title: Sleep Strategies of Night-Shift Nurses on Days Off: Which Ones are Most Adaptive?
abstract: OBJECTIVE
  To determine the off-shift sleep strategies of bi-ethnic night-shift nurses, the relationship between these sleep strategies and adaptation to shift work, and identify the participant-level characteristics associated with a given sleep strategy.
  
  
  METHODS
  African-American and non-Hispanic White female, night-shift nurses from an academic hospital were recruited to complete a survey on sleep-wake patterns (n = 213). Participants completed the standard shiftwork index and the biological clocks questionnaire to determine sleep strategies and adaptation to night-shift work. In addition, chronotype was determined quantitatively with a modified version of the Munich ChronoType Questionnaire. Most participants worked ~3 consecutive 12-h night-shifts followed by several days off.
  
  
  RESULTS
  Five sleep strategies used on days off were identified: (a) night stay, (b) nap proxy, (c) switch sleeper, (d) no sleep, and (e) incomplete switcher. Nap proxy and no sleep types were associated with poorer adaptation to night-shift work. The switch sleeper and incomplete switcher types were identified as more adaptive strategies that were associated with less sleep disturbance, a later chronotype, and less cardiovascular problems.
  
  
  CONCLUSIONS
  Behavioral sleep strategies are related to adaptation to a typical night-shift schedule among hospital nurses. Nurses are crucial to the safety and well-being of their patients. Therefore, adoption of more adaptive sleep strategies may reduce sleep/wake dysregulation in this population, and improve cardiovascular outcomes.
authors.affiliation: College of Nursing and Health Innovation, Arizona State University , Phoenix, AZ , USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Petrov
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham , Birmingham, AL , USA.
authors.forename: C Brendan
authors.initials: CB
authors.lastname: Clark
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham , Birmingham, AL , USA.
authors.forename: Hylton E
authors.initials: HE
authors.lastname: Molzof
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham , Birmingham, AL , USA.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Johnson
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham , Birmingham, AL , USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Cropsey
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham , Birmingham, AL , USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Gamble
keywords: cardiovascular symptoms; chronotype; nurses; shift work; sleep disturbance