Working night shifts and always tired: what can I do?

Feeling worn out almost all the time is common when you work nights. Your body is being asked to work during the hours its clock has set aside for sleep, and daytime sleep tends to be shorter and lighter than night-time sleep, so the shortfall builds up. The things to look at first are when you sleep after work, light during the shift, when you have caffeine, when you eat, and how you use your days off. If you have felt tired for weeks without knowing why, see a doctor.

In Thailand, night work covers a wide range of jobs: nurses, factory workers on rotating shifts, building guards, call-centre staff serving overseas customers, and staff at 24-hour convenience stores. They all face the same problem: working when the body wants to sleep, and sleeping when it is brightest and busiest outside.

I work night shifts and feel tired all the time. Where should I start?

Health guidance for shift workers, such as from the US NIOSH and Cleveland Clinic, puts sleep, light, caffeine and meals first, because the main drivers of tiredness on night shifts are not getting enough sleep and living out of step with the body clock.

What to look at first

Why am I always tired when I work nights?

Night-shift tiredness is not about being lazy or not tough enough. Several things stack up at once.

Working against your body clock

NIOSH explains that night-shift workers are working against their body clock, which is strongly influenced by the sun's light–dark cycle. The body is set up to sleep in the dark and be active in daylight, and the body's cells have their own clocks that do not adjust well to night work, so digestion, body temperature and other functions fall out of step.

Cleveland Clinic adds that the body uses light as a cue for when to sleep, so night-shift workers have to sleep during the day, when the body's signals to stay awake are strongest.

Daytime sleep is shorter and lighter

Cleveland Clinic says most shift workers sleep one to four hours less than people who do not work shifts, and daytime sleep tends to be short and broken. NIOSH likewise says night-shift workers usually get less sleep, and poorer-quality sleep, than day-shift workers.

In a Thai home, daytime sleep has extra competition: sun coming through the curtains, afternoon heat, traffic and building work, family members going about their day, and a phone that rings on everyone else's working hours.

Sleep loss adds up

Cleveland Clinic notes that adults should aim for seven to nine hours of sleep a day. If you only manage four or five hours of daytime sleep on each work day, the shortfall keeps growing. That is why NIOSH suggests night-shift workers spend as much time in bed as they can, so they do not become chronically short of sleep.

Your hours don't match everyone else's

NIOSH notes that relationships with family and friends can become strained because the people around you live on daytime hours. Many night workers cut into their sleep to do the school run, eat with the family or deal with errands that are only open during office hours, which makes the sleep shortfall worse.

How should I plan sleep after work and on days off?

Go to bed as soon as you get home

NIOSH suggests that on work days you go to bed as soon as you get home, for example around 8 a.m., and sleep as long as you can. If possible, take another nap before going back to work, which adds to your total sleep and can help you stay alert that night. Stopping for several errands on the way home can quietly cut your sleep short.

A dark, quiet room and a household that helps

Cleveland Clinic suggests a quiet, dark and peaceful bedroom, and asking people in the house to wear headphones or avoid noisy activities while you sleep. In a home shared by several generations, agreeing on which hours are your sleep time makes a real difference.

For more detail on darkening the room and adjusting your sleep after a shift, read more on sleeping after a night shift.

Sunglasses on the way home, only if you're not driving

Morning sunlight makes the body more alert, so Cleveland Clinic suggests wearing sunglasses on the morning commute home to cut down that light. NIOSH, however, warns that sunglasses can block the alerting effect of light and make drowsy driving worse, so it recommends them only when someone else is driving. On the BTS, a bus or the back of a motorbike taxi, they are fine. If you are driving or riding yourself, leave them off.

On days off, keep some sleep hours the same

NIOSH says switching to full night-time sleep on days off and then back to night work leaves you in a constant state of jet lag. A compromise is to stay up until around 3 to 4 a.m. on days off and sleep until noon or 1 p.m., so some hours of sleep stay the same in every 24 hours.

NIOSH also warns against staying awake too long before your first night shift or after your last one, because it raises the risk of accidents in the short term and leads to chronic sleep loss.

Daylight on days off

Night workers often spend most daylight hours in a dark room. As NIOSH explains, the body clock is strongly influenced by the sun's light–dark cycle, and Cleveland Clinic notes that the body uses light as a cue for when to sleep. Daylight is one of the ways your body keeps time. If you go out walking, run errands or meet friends during the day on your days off, plan it for times that do not cut into your main sleep.

If you have a say in your roster

Cleveland Clinic suggests working no more than five night shifts in a row with days off in between, and taking more than 48 hours off after a run of night shifts if possible. If your workplace lets you choose or swap shifts, it is worth raising this with your supervisor.

How should I handle light, coffee and naps during the shift?

Brighter light early, dimmer light later

NIOSH suggests more light exposure in the first half of the shift to stay alert, without needing to sit right in front of the light, and less brightness in the second half so daytime sleep comes more easily. Avoid bright light near the end of the shift unless you are very sleepy.

Stop caffeine in the later part of the shift

Cleveland Clinic suggests moderate amounts of caffeine, such as coffee, to help you stay alert while working, and stopping caffeine in the later part of the shift so it does not disturb your sleep when it is time for bed. A large iced coffee, Thai tea, iced green tea or an energy drink from the convenience store at 4 or 5 a.m. is late-shift caffeine that many people overlook.

Short naps when you can

Cleveland Clinic suggests planning short naps before or during night shifts to help with alertness. NIOSH likewise encourages night-shift workers to nap when they can, since they tend to sleep fewer hours overall than day workers.

What and when should I eat on night shifts?

NIOSH explains that the digestive system has its own clock too, and the middle of the night is when the body is preparing to rest. A big meal at that time works against the body's rhythm, so when you eat matters as much as what you eat.

Eat less between midnight and 6 a.m.

NIOSH suggests avoiding food or eating less between midnight and 6 a.m., and keeping to three meals in 24 hours. If you need energy during the shift, NIOSH suggests eating more often. A big plate of pork leg rice or chicken rice at 2 a.m. is a meal to move to before midnight, or to swap for a small snack.

What to choose during the shift

Source: NIOSH

NIOSH says sugary foods and low-fibre carbohydrates can make you sleepier, especially when you need to stay alert. Bubble tea, sweet buns and soft drinks that many people reach for to stay awake late at night may do the opposite. Where possible, NIOSH suggests eating with colleagues somewhere pleasant, away from your workstation.

When is night-shift tiredness worth seeing a doctor about?

The UK's NHS advises seeing a doctor if:

• you have felt tired for a few weeks and are not sure why
• tiredness affects your daily life
• you feel tired and have other symptoms, such as weight loss or mood changes
• you have been told you make gasping, snorting or choking noises while asleep

Cleveland Clinic suggests talking to a doctor if sleep problems from shift work continue after several weeks of changes.

Too sleepy to drive safely

Cleveland Clinic warns that if you are too sleepy to drive home after a shift, you should take a nap first or find another way home. Do not push through a morning drive or motorbike ride with your eyes closing. If it happens often, tell your doctor.

Note these down before your appointment

• your shift pattern over the past two to four weeks
• when you went to sleep and woke up each day, on work days and days off
• how much coffee, tea and energy drinks you have each day
• all the medicines and supplements you take
• anything else you have noticed, such as weight or mood changes, or noises during sleep that family members have mentioned

This helps the doctor see the full picture.

Before starting any product or medicine

If you take regular medicines, are pregnant, or are not sure something suits you, talk to a doctor or pharmacist before you start taking anything new. NIOSH says it is best to make full use of non-medicine approaches first, and to see a sleep specialist if sleep problems continue. Don't start any medicine on your own.