shift work

introduction:

compared with non-shift workers, shift workers:
- quality of sleep is poor:
- they have less sleep
- are more likely to suffer sleep disorders
- are more likely to suffer from:
  - hypertension, GIT disturbance, CVS disease, O&G disturbance, CFS, immune dysfunction, depression & marital disharmony
rotating shift workers experience the most stress in the work place
have poorer dietary habits, often resulting in weight gain
altered pancreatic function and insulin secretion increasing risk of weight gain and diabetes mellitus ¹⁾
are less likely to exercise increasing risk of weight gain
decreased basal metabolic rate increasing risk of weight gain ²⁾
have a greater incidence of smoking & alcohol consumption as well as tendency to use other drugs to overcome effects of shift work (eg. sedatives & stimulants)
have higher risk of workplace injury & errors
have higher risk of near or actual car accident whilst travelling to & from work, especially on night duty
ED registrars on night shifts have substantially lower psychomotor skill scores than those on day shifts³⁾
have greater security risks if travelling late at night
ability to sleep during the day deteriorates with age
2 or more night shifts per week increases risk of miscarriage by 32% (Danish study 2019)

Coping strategies:

rostering:

3-shift, forward rotating rosters (morning-afternoon-night) are less disruptive than backward rotating rosters (night-afternoon-morning)
allow for recovery time after night duty - 2 whole days are recommended
two main night shift options:⁴⁾
- aim to never reset your circadian rhythm:
  - work as few a number of nights in a row as possible, ideally one, but up to 3.
  - avoid 4-7 consecutive nights as accumulated sleep deprivation will become excessive, and then just when the body has become used to nights, you revert back to day shifts - 4-7 nights followed by days off then day shifts is the worst possible option.
- aim to retain a changed body clock for at least 2 weeks by:
  - without a permanent night worker the best rotation is to have group members work a long string of nights, four to six weeks. The idea is that each person can group their nights for the year together and only have to shift their circadian rhythms twice, once coming onto nights and once coming off
  - “If you have to work nights each month you should gradually shift your circadian rhythms in a clockwise fashion and then work an extended period of nights in a row with no more than two nights off
  - Adjust your diet with complex carbohydrates at bedtime
  - Avoid stimulants such as caffeine or alcohol.
  - No sleeping pills or sedatives are appropriate.
  - Have a bright-lighted work space when you arrive.
    - Bright light of greater than 3,000 lux can also hasten resetting of circadian rhythms. Bright lights during the nights will increase alertness on the night shift and rapidly convert circadian rhythms.
  - Maintain regular exercise and social gatherings.
  - Do not try to live a daytime existence while working night shifts.
  - Always maintain good sleep hygiene with a darkened room and no disruptions.
  - Maintain an anchor sleep period”⁵⁾
    - anchor sleep:
      - you can help keep your biological clock tuned in to your sleep with anchor sleep.
      - aim to have at least four hours sleep at the same time every night/morning
      - it is a strategy that can be used for days off between periods of night shifts which is basically a compromise to switching to a diurnal orientation. One would stay up until 3 am or 4 am and then sleep until 10 am or 11 am. That way one gets some time to socialize but doesn't completely lose a nocturnal orientation.
  - Consider a split sleep strategy:
    - A split sleep period is a technique where one sleeps for 3 to 4 hours immediately before and 3 to 4 hours immediately after a night shift. The rationale is that at least part of each sleep episode is during the circadian period when sleep is expected.
  - Don't sleep more than 4 hours on the day following the last night shift
8 hour shifts are least disruptive - avoid 12 hour shifts
it is favourable to have regular & predictable roster arrangements
self-rostering is the preferred rostering system

workplace management:

staff should have an achievable & realistic workload
“controlled rest” or power napping should be supported eg. 20-30min sleep during night duty
for serious fatigue, staff should be able to get a colleague or taxi to take them home

personal initiatives:

avoid bright light after night shift to avoid the start of the diurnal circadian rhythm. Try wearing sunglasses when travelling home.
sleep in a dark quiet room (try a face mask, ear plugs & turn the answering machine on)
sleep in a room away from traffic & neighbourhood noises
consider insulation, double-glazing or air conditioner (all mask intrusive noise & reduce heat) if noise & room temperature are problems
go to bed at similar times where possible during the day or night
develop sleep time routines to allow your body & mind to shift gear & get ready for sleep:
- eg. shower, read, watch TV, listen to music, clean teeth, go to toilet then go to bedroom
- nap before start of night shift
if you cant get to sleep, get out of bed, read, watch TV, or listen to music and relax then return to bed when ready to sleep
investigate relaxation modalities such as herbal teas, aromatherapy, learned relaxation methods
plan your meals in advance
try healthy snacks such as fruit & products like UP&GO, breakfast bars, & Ensure nutritional supplement if you don't feel like a full meal
avoid caffeine, high calorie & high fat foods before sleep - if you must take caffeine, take it before or at the start of your shift and little or none in the 6-8 hours before you attend to sleep.
enlist family members to support your sleep time
get them to use headphones while watching TV or listening to music
let others know you are trying to sleep during the day, then hopefully they will avoid waking you
undertake regular exercise after waking - not before sleep
plan with family & friends for regular quality time - don't just let it happen

consider working part-time

if one is over 40 yrs age, there is evidence that working more than 25 hours a week increases cognitive decline irrespective of whether one is a shift worker ⁶⁾