The HSE has issued new guidance for shift workers to help them stay healthy. Shift work is an employment practice designed to make use of, or provide service across, all 24 hours of the clock, each day of the week. The day is typically divided into shifts, during which different groups of workers perform their duties. Poorly designed shift working and long working hours that don’t balance work demands with time for rest and recovery can result in fatigue, accidents, injuries and ill health. People vary in how they cope with shift work, depending on their health, fitness, age, lifestyle, and domestic responsibilities. Whilst we cannot change our inbuilt characteristics, the HSE says, it is possible to alter our behaviour or make lifestyle changes that may make shift work more tolerable. Its hints and tips draw on commonly available advice and best practice from a range of sources and may improve sleep quality, increase alertness and reduce health risks for shift workers.

Driving to and from work
Driving to and from work can be risky, particularly after a long shift, a night shift or before an early start. The following strategies may make driving safer:

• Consider using public transport or taxis rather than driving;
• Exercise briefly before your journey;
• Share driving if possible;
• Drive carefully and defensively;
• Try not to hurry;
• Stop if you feel sleepy and take a short nap if it is safe to do so; and
• Make occasional use of caffeine or 'energy' drinks.

Identify a suitable sleep schedule
Most adults need seven to eight hours’ sleep a day, although this may decrease with age. Recording sleep patterns and problems using a diary may help to explain fatigue and tiredness. It can also be used to help find the most suitable strategies and conditions for a better quality of sleep.

• If you work regular shifts, try going to bed at different times e.g. soon after you arrive back from work or stay up and sleep before the next shift.
• Have a short sleep before your first night shift.
• If coming off night shifts, have a short sleep and go to bed earlier that night.
• Once you have identified a suitable sleep schedule try to keep to it.

Make the environment favourable for sleeping
Sleep loss and fatigue are some of the most significant problems for shift workers. It is important to try and maintain your normal level of sleep and rest. Daytime sleep is usually lighter, shorter and of poorer quality than nighttime sleep. It is more frequently disturbed because of warmer temperatures and daytime noise. To help make the environment favourable for sleeping:

• Sleep in your bedroom and avoid using it for other activities such as watching television, eating and working;
• Use heavy curtains, blackout blinds or eye shades to darken the bedroom;
• Disconnect the phone or use an answer machine and turn the ringer down;
• Ask your family not to disturb you and to keep the noise down when you are sleeping;
• Discuss your work pattern with close neighbours and ask them to try and avoid noisy activities during your sleep time;
• If it is too noisy to sleep, consider using earplugs, white noise or background music to mask external noises; and
• Adjust the bedroom temperature to a comfortable level, as cool conditions improve sleep.

Techniques to promote sleep
To promote sleeping, try to follow a similar routine to the one you follow before a normal night’s sleep. The following tips may help you relax after a shift and promote sleep:

• Go for a short walk, relax with a book, listen to music and/or take a hot bath before going to bed;
• Avoid vigorous exercise before sleep as it is stimulating and raises the body temperature;
• Avoid caffeine, 'energy' drinks and other stimulants a few hours before bedtime as they can stop you going to sleep;
• Don't go to bed feeling hungry: have a light meal or snack before sleeping but avoid fatty, spicy and/or heavy meals, as these are more difficult to digest and can disturb sleep; and
• Avoid alcohol as it lowers the quality of sleep.

Diet
It is very important to consider the timing and quality of your meals. Digestive problems are common in shift workers due to disruption of the body clock and poor diet. Plan your meals to help you stay alert at work and to relax/sleep when you need to rest.

• Regular light meals/snacks are less likely to affect alertness or cause drowsiness than a single heavy meal.
• Choose foods that are easy to digest such as pasta, rice, bread, salad, fruit, vegetables and milk products.
• Avoid fatty, spicy and/or heavy meals as these are more difficult to digest. They can make you feel drowsy when you need to be alert. They may also disturb sleep when you need to rest.
• Avoid sugary foods, such as chocolate – they provide a short-term energy boost followed by a dip in energy levels.
• Fruit and vegetables are good snacks as their sugar is converted into energy relatively slowly and they also provide vitamins, minerals and fibre.
• Drink plenty of fluid as dehydration can reduce both mental and physical performance but avoid drinking too much fluid before sleeping as this may overload the bladder.

Stimulants and sedatives
Shift workers often turn to stimulants such as coffee or cigarettes to keep them awake and sedatives such as alcohol or sleeping pills to help them sleep. Avoid such aids as they only have short-term effects on alertness as tolerance to their effects develops. Persistent use may also increase the risk of dependence.

• Caffeine is a mild stimulant present in coffee, tea and cola as well as in tablet form and in special 'energy' drinks. It can improve reaction time and feelings of alertness for short periods. Only use caffeine occasionally and don't rely on it to keep you awake. If you do decide to take caffeine or other stimulants, you should consider what might happen when its effects wear off e.g. when you are operating machinery or driving.
• Avoid the use of alcohol to help you fall asleep. Although alcohol can promote the onset of sleep it is also associated with earlier awakenings, disrupted sleep and poorer sleep quality. Regularly drinking too much increases the risk of long-term damage to your physical and mental health, your work, social and personal relationships.
• Regular use of sleeping pills and other sedatives to aid sleep are not recommended because they can lead to dependency and addiction.
• New drugs have recently been developed that can alter our state of alertness. Although their use may be widespread abroad, the ways in which they work and their long-term effects are not yet fully understood and consequently their use is not advised unless under medical supervision.

Physical fitness and a healthier lifestyle
An unhealthy lifestyle combined with shift work may increase the likelihood of sleep disorders and sleep loss or exacerbate existing sleep problems. A good diet, regular meals and exercise can improve sleep quality, health and wellbeing.

• You can improve your fitness by spending 30 minutes a day on a physical activity including housework and walking. Consider joining a gym or taking part in a regular exercise class.
• Eat healthy meals on a regular basis.
• Cut down or give up smoking.
• Reduce your alcohol intake.
• Seek advice from your doctor if you require regular medication such as insulin for diabetes or suffer from a chronic condition such as epilepsy.

Family and friends
Working shifts that differ from the routines of friends and family can leave you feeling isolated and it is important to make the effort not to lose contact with them:

• Talk to friends and family about shiftwork. If they understand the problems you are facing it will be easier for them to be supportive and considerate.
• Make your family and friends aware of your shift schedule so they can include you when planning social activities.
• Make the most of your time off and plan mealtimes, weekends and evenings together.
• Plan your domestic duties around your shift schedule and try to ensure that you do not complete them at the cost of rest/sleep. You may need to change the times/days when some jobs are done.
• Invite others who work similar shifts to join you in social activities when others are at work and there are fewer crowds.

Ways to improve your alertness at work
On some shifts, such as nights and very early mornings you may find it difficult to remain alert and this can affect your performance. It may also increase the risk of errors, injury and accidents. You may find it helpful to:

• Take moderate exercise before starting work, which may increase your alertness during the shift;
• Keep the light bright;
• Take regular short breaks during the shift if possible;
• Get up and walk around during breaks;
• Plan to do more stimulating work at the times you feel most drowsy; and
• Keep in contact with co-workers as this may help both you and them stay alert.