photo of tired nurse resting in hallway at work

Sleep tips and insomnia remedies for nurses: A practical sleep survival guide for day and night shift workers

By Jason Wooden, PhD and Kristal McKinney, LICSW, CMHS | September 28, 2021

It’s no surprise so many nurses struggle with poor sleep given the many demands of the job.  Unfortunately, poor sleep can affect your job performance, make work more stressful, affect your health, and pose a safety risk.

Your options include sleep hygiene, improving your sleep environment, stress management, sleep counseling, and sleep teletherapy.  You should also see a doctor to check for sleep disorders and other health issues linked to poor sleep.

No wonder nurses are sleeping so poorly

Is anyone surprised how many nurses aren’t getting the sleep they need?

After all, being a nurse is one of the most challenging jobs you can have.

For starters, there’s the work shifts which can be pretty challenging and sometimes mentally exhausting whether it’s day or night.

Some days you finish on time and some days you don’t…

The ongoing nursing shortage hasn’t helped.

Have extended and extra work shifts become the norm for you?

There’s also dealing with doctors, specialists, patients from all walks of life and situations, managers, administrative duties, and bureaucracy.

Add to the list the unpredictability of a job where anything can happen at any time.  You’re talking about a job where you deal with some very intense situations and even people dying.

That’s enough to run anyone ragged.

How does anyone come down from all of that?

Even when off duty, you may still be affected even if you’re just going out for a family dinner.

So, it’s no surprise the toll the job may take on people over time.

And it’s no surprise nurses and other healthcare providers are sleeping so poorly.

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How far are nurses behind the eight ball on sleep?

The thing to keep in mind about sleep is that how WELL you sleep is just as important as how LONG you sleep.

To wake up feeling rested and ready for the new day, it’s important to get DEEP RESTFUL SLEEP.

That means you need to get enough cycles through the four sleep stages:

N1 stage:  between awake and falling asleep
N2 stage: onset of sleep
N3 stage:  deep restorative sleep
REM stage:  rapid-eye-movement and dreams

Those later stages are really important because it’s when your body restores and replenishes itself.

A full sleep cycle through all four stages is roughly 90 minutes long.  Sleep experts say that adults need at least four to five cycles to feel rested.

That works out to about 6 to 9 total hours of sleep for an adult.

(Some people can get away with less and some need more.)

So, how bad is the sleep situation for nurses?

Unfortunately, all too many nurses are running a sleep deficit with studies finding they get less than the recommended amount of sleep before work.

The situation is even worse for nurses who work night shift.  In studies, as many 69 percent of them experience poor sleep quality and go to work sleep-deprived.

That’s a whole lot of people going to work behind the eight ball on sleep.

The price nurses and other health care providers pay for poor sleep

Every night as many as a third of adults struggle with sleep.  I’ve already mentioned how much worse the sleep crisis is for nurses with almost 70 percent waking up sleep-deprived.

Whether this is you or someone you know, we all pay a price when we miss out on sleep on a regular basis.

That’s because sleep is as essential as breathing, drinking, and eating.  It’s how the body replenishes and heals itself.

We’re not wired to operate without it.

Sleep deprived people don’t think as clearly, have a harder time coping, and don’t perform as well at school or on the job.

They’re also more irritable and moody.

Did you know that studies have found that when you’re sleep-deprived what it does to your brain is the same as being drunk?

Chronic sleep loss puts you at risk for all sorts of issues – diabetes, high blood pressure, cardiovascular disease, obesity related illnesses, a weakened immune system, anxiety, and depression.

Intimacy can suffer due to suppressed sex hormones and low energy.

The job is tough enough on its own.  Add poor sleep to the mix, it’s not just simply that you’re dragging, less alert, and not thinking as clearly.

You can put your safety and the safety of others at risk.

Your decision making is compromised and there’s more of a chance for errors or injury.

(Studies have found that nurses working longer shifts commit more than 3 times as many errors and that sleep-deprived night shift nurses made more patient care errors.)

