Night Shift

Dear World

The following is an extract from our forthcoming book – The Real Truth about Sleep.

Night Shift work comes with serious health consequences and this article presents what some of us may not be aware of.

Addressing the Health Impacts of Night Shift Work

July 2020

1 in 5 people in developed countries now work night shifts.

Reasons why people work night shifts include:

  • Increased pay rates
  • Lack of choice
  • Family responsibilities

Shift work is associated with other health risks including:

Night shift work increases the risk of Mental Health issues, including:

  • Mood disorder
  • Sleep disorder

There is an increased risk of metabolic diseases including:

New information now identifies that night shift work carries a clear and significant risk to mental and physical health, even after other factors, such as Smoking have been taken into account.

Researchers now understand WHY shift work carries the risk.

It is the mis-alignment of the biological clock in the worker with the external light-dark environment. This is a major advance, as it offers a rational target for intervention to protect the health of night shift workers. (1)

We have confirmation telling us that night shift work carries a clear and significant risk to mental and physical health and our researchers understand why – it is the mis-alignment of the biological clock in the worker.

This is called a “major advance” because now they can intervene to protect the health of nightshift workers.



Do we need to wake up literally and simply apply a dose of common sense or operate how we did in the past, using that biological clock for work and Sleep?

Can we really call this a major advance if common sense gave us the answer a long time ago and it can still apply today?

Is it a major advance because we can offer intervention?
Is interference (another name for intervention) the answer?

Can we really protect the health of nightshift workers in this way?

Keep reading this article as there is much by way of presenting a commentary, from the author, on this much needed topic about Night Shift.

Save your opinions and critique until the very end, as there is so much more being shared to bring awareness about Night Shift work.

Increased Risks

Working night shift causes disruption to the circadian rhythm and there is greater risk of various disorders, accidents and misfortunes, including:

  • Increased risk of Cardiovascular Disease
  • Higher risk of mood changes
  • Increased risk of gastrointestinal problems
  • Higher risk of motor vehicle accidents
  • Higher risk of work-related accidents
  • Increased likelihood of Family problems, including divorce

Sleep deprivation caused by shift work can increase the risk of epilepsy in pre-disposed people.

Shift workers with Diabetes can experience difficulties in controlling their blood sugar levels. (2)

The Negative Health Impacts of Night Shift Work

Night shift work typically attracts higher rates of pay in compensation for being unpleasant.

Some night shift workers are unable to continue in role due to immediate difficulties in coping.

Adverse mental and physical health outcomes have been associated with night shift workers for many years.

As a group, night shift workers have been marginalised and there is a lack of evidence based advice to help night shift workers with immediate problems associated with fatigue, Sleep disorder and nutrition; and a complete lack of health surveillance and harm mitigation to protect workers from developing serious, long-term health issues such as Cancer.

There is a pressing need to ensure immediate safety for the worker and the safety implications of their work.

Major industrial accidents that have occurred during night shift include:

  • Chernobyl
  • Texas City
  • Exxon Valdes

Recognition and Management of these immediate risks have important implications for safe night shift work and the potential to avoid massive liabilities and reputational damage resulting from accidents occurring on the night shift.

The journey home after a night shift is a dangerous time interval with many near-miss incidents reported, including sleeping while driving.

Advances in population health science, coupled to larger cohorts of night shift workers has allowed the contribution of night shift work to be measured.

For example – many studies now report increased risk of Breast Cancer in night shift Women workers.

Following this association, further studies have sought to identify how night shifts could cause Cancer.

Animal models subject to simulated shift work changes in the light-dark were also found to have increased risk of Cancer and faster progression of Breast Cancer.

These studies help to link the observations made in night shift workers to a mechanism of action, which might offer ways to intervene and reduce the risks of night shift work.

It is thought that the core body clock exists to maintain alignment with cycles in body function with the external light-dark cycle as we move through day and night.

Night shift work involves living against the clock with activity and light at the time our body clock would be expecting dark and Sleep.
This mis-alignment also occurs in those with extreme chronotypes; reference to morning or evening activity.

For shift workers there is an unmet need helping them manage their shift work schedule in terms of coping with Sleep and eating against their internal body clock.

The emergence of strong evidence that night shift exposures increase the risk of physical illnesses including Cancer, metabolic diseases and inflammatory conditions is new.

The development of these diseases is irreversible and so prevention is very important.

For example – in the Netherlands, Breast Cancer is a recognised industrial disease for female nightshift workers, with implications for compensation.

Directing effort to mitigating the risks of night shift work will be cost-effective and offer immediate improvements in well-being and reduce longer term health risks.
David Ray – Professor of Endocrinology | University of Oxford (1)

Dear World

As we come to the end of this section about the Negative Health Impacts of Night Shift Work, a very important point to note is that – night shift work generally offers higher rates of pay.

How many of us are attracted by more money as a compensation, even though we all know it affects our mental and physical health, but we ignore that bit as it suits us?

Do we pay attention to the fact that some people are actually unable to continue a job because they experience “immediate difficulties in coping” when it comes to night shift?

