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Does working in night shifts for long time have adverse effect on health?

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Posted on Fri, 20 May 2016
Question: Hi there,

We've spoken before about other issues, and I appreciate your thoroughness, so I wanted to ask you another question. I don't know if sleep questions fall into your wheelhouse, but I'm hoping so.

This is a matter of wondering about longterm effects of my health. As we discussed a bit previously, I have some weight to lose and have had some prehypertensive issues in the past, but I'm doing okay with both of those.

My lifestyle is reasonably healthy. I don't smoke (though I do drink - I try to keep it moderate most of the time time), exercise regularly, and work to eat more whole foods in proper portions and less processed stuff.

My main question is about sleep. For many years (I'm 35 now, and since at least 22 or so), I've had a nocturnal schedule. I tend to be awake from ~3-4PM through 7-9AM, then sleep til ~3-4PM. I always aim for at least 6 hours and preferably 7-8 hours of sleep. I also supplement with Vitamin D and more recently melatonin when I sleep.

I've read articles that people on night shifts tend to have shorter lifespans and increased risk of heart disease, diabetes, cancer, etc., which alarmed me. Unfortunately but understandably, many of these studies are short term (so potential for adjustment isn't necessarily there), many don't include supplementation of D/melatonin, and many focus on frequently changing shifts or unhealthy habits due to night work.

So I guess what I'm wondering is, in your professional opinion, does sticking with a night schedule for the forseeable future put my health in jeopardy, even if I try to live a healthy lifestyle in other areas.

I suppose my nocturnal schedule isn't 100% necessary, but I genuinely do prefer it, and find the idea of switching to a day schedule for the long term quite unpalatable.

Thanks much for your help and advice!
doctor
Answered by Dr. Dariush Saghafi (25 hours later)
Brief Answer:
No need to switch anything around is unnecessary to me.

Detailed Answer:
Thank you very much in bringing your question specifically to my attention given the numerous choices you had for anyone to answer your question.

I do not see where either your work or how you perform things at night as well as during your work shift puts you at significantly increased risk for serious morbidity or mortality. I XXXXXXX you that your choice of work hours coupled with choices of when to sleep vs. be awake are not the standards of practice but that's well compensated in your situation given the fact you sleep the approximate number of hours recommended for restful and restorative sleep as well as keeping track of other important elements having to do with your chemistries/biochemistries such as melatonin and Vit. D that I believe you've essentially minimized your risk for an early demise based upon risk factor control of developing spontaneous forms of cancer, tumors, or other reasons to have shortened longevity.

I would point out that if you are overweight and especially if you are SIGNIFICANTLY overweight then, your risks for morbidity due to ALL CAUSE death and disability dramatically rises. The same can be said if you were to be borderline diabetes, hypertension, or hypercholesterolemia. It doesn't sound like you have anything to much worry about in practical terms so in my humble opinion I see no urgent need for you to switch anything around in terms of your chosen shift of work or the amount of sleep or other parameters having to do with sleep are obtained. It is just as important to your overall state of health and happiness that you are engaging in a form of lifestyle which is satisfying and fulfilling to yourself as opposed to forcing yourself to fit into a certain "expected mold" of what the IDEAL XXXXXXX should be in terms of when or where they work, how many hours they sleep, and other things that we are good at doing by coming up with guidelines and recommendations without taking anything else into account except what is supposed to be the needs and wants of physiological corporeal processes.

The MIND is a terrible thing to waste.....or not listen to.....as the old saying goes! LOL....

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to also upload images or test results as well for me to reference.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates and many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 27 minutes of time to read, research, and respond.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (2 hours later)
Thanks so much for your, as always, detailed responses! I appreciate that you feel like I'm minimizing the excess risk. I do have a few followups.

My first question is if you're aware of any studies to this point that specifically deal with *stable* night work. That is, most of the studies I've found that show risks seem to always deal primarily with rotating shifts, which is not something I normally deal with. (As with anyone, there are occasional times when I need to shift things around for a day or two, but it's not what I consider often, usually less than once a month.) I'm wondering if there's any chance that with a stable night schedule, circadian rhythm adapts to an extent. I know it's shown not to in the short-term, or with rotating shifts, but I'm not aware of any long-term studies, which I'd love to see.

Secondly, can you think of anything else besides the D and melatonin I need to pay attention to/possibly supplement? I have read about leptin and planned to talk to my nutritionist next appointment about that. I've also read cortisol levels can be higher in night workers, but again, it seems to be mostly in rotating shift studies (which would cause a type of stress I don't have). I also don't know if the melatonin I take might help counter that?

