-hour nap before the shift and drinking caffeine while on shift.

As for sleeping better during the day, Walsh supports behavioral interventions and the use of short-acting sleeping agents. "Our research and research of others indicate that sleeping pills can be helpful for shift workers," he said.

"I believe they are underutilized. When using these agents, more night workers can get higher quality or more sleep during daytime. Before, we shied away from agents because of the risk of high dependence or abuse. The drugs available today are short-acting benzodiazepines, such as Ambien (zolpidem tartrate) or Halcion (triazolam), so you are not hung over when you wake up."