Sleep Soundly Every Night, Feel Fantastic Every Day (20 page)

Q.
 
I was switched to the night shift at my factory. I am having a hard time staying alert while on the job. I started drinking coffee all night but then I can't stay asleep the following day when I need my sleep. Is there anything that can be done to help my situation?

A.
 
Yes, what you are experiencing is a very common problem in people working the night shift. However, there are some potential solutions. First, try taking a one- or two-hour
nap just before going to work. Second, it's okay to drink coffee, but limit it to no more than one cup at the beginning of the shift. In fact, this combined with a prework nap has been found to be more effective than either alone. Finally, if all else fails, speak to your doctor about the medications that have been approved by the FDA for excessive sleepiness and can help shift workers to stay alert and awake at work.

Q: I am 57 years old and for years I have worked as the night manager of a supermarket. I work four 10-hour shifts and then I am off for three days. For the last few years, I have had more trouble staying awake at work, as well as sleeping at home. Would you have any ideas?

A: As we age, our ability to do night shift work becomes increasingly more difficult. On average, after the age of 50, our circadian clock tends to shift to an earlier sleep time, making night shift work more difficult. I would recommend you wear dark glasses on your way home from work. Your bedroom should be dark. The use of blackout blinds is helpful. At work, try to be in a well-lit environment at least for the first half of your shift. A brief power nap (less than 45 minutes) one hour prior to work may help. In addition, a 30-minute nap at work might be beneficial. On your days off you should try to adhere to the same schedule as you have at work.

The original questionnaire was first published in 1976 as the Horne–Ostberg test. The shortened version that follows reveals whether you function better toward the end of a day or at the beginning of one.

For each question, choose the one response that best describes you. When complete, add up the score for each response. The final score will give you some indication of whether you are more of a person of the morning or of the evening.

Breakfast: How is your appetite in the first half-hour after you wake up in the morning?

1 ____    Very poor

2 ____    Fairly good

3 ____    Fairly good

4 ____    Very good

How do you feel for the first half-hour after you wake up in the morning?

1 ____    Very tired

2 ____    Fairly tired

3 ____    Fairly refreshed

4 ____    Very refreshed

When you have no commitments the next day, at what time do you go to bed compared to your usual bedtime?

4 ____    Seldom or never later

3 ____    Less than one hour later

2 ____    One to two hours later

1 ____    More than two hours later

You are staring a new fitness regime. A friend suggests joining his fitness class between 7:00 a.m. and 8:00 a.m. How do you think you'd perform?

4 ____    Would be in good form

3 ____    Would be in reasonable form

2 ____    Would find it difficult

1 ____    Would find it very difficult

At what time in the evening do you feel tired and need sleep?

5 ____    8:00 p.m. to 9:00 p.m.

4 ____    9:00 p.m. to 10:15 p.m.

3 ____    10:15 p.m. to 12:45 a.m.

2 ____    12:45 a.m. to 2:00 a.m.

1 ____    2:00 a.m. to 3:00 a.m.

If you went to bed at 11:00 p.m., how tired would you be?

0 ____    Not at all tired

2 ____    A little tired

3 ____    Fairly tired

5 ____    Very tired

One night you have to remain awake between 4:00 a.m. and 6:00 a.m. You have no commitments the next day. Which suits you best?

1 ____    Not to go to bed until 6:00 a.m.

2 ____    Nap before 4:00 a.m. and after 6:00 a.m.

3 ____    Sleep before 4:00 a.m. and nap after 6:00 a.m.

4 ____    Sleep before 4:00 a.m. and remain awake after 6:00 a.m.

At what time of day do you feel your best?

5 ____    5:00 a.m. to 8:00 a.m.

4 ____    8:00 a.m. to 10:00 a.m.

3 ____    10:00 a.m. to 5:00 p.m.

2 ____    5:00 p.m. to 10:00 p.m.

1 ____    10:00 p.m. to 5:00 a.m.

Do you think of yourself as a morning or evening person?

