Shift work: Sleepless in more than Seattle
NIOSH to offer strategies to reduce risks
Working nights and rotating shifts can wreak havoc with your sleep schedule. Shift work has been linked to a wide range of hazards, from cardiovascular disease and cancer to fatigue that leads to errors. But researchers have an upbeat message about shift work: You can reduce those ill effects.
"If there are unavoidable times when [employers] need people to work shift work and long work hours, it is helpful to find ways to reduce demands on the workers to help them cope," says Claire Caruso, PhD, a research health scientist with National Institute for Occupational Safety and Health in Cincinnati who has researched the impact of shift work.
Caruso and colleagues are developing a training module shift workers to provide education and strategies to minimize the effects. The module is expected to be available in 2009. Not surprisingly, there is one overriding issue: Sleep. Or lack of it.
Sometimes there is literally not enough time between shifts for workers to commute home, have some family interaction, and sleep adequately before going back to work. Lack of sleep can slow response time, reduce short-term recall and working memory, and cause other cognitive declines, says Caruso.
"The brain can go into micro-sleeps. It's uncontrollable," she says. The sleep-deprived person can actually fall asleep for a few seconds even though they are trying hard to stay awake, Caruso adds.
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Dead of night: Fatigue culprit in major accidents Some of the catastrophic events in the last few decades occurred on the night shift or have been linked to sleep deprivation, including:
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Shift work strategies focus on improving the quality and quantity of sleep. The average person needs seven to eight hours of sleep a night, although that can vary, says Caruso. "Whatever a person needs, they should strive to get," she says. "If I need eight hours and I'm getting seven hours, then each night I'm down one hour. That accumulates over time.
"Keep an account of your sleep debt and try to pay it back," she advises. Changes in sleep patterns also affect the circadian rhythm, the body's natural clock. But working through a forward rotation (day, evening, night) is less disruptive than other scheduling patterns, according to an analysis of studies on shift work by researchers at Durham University in England.1 A fast rotation changing shifts within three or four days, followed by time off is preferable to a weekly rotation, the researchers found. With a weekly rotation, "your body starts to make an adjustment but it never really makes the adjustment," explains Caruso.
Research has shown other important strategies to mitigate the effects of shift work:
- Create a dark, cool sleep environment. "If you have to sleep during the day, you need to have a very dark bedroom. People should put special covers on their windows and under their doorways to prevent any light from coming in," advises Caruso. You also can use earplugs to block out noise and turn the phone off to prevent sudden awakening.
- Use strategic naps and rest breaks. Some hospitals have created a "nap" space for employees or physicians who work nights or extended shifts. "Even a short nap, 15-20 minutes long, has an alerting effect," says Caruso. Night shift workers also should take a "lunch" break, just as they would if they worked during the day, she says.
- Avoid unplanned shift changes. When employees are called in for "on-call" or emergency coverage, or when nurses are asked to work mandatory or other unplanned overtime, they haven't had the opportunity to adjust their sleep patterns. "Regularity and predictability helps workers plan ahead for sleep," says Caruso. Without adequate sleep, clinical workers may suffer from fatigue and all its consequences during their extended hours. Be aware that some studies report similar deficits in functioning when comparing participants who are under the influence of alcohol and participants who have been kept awake for 17 hours or more, Caruso says.
- Be cautious about assigning permanent night shifts. An obvious answer to rotating shifts may be to assign night shifts to the same workers. Theoretically, they can orient their lives to be awake at night and asleep during the day." There are some people who are able to adjust to night work," says Caruso. But for the circadian rhythm to adjust, people need to maintain that wake sleep schedule throughout the week. For personal reasons, most employees will switch to sleeping at night during their days off, which means their bodies are constantly readjusting. It's like repeatedly going through jet lag, Caruso notes.
- Extra services may help employees cope better with shift work or long work hours. Some hospitals provide laundry and other domestic services for employees who work odd hours or overtime that frees them to use their time off to get adequate sleep. Workers who are very sleepy after completing their work shifts may pose a risk to themselves and others and even a potential liability for the hospital, Caruso says. The insurance industry lists shift work as one of the key factors that are linked to automobile crashes. Two strategies to reduce that risk are providing transportation home or providing a place to nap at the work site after the work shift.
While employees need to manage their time outside of work to allow for adequate sleep, employers play an important role, too, Caruso says. "It's a joint responsibility between the employer and the worker to reduce risks [from shift work]," she says.
Reference
1. Bambra CL, Whitehead MM, Sowden AJ, et al. Shifting schedules: The health effects of reorganizing shift work. Am J Prev Med 2008; 34:427-434.
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