The Solitude of Working Nights

With shift-work sleep disorder comes social isolation, but also meaningful solidarity.
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There was a two-year period in my life I refer to as the Dark Ages. Although I've always enjoyed cereal at random hours, my evening consumption of Cocoa Puffs during that time was actually my breakfast.  Wake-up alarms set for the PM were intentional, not accidental. And sunset signaled the start of my day, while I fell asleep shortly after dawn.

At most hospitals, newly employed nurses start out working the night shift and transition to days once they reach higher seniority. While many people have pulled all-nighters at some point in their lives, to live a prolonged nocturnal existence is an entirely different story—only those who experience it can truly understand it. When after-hours are your actual hours, it disrupts your internal biological clock, or circadian rhythm. The International Classification of Sleep Disorders dubs this condition "shift-work sleep disorder." People with SWSD have altered levels of melatonin, a hormone affected by exposure to light. Melatonin helps to maintain our circadian rhythm, which in turn helps to maintain not only our sleep and wake patterns, but our cardiovascular system, metabolism, digestion, immune system, and hormonal balance. Many studies show evidence that people who suffer from long-term SWSD have an increased risk for diseases in these areas. Thankfully, my SWSD only lasted a couple of years. But even in that short interim, life was defined by a thoroughly confused circadian cycle.

If you have ever taken a trip halfway across the globe, you've probably experienced some degree of desynchronosis—or as most people refer to it, jet-lag. Working the night shift is essentially like living in a perpetual state of jet-lag; you are always in that tug-of-war battle between your mind and body. My hours on nights were 7 p.m. to 7:30 a.m. No matter how many shifts in a row I would work or how many consecutive days I’d have off, every time I started to feel like I was adjusting to either daylight or twilight, it was time to go back to the opposite and I was at square one again. It was a vicious, endless cycle of midnight insomnia and afternoon siestas. As I tried to readjust my schedule to accommodate for errands that could only be accomplished in the 9 to 5 schedule that the rest of the world existed in (trips to the bank, doctors appointments, etc.), it resulted in inadequate sleep, and so I always functioned in a state of low energy and slow motion.

While some co-workers had difficulty sleeping in the day and resorted to ear plugs, dark curtains, and eye masks, I personally had no problem immediately crashing after work around 8:30 a.m. My issue was never in falling asleep, but I've always struggled to wake up. I still set about eleven alarms every morning, concluding with a final "danger zone" alarm of the radio turning on at full blast (often set at a Spanish music station or simply loud static to really startle me). The distinguishing feature in working nights is not having trouble waking up, but the complete disorientation that ensues almost every time you do. My coworkers and I share similar stories of awakening in discombobulation. Many of us would misinterpret our wake-up rings/buzzes as cardiac alarms or ventilator alerts. And we refused to hit snooze, in fear that we would silence a signal that indicated a patient’s heart rate was severely low or a patient was disconnected from his or her breathing machine. My roommates also have anecdotes of me waking up in a frenzy and blurting out “Who’s watching my kids, who’s watching my kids?!” (I work in a pediatric hospital). Other times, I have been told that I would get up with a jolt, thinking I was late for work, shout a few obscenities at my phone, and then collapse back into a deep sleep when I realized it was only 1 p.m. When your biological clock is winded in reverse, you can’t help but lose your sense of time (and sometimes your sense of propriety).

Accompanying the strain on our biological clocks was the strain on our social lives. Many social gatherings occur at night and were missed for work. It was particularly depressing heading to the hospital at 6 p.m. on a beautiful summer Saturday as everyone around you planned for an evening of fun. And the problem about working nights is that even if you are working one isolated shift, it doesn't mean sacrificing only those twelve hours. It also requires sleep during the day before the shift, and most of the day after—so each shift can interfere with a 36-hour window of time. No matter how much you explain this to others, though, it never comes out right when you tell a friend you can’t make it to her 2 p.m. birthday lunch because you will be sleeping. And when you roll out of bed at 4 p.m. on a Sunday and bump into your roommate’s friends hanging out in the living room, the look of shock you are received with makes you cringe. You attempt to defend yourself, but even after you explain your profession and hours, as you glance down at your “Cereal Killer” pajamas and fuzzy slippers and try to calm the  monstrosity that is your bed hair, you can’t help but actually feel like the bum they judge you to be.

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Shazia Memon, RN, CCRN, is a pediatric critical care nurse in New York City.

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