Tips to Mitigate the Effects of Performance and Sleep Decline Associated with Shift Work

This blog is designed primarily for First Responders, LEOs, Military, Healthcare shift workers. The most common question that I asked is; “how do I compensate for shift work”. The unfortunate answer is that you cannot, at least not completely. Two plus two will always equal four. It would be no different than saying, how do I compensate for eating McDonald’s twice per day.However, there are things that you can do to mitigate against the health consequences and performance declines associated with shift work. I go into greater detail about this in my book, but below are the basics.The primary concern for most people is how to feel less sleepy during the time that they need to be awake. The obvious answer is to sleep more at night, but I also realize that might not be an option. There are several options available.

Stimulants:

- Over the counter:

• Caffeine is, of course the most popular and ubiquitous player. Approximately 60mg every 4-6 hours has been shown to be the most effective in prolonging attention enhancement. Approximately 200mg seems to be the most that one can benefit from at any one time—above 200mg seems to have the opposite effect for most people.
• Nicotine is also quite common. Cigarettes are, of course the most common delivery vehicle for nicotine, but it can also be delivered through dipping, chewing tobacco, mints, patches and gum. We know that cigarettes can be an extreme health hazard risk (not actually from the nicotine) and are exceptionally addictive. Addiction studies have shown inhaled nicotine to be one of the most addictive substances known. I do not believe that the same is true for non-inhaled nicotine. I have not seen any research on the topic, but in my practical observations and consulting, I have never seen anyone become addicted to nicotine mints or gum. Approximately 2mg every 4-6 hours seems to have the best effect.

- Prescription:

• Amphetamines and chemical analogues are the most commonly prescribed. These include drugs like Adderall, Concerta and Ritalin. Again, these drugs are analogues of stress hormones, and have a huge potential for abuse and dependence. When used occasionally, they are highly effective for getting through an intense period of required sleep deprivation. However, when used chronically, they tend to cause habituation—meaning that you will need them just to have normal energy and alertness.
• Modafinil is a drug within its own class. It is not an amphetamine and seems to have much less potential for abuse, but has an even greater risk of habituation than amphetamines.

Naps:

• It is a common misconceptions that naps will interfere with your ability to sleep at night. Research has proven this to be false. As long as naps are taken within a few guidelines, they can enhance performance while having zero effect on nocturnal sleep.
• A nap is defined as being between 20-120 minutes long. A 3-hour nap is sleeping, and will interfere with your ability to sleep at night.
• A nap should be done in a slightly warm environment as opposed to the cooler environment of night-time sleep.
• Different durations of naps have different benefits.
• Naps can be strategically placed during your day to enhance whatever type of performance you are trying to enhance. There is an entire book on this subject. Trying to summarize all of the information in that book would be like adding a book within a blog, and I believe it would also be called plagiarism. The book is entitled Take a Nap! Change Your Life, by Sara

Nutrition:

Nutrition and sleep are inextricably linked. Optimizing your nutrition will go a long way towards making your body and brain more resilient to periods of inadequate sleep, as well as increasing daytime energy and focus. Proper nutrition will also enhance exercise tolerance, which will lead to more physical resilience and self-confidence. I do not proclaim to be a nutrition expert. So, I will simply offer these few basic guidelines:

• First my philosophy and why: As with sleep, I believe approximating the diet that our ancestors evolved with is most likely to be the optimal diet. Natural selection dictates that those who ate the best diet would have been the most likely to procreate, protect their offspring, and survive hardship. We do know what they ate, by analyzing their bones, teeth, tools, artwork and other artifacts. It is not hard to imagine what they would have eaten by simply watching how modern-day hunter-gatherer tribes eat.
• I will concede however that it is very hard to duplicate this diet and lifestyle in the modern world, and if we are going to limit ourselves to what was accessible to our ancestors, we would also need to add in the additional things that have become less appealing to us—such as eating the organs, brains, eyes and the like of animals, and limiting ourselves to animals that were not raised on a ranch.
• With those caveats, my approach to nutrition is fairly simple. Eat whole foods. Do not eat things that come in a box or a bag. When you go grocery shopping, you should only be going around the periphery of the store; produce, meats, and the dairy section. Nothing else in the store was available to our ancestors, and they presumably ate the absolute best diet possible that led to this 100,000-year-old body that we continue to enjoy. Meat, fruits, vegetables, seeds, and nuts are all you need. Add some spices and additional healthy fats, and you can make an endless array of tasty meals.

Exercise:

I will not distinguish between exercise and activity, other than to say that exercise—in my mind—connotes an intentional desire to enhance athletic performance, while activity is sufficient to maintain physical and mental health. Exercise should be dictated by your physiologic state. If you are sleep-deprived, intense exercise is counterproductive. Don’t cut your sleep short in order to exercise. This exacerbates sleep deprivation and accelerates all of the stress hormones and their catabolic effects. Exercising in the morning can be used to enhance alertness. The best way to do this is when the sun is well up, and you have had adequate sleep. This will fortify your circadian alignment, enhance your daily performance, elevate your mood, and make you more likely to feel sleepy at the right time of the night. Exercise can be used to stimulate stress hormones and temporary wakefulness. Doing a little bit of exercise when you feel sleepy—and a nap isn’t an option—can improve alertness more than stimulants. We frequently did 40-50 push-ups when were feeling sleep—while I was in the SEAL teams. Just enough to get the heart rate up a bit, and release some hormones

Supplements:

Apart from the stimulants already discussed there are some “nutritional” supplements that can increase alertness. These are usually the plant derivatives of the stimulant (i.e. guarana is an herbal form of caffeine). Supplements like Phosphatidyl Serine, Valarian, L-Theonine, GABA, and Kava can be used to reduce stress, anxiety, and stress hormones—while also calming the mind. Certain supplements have been proven to improve sleep. I have my own product that I developed to help the SEALs get off of sleep drugs—while I was a physician for the SEALs. You can read more about that on my shop www.docparsley.com. Other sleep supplements exist of course and are generally designed to either make one feel more calm, decrease stress hormones, or concentrate substances (in our brains) that are usually associated with sleep state. All I can say about these supplements is that I have never seen a supplement with a single ingredient be effective for many people or be effective over a significant period of time. Whatever your goals and plans are that you have set, I promise you that everything that I have learned in my life has led me to this statement: Nothing will improve your life more than making sleep one of your highest priorities. I wish you all the best.