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Coping with shift work.

People working shifts other than a traditional business day (nine to five) are increasing at an estimated rate of 3% annually. Currently about 20% of male and 15% of female workers work afternoon and night shifts either on a permanent schedule or in a rotating fashion. Health care workers have long been in this group.

Anyone who has worked night shift is aware of the challenges faced by the need to be awake while the rest of the world is sleeping. They constantly battle the natural sleep-wake pattern. Multiple studies have shown that shift workers have a higher reported rate of involuntarily falling asleep while on the job. Night-shift workers typically sleep 1.5 hours less in a 24-hour period than day-shift workers. Additionally night-shift workers' sleep is often less restful. Shift workers describe difficulty staying awake during their shift as well as difficulty falling asleep and staying asleep during the day. The resulting sleep deprivation can have significant impact on physical and mental health. Shift workers describe more gastrointestinal upsets, particularly heartburn and indigestion, colds, flu, weight gain and menstrual irregularities than day workers. Cardiac problems are also more common as are mood problems such as depression, anxiety and irritability. Shift workers report higher rates of problems with family relations. Perhaps the most dangerous is the increased risk of accidents, both at the workplace and particularly during the drive home. One study showed that 95% of night nurses working 12-hour shifts reported having had an automobile accident or near-miss accident while driving home from work.


Most problems occur on the night shift, 11:00 p.m. to 7:00 a.m. However, day shifts that start prior to 7:00 a.m. are also at risk. Working overtime or extended shifts also often result in higher employee complaints. Twelve-hour shifts are at the far end of acceptable duration, although there is some controversy over the risk of even this duration. Rotating shifts puts the shift worker at higher risk than remaining on a shift for an extended period. The more frequent the rotation--weekly, daily, etc.--the greater the impact of the shift work.

Why is sleep so difficult for shift workers? The body has a natural circadian rhythm for rest and alertness. This internal circadian clock is closely linked to the natural light and dark cycle with the strongest sleep tendency between midnight and 6:00 a.m. There is an additional, but less dramatic, sleep tendency during the mid-afternoon. Given this natural pattern, shift workers are trying to stay awake during the body's strongest dip in alertness and trying to sleep during the period with less natural sleep tendency.

There are strategies that will improve a shift worker's ability to cope with these issues. The most important is to plan your schedule so that you are as well rested as possible. It is important to protect your sleep time so that you will have the best chance for good sleep. On the drive home, wear sunglasses to minimize the alerting effects of the sunlight.

Before going to bed, some considerations will improve the likelihood of a successful sleep period. When you get home, make the bedroom as conducive as possible for sleep. It is helpful to use blackout drapes and disconnect the ringer on the phone. Sleep masks can reduce light exposure as well. Use earplugs or a white noise machine to block noise. Enlist the help of family and friends. Make certain that they use headphones when they watch television or listen to the radio. Ask that noisy activities such as vacuuming or doing the dishes be done after you are finished sleeping. Consider putting a "Do Not Disturb" sign on the door so that delivery people and friends know not to ring the doorbell or knock. Avoid caffeine for at least five hours before bedtime. Don't drink alcohol prior to bedtime. Alcohol may relax you initially, but it disrupts sleep over time. Don't go to bed either hungry or too full. Overall, exercise will improve sleep. Exercise is alerting and raises the body temperature. If you exercise less than three hours prior to bedtime, it may prolong the time it takes to fall asleep.

If you are not able to get adequate sleep during time you set aside for sleep, take a nap prior to going in to work. Naps as short as 20 minutes can improve alertness, performance and mood.

While on the job, there are tactics that will help you promote alertness during the shift. Rather than one extended break, schedule short breaks throughout the shift. Try to be active during these breaks by taking a walk or other types of exercise. Find a coworker with whom you share the responsibility of watching each other for signs of drowsiness. Simply talking with others can help you stay alert. Try to schedule your tasks so the most boring or tedious tasks are completed earlier in the shift when you are less likely to be drowsy. Typically around 4:00 a.m. is the most difficult time to maintain alertness, so this would be the ideal time for the most active tasks to be performed.

Employers can provide a safer and more productive workplace for shift workers as well. Bright lights installed in the work areas help signal the body that it is time to be awake and alert. Make certain that healthy food choices are available either in the cafeteria or vending machines during the night shift. Schedule the shifts in a manner that will allow employees sufficient breaks and days off. Allow employees to have enough time between shift to not only sleep but attend to their personal lives. Discourage overtime for shift workers. Encourage napping for shift workers and develop guidelines for the acceptable times for napping. Since most shift workers admit to napping on the job whether or not it is acceptable, set up the expectation that napping is allowed only within prescribed guidelines. It is clear that napping will improve alertness, safety and performance. Provide the employees with an area conducive for sleeping as well as time for scheduled naps. Assist the employees in safety particularly traveling to and from work. Aid in setting up car pools or the use of public transportation.

Shift workers may not recognize symptoms of sleep disorders or may simply blame them on the shift work. If you have symptoms suggestive of sleep apnea, periodic limb movement disorder or narcolepsy you should contact you physician immediately so that treatment can begin.

While shift work comes with difficulties, many people enjoy to relative calm and freedom enjoyed on a night shift. Whether you are on night shift by choice or are required to work them, try the strategies listed and encourage you employer to support the efforts to make the shifts more alert and safe.

by Robert Turner, RPSGT
COPYRIGHT 2003 Focus Publications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2003 Gale, Cengage Learning. All rights reserved.

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Title Annotation:SLEEP MEDICINE
Author:Turner, Robert
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Date:Sep 22, 2003
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