You’re just not at your best.

It should be clear you really need your sleep.

The good news it there’s plenty you can do to improve your sleep and make the job more manageable.

Let’s take a look at what you’re up against, some practical sleep tips and insomnia remedies for nurses, and what else you really need to think about.

Four big sleep-killers for nurses

There are plenty of things that could make it harder for nurses to sleep.  Some are obvious and some not so obvious.

People who sleep poorly are often dealing with more than one issue.

What are your current sleep challenges?

Let’s take a look at what you could be up against:

1) Stress and anxiety:

Stress and anxiety are among the most common causes for poor sleep.  Unfortunately for nurses, the stress levels can get off the chart.

Stress from unpredictable and life threatening situations, long work hours, organizational pressures, shift work, compassion fatigue, and secondary trauma…

On the home front, you may be dealing with stress from relationships, finances, and trying to balance work with family.

And there’s the toll of doing extra shifts.

That’s a long list and a lot for anyone.

Occasional stress and anxiousness is a normal thing.  It’s when it keeps happening you can really get in trouble.

We all know from personal experience how hard it is to fall asleep with a racing mind.

As a response to stress and anxiety, your body may turn on the fight-or-flight response and pump out stress hormones designed to get you in a heightened state of arousal.

(It’s a primal response to danger that unfortunately becomes a chronic condition affecting sleep and behavior.)

That’s why stress and anxiety are so bad at night – they make it harder to fall asleep AND harder to stay asleep throughout the night.

Stress can also worsen sleep issues such as chronic pain, body tension, mood, and various other illnesses that affect sleep.

And the more you stress out about falling asleep, you can get a sleep anxiety that feeds back on everything else.

2) Undiagnosed sleep disorders:

You may be living with an undiagnosed sleep disorder.  There are many different types, some more common than others.

In surveys, more than a third of firefighters screen positive for a sleep disorder.

Shift work disorder is common among nurses affecting as many as 44 percent of workers.

Working nontraditional hours such as on an evening, night, or rotating shift is a common cause for fatigue on the job.  It’s just hard to keep your natural sleep clock on schedule when your sleeping at odd hours and out of sync with the sun.

People with shift work disorder have trouble falling asleep and struggle with excessive sleepiness when awake.

Obstructive sleep apnea is another common sleep disorder.

It happens when the muscles in the throat relax too much during sleep causing your airway to collapse and restrict the flow of oxygen.

It’s a real sleep killer that keeps you out of deep restorative sleep so you wake up in the morning feeling as if you haven’t slept at all.

You may think it’s just an issue for overweight males.  Unfortunately, women of all sizes can get it too.

Studies suggest that as many as 18 percent of nurses are at risk for moderate to severe obstructive sleep apnea.

Do you have sleep apnea?

  • Pauses in breathing while asleep
  • Choking, gasping, or snorting sounds
  • Loud snoring, although not all people who snore have sleep apnea
  • Dry mouth or sore throat
  • Difficulty staying asleep
  • Waking up frequently to urinate
  • Morning headaches
  • Fatigue during the day
  • Excessive daytime sleepiness
  • Irritability or mood swings
  • Attention, memory, or learning problems

Source: American Academy of Sleep Medicine

3) Depression:

It’s not uncommon for people working in very stressful jobs to get worn down, experience burnout, and start feeling down.

One study found that as 18 percent of nurses have symptoms of depression.  This is twice the rate for the general public.

It’s no surprise and understandable given the challenges of the job.

Did you know there’s a strong link between poor sleep and depression?  Many people who struggle with depression also struggle with sleep.

And people with insomnia are more likely to develop major depression associated with sleep problems.

If you’re not careful, you can get in a vicious cycle where feeling down leads to more poor sleep and poor sleep leads to more depression.

In some cases, depressed people may even sleep too much which is its own problem.

4) Underlying health issues:

Did you know there could be something going on with your body that’s making it harder to sleep?  There’s a long list of health challenges that can cause or worsen sleep issues.

