BACKGROUND: Shift work is essential to hospital operations but disrupts circadian rhythms and is associated with increased metabolic, cardiovascular, and sleep health risks. Medications, naps, etc. may reduce symptoms but do not solve the underlying problem of an unstable sleep schedule. Anchor sleep, where an individual maintains a core daily sleep period, is recommended to reduce circadian misalignment but is difficult to maintain. Casino schedules, which use a 4:00 a.m. turnover, provide a practical way to preserve anchor sleep, particularly during dark hours. Reports suggest casino schedules benefit wellness and cognition in healthcare workers, but other potential benefits have not yet been evaluated.
METHODS: We completed a pilot study to assess inflammatory biomarkers and sleep in 12 emergency medicine physicians over a 6-month period. Each participant was studied under three conditions: baseline (96 h without overnight shifts), traditional overnight shifts, and casino shifts. We measured white blood cell and platelet counts, erythrocyte sedimentation rates, hemoglobin, and hematocrit. We also measured minutes of deep sleep using Fitbits and post-shift sleepiness using surveys.
RESULTS: Traditional overnight shifts were associated with higher inflammatory markers and worse sleep outcomes, while casino shifts showed improvement. White blood cell and platelet counts increased during traditional overnight shifts and returned to baseline during casino shifts. Hemoglobin and hematocrit were unchanged. Deep sleep was better-preserved and participants reported less sleepiness during casino shifts.
CONCLUSION: Casino shifts may improve sleep and inflammatory markers. These preliminary findings support larger, long-term studies on implementing casino shifts in healthcare.
