Shift Work and Sleep

A shift worker is anyone who follows a work schedule that is outside of the typical "9 to 5" business day. In the past few decades the United States has become increasingly dependent upon shift workers to meet the demands of globalization and our 24-hour society. From a competitive standpoint, shift work is an excellent way to increase production and customer service without major increases in infrastructure. According to the Bureau of Labor Statistics, millions of Americans are considered shift workers, including doctors and nurses, pilots, bridge-builders, police officers, customer service representatives and commercial drivers.

However, while shift work does create potential productivity advantages, it also has many inherent risks. Some of the most serious and persistent problems shift workers face are frequent sleep disturbance and associated excessive sleepiness. Sleepiness/fatigue in the work place can lead to poor concentration, absenteeism, accidents, errors, injuries, and fatalities. The issue becomes more alarming when you consider that shift workers are often employed in the most dangerous of jobs, such as firefighting, emergency medical services, law enforcement and security. Managers and policy makers who are responsible for writing and enforcing rules regarding employee work hours must address the specific issues of a 24-hour work force in order to succeed and benefit from such a labor force. Although addressing these issues may require some investment up front for training and other measures, the bottom line is that improved sleep in workers may lead to improved productivity. In fact, to ignore the needs of the shift worker is reckless and irresponsible when you consider that billions of dollars in yearly costs, thousands of deaths, and some of the most notorious of modern catastrophes such as the failure of the Space Shuttle Columbia and the crash of the Exxon Valdez have been attributed to human fatigue.

According to the International Classifications of Sleep Disorders, shift workers are at increased risk for a variety of chronic illnesses such as cardiovascular and gastrointestinal diseases. Whether this is related to the fact that shift workers are awake and active during the night hours or because they tend to get fewer hours of sleep overall than traditional workers is not known. Also, shift workers often miss out on important family and social events due to their work schedules. Most managers recognize that understanding and addressing these issues improves employee morale, performance, safety and health, and can dramatically improve the bottom line of the company.

People who work in the transportation industry face some of the most serious challenges. They battle fatigue because of their irregular sleep schedules and endure long tedious hours at the controls or behind the wheel. In fact, research suggests that driver fatigue behind the wheel caused by sleep deprivation is one of the leading safety hazards in the transportation industry.

According to the International Classifications of Sleep Disorders, shift work sleep disorder is a circadian rhythm sleep disorder. Circadian rhythm refers to the ~24hr rhythmic output of the human biological clock. It is considered a disorder because of the frequency with which people suffer from sleep disturbance and excessive sleepiness in trying to adapt to a shift work schedule.

SYMPTOMS:

The main complaint for people with shift work sleep disorder is excessive sleepiness. Other symptoms include:

• Insomnia
• Disrupted sleep schedules
• Reduced performance
• Difficulties with personal relationships
• Irritability/depressed mood

TREATMENT:

Unfortunately, treatment for shift work sleep disorder is limited. Both behavioral and pharmacological remedies can help alleviate symptoms. Some research indicates that the body may never fully adapt to shift work, especially for those who switch to a normal weekend sleep schedule. But there are ways of getting adequate sleep while doing shift work.

COPING:

If you are a shift worker and have difficulty sleeping during the day, chances are you also have difficulty staying awake at work. Also, the more sleepy/fatigued you are, the more likely you are to experience a "microsleep," an involuntary bout of sleep brought on by sleep deprivation that lasts for a few seconds.

Here are some tips for staying alert on the job:

• Avoid long commutes and extended hours.
• Take short nap breaks throughout the shift.
• Work with others to help keep you alert.
• Try to be active during breaks (e.g., take a walk, shoot hoops in the parking lot, or even exercise).
• Drink a caffeinated beverage (coffee, tea, colas) to help maintain alertness during the shift.
• Don't leave the most tedious or boring tasks to the end of your shift when you are apt to feel the drowsiest. Night shift workers are most sleepy around 4-5 a.m.
• Exchange ideas with your colleagues on ways to cope with the problems of shift work. Set up a support group at work so that you can discuss these issues and learn from each other.

For some shift workers, napping is essential. It can be extremely effective at eliminating fatigue-related accidents and injuries and reducing workers compensation costs. Although most employers do not allow napping in the workplace, a ban on napping may soon prove to be a legal liability. Thus, efforts to make workplace policies nap-friendly may soon gain popularity as the issue increases in global significance.

Here are some tips for sleeping during the day:

• Wear dark glasses to block out the sunlight on your way home.
• Keep to the same bedtime and wake time schedule, even on weekends.
• Eliminate noise and light from your sleep environment (use eye masks and ear plugs).
• Avoid caffeinated beverages and foods close to bedtime.
• Avoid alcohol; although it may seem to improve sleep initially, tolerance develops quickly and it will soon disturb sleep.

POLL DATA:

According to NSF's 2005 Sleep in America poll, 14% of Americans do shift work . Compared to their day shift counterparts, shift workers are more likely to suffer from insomnia as well as excessive daytime sleepiness (61% vs. 47% and 30% vs. 18% respectively). Shift workers are also more likely to drive while fatigued and almost twice as likely to fall asleep at the wheel.

Reviewed by:

Christopher Drake, Ph.D.

Senior Scientist at the Henry Ford Hospital Sleep Disorders and Research Center in Detroit and Assistant Professor of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan. Dr. Drake completed a two-year research fellowship at the National Institute of Mental Health, Clinical Psychobiology Branch under Dr. Thomas Wehr and earned his Ph.D. in clinical psychology from Bowling Green State University in Ohio. Dr. Drake received his board certification in sleep medicine in 2003 and currently serves as a member of the Sleep in America Task force for the National Sleep Foundation. He has also served on a number of other national and international committees for the APSS and SRS. Dr. Drake has also been an advisor to the World Health Organization on sleep and health. He has authored many publications in the field of sleep research and serves as a reviewer for numerous scientific journals. Dr. Drake is currently funded by the National Institute of Mental Health to study the predisposition to insomnia and his areas of research include individual vulnerability to acute sleep disturbance and chronic insomnia.