Finally, do you know if it's presumed the melatonin/D helps offset the risks I'm worried about, specifically heart/cardiovascular health and cancer? Are there any other specific factors (other hormones or mechanisms) theorized for night work that might up the risk in a night worker?

And to answer your question, I'm more overweight than I'd like to be (though also not nearly as bad as I could be), but I'm also doing everything I can to try to tackle that. I don't live a perfect lifestyle, but I've improved it immeasurably in the last few years through eating better (if occasionally more than I should) and exercising lots (which I stick to quite well) and am working to continue to do so, but for me, sustainability is key - I need to make those small changes I know I can stick to.

I do appreciate your insights, and keeping things in perspective, because it is true that right now, having a night schedule is the only way I can fit everything in and get the type of free time I find most fulfilling. There may be a time coming where that's no longer the case and I'll shift to days out of necessity or more of an ability to do so, but I don't feel I'm at that point yet.

Thanks again for your help and continued patience with my questions!
doctor
Answered by Dr. Dariush Saghafi (23 hours later)
Brief Answer:
Thank you for your kind words and response for clarification

Detailed Answer:
Once again, I cannot thank you enough for your kind words. I will have to admit that the topic is not precisely down my line of expertise and for that reason must claim a degree of ignorance to specific studies you are asking about referencing whether or not a stable work environment as opposed to swing shift workers is available. I am not immediately aware of such a study (but would be shocked if one DIDN'T exist) that looked at the very reasonable and logical question of whether or not a person's theoretically ENGRAINED or DNA dictated circadian rhythm can be retrained and/or adapted to so as to allow for the same overall risk of morbidity/mortality when only basing those risks upon the variable of not adhering to the rhythm. I am aware of the generally held belief, which I utilize in counseling or talking to patients in my clinics when I do undertake such discussions, is that a stable work schedule becomes like any other work schedule performed and this can be easily adapted to if the person has no other interfering factors or comorbid disease states to say otherwise. Therefore, I wouldn't predict any adverse outcomes to a person in terms of risk of morbidity/mortality simply based upon diurnal phase shifts if the patient is in this environment on a regular and constant basis. If anything I might say that the patient could run into problems down the road if they ever decide to change that schedule and that if they were to suddenly pick up a more diurnally CONVENTIONAL set of work hours experience issues.

To the question of medications/supplements that would be beneficial in workers not otherwise in more standard/conventional shifts looking to make the body "believe" more closely that it is working under normal diurnal hours of operation...again, we are treading into areas of medicine I'm not terribly familiar with, however, my long held professional opinion on such matters parallels folks who submit for cosmetic surgeries or other procedures so they can APPEAR to be more like another person, or another race of individual, or something along those lines as opposed to simply embracing the individuality they have and what they are capable of contributing as that person if they simply interact with the rest of the world in the best way they possibly can.....in this case....I don't advocate nutritional or medication supplementation of a person's diet or have them take additional substances JUST for the purpose of making the body/brain believe that something else is happening...especially if they are operating in the type of situation you describe which is stable, that they are clearly adjusted to, and have not experienced any adverse or aversive effects as a consequence UNLESS there are clear and present deficiencies found in their blood chemistries or nutritional profile that absolutely shows they MUST have elements such as Vitamin D, melatonin, Ca, Mg, etc. based upon clinical aspects of organ or system problems or defects.

I am a promoter of healthy diet and healthy lifestyles WITHOUT looking to supplement regimens or protocols that add what I consider unnecessary cost and activity to a system which is rather resilient and remarkable, namely....Mother Nature and the human body's ability to navigate biochemical and architectural pathways specific to the moment with the minimum amount of inconvenience or despair so long as one takes care of the body, physically, mentally, and does not abuse it according to dangerous habits which would include dangerous sexual practices, smoking, excessive alcohol and/or illicit substance ingestion, etc. And of course, to eat as much FRESH, organic, NON-artificial and non-preserved foods that are made from scratch (again within reason and feasibility). I can appreciate that in order to live in a society such as ours carries some degree of having to "take" the junk...such as foodstuffs, air, and water that we are inevitably exposed to....but doing our best to overload the system with GOOD stuff....WITHOUT OVEREXPENDING finances or efforts at things already contained in the good lifestyle protocol....well, you get the idea that I'm trying to communicate.