Is this not a sign, a big red flag telling us SOMETHING IS NOT RIGHT?

Next –

Adverse mental and physical health outcomes have been associated with night shift workers for many years.

Do we understand what the word “adverse” means in the text above?

The origin of the word means against or opposite

What is this telling us and the fact we have known for many years leads to the question  WHY ARE WE IGNORING this?

Why do we simply accept anything when it is not supporting the human body?

We are told that “there is a lack of evidence based advice to help night shift workers…”

This means we must wait until our researchers gather evidence as this evidence based advice is what we have to rely on to help our night shift workers with immediate problems linked to fatigue, Sleep disorder and nutrition.

Those of us who are up to date and have worked it out – we know that researchers never ever say it as it is and end the study. There is always more to research and whilst this is ok and much needed, as we all like evidence, we are not sensing the urgency as things are not improving at the pace and rate we could be at, if we used some serious common sense in our approach.

Fatigue comes because we are not resting and sleeping according to that natural clock inside us – that is what good old fashion talk from granny would have to say on that matter.

Granny would also chime in and say Sleep Disorder is there because there is no honouring of the common sense go to bed early as we old people do and wake up early and Get On With It.

Nutrition – Granny would most certainly say, how on earth can you put food in your mouth when you are supposed to be sleeping?

Working opposite to the times you should be asleep and missing out on natural light are why you need the wrong foods to keep you going and get Real – the whole thing is out of sync and that means off track.

Next –

If there is a pressing need to ensure immediate safety for the worker and their work – how come night shift work is on the rise? Have we considered this?

Those that employ night shift workers do not want the risks involved with “massive liabilities and reputational damage resulting from accidents occurring on the night shift”.

WHY has it taken so long for our researchers to give us the confirmation that there is an “increased risk of Breast Cancer in night shift Women workers”?

When are we going to get out of the lab, stop using the rats and mice and allow these species their own evolution and start with observational studies and take on board the anecdotal evidence, which is Real life and the proof we all need to know?

Our human body is a living science. Surely this is the best way to get to the research evidence we rely on before we make our changes.

We do not need rodents to confirm human behaviour or dis-ease, as they are gnawing mammals and humans are not. End.

Let is repeat again –


Is this spelling out to ALL of us that this is WHY night shift workers are not coping well with Sleep and eating against their internal body clock comes with a whole new level of Complications.

Next –

We now have STRONG EVIDENCE that night shift increases the risk of Cancer, Metabolic Diseases and Inflammatory conditions.
The development of these diseases is ir-reversible.

How serious is this now that we know it is IRREVERSIBLE?

So what are we going to do with this ‘strong evidence’ Dear World.

Operate like before and simply wait for more research as this ‘strong evidence’ is not enough or are we going to wake up and pay attention and take a look at where we have a personal Responsibility?

Where do we make demands to want more of our 24/7 world which then means the suppliers have to employ workers 24/7 and that includes night shift work?

How are we going to direct our efforts and is effort in any form the actual true answer?

How are we going to mitigate – make this less serious, harmful and less severe really?

How are we going to offer ‘immediate improvements in well-being’ that a Professor of Endocrinology is saying to us?


3 million work night shift – 11.7% of the workforce (3)

Night Working Hours – Government Guidance

Night Period = 11pm to 6am
Unless employer or worker agree in writing a different night period.
This must be 7 hours long and include midnight to 5am.

Staff working at least 3 hours during the ‘night period’ are night workers.

Staff may also be night workers if there is a collective agreement that states their work is night work. (e.g., trade union agreement).

Night workers must not work more than an average of 8 hours in a 24 hour period. (4)

Night work that involved special hazards or heavy physical or mental strain – there cannot be more than 8 hours work in any 24 hour period. (5)

What if many night shift workers and their employers turn a blind eye to the government guidance of not working more than 8 hours in a 24 hour period?

What if night shift work as bad as it is for our true health and well-being offers us rewards that we simply cannot refuse? More money means we are financially sorted and the dream Holiday or an apartment with the extra room to show off to others how well off we are is a reality.

What if we like the extra income and put up with the dis-harmony we feel inside that leaves us with a constant un-rest, un-settlement because it means our kids can have More and we become the great Mum or Dad as we always do more than the average Family can?

What if we do night shifts as we see others doing it and they make it look easy and Simple, so we jump on the bandwagon (mainly to get noticed so others recognise and say ‘wow’ but we are making Mistakes, are totally off sync with our Sleep and cannot seem to get settled even on our Days Off?

What if night shift gives us the lifestyle we like – no one to talk to, just going solo and that suits us, as we don’t like the stuff that relationships come with?  Who wants another reflecting something back to us to learn and evolve when we can just carry on with the single life perks and keep a distant with all of humanity at arms length? That means we don’t form true and meaningful relationships because it suits us.

Dear World

Have we considered all the above “What If’s” as these are real life examples and that makes them very relatable?




