Shift Work

According to NSF’s 2005 Sleep in America poll, 14% of North Americans take part in what is called shift work. Shift work is an employment practice designed to make use of, or provide service across, all 24 hours of the clock each day of the week (often abbreviated as 24/7). The practice typically sees the day divided into set periods of time (shifts) during which different groups of workers perform their duties.

As you probably guessed, 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).

Hello, my law enforcement luminaries, military magnates, healthcare heavyweights, service station superstars, transportation troubadours, fire stations favourites, and call centre conquerors. My name is Brock Armstrong, and I am… not the Workplace Hero. Not yet, anyway. If I am doing my job correctly, you and I are both slowly but surely, episode by episode, becoming a Workplace Hero. You can think of me as your partner in this endeavour or maybe your information funnel, conduit… or crazy straw?

According to NSF’s 2005 Sleep in America poll, 14% of North Americans take part in what is called shift work. Shift work is an employment practice designed to make use of, or provide service across, all 24 hours of the clock each day of the week (often abbreviated as 24/7). The practice typically sees the day divided into set periods of time (shifts) during which different groups of workers perform their duties.

Shift work often involves evening or night shifts, early morning shifts, and rotating shifts. Many industries rely heavily on shift work, among them is:
Emergency responders & health care, Hospitality, Logistics, Manufacturing, Military, Public utilities & power, Telecommunications & media, Transportation, and Security, just to name a few.

The term “rotational shiftwork” covers a wide variety of work schedules and implies that shifts rotate or change according to a set schedule. These shifts can be either continuous, running 24 hours per day, 7 days per week, or semi-continuous, running 2 or 3 shifts per day with or without weekends.

As you probably already imagined, 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).

I actually coach a shift worker over at SkywalkerFitness.ca. She is a pretty darn competitive marathon runner who works a rotational shift and we really have had to fight an uphill battle in terms of energy levels and the ability to do the prescribed workouts. There is also the challenge of keeping her feeling good and overcoming some of the hormonal fluctuations that tend to occur during night shifts. Then there are some serious issues that creep up when you’ve thrown a curve ball at your circadian rhythm like you do on a night shift.

And there have been several studies on this. Here are a few:

They did a study in the Journal of Workplace Health and Safety on the police and found that police officers who are working at night or on an evening shift basically had lower serotonin levels than their non-evening working counterparts. And serotonin is one of our measurements of happiness and also our ability to do things like be motivated to exercise. It is also very helpful in helping reduce appetite cravings.

In the International Journal of Cancer, it was reported that a woman’s risk of breast cancer increases by 30% from night shift work. And a big part of that is because of hormonal fluctuations in particular, estrogen dominance, with estrogen being a pro-growth hormone that can increase when your circadian rhythms are thrown off.

There is another study in the Science of Translational Medicine which found that night shift style work can increase your likelihood of developing diabetes or becoming obese. This was a relatively small study with only 21 individuals but it found that circadian disruption can cause some serious issues with insulin sensitivity. So that again, throws a curve ball if you’re trying to lose weight or even maintain your body weight while you’re working night shifts.

Another paper in the British Medical Journal found that working night shifts could cause you to be more likely to have a heart attack. Particularly ischemic strokes and coronary events were found to be higher in people who were working night shifts.

A paper in the journal Proceedings of the National Academy of Health Sciences found that shift workers had decreased sensitivity to leptin when working at night. Leptin is the hormone that plays a pretty significant role in regulating your weight and appetite as well as your blood sugar and insulin levels.

Working in shifts can nearly double your risk of suffering a workplace injury and that’s because of the drowsiness, the fatigue and the lack of focus that can occur when you are working with no exposure to natural light or in any situation where our brains have been ancestrally programmed that they should be asleep.

So, am I basically saying that shift workers are screwed then?

Well, I don’t wanna sound harsh but yes, to a certain extent, you have to accept the fact that if you are going to work night shifts, your hormones and metabolism are going to, as they say, take a hit.

But, the fact that you have an important and noble job or that you’re making more money per hour may outweigh many of those drawbacks. There is a risk vs. reward benefit especially if that’s how you are paying the bills and putting food on your table.

And speaking of bills and food, keep in mind the benefits of not having to grocery shop on an evening or weekend, commute during rush hour both ways, or fight the lineup at the movie theatre on a Saturday night. Having your life be upside down or backwards can have its advantages too!

Now, let’s take a closer look at the issues and what you heroic shift working maniacs can do about them.

Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia and excessive sleepiness affecting people whose work hours overlap with the typical sleep period.

Over at sleepfoundation.org they say that 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 and 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 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.