My previous answer in the above LOQUACIOUS paragraph on healthy paragraph is all too predictive of the balance of your question on the relationship of Vitamin D/melatonin on the prevention of cancer, etc. therefore, I shan't repeat it at the risk of boring you unnecessarily but in my opinion I believe that worrying or trying to keep up with the plethora of information that is deluging us from all angels everyday on the preventative/prophylactic/beneficial/ALERT! ALERT! perspective is an unfortunate product of our society that seems to be clammoring for either immortality or perfect existence for the time we're alive. All of this informational OVERLOAD (as I see it) is also a function of the fact that many people have to fulfill job descriptions for news and radio channel stations which require that they search and sometimes "destroy" a lot of useless (and sometimes useful) information in the journals, blog sites, and hallway lore having to do with the studies that show cranberry juice to prevent UTI's, prevent cancer, and make bladders 10 years younger than the rest of a person's anatomy....I'm being facetious about some of what I just wrote...but no worries....in 5 years that may all change. Cranberry juice may actually be shown to be detrimental, cancer producing, and make one's urinary tract system appear to be that of a giant tortoise who has survived the ravages of seagoing life for the past 200 years! LOL.....make sense?

In other words, we are once again, pitting ourselves (in my humble opinion) against unnecessary forces of HOW TO LIVE THE BEST lifestyle when in fact, Mother Nature has already provided the blueprint. Studies (good studies that is) have actually looked at the lifestyles, eating habits, and exercise regimen that people such as those living in the XXXXXXX jungles, Australin Aborigines, and the mountain people of the Andes and compared those individuals who have COME FROM that life into Western society and those who have GONE BACK and shown that virtually all cause rates for the major diseases that we suffer from in the U.S. (heart disease, diabetes, stroke, pulmonary disease, obesity) skyrocket in very short periods of time when individuals switch to our lifestyle....their disease states can also miraculously REGRESS and disappear within 8-12 weeks after returning to the pure lifestyles they once had IF THEY GO BACK before they either die or get to a point of no return.

In other words, the blueprint nature puts out there for us to live alongside is a pretty damn good one.....did you read it yet? I understand what you're saying when you say that you're overweight and recognize you do not live the perfect style, guess what....NOR DO I though I could tell you about how I am a fiend in the gym compared to anybody else my age...I am still competitive in the sport of wrestling and racquetball against people half my age and train an average of 2 hrs. daily (6 and often 7 days a week)....no smoking, no drinking, and no steroids! HA! I lift, run, and stay mentally challenged on any of the hours I'm not otherwise, in the gym...I'm active in performing and playing my violin at professional venues and with other professional musicians and earn a good revenue stream doing that as well as other job descriptions I could tell you about......BUT I'M NOT PERFECT....partly because of discipline and perhaps partly due to the environment which is not in the XXXXXXX jungle, the Subsaharan tropics, or the aboriginal deserts and terrains of Australia.....in other words, I LIVE THE GOOD LIFE....I use a car, use telephones, and enjoy electricity and running hot and cold water.....damn spoiled and so will probably succumb to some disease process in the future as byproduct of my environment.

I do not believe that ADDITIONAL SUPPLEMENTS of Vitamin D, melatonin, or other advertised, studied, or Doctor approved (even if the Surgeon General puts his name on it) are going to help BETTER than for me to get my discipline straps together, lace them up like I do my wrestling shoes, and just take care of personal business....so that my well put together body can do its planned activities and take care of me as Momma Nature had intended.

Sorry this turned into more of a blog than a scientific discourse...but honestly, I am very passionate on living and advocating as simple yet complete a lifestyle as possible which only looks at the minimum number of variables when it comes to body preservation/conservation and propagation....they are:

1. Best available diet as I outlined above....lots of FRESH (not frozen packaged) and prepared FRUITS and VEGETABLES.....I do believe also that meat and dairly are completely fine if done in decent proportions. I used to survive entirely on porterhouse steaks...when I was a kid...because that's what mom fed us....some other stuff....but meals were virtually for carnivores only.....but I've learned differently since going to medical school and marrying a near vegetarian...she sometimes wishes she were Vegan...but I don't!!! That would've killed me!! HAHA!

2. The principle of intense and ongoing physical activity to keep the heart pumping at a high and efficient rate to include a VARIETY of exercise types...not strictly running, nor strictly wrestling though that's my passion...as is racquetball....but I'll try and look to try many different things to get different muscle groups involved on a regular basis.....(i.e. what would one do in a completely wild environment? Probably LOTS of different things in order to survive.....from needing good strength to climb, to needing outstanding stamina and speed to hunt and PREVENT from being hunted as importantly....)....again, you get my ideas on physical training.