(1) Ray, D. (2020, July 7). Addressing the Health Impacts of Night Shift Work. Retrieved February 25, 2022 from

(2) (2014, June 30). Shiftwork. Better Health Channel. Retrieved February 7, 2022 from

(3) Smith, R. (2018, February 12). Working Night Shifts Could Be Killing You – Here’s Why. World Economic Forum. Retrieved February 14, 2022 from

(4) (n.d). Night Working Hours. Retrieved February 19, 2022 from

(5) (n.d). Working at Night. Retrieved February 19, 2022 from





Comments 5

  1. British Medical Journal – 15 December 2020


    Shift work causes mis-alignment between internal circadian time and the external light/dark cycle and is associated with metabolic disorders and cancer.

    20% of the working population in industrialised countries work permanent or rotating night shifts, exposing this large population to the risk of circadian misalignment-driven disease.
    Analysis of the impact of shift work on chronic inflammatory disease is lacking.

    This research study investigated the association between shift work and asthma.

    Results of the study
    Compared with day workers ‘permanent’ night shift workers had a higher likelihood of moderate-severe asthma and all asthma.

    Individuals doing any type of shift work had higher adjusted odds of wheeze/whistling in the chest.

    Researchers conclude – The public health implications of these finding are far-reaching due to the high prevalence and co-occurrence of both asthma and shift work.

  2. Science Daily – 27 June 2022

    According to a new study, Physicians were 20% to 30% less likely to prescribe an analgesic during nightshifts, compared to daytime shifts and prescribed fewer painkillers than were generally recommended by the World Health Organization.

    These doctors were either at the end of a 26 hour shift or just beginning their workday.

    The study found that doctors that recently completed night shift exhibited decreased emotional responses to pictures of people in pain and consistently scored their patients low on pain assessment charts.

    In the second part of the study, researchers look at actual medical decisions made by emergency room doctors in the United States and Israel.

    Across all data sets, physicians were 20-30% less likely to prescribe an analgesic during nightshifts.

    This bias remained significant even after adjusting for patients’ reported level of pain, patient and physician’s demographics, type of complaint and emergency department characteristics.

    “These findings say the researchers may have implications on other workplaces that involve shift work including crisis centers, first responders and the military. In fact, they should matter to all people who are sleep-deprived.”
    Dr. Alex Gileles-Hillel – Hadassah Medical Center and Hebrew University

  3. Mail Online – 1 December 2022

    A junior doctor in the UK ‘fell asleep’ at the wheel after a 12-hour shift at a hospital and struck a woman and her two young children, then hit another woman. One victim had a leg amputated.

    The barrister said it was “overwhelmingly likely’ that the doctor had briefly fallen asleep after finishing his night shift.

    The knock on effect with injuries sustained by the victims tells us that this driving under extreme tiredness/exhaustion should not be possible.

    We have nothing in our world that bans drivers when they are unfit to drive due to lack of sleep.

    WHY have we not got any form of self care in our agenda for all physicians as we know how tiring their job is?

    If we have got this going on at junior level – how will they end up once fully qualified?
    Have we considered that if our doctors are unable to do 12 hour night shifts then what kind of care and advice will they be giving their patients?

    We all know the NHS is at breaking point with not enough staff and in particular shortages of doctors, which leads to very long waiting times, in particular at emergency departments during the night but how do we change this?

    What if part of the doctors training was in self care and well-being, as common sense tells us that a person with vitality levels that can be seen and felt means that we are in the best hands possible for our own medical needs?

    It is high time we changed how we allow our caring profession to be trained without any serious self care measures in place.

  4. Medicine Net – 8 December 2023

    Night Shifts are Triggering Sleep Disorders in Workers.

    51% of night shift workers have at least one sleep disorder as night work plays havoc with the body rhythms.

    26% reported two or more sleep disorders.

    Senior study author Dr. Marike Lancel said “We showed that compared to working regular shifts during daytime hours, working other shift types is associated with a higher occurrence of disordered sleep, particularly in rotating and regular night shift work.
    The effects of sleep are more pronounced in young adults with lower education.
    Because those working night shift will remain de-synchronized with the day-work focused environment they live in, it is unlikely to completely prevent all negative consequences of night work.”

    15% of American workers have a non-daytime shift schedule, according to the U.S. Bureau of Labor Statistics.

  5. American Heart Association – 25 March 2024

    Too much exposure to bright outdoor lights at night may increase stroke risk, according to a new study.

    Researchers found that people exposed to the highest levels of artificial light at night had a 43% increased risk of developing cerebrovascular disease.
    Cerebrovascular disease includes stroke and other conditions affecting blood flow to the brain.

    This is the first study to explore the relationship between light at night and brain health.

    80% of the world’s population lives in light-polluted environments.

    Continuous exposure to artificial light at night can suppress production of melatonin, which is the hormone that promotes sleep.

    People with poor sleep are more likely to experience worse cardiovascular health over time.

    Participants in the study exposed to the highest levels of the type of air pollution associated with the combustion of gasoline, oil, diesel fuel or wood had a 41% increased risk of developing cerebrovascular disease compared to those with the lowest levels of exposure.

    Those exposed to the highest levels of nitrogen oxide from motor vehicle and power plant emissions had a 31% higher risk of cerebrovascular disease compared to those with the lowest exposure.

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