It’s obvious what ongoing pain and body aches does to sleep.  Allergies, asthma, heart burn, heart disease, and diabetes are also on the list of trouble makers.

And unfortunately, sometimes the meds for health issues can cause problems for sleep too.

Sleep hygiene tips for nurses

It’s important to get the best possible sleep when you’re home.

What you do during the day, evening, and at night can make a big difference for your sleep.

Practicing good sleep hygiene will help you make the best of your sleep opportunities. 

It’s the foundation for quality sleep.

Poor sleep hygiene can sabotage the other things you do to improve your sleep.

Sleep hygiene is important for everyone, but it’s really important for nurses given the many challenges of the job.

There’s already a lot working against you to derail your sleep, so why make it any harder?

For better sleep you should:

  • keep consistent wake up & sleep times
  • avoid naps
  • exercise and movement during the day
  • avoid large meals, alcohol, or stimulants such as caffeine before bedtime
  • maintain a regular bedtime routine
  • include stress management strategies in your daily routine
  • avoid using TVs, laptops, or other electronics before sleep
  • keep your bedroom dark, cool, quiet, & relaxing

Bedroom sleep tips for nurses

To get the best possible sleep on your days off, you need to make sure you have a sleep-friendly environment.

Is your bedroom comfortable and set up to make the most of your sleep opportunities?

Having a great sleep environment is one of the most important sleep hygiene rules.  Your bedroom can have a big impact on how easily you transition to sleep and how well you sleep.

It’s even more important for nurses to get the best possible sleep whether they are working day, night, or rotating shifts.

photo of bedroom at night

For optimal sleep, experts recommend that you keep your sleeping space DARK, QUIET, and COOL:

Keeping it dark

Bright light can interfere with your body’s natural sleep-wake cycle and keep you from feeling sleepy.   Even small amounts of ambient light can affect melatonin production and keep you from getting quality sleep.

Sleep aides for nuisance light

Keeping it quiet

Nuisance noises can keep you from falling asleep and keep you out of restful deep sleep even when you’re not awake.  Experts recommend you turn off your TV or radio.

Try using ear plugs or white noise if there are surrounding sounds you can’t get rid of.

Sleep aides for nuisance noise

Keeping it cool

Cooler room temperatures help your body’s natural sleep process.  A temperature between 60 and 67 degrees Fahrenheit is optimal for sleeping with 65 degrees being the sweet spot.  Obviously, everyone’s body is a little bit different.

You don’t want to lay in bed shivering because your bedroom is too cold.  You also don’t want to toss and turn because you’re too hot.

Stress management tips for nurses

What’s your current level of stress?

Since it’s one of the biggest enemies of sleep and nurses face some of the highest levels of work-related stress, it’s important to do whatever you can to manage it.

For starters, you should avoid unhealthy ways of coping with stress which can make it harder to sleep:

  • smoking
  • drinking too much
  • overeating or under eating
  • zoning out for hours in front of the TV or computer
  • withdrawing from friends, family, and activities
  • using pills or drugs to relax

Other things that can help with stress include:

Avoiding unnecessary stress – set boundaries around people and commitments

Regular sleep – people who sleep poorly are more stressed once awake

Exercise – it’s a natural mood booster and great way to fight the effects of stress

Healthy eating – good nutrition equips the body to better handle stress and its effects

Setting aside time for fun activities

Scheduling vacations and personal downtime

Post-work relaxation routine

Mindset – how you think about things and react to them can have a big impact

Manage your expectations – be realistic about what you can do on your time off

Support network – having supportive people in your life can really help with stress; it can include more formal support such as psychotherapy

Living within your means – can help keep the financial stress down

Managing marital stress – take positive steps to foster effective communication as a means to deal with any issues and to re-energize relationships

Sleep tips for nurses working night shift

Are you doing the right things to get the best possible sleep when working nights?

Okay, here’s the challenge – our bodies are wired to be awake when the sun is up and sleep when it’s dark.

