By Virginia Gurley, MD, MPH

MB (Marc Braman, MD, MPH):
Our topic this session, as part of Sleep 201, is “Meal Time Prescriptions for Night Shift Workers”. Thank you for joining us, Dr. Gurley.

VG (Virginia Gurley, MD, MPH):
Thank you, Dr. Braman.

MB:
How can we help our friends who work at night still get good sleep by managing their food or fuel well?

VG:
Well, like we talked about in the light prescriptions for night workers session, the best meal timing and meal sizes for people who work night shifts depends on whether your ideal sleep time begins shortly after finishing work, which means you want to sleep in the morning and early afternoon, or if your ideal sleep time ends shortly before going to work, which means want to sleep in the afternoon and evening.

MB:
Ok, so let’s start from the beginning, the first meal after waking up, what should night shift workers know?

VG:
Well, a common problem for people that work night shifts is difficulty waking up and feeling alert after sleep. And having a good sized breakfast with plenty of complex carbohydrates within 45 minutes of your ideal wakeup time helps the body transition from sleep to wakefulness much more quickly.

MB:
Fascinating. Do we know why that is or how it works?

VG:
Yeah, well, breakfast helps you transition out of sleep because after the 8 to 10 hour fast that occurs during sleep, your body’s anticipation of a significant breakfast increases the secretion of cortisol, and cortisol is the hormone that most strongly affects how easily you move from sleep to wakefulness.

MB:
So we can manage our “wake-up” hormone signals with managing the timing and quality of our first meal of the day?

VG:
Yes, so if you’re on a sleep-after-work schedule, you should eat your breakfast shortly after you wake up in the afternoon. And if you’re on a sleep-before-work schedule, you should eat your breakfast in the evening shortly before you go to work. It’s not that you need to eat eggs or granola at this time, it’s just that it needs to be a substantial meal with plenty of complex carbohydrates like whole grains, nuts, or legumes.

MB:
Lunch or midday meals will be 4 or so hours after the first meal of the day. What about dinner, or our last meal of the day? How do we manage that for optimal sleep?

VG:
For night shift workers, dinner is the meal you eat a few hours before you go to sleep. And if your dinner is too close to bedtime or it’s too large, especially with too many simple carbohydrates or too much protein, it will be harder to get to sleep and you may also have trouble staying asleep.

MB:
What does that look like for the two different sleep schedules?

VG:
Yes, so if you’re on a sleep-after-work schedule, you should eat your dinner in the morning, shortly after you get home from work. If you’re on the sleep-before-work schedule, you should eat your dinner around midday, a few hours before you go to sleep.

MB:
And, what about what we drink? How does that fit in?

VG:
The other important meal-related consideration for night shift workers is when to drink the majority of your water and non-caffeinated beverages. Being dehydrated during sleep can block the drop in body temperature that helps you have deep restful sleep. But, on the other hand, drinking too much water shortly before sleep can also disrupt sleep by waking you up to use the bathroom.
So, sleep-after-work people should get the majority of their fluids in the afternoon and night and then start tapering off shortly after they get home from work in the morning. Sleep-before-work folks should get the majority of their fluids during the night and morning and then start tapering off around dinnertime, at midday.

MB:
Points to remember regardless of your schedule:
Eat a solid meal with complex carbs reasonably soon after waking up.
Avoid eating several hours prior to going to sleep so your body can go into sleep mode and rest well.
For our night shift working friends there is a lot that you can do to greatly improve your sleep by managing your fuel. Thank you from the rest of us who benefit from your night time work.

Adrenal glucocorticoids have a key role in circadian resynchronization in a mouse model of jet lag. Kiessling S, Eichele G, Oster H. The Journal of Clinical Investigation. 2010;120(7):2600-2609. doi:10.1172/JCI141192.

Alteration of Internal Circadian Phase Relationships after Morning versus Evening Carbohydrate-Rich Meals in Humans. Krauchi K, Cajochen C, Werth E, Wirz-Justice A. Journal of Biological Rhythms. 2002; 17;364. doi:10.1177/074873040201700409.

Thermophysiologic Aspects of Three-Process-Model of Sleepiness Regulation. Krauchi K, Cajochen C, Werth E, Wirz-Justice A. Colin Sports Med. 2005. 24:287-300, doi:10.1016/j.csm.2004.12.009.

Virginia Gurley, MD, MPH

Dr. Gurley is Founder and President of AuraViva, a health education organization dedicated to increasing accessibility and efficacy of healthy lifestyle strategies. She has over 25 years experience designing and implementing health promotion and disease prevention programs and has served 15 years in physician executive positions. She is faculty at the American College of Lifestyle Medicine and member of American Academy of Sleep Medicine.

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