Nurses and Shiftwork: Sleep Well to Be Well, by Dr. Carolyn Gotay

It’s estimated that most people spend one-third of their lives sleeping, but until recently, the links between sleep and health were not well understood. Recent research has identified relationships between disrupted sleep and increased risk of obesity, diabetes, cardiovascular disease, and some cancers, suggesting that sleep has significant effects on health and well-being.

There are an estimated 4.1 million shift-workers in Canada, and approximately 1.9 million regularly work shifts between midnight and 5AM; these workers are the largest group at risk of disrupted sleep. According to a Statistics Canada Survey of nurses from 2005, six percent of B.C. nurses work permanent night shifts, and an additional 45 percent work mixed shifts, including nights. This suggests that slightly more than half of all 38,000 registered nurses in B.C. suffer from regular circadian disruption due to shiftwork. In fact, in 2010, IARC classified shiftwork with circadian disruption as Group 2A, “probably carcinogenic to humans.” In particular, IARC identified increased breast cancer risk in night shift-workers.

The ICOS study (Improving Cancer-related Outcomes in Shiftworkers) is funded by the Canadian Cancer Society and led by Dr. Carolyn Gotay, Canadian Cancer Society Chair in Cancer Primary Prevention at the University of British Columbia. The study tested whether a sleep hygiene intervention for women who work shifts could reduce their risk of breast cancer.

Study participants were 47 women (including 23 nurses) from the Vancouver region. On average, these women had worked seven night shifts per month for more than 16 years. At baseline, about four in five (79 percent) reported poor sleep. Since obesity is an additional risk factor for breast cancer that is linked to poor sleep, participants also self-reported their BMI and were categorized as normal weight, overweight, or obese.

The sleep intervention consisted of 10, telephone-delivered cognitive behavior therapy (CBT) sessions. CBT is a psychotherapeutic method that focuses on changing unhealthy patterns of behaviour and thinking, and it has been endorsed as a first-line treatment for insomnia by a National Institutes of Health Consensus Conference and the British Medical Association. The intervention was delivered by an experienced sleep counselor.

Six months after the intervention, the proportion of participants reporting poor sleep had decreased by more than one-third, from 79 percent to 49 percent. This positive impact was maintained when we went back to the women six months later, a year after they began the study. The effect was stronger in women with BMIs less than 25, but it was also statistically and clinically significant in women who were overweight and obese. This promising finding suggests that a sleep hygiene program like the one used in the ICOS study can result in significant and lasting improvements in sleep quality in night shift-workers.

We are still analyzing other data collected in the study, including information about health behaviours, objective measures of physical activity, and biological indicators in blood and saliva. We are very grateful to the nurses who took part in this research – we couldn’t have done it without them! We’ve already learned a lot from this study, and we plan to build on our findings in future research. In particular, we are thinking about providing sleep hygiene sessions for nurses who are just beginning their careers as night shift-workers.

If you have comments about this idea, suggestions for other sleep research that would be helpful to you, or if you’d like more information about the ICOS study, please contact Jennifer Parisi, Communications Director at the Centre of Excellence in Cancer Prevention (communications@cancerprevent.ca).


Carolyn Gotay, PhD, FCAHS is Professor and Canadian Cancer Society (CCS) Chair in Cancer Primary Prevention at the University of British Columbia (UBC). She also holds an appointment at the BC Cancer Agency. Dr. Gotay received her PhD in psychology from the University of Maryland, and she came to UBC in 2008 after positions at Gettysburg College, the University of Calgary, the (US) National Cancer Institute, and the University of Hawaii.

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Lori Campbell

Fascinating! I participated in a sleep study a couple years ago when I was working in ICU, the wrist sleep monitor showed me that I woke up a LOT more often than I thought that I did, especially during my day sleep! Really was a wake up call (haha, pun intended) that my sleep was impacted more than I thought, so after that I implemented ear plugs and a sleep mask which helped a bit!

I'm really glad to see that you are researching solutions, rather than just more that is confirming that nurses have significant sleep disruption! Thanks for sharing!

Leeza Robinson

Wow this is just great. I am so interested in learning more about how sleep patterns are impacted by shift work, but also how shift work impacts sleep patterns. This is something nurses have been dealing with for decades, and we're only now starting to understand how bad it is for our health long-term. There is so much to learn. Thank you Dr. Gotay - I will follow your work and give thought to how I can take your words to heart.

Julia Baratto, RN

What an important point to make! Is it not ironic that a profession centered around health has one of the unhealthiest schedules. I suffer from shift work sleep disorder despite only being six months into the job. All the recommendations made around proper sleep hygiene to minimize the effects of shift work are ones that are impossible to implement. I work full-time, mostly two days, two nights and four off. It is recommended that you stick to one schedule. For example, if one works nights it is recommended they keep the same schedule on ones days off. That can only be applied to the one individual that owns a nights-only line on my unit. The second recommendation is that if you have to work a variety of shifts is to slowly transition. I know I have colleagues in other provinces that work a set of days, have some days off and then work a set of nights. For these colleagues, the recommendation to slowly transition from days to nights over the days off would likely work. However, my schedule forces me to switch from 12 hours days to 12 hour nights within the same set. I spend all four of my days off struggling with a mix of insomnia and hypersomnia, depending on what my body feels like doing that week. I do not want to end up spending my career relying on caffeine and sleep aids so I do hope to see scheduling changes in the future that allows for healthier sleep hygiene, and well-rested nurses!