Working at night causes you to go against the natural sleep-wake cycle of the body.

You’re forcing yourself to be awake when your body is receiving signals it should be asleep.  Likewise, when you get home, daytime light tells your body it’s supposed to be awake.

Besides getting your sleep out of the whack, there’s the challenge of balancing the need for sleep with the demands of family and friends.

Some of the things that can help night shift nurses keep their sleep on track are:

Moving around while at work – exercise is great for sleep, so try to get in a quick walk when you can

Wear sunglasses on the way home – our sleep-wake cycle is in tune with natural daylight, this will make it easier to fall asleep once you get home

Have a regular routine – this will help you unwind and prepare for sleep

Have a snack – hunger pangs can keep you up

Block out time for sleep

Get everyone else on board – make sure family and friends know to leave you alone

Get creative with your commitments – you might have arrange for child care, schedule your activities so that you get a solid block of sleep during the day

Unplug from electronics – even if friends and family are respectful, there’s still the telemarketers, normal phone calls, and all those phone alerts.  Set your phone to “do not disturb” mode.

Check your sleep environment – do everything you can to keep it dark, quiet, and cool!

Go to bed right away – the more you delay, the greater the chances you have trouble falling asleep

Avoid anything that can keep you up – stimulants such as caffeine or nicotine, activities that will get you wired up will make it harder to get to sleep on time; some medications can also affect sleep

 

13 Insomnia remedies for nurses and health care providers

So far, we’ve talked about how you can keep your sleep on track.  You’re probably wondering if there’s anything else you can do if you’re struggling to fall asleep

Depending on your situation, there are plenty of insomnia remedies for nurses worth a try:

photo of nurse reading a book by the fireplace

1) Light reading

Reading can take your mind off things, be sure to avoid those page turners that keep you up too late.

2) Relaxing music

Calming music has been shown in studies to reduce anxiety and help people relax.  In sleep studies, subjects fall asleep faster and experience better sleep quality.

What you want is music that will sooth you to sleep, not something that will get your heart racing.  Slow rhythm songs (60 to 80 beats per minute) is what’s been shown in studies to improve sleep.

Popular choices include classical and new age music.  You may have to experiment a little to figure out what works best for you.

3) Sleep music tracks

Similar to calming music, sleep tracks are designed to help people fall asleep more quickly. Often, they combine quiet music with nature sounds.

You can purchase them online or stream them for free on YouTube and phone apps.

cartoon drawing of nurse at home doing breathing exercises

4) Deep breathing

Deep breathing is a simple way to calm the body.  One popular technique is 4-7-8 breathing pioneered by Dr Andrew Weil.

It involves holding your breathing to various counts of 4, 7 and 8.

Learn more about the 4-7-8 breathing technique

cartoon drawing of nurse at home doing gentle stretching to help fall asleep

5) Gentle stretching

Light stretching can help the body relax.  It may also help with the aches and pain that keep people from sleeping deeply.

Learn more: 8 Stretches for Your Best Night’s Sleep (SleepAdvisor.org)

6) A warm shower

Did you know your body temperature naturally dips at night before bedtime?  It’s one of the things that can signal your body it’s time for sleep.

A warm shower or bath can help you relax while raising your body temperature.  When finished you return to a cooler bedroom and get a temperature saying it’s time to sleep.

7) Write it down

Sometimes when there’s a lot on your mind, it helps to put things down on paper.

photo of person doing progressive muscle relaxation with arm to relax for sleep

8) Progressive muscle relaxation

Progressive muscle relaxation is a technique where you tense and then relax one muscle group at a time. It has been found to help with stress and insomnia.

Learn more

photo of African american nurse at home practicing mindfulness meditation for better sleep

9) Meditation

Mindfulness meditation is a mind-calming technique that involves focusing on your breathing and keeping your awareness on the present moment.

This simple technique has been shown in studies to promote sleep.