The main complaint for people with shift work sleep disorder is excessive sleepiness. But other symptoms include:
-Insomnia,
-Disrupted sleep schedules,
-Reduced performance,
-Difficulties with personal relationships,
-Irritability and depressed mood.

Unfortunately, treatment for shift work sleep disorder is limited. Both behavioural and pharmacological remedies can help alleviate symptoms but some research indicates that the body may never fully adapt to shift work, especially for those who switch to a normal sleep schedule as part of their regular rotation. But there are ways of rocking it while doing shift work.

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 in the break room).
– Drink a caffeinated beverage (coffee or tea) 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.
– Keep your workplace brightly lighted to promote alertness. Circadian rhythms are the body’s internal clock that tells us when to be awake and when to sleep. These rhythms are controlled by a part of the brain that is influenced by light. Being exposed to bright light when you start your “day” can help train your body’s internal clock to adjust.
– And most importantly, 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.

And speaking of staying alert – on the day when your night shift cycle is complete, avoid planning anything important on that day (aside from perhaps a massage or some time with a good book). Acknowledge that you are out of whack (I believe that is the technical term) and that you will need this day to recover and reset.

A big question that new or non-shift workers have is: how the heck can you sleep during the day? Well, here are some tips for getting good sleep during the day:
– Try to avoid long commutes that take time away from sleeping.
– Limit caffeine. Drinking a cup of coffee at the beginning of your shift will help promote alertness. But don’t consume caffeine later in the shift or you may have trouble falling asleep when you get home.
– Avoid bright light on the way home from work, which will make it easier for you to fall asleep once you hit the pillow. Wear dark or yellow tinted, wraparound sunglasses and a hat to shield yourself from sunlight. And don’t stop to run errands, as tempting as that may be.
– Stick to a regular sleep-wake schedule as much as you can. Find the times that work best for you for each rotation of your shift work and use them every time that rotation comes up.
– Ask your family or roommates to limit phone calls and visitors during your sleep hours.
– Use blackout blinds or heavy curtains to block sunlight when you sleep during the day. Sunlight is a potent stimulator of the circadian rhythm, and even if your eyes are closed, the sunlight coming into the room tells your brain that it’s daytime. Yet your body is exhausted and you’re trying to sleep. That discrepancy is not a healthy thing for the body to be exposed to.
– Eliminate noise and light from your sleep environment (use eye masks and ear plugs).
– Avoid alcohol; although it may seem to improve sleep initially, alcohol is known to inhibit the most restful part of the sleep cycle so you will wake up not feeling as rested as you would want to be.
– Try not to work a number of night shifts in a row. You may become increasingly more sleep-deprived over several nights on the job. You’re more likely to recover if you can limit night shifts and schedule days off in between.
– Avoid frequently rotating shifts. If you can’t avoid them, it’s easier to adjust to a schedule that rotates from day shift to evening to night rather than the reverse order.

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.

Light therapy can be very helpful as well. Studies show that timed exposure to bright light can be used to adjust your body’s sleep cycle. Artificial bright light can affect the body clock in the same way that sunlight does. Light therapy is used to expose your eyes to intense but safe amounts of light. This is done for a specific and regular length of time. In general, using light treatment in the evening should help someone who regularly works nights. In this case, you would also want to avoid daylight when you come off work and are ready to go to bed.

Light boxes sessions may take as little as 15 to 30 minutes. More than one session may be needed each day. It depends upon your body, your need, and the strength of light being used. The key is to use the light at the right time of day and for the right amount of time. A sleep specialist can help you develop a light therapy plan that will be both helpful and safe.

There are a few supplements and medications that can help with the issues associated with shift work.

Melatonin may increase sleep length during both daytime and nighttime sleep in people who work night shifts. A medication called Zopiclone has also been investigated as a potential treatment, but it is unclear if it is actually effective in increasing daytime sleep time in shift workers. There are however no reports of side effects unlike using something like NyQuil or Benadryl to knock yourself out.

Modafinil and R-modafinil are useful to improve alertness and reduce sleepiness in shift workers. Modafinil has a low risk of abuse compared to other similar agents. However, 10% more people reported side effects, nausea and headache, while taking Modafinil. The European Medicines Agency withdrew the license for Modafinil for shift workers for the European market because it judged that the benefits did not outweigh the side effects. So, use this one with caution.

As I said earlier, using caffeine has also been shown to reduce errors made by shift workers. Over at HealthFitnessRevolution.com they have this list of the healthiest way to get caffeine.

Green Tea: Most varieties have a lower caffeine content at about 25mg per 8oz cup but that’s enough to clear out the cobwebs but not enough to have you wired all night. The benefits of green tea are the flavonoids boost immunity, it has been shown to aid in weight loss, and antioxidants even have anti-aging effects to keep free radicals at bay.

