About the author: Dr David Lee is a chartered psychologist and Clinical Director at Sleep Unlimited Ltd. and author of “Teaching the world to sleep”.
Shift-working has been implicated in reduced quality of life, and associated with increased morbidity and mortality rates in shift-workers. These are exacerbated by the longer time spent working shifts, the rapidity with which those shifts rotate, and the more antisocial the hours worked (e.g. night-shifts). Increased stress hormones (especially cortisol) are implicated in this increased morbidity and mortality. These are most certainly driven by inadequate amounts of sleep and continually adjusting and readjusting the circadian rhythm.
A consistent routine is an essential part of a healthy sleep (and wake) pattern. With a consistent routine, the circadian rhythms of sleep / wakefulness (alertness) and body temperature become synchronised, or entrained to each other. Concurrent dips in body temperature and alertness culminate in a strong signal for the induction of sleep (in the late evening), and concurrent rises in body temperature and alertness culminate in a strong signal to wake (in the morning). Rotating shift patterns disrupt the synchrony between these two rhythms, making sleep less easy to induce and to maintain. Thus, people living with frequently rotating shift patterns are continually disrupting the synchrony of their circadian rhythms and their sleep often suffers as a result.
The consequences of this are manifold. Long-term there are clearly established negative health consequences (Costa, 1996), but in the short- and medium-terms there are feelings of fatigue, and impaired performance, which leads to mental health problems (Lac & Chamoux, 2004), decreased productivity and an increased rate of work-related accidents (Rajaratnam & Arendt, 2001).
The role of employers
Many employers are behind the curve with respect to their shift-working employees. Allowing workers to choose their own shifts (so owls can work the later shifts and larks the earlier ones) would enable employees to feel as though they are valued and have some autonomy in how they work. Selecting permanent shifts would mean that workers can synchronise to one working pattern and so avoid continually disrupting their circadian rhythms (with concomitant advantages to mental and physical health in the short-, medium- and longer-terms).
On the back of these positive outcomes, employers would have a happier, healthier, more productive (and less accident prone) workforce. There would be less time taken off work with stress-related illness and less litigation involved in resolving work-related accident cases and complaints of unfair treatment by workers. A win – win situation. The multiple employers that adopt rapidly rotating (often 2-week rotation patterns) to maximise efficiency, and so productivity, in the short-term are almost certainly shooting themselves in the foot in the medium- and longer-terms, spending their short-term profits on sickness and litigation pay-outs later.
Tips for shift workers
Here are a few tips for people who work shifts, to help to maintain as healthy a lifestyle as possible and to protect their sleep as much as possible:
Managing the Change
- Adapt to the new routine as soon as possible.
- Even before the shift-change, begin by ‘going half-way’ for a couple of nights before the shift change.
- Manage sleepiness at work with relaxation techniques / power napping during breaks.
- If your working practices include physically and not so physically active duties, attempt to synchronise these activities so that whatever shift you work your activity levels remain as consistent as possible with your ‘natural rhythm’.
Caffeine Consumption
- Drinking coffee / tea can offset tiredness and fatigue, however consumption should be:
- Moderate
- Avoided in the 4-hours before bedtime
- Topped up only after approximately 4-hours
- The effects of a caffeinated drink may not last beyond four hours
- There may be ‘rebound’ tiredness after four hours post-consumption
Stimulant Drugs
- Stimulant drugs should not be consumed without the express direction of your GP and should only be taken in moderation and only when strictly necessary.
- Should be avoided if possible.
- Napping, relaxation and caffeine strategies should be used in the first instance and can be highly effective without resorting to medication.
Managing Your Health
If you do feel excessively tired a lot of the time:
- Consult with your managers about the possibility of working more flexibly.
- Try out relaxation exercises.
- Optimise your sleeping practices at home.
- Be aware that shift-working does not ‘agree’ with everyone.
- Some people are naturally more resilient to circadian phase shifting (particularly younger people).
If you feel excessively tired, unwell or that you might be at risk of having an accident due to poor sleep then please consult your GP or email us at: info@sleepunlimited.co.uk for further advice.
Read More in:
Lee DR. 2017. Teaching the World to Sleep: Psychological and Behavioural Assessment and Treatment Strategies for People with Sleeping Problems and Insomnia. Routledge, London.
References
Costa, G. (1996). The impact of shift and night work on health. Applied Ergonomics 27(1): 9 – 16.
Lac, G., & Chamoux, A. (2004). Biological and psychological responses to two rapid shiftwork schedules. Ergonomics 47(12):1339 – 1349.
Rajaratnam, S.M., & Arendt, J. (2001). Health in a 24-h society. Lancet 358(9286): 999 – 1005.
