Can a nap during night shift improve performance?

Anyone who has regularly worked through the night knows the tired, sluggish feeling associated with a string of night shifts, and the difficulty of catching up on sleep during the day.

Research has consistently shown that accidents and errors are more frequent overnight when workers are sleep deprived, but what’s the solution? Our aged care system – and health system more widely – relies on shift workers to provide 24-hour care.

The pitfalls of night shifts

Long-term night shift work is associated with a range of diseases and illnesses. ‘Shift work disorder’ refers to a chronic condition of misaligned sleep patterns, meaning that it is difficult to sleep when you want or need to.

It is a direct result of the unstable sleep schedule related to working night shifts. Shift work disorder can affect a person’s physical and mental health, as well as their performance on the job and their general safety.

This is particularly pertinent at the moment, with healthcare professionals reporting interrupted and poor-quality sleep due to the stress of the COVID-19 pandemic.

A US study conducted by industry group Sleep Standards found that one in every three healthcare workers have been sleeping poorly, with 41% suffering from insomnia.

Is napping a solution?

Napping can assist shift workers to avoid building up a ‘sleep deficit’ in the time when they are working night shifts. Missing too much sleep can impair short-term memory, judgment, reaction time, and vigilance – all of which are crucial for carers.

A 15 to 30-minute nap can restore energy and hold off fatigue. Many night shift workers report improved alertness after a nap and will take one as a preventative measure before driving home in the morning.

Longer naps of an hour or more result in greater improvement of cognitive function, but have the associated downside of allowing your body to get into a deeper stage of sleep, from which it’s more difficult to wake up.

If you do experience sleep inertia, or a feeling of grogginess after a nap, your performance is impaired for up to an hour after waking.

Napping for too long, or too often, can also have a negative effect on overall sleep patterns.

A US study from the University of Arizona concluded that napping should be used as a way to catch up on missed sleep, rather than as a regular occurrence.

“If an individual has significant sleepiness leading to inadvertent or spontaneous naps, it usually indicates sleep quantity or sleep quality issues,” researcher Dr Clete Kushida says.

Napping for healthcare workers

Patrick Prunster, who conducted a trial with nurses at the Royal Children’s Hospital (RCH) in Melbourne, says that napping can reduce sleepiness on the job.

“We want nurses to take their breaks. Policy must include adequate provision for staff to rest,” Mr Prunster says.

The University of Maryland in the US backs this up with a study that offered naps to nurses across two hospitals, and used a Nap Experience Survey to measure quality of sleep, sleep inertia after the nap, and the perceived helpfulness of the nap.

Only 1.3% of nurses reported feeling groggy and sluggish following their nap. On a scale of 1 to 10, the average score of nap helpfulness was 7.3. The study concluded that “scheduled naps during night shifts result in decreased sleepiness, increased alertness and improved response accuracy”.

Recent research from the University of South Australia backs up the positive effects of napping and goes further to suggest an unusual combination for more efficient night shift breaks: napping and caffeine. The study found that drinking a coffee and then taking a 20 to 30-minute nap was the best for countering the effects of sleep inertia.

Dr Stephanie Centrofanti, who led the study, says that a “caffeine-nap” could be considered a “win-win”.

“Caffeine is used by many people to stay awake and alert. But if you have too much coffee it can harm your overall sleep and health. If you use it to perk you up after a nap, it can take a good 20 to 30 minutes to kick in, so there’s a significant time delay before you feel the desired effect,” Dr Centrofanti says.

“By drinking a coffee before taking a nap, shift workers can gain the benefits of a 20 to 30-minute nap, then the perk of the caffeine when they wake.”

Barriers to napping

Although the research generally suggests that napping can have benefits for healthcare workers, the industry has been slow to accept this as a part of everyday practice.

In a survey conducted before the RCH study began, 45% of nurses reported not taking all of their breaks during a night shift. Although nurses recognised that taking breaks was important for quality of patient care, there was also a stigma attached to taking breaks, and especially to napping during these breaks. Nurses also felt that the workload on colleagues was too great if they took time for a break.

Mr Prunster notes that for scheduled naps to be implemented, a cultural shift needs to occur so that nurses feel empowered to take the breaks that they are entitled to. Colleagues also need to liaise with supervisors to work out the most effective way to schedule breaks for night duty, and ensure that there are adequate staff rostered on to allow time for rest.

What do the experts recommend?

When it comes to the benefits of napping during a night shift, the jury is still out. While some studies have shown that staff feel less tired after napping, other evidence suggests that employee performance is impaired by even a short sleep during a shift.

Dr Centrofanti recommends testing a nap routine in a safe environment (not at work) to find out what works best for the individual.

“Napping may be helpful for some people but not others,” she says.

It is best not to drive immediately after waking up from a sleep. Even if you feel more alert, you may still be at risk of fatigue-related accidents.

Most importantly, all shift workers should aim to practice good “sleep hygiene” between shifts. This means keep a stable sleep schedule when you can, making your bedroom free of disruptions, and following a relaxing pre-bed routine.

And if your facility bans napping, make sure you abide by the rules.