Today in the chart

Nightshifters and dayshifters alike have their own sleep struggles.

A nightshifter’s request for their family to wake them up at noon after their shift can quickly spin into a disaster. They don’t want to waste the day sleeping, but after a few short hours of sleep, they realize how sleep-deprived they are despite a genuine desire to get a head start on the day with the remaining diurnal population, sometimes, the fatigue wins.

And day shifters have their own challenges, too. Stress and anticipation about the early AM shift can prevent them from falling asleep early enough to get those much-needed ZZs.

But, this anecdotal evidence is only part of the picture. The Nursing Beat teamed up with Thorne, a science-driven wellness company, to get real numbers to answer the question: How much sleep are nurses getting, and why?

Pillow Talk: Survey Results

A survey of 210 nurses representing 48 US states shows several sleep concerns.

• 85% of respondents reported getting between five to seven hours of sleep per night.
• Less than 3% of nurses reported getting eight or more hours of sleep per night on average.
• 48% of respondents are dissatisfied with their sleep. In particular, their sleep quality, duration, and sleep disruptions were priority concerns.
• Three in four nurses believe it’s harder for them to get quality sleep than the general public.
• Three in five nurses say sleep deprivation affects their ability to deliver patient care and remain alert.

One survey respondent shared, “Nurses… have trouble shutting the stress and busyness off.” Another said, “I never feel well rested… Sometimes I can’t think straight because I’m so tired.”

No Rest for the Weary

The demands of a churn-and-burn healthcare system can make nurses feel overlooked. Despite their dedicated efforts, they often go unnoticed. This lack of recognition can prompt nurses to develop a martyr complex, where even basic human needs, such as sleep or bathroom breaks, are considered luxuries.

One survey participant shared, “Nurses sometimes use their tiredness as a badge of honor, but we should strive to create an environment where sleep is a priority and praised.” A nurse’s lack of sleep doesn’t make them more dedicated to their profession or patients. In fact, it can impede their practice.

Here’s why a lack of sleep is nothing to brag about:

• The CDC compares being awake for 24 hours to a blood alcohol content of 0.10%, which is above the legal limit for DUI citations.
• The Agency for Healthcare Research and Quality (AHRQ) recognizes that acute fatigue leads to increased medical errors due to its impact on executive functions like decision-making. They also mention chronic sleep deprivation can contribute to burnout.
• A 2022 analysis reports that sleep-deprived nurses' medical errors were significantly increased compared to non-sleep-deprived nurses.

Some nurses don’t wear their drowsiness on their sleeve, but their fatigue is merely a product of a busy schedule and high-demand working conditions, like:

• Working night shift
• Picking up extra shifts to earn money or minimize staffing shortages
• The responsibility of caring for the lives of others while at work
• Fear of disciplinary action for workplace mistakes

Stress, burnout, or mental health conditions can cause difficulty falling or staying asleep. Unfortunately, many nurses don’t report getting The National Sleep Foundation’s recommendation of seven hours of sleep per night.

Do Nurses Have Sleep Disorders?

Sleep disorders in the general population are common; about 25% of people have obstructive sleep apnea. There isn’t much data on the prevalence of sleep disorders among healthcare workers. Still, given their stress levels and working hours, it’s safe to assume their sleep disorders are at least as common as the general population.

Common sleep disorder categories from the American Academy of Sleep Medicine include:

• Insomnia disorders
• Sleep-related breathing disorders, like obstructive sleep apnea
• Parasomnias, like sleepwalking, vivid dreams, or exploding head syndrome
• Sleep-related movement disorders, like restless leg syndrome

If you notice your sleep feels less refreshing, you are having trouble falling asleep, or you notice symptoms like restless legs or nightmares, talk to your medical provider. A pulmonologist can evaluate your symptoms and have you answer questionnaires like the Epworth Sleepiness Scale or the STOP-Bang. This evaluation will determine if medical treatment may be necessary or if you need a sleep study.

Sleep, Your Hormones, and You

Shift work, in particular, affects hormones that play a key role in sleep.

A few of these hormones include:

• Sex hormones, like estrogen and testosterone.
• Melatonin: Melatonin helps regulate the circadian rhythm and promotes sleep.
• Cortisol: Cortisol and melatonin are inversely related. When cortisol is low, melatonin production increases. Stress and inflammation increase cortisol.

Want to learn more about how sleep impacts your health and workplace safety? The National Institute for Occupational Safety and Health (NIOSH) has a course for nurses that provides contact hours for CEU requirements.

Slumber Scripts

You may consider a sleep supplement if your sleep concerns are mild or you haven’t tried treating it alone. Talk with your medical provider to ensure sleep supplements won’t interact with your other medications or health conditions.

A few supplements that may help you with sleep include:

• Melatonin: Melatonin helps maintain the circadian rhythm and promotes healthy cardiovascular and endocrine health.
• Magnesium: Magnesium supports sleep through skeletal muscle relaxation and enhanced blood flow.
• PharmaGABA-250: GABA is an essential neurotransmitter for sleep and allows the brain to relax.

Nurses and other credentialed healthcare professionals, including first responders and military, can register for a discounted Thorne account through GovX.

Get the Sleep of Your Dreams

The answer is clear: Nurses deserve and require adequate sleep to perform their job duties and to maintain their well-being.

The solution is not so clear. Nurses can treat recurring sleep concerns and support one another in treating rest as essential to their professional duties. However, there’s still a need for healthcare reform to allow nurses to properly rest and recover between shifts.

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