MS, After Midnight: A Cautionary Tale

I went back to school at age 47 to study sleep technology in 2012.

During finals week (March 2013), I plunked open my sleep medicine textbook, paging to the section where I’d highlighted text in bright chartreuse.

An RRMS diagnosis was confirmed

I discovered, then, that I couldn’t read. I could see the black letters under their veil of neon green. I just couldn’t comprehend them.

This prompted a visit to my doctor. Six weeks later, an MS specialist confirmed I had relapsing-remitting MS.

The circadian connection

Also six weeks later, I’d started clinical training, working third (overnight) shift.

Third shift is hard even when you’re healthy. Our bodies and brains aren’t designed to be active overnight.

The obvious concern? Adjusting to daytime sleep and getting enough to bolster you through another 12- to 13-hour shift the next night.

After I finished school, I passed my boards and worked a regular schedule at a local lab.

It wasn’t long after that I began to notice changes in the way I felt.

Is it MS? Or something else?

It’s hard to know which changes in my overall function were caused by MS or by circadian disruptions inherent in third shift.

Starting a brand-new disease-modifying therapy — Tecfidera – means deciphering symptoms from side effects. On top of that, menopause had hitched a ride.

What could I blame for my ongoing fatigue?

What could I blame for my ongoing fatigue? MS? Third shift? Sleep deprivation? Menopause? Tecfidera side effects?

And was my diarrhea caused by my DMT, or was it a symptom of MS, or was my digestive system out of whack because of circadian disruption? After all, night workers eat during shifts to stay awake, just when the liver wants to rest.

Cups of coffee at night (alternating with water to avoid the “crash and burn” of caffeine dehydration) helped, but not nearly as much as the modafinil (Provigil) I took right before I punched the clock.

It lasted the full shift and not a second more. Once home from work, my body would sink into dreamless abandon the moment my head hit the pillow. Then I’d awaken to cognitive fog caused by…?

Saying goodnight to third shift

I did this for a couple of years until it became obvious that working overnight wasn’t in my best interest.

Reasons why I stopped working overnight:

  • I began to notice short-term memory issues that affected my job performance.
  • On days off, even after full nights of sleep, I felt as if plowing through perpetual fog.
  • The modafinil worked… for a while. But its impact on heart health worried me.1
  • I began to feel a spiraling drowsiness at around 4am every shift—the witching hour for very sick patients. More heart attacks and strokes can happen at this time. I needed to be sharp and responsive, not drowsy and distracted. This created huge job stress.
  • I began to get sick all the time. Even with my annual flu shot, I couldn’t shake off respiratory infections. I ended up missing more and more work. Fears of an MS relapse constantly crept in.
  • My chronic diarrhea began to interfere with my job, too. I should’ve been getting up to help the patients use the restroom; instead, I made multiple bathroom trips myself every night at work, and not because of coffee.
  • Maybe it was menopause, but maybe it was the Tecfidera flushing that overheated me. I was also very active through the first half of the shift (7pm to 1pm). Bursts of stress hormones like cortisol can raise your core body temperature unnaturally at a time when it should be dropping.2 In any case, feeling overheated messed with my ability to read, though eye appointments showed no vision changes. Also, it’s hard to ignore a known circadian connection between overheating and MS vision problems.3

Third shift and MS: The risks

Research now shows that working third shift may increase the risk of developing MS in young people.4 This can be especially true for those working rotating shifts, such as nurses.5

It turns out I’ve had MS for most of my life (that’s another story for another day), so I can’t blame my sleep lab job for giving it to me. But I did finally leave my job. At the end of the day, the stress of not being alert while taking care of patients—and the ongoing concern about relapse—was enough for me to seek a healthier way to earn a living. I still miss it.

Choosing a career that won't aggravate MS

Meanwhile, my neurologist cheered when I told her I’d quit third shift. She knew I’d started an exciting new career path and admitted she couldn’t advise me how to live my life. But she, too, worried it might aggravate my MS.

If you’ve had to work night or third shift and found it hard to sustain, I’d love to hear from you.

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