Learn more

photo of sleeping pills

10) Sleep meds

As a short-term remedy, your doctor may recommend over the counter or prescription sleep meds to help you get some rest and restore your sleep schedule.

Sleeping pills are not the first choice for treating long-term insomnia due to side effects such as dependency.

Sleep meds might help while you figure out a long term solutionSleep meds might help while you figure out a long term solution

11) Natural sleeping aids

There are all sorts of natural supplements that can help the body transition to sleep.  Some have been scientifically tested while others have not.

Among the more popular are melatonin, chamomile, hops, and valerian root.

Learn more: 15 natural sleep aids

photo of nurse talking with sleep counselor

12) Sleep counseling

Did you know that counseling is one of the most effective treatments for insomnia?

There’s a strong connection between the mind and body.  Your mind, brain, behaviors, and body can interact in powerful ways that affect health and wellness.

Too often, people develop bad attitudes, habits, and associations that make it harder to sleep.

A specialized type of sleep counseling, cognitive behavioral therapy (CBT-i for short), can help identify and change thoughts and behaviors that affect sleep.  It’s one of the most effective insomnia treatments.

Learn more

cartoon drawing of online sleep counselor talking to a nurse at home

13) Sleep teletherapy

With modern computer technology, you can now get sleep counseling from the comfort of your own home thanks to Sleep Easy.

It’s a first of a kind online counseling program developed by Dr. Richard Shane based on his clinical work helping thousands of people suffering from chronic insomnia.

We’ve partnered with Sleep Easy to help get the word out and we’re urging all of our readers take a look at them.

Another reason we’re including them on the list is because Dr. Shane’s approach has been used for decades to help first responders.

Sleep Easy’s teletherapy is confidential.

Learn more about Dr. Shane and Sleep Easy

Don’t forget to get a check up

When is the last time you’ve had a physical?

Unfortunately, it’s not unheard of for people in the medical profession to neglect their own self-care.

If you haven’t had a recent checkup, it’s really worth getting one.  We’ve already mentioned all the things that could be going on with your body making linked to poor sleep.

If you don’t deal with these underlying issues, you may be just sticking a band aid on things. 

That makes it important to see a doctor, especially if your insomnia has become a long-term problem.

Your doctor can check for health issues and sleep disorders you may not be aware of.  They can also make sure any medications you’re taking are not making it harder for you to get sleep.

You may also be living with an undiagnosed sleep disorder.

Sources:

1. “What Happens When You Sleep?”, 2020, sleepfoundation.org

2. “Enhance Your Sleep Cycles”, 2016, alaskasleep.com

3. Nurses’ sleep, work hours, and patient care quality, and safety. Sleep Health. 2020 Jun;6(3):314-320.

4. Effects of Sleep Deprivation on the Cognitive Performance of Nurses Working in Shift. J Clin Diagn Res. 2017 Aug;11(8):CC01-CC03

5. “Talking Points”, World Sleep Society website

6. “Sleep Deprivation Has The Same Effect as Drinking Too Much, Says Study”, Science Alert

7. The working hours of hospital staff nurses and patient safety. Health Aff (Millwood). Jul-Aug 2004;23(4):202-12.

8. Sleep deprivation and error in nurses who work the night shift. J Nurs Adm. 2014 Jan;44(1):17-22.

9. Shift Work Disorder in Nurses – Assessment, Prevalence and Related Health Problems. PLoS One. 2012; 7(4): e33981.

10. 0630 Sleep Health of Nursing Staff in an Academic Medical Center: Results of a Survey Study. Sleep, Volume 42, Issue Supplement_1, April 2019, Page A251,

11. “Combating depression in nurses”, 2016, HCPro.com

12. “Depression and Sleep”, 2021, sleepfoundation.org

13. “Insomnia: The Mind, Body, and Emotion Connection”, American Sleep Association website

14. “Stress Management: How to Reduce, Prevent, and Cope with Stress”, BrainLine.org

15. “Life hacks: How to cope with night shifts”, 2017, MedicalNewsToday

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