3. Mental/spiritual challenges daily which also includes hand/eye coordination, training my balance mechanism (not just through wrestling) but by doing specific exercises for equilibrium since we know that deteriorates over time....it'll help a lot in older years when falls risks become real, it will also allow me to carry heavier loads for longer time in the future if balance is optimal than if I don't work on that....but there you have it....challenging the mind and spiritual aspects of philosophizing so that I'm also always pondering things that can make the body better and how to make it operate more smoothly within the context of the environment.....mind you...I will NEVER join the POLAR BEAR CLUB or whoever those folks are who mindlessly torture their systems by voluntarily putting themselves in harm's way and jumping into near freezing water for no reason at all....same thing goes for HOT YOGA...pointless in my opinion and dangerous.....look, if you're on an oceanliner in the North Atlantic and it gets sunk by a U-boat...fine, then, you'll tell me I should've practiced being a polar bear...but guess what...if that were to happen???...anybody really believe that being in that club is going to save your butt? Helllllll Nooooo! You're a goner....so much for the utility of that crazy activity.....

4. And lastly, there's restorative sleep which some people like to argue I fail to even come close to doing....pishaw.....If I'm not nodding off either while driving or seeing patients at the hospital right after having a nice big lunch (avoid those fries since they are now saying they can cause cancer! HAHA!) then, my sleep was plenty restorative the night before! So that's how I look at the # hours of sleep that are ABSOLUTELY NECESSARY for either myself or any individual......Can I fall asleep when I want? You bet your sweet bippy I can.....so sound can I sleep that my kids obviously have those genes as I am forever having to get up all over the house and bang on bedroom doors to wake them up to turn off alarms they don't hear!! You'd think we were in the middle of Station #5 in Central Park with one of my daughter and with my son....it seems that we are constantly DEFCON status below the Rocky Mountains on the basis of his chose alarm that constantly goes off at 3am for no reason since the last time he ever got up at 3am was when he was sucking on nipples attached to Playtex Bottles!!!

Be well...thanks for giving me the opportunity to rant a bit about how our society has done it to themselves/ourselves and how there's just NO HOPE! LOL......NOT! Of course, there's hope....but you have to be willing to look in the mirror and take responsibility for who and what you are and realize that blaming others can only go so far.....

Time to get some sleep before I get up in an hour and write up some briefs I need to get to the Appeals Court by tomorrow in order to protect my case with the 9th District! ROFLMAO!!!


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (19 hours later)
Thanks again for the wonderful (and lengthy!) reply!

As with most studies, there were a series of news stories last years about the risk of night shift work, but that seems to *exclusively* deal with rotating shifts, with some studies engineered to specifically cause changes in shift. (One where the schedule was continually pushed back an extra 4 hours every day comes to mind.) Even studies where that wasn't the case, most at least seem to be in populations that work nights part of the time and days part of the time. To my mind, of course that's going to cause havoc. Like you, I'm fairly shocked that I can't seem to find much on stable night work, but at best, it's rare. I understand your points about stable night work, and to my mind, they sound reasonable as well.

Understood regarding your stance on additional supplementation. Vitamin D is monitored by my doctor and I'm adjusting based on that. The melatonin I did add on my own, but I feel a little more comfortable knowing for sure I am getting some of that at my "night" as I know it does have some benefits. Still, I do see your point about the body's remarkable abilities to adapt, and I will keep that in mind and keep my dosage low. I do take supplements, which may well be wasted money, but I also go to a nutritionist who's helped narrow them down to some degree, and most of the supplements I do take now (melatonin aside) are food-derived.

Over the last few years, I've made big strides into living a more wholesome life. I've minimized junk food (yes, it still happens from time to time, but much less than it used to), cook a lot more meals with fresh ingredients, and get a wide variety of vegetables especially, but also nuts, fruits, fish, etc. I do eat meat, but am eating somewhat less than I used to. I also exercise most days of the week and mix it up a bit. I try for 45 minutes 4 days a week on the incline trainer (sometimes running, sometimes walking with incline), and then 3 days a week are a 30 minute session of various stretches, balance ball exercises, light weights, pushups, situps, etc. Aside from that, I'm trying to do a bit more everyday walking (parking a bit further away, walking places close by instead of driving, taking the stairs sometimes, etc.). Certainly not as impressive as your exercise schedule (which sounds amazing!), but for me, it's a major improvement on the past and something I've been able to stick with!

Your critique of the media is well taken. Many times, I've found a news story that sounds terrifying really isn't once you look at the actual study, and sometimes even the main points the articles seem to make just aren't there or seem misinterpreted. You're also right in that we should be aiming for our best life, not a perfect one, as that just doesn't exist.