Espresso: A smooth, robust, and aromatic shot of espresso is a great way to get caffeine if you need it, like, now. It is also super low calorie and full of anti-oxidants.

Unsweetened Iced Tea: A glass of unsweetened iced tea has about 47mg of caffeine. Instead of adding sugar (which will increase the likelihood of a crash) spruce it up with some lemon or a natural sweetener like Stevia.

Matcha: A type of stone-ground Japanese green tea, Matcha is different than its other green teas. It doesn’t need to be steeped because it is ground into a fine super green powder. It has an umami taste and sometimes a sweetness, due to the high amino acid count. The high L-theanine content in Matcha gives a calming effect and the 25 mg of caffeine per scoop energize you. The result is a clear-headed serenity that allows you to focus on your work without jitters. Oh, The Vitamin C, antioxidants, magnesium and Zinc are good for you as well.

Guarana Berries: These little guys are found in the Amazon and pack quite a punch. Each one contains about twice the amount of caffeine found in coffee beans. They are available in extracted form or herbal teas.

Yerba Mate: Another herb found in the Amazon and popular throughout South America, yerba mate is an energizing and social drink.

Plain Black Coffee: The classic for a reason. Coffee has a high caffeine content and is low in calories, so long as fatty creamers and sugary syrups are avoided.

Earl Grey Tea: This classic cuppa gives you about half of the caffeine of a cup of coffee but is filled with antioxidants. The aromatic bergamot used to make the tea also has calming properties that relieve stress and anxiety.

Or good old Dark Chocolate: Not just a delicious dessert, dark chocolate also contains a smidgen of caffeine. It is also known to reduce cholesterol, promote weight loss, and can help brain function.

Eating well is both an issue and a solution to some shift work challenges. Stomach problems are common in shift workers and many shift workers eat poorly and at odd times. Try to eat three regular meals spaced evenly over the course of your day (what ever your day may be). Regular meal times are important for your body because they serve as time cues for your body’s clock and these cues help your body know when to make you sleepy. Avoid eating a lot of snacks and fast foods. Eat a balanced diet with plenty of vegetables, protein and un-processed foods.

You may feel tempted to grab an energy bar, sugary snack or simple carbs to get that quick boost of energy but remember that every high has an equal (or greater) crash associated with it that can leave you in worse shape than you were before. Think of yourself as a strong, slow burning fire (sorry first responders). You want to use the big logs and keep them going through the night to avoid burning up more kindling once you have’ve got it burning. In this analogy, healthy protein, fat and complex carbs are the big logs and sugary fruit, processed carbs and junk food are the kindling.

Workplace conditions are very important as well. While this is not possible in every situation, your employer should strive to create a work environment that will promote safety. This is even more important for those working the night shift. The workplace should be bright and cool. This will help workers to be more alert on the job. Don’t be afraid to discuss with your employer any changes that need to be made in your workspace – especially during the night. Safety can be increased without losing any productivity.

Ok. Now your homework. The next time you work a night shift and are headed home to bed, I want you to incorporate at least two things for this list:
1. Use curtains with block-out backing or blinds or cover the windows with black plastic garbage bags to reduce the light level in your bedroom during the day,
2. Make sure the temperature in the bedroom isn’t too warm because cool conditions help you get to sleep and stay asleep,
3. Try to make your bedroom as soundproof as possible. Use a white noise generator (there are a bunch of smart phone apps for that) or air conditioner or fan can help mask external noise. Earplugs help too.
4. Put your phone on Airplane Mode and put a notice on your bedroom door to let people know you’re sleeping and that they should keep it down, and ask other household members to use headphones for the TV and stereo while you’re asleep.
5. Plan what we call in our shift-working household your “dinner/breakfast” before you go to bed so you are not worried or hurried when you wake up. Better yet, offload that chore to a spouse, child or helpful roommate.

With some planning, some purchasing, some research and maybe some help from your doctor, you should be able to make this upside down lifestyle work for you. And if it simply isn’t working for you, there is no shame in admitting it. Many of us aren’t brave enough to even give it a try in the first place. It isn’t just the blood and guts that kept me from becoming an EMT and working in digital media instead.

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Workplace Hero is researched, written, narrated and recorded by me Brock Armstrong in rainy downtown Vancouver. Podcast logo by Ken Cunningham and music by my old band, The Irregular Heartbeats. Today’s heroic topic is courtesy my own personal ER Nurse and research partner, Eleanor Cohen. Who, when she wakes up, will go and make this week count!

One Reply to “Shift Work”

  1. so glad I don’t do shifts BUT the sleep tips were great – I’ll try them for sure. I’ll also pass this on to all my shift working pals

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