6 ____    Morning type

4 ____    More morning type than evening type

2 ____    More evening type than morning type

0 ____    Evening type

Suppose that you can choose your own work hours, but you have to work five hours per day. When would you like to START your working day?

5 ____    4:00 a.m. to 8:00 a.m.

4 ____    8:00 a.m. to 9:00 a.m.

3 ____    9:00 a.m. to 2:00 p.m.

2 ____    2:00 p.m. to 5:00 p.m.

1 ____    5:00 p.m. to 4:00 a.m.

1.
 
Add up the number of points that you scored for each answer.

2.
 
The maximum number of points you have from this questionnaire is 46 and the minimum is 8.

3.
 
The higher your score, you are more of a lark that functions better in the morning.

4.
 
The lower your score, you are more of a night owl that functions better in the evening.

5.
 
The majority of people come somewhere between these two extremes.

 

 

Laugh and the world laughs with you, snore and you sleep alone.

—ANTHONY BURGESS

While there are differing types of sleep disorders, only a few are part of the common vernacular. One of them is sleep apnea. You may associate it with snoring. Sleep apnea is a chronic sleep condition in which breathing repeatedly stops and starts. An apnea is a complete cessation of airflow, while a hypopnea is a reduction in airflow accompanied by either a drop in blood oxygen level or an arousal from sleep. There are two types of sleep apnea, which are different in their symptoms and require different treatments. The more common type is obstructive sleep apnea, and the less common is central sleep apnea.

Most bed partners might call the first symptom of apnea the loud snoring that keeps them awake. The silence of suspended breathing would be a more telling symptom of apnea. Not everyone who snores has sleep apnea, but those
who do are at risk not only for diminished quality of life, but also for life-threatening conditions including stroke, heart attack, and diabetes.

Moreover, others' sleep apnea could be a threat to your own life if they are behind a wheel and have not adhered to treatments. The following stories are not rare. In fact, nearly every day you can read or see news about a car veering off the road, 18-wheelers sliding into cars, or school buses full of children swerving in traffic. The news always reports how many cars were damaged, how many homes were evacuated due to toxic spills, how many people died and were injured, but you rarely learn why the event happened. The following four incidents are not anomalies, but quite common:

  
In 2008, Train 533 of the Canadian National/Illinois Central Railway was heading south around dawn and the engineer failed to see or stop at the glowing red stop light. The conductor also failed to see the flashing red light and did not warn the engineer that he had passed it. Meantime, train 243 was clipping along northbound on the same track. Both locomotives with loaded boxcars snaking behind them smashed head-on into each other. The National Transportation Safety Board (NTSB) reported, “… probable cause … was the train 533 crew members' fatigue … primarily due to the engineer's untreated and the conductor's insufficiently treated obstructive sleep apneas.”

  
In 2008, in Hawaii, island-hopping passengers of Flight 1002 left Honolulu airport on time and expected to land at Hilo within the hour. Instead, the plane flew over the island, over the next two islands, and headed toward the watery horizon. Only one pilot was diagnosed with sleep apnea, yet both fell asleep. “Both pilots unintentionally
fell asleep during cruise flight. The Safety Board received information after the accident that one of the pilots was diagnosed with obstructive sleep apnea, which, without medical treatment, is associated with reduced sleep.”

  
In 2008, a refrigerated Volvo semitrailer headed east on I-44 at 69 miles per hour with the cruise control on. The truck driver failed to slow down or brake and collided full force with a long line of cars that were slowing or stopped. The NTSB summarized the cause as, “driver's fatigue, caused by the combined effects of acute sleep loss, circadian disruption associated with his shift work schedule, and mild sleep apnea, which resulted in the driver's failure to react to slowing and stopped traffic ahead by applying the brakes or performing any evasive maneuver to avoid colliding with the traffic queue.”

  
In 2011, the NTSB attributed a collision between two BNSF Railway freight trains in Red Oak, Iowa, to the “failure of the crew of the striking train to comply with the signal indication requiring them to operate in accordance with restricted speed requirements and stop short of the standing train because they had fallen asleep due to fatigue resulting from their irregular work schedules and their medical conditions.”