As to your checklist:
1.) I do eat fresh a few times a week (2-3 days) home-cooked meals (usually lots of veggies included). I do sometimes do the frozen meals, but they are flash-frozen and healthy (from a company called BistroMD). I know frozen isn't optimal, but these are about as good as you can get for frozen meals.
2.) Already covered, but I try to stay active and have at least some variety.
3.) I try to do things to keep my mind active, whether it's problem solving for my work (fixing computers), enjoying satire and political comedy (especially this year, despite the horror...), learning about new things, or playing video games (I know, but it is SOME hand/eye coordination!)
4.) I do try to get plenty of sleep, making it up if for some reason I am short for a period of time. But I try to get a minimum of 6 and usually more like 7 hours a night, with sometimes a bit extra on weekends/free days. Fortunately, I don't usually have trouble sleeping either - it happens once in a blue moon, but not often!

You sound like you're a busy guy! Thanks again! I just wanted to give you a thorough reply - no more followups; I'll be glad to close the query with a great rating after I submit this (if it lets me) or upon your next reponse if that's required first (which can be brief as you like)!

Thank you again for your time, patience, and advice! I really do appreciate it!

Warmly,
XXXXX
doctor
Answered by Dr. Dariush Saghafi (6 hours later)
Brief Answer:
I have faith in your direction

Detailed Answer:
Thank you once again for the kind words and your patience in putting up with my blogs....some things strike a chord and then, OUT COMES THE SOAPBOX! LOL.

After reading everything you've written I'm again impressed with the amount of insight and openness you demonstrate with respect to other opinions. At the end of the day this type of forum is for the purpose is putting ideas out there which are not necessarily identical to the ones that the patient may feel are the best or most correct but rather to allow the patient to have options to make the best decision.

I see nothing wrong with your doing things such as taking and paying out of pocket expenses for supplements or nutritional things that make you feel better. After all, I have no direct of proving or disproving the majority of what I say...frankly, neither does the nutritionist...it's all a matter of relative chance and it comes down to where your gut tells you to go.....

I have faith in your direction and I believe both your SCIENTIFIC as well as personal compass are well set taking into consideration the variables and different scenarios that could occur. I applaud your persistence in trying to find support and looking for evidence based data to help with further decisionmaking so that it's somewhat grounded in fact as opposed to LOGICAL THINKING ONLY....

You have some very well rounded principles upon which you live your life....as "imperfect" as it may be.......(shame on you for only striving to be such! LOL!!) and I wish you the best. In my opinion and based on my limited scientific fund of knowledge regarding what we've discussed I see your lifestyle as being complementary (even though you work hours of the day that many do not) to your longevity not contrary.

Keep us abreast of any other questions you may have down there in that burning well of yours! Such questions keep the ocean currents spinning and prevent the silt from accumulating too much in our brains! LOL.....


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Does working in night shifts for long time have adverse effect on health?

Brief Answer: No need to switch anything around is unnecessary to me. Detailed Answer: Thank you very much in bringing your question specifically to my attention given the numerous choices you had for anyone to answer your question. I do not see where either your work or how you perform things at night as well as during your work shift puts you at significantly increased risk for serious morbidity or mortality. I XXXXXXX you that your choice of work hours coupled with choices of when to sleep vs. be awake are not the standards of practice but that's well compensated in your situation given the fact you sleep the approximate number of hours recommended for restful and restorative sleep as well as keeping track of other important elements having to do with your chemistries/biochemistries such as melatonin and Vit. D that I believe you've essentially minimized your risk for an early demise based upon risk factor control of developing spontaneous forms of cancer, tumors, or other reasons to have shortened longevity. I would point out that if you are overweight and especially if you are SIGNIFICANTLY overweight then, your risks for morbidity due to ALL CAUSE death and disability dramatically rises. The same can be said if you were to be borderline diabetes, hypertension, or hypercholesterolemia. It doesn't sound like you have anything to much worry about in practical terms so in my humble opinion I see no urgent need for you to switch anything around in terms of your chosen shift of work or the amount of sleep or other parameters having to do with sleep are obtained. It is just as important to your overall state of health and happiness that you are engaging in a form of lifestyle which is satisfying and fulfilling to yourself as opposed to forcing yourself to fit into a certain "expected mold" of what the IDEAL XXXXXXX should be in terms of when or where they work, how many hours they sleep, and other things that we are good at doing by coming up with guidelines and recommendations without taking anything else into account except what is supposed to be the needs and wants of physiological corporeal processes. The MIND is a terrible thing to waste.....or not listen to.....as the old saying goes! LOL.... I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to also upload images or test results as well for me to reference. Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response. Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates and many thanks for using this service to ask your questions. Be well. This consult request has taken a total of 27 minutes of time to read, research, and respond.