Sleepiness/fatigue in the work place can lead to poor concentration, absenteeism, accidents, errors, injuries, and fatalities. In the USA, shift work sleep disorder results in the loss of thousands of lives and approximately $18 billon annually. The tragedies of Chernobyl, Three Mile Island, Space Shuttle Columbia, and the Exxon Valdez all occurred during the night shift and were attributed to human fatigue. There are 22 million Americans who work at least half of their hours from 1800-0600 hours. The issue becomes more alarming considering that shift workers are often employed in the most dangerous of jobs, such as law enforcement, firefighting and emergency medical services.
Shift work sleep disorder (SWSD) is characterized by excessive sleepiness when performing nighttime work and insomnia during daytime sleep opportunities. Shift work schedules include night shifts, evening shifts, split shifts, rotating shifts, and extended duty hours. It occurs when the normal 24-hour circadian rhythm is compromised. This cycle regulates sleeping, waking, digestion, secretion of adrenalin, body temperature, blood pressure, pulse and many other important aspects of bodily function, as well as thought processes, human emotion and behavior. These rhythmical processes are coordinated, typically, to allow for high activity during the day and low activity at night. Disturbance of circadian rhythms can affect concentration, motivation, and reaction time (particularly at night), resulting in an increased risk of accident and injury. While individual sleep requirements are inborn, studies have shown that most adults need seven to nine hours of sleep. Only 1 in 100 needs only 4½ hours or less.
- 80% of shift workers feel tired during their night shift.
- 60% believe they doze off at work about once per week.
- 20% fall asleep on the night shift.
- 60-70% of shift workers complain of problems with sleep disturbances and sleepiness.
- Sick leaves are reported in 63% of night shift workers compared with 34% in permanent day workers.
- 25% of shift workers have SWSD
- People with SWSD are twice as likely to have a work-related accident.
The primary complaint for people with SWSD is excessive sleepiness. Other symptoms include insomnia, disturbed sleep schedules, reduced performance, difficulties with personal relationships, irritability, depressed mood, anxiety, impatience, feelings of loneliness/isolation, and frequent illness. There are also significant increased health hazards for shift workers including heart disease (50% higher incidence), ulcers (50% higher incidence), increased levels of blood glucose, triglycerides and cortisol, hypertension, obesity, and menstrual irregularities. SWSD may worsen existing conditions of asthma, diabetes, epilepsy and depression. It may also contribute to sleep disorders that surface later in life, including sleep apnea and narcolepsy.
Survival Techniques for the Staying Alert on the Night Shift
- Drink a caffeinated beverage early in the shift.
- Night shift workers hit their lowest period between 0400-0500, so plan accordingly.
- Take short breaks throughout the shift. Try to exercise during breaks: take a walk, shoot hoops in the parking lot, or climb stairs.
- Talk with partners who can be on the lookout for signs of drowsiness in each other.
- Don't leave the most tedious or boring tasks to the end of your shift when you are apt to feel the drowsiest.
- Naps as short as 20 minutes can maintain or improve alertness, performance and mood. Some people feel groggy or drowsy after a nap. These feelings usually go away within 1-15 minutes, while the benefits of the nap may last for many hours.
Maintaining your Health, Happiness and General Well-Being
Maintain regular eating patterns as much as possible. Eat smaller portions throughout the day instead of three large meals, to avoid heartburn and other stomach problems. Drink lots of water and eat the usual balance of vegetables, fruit, lean meat, poultry, fish, dairy products, grains and bread. Going to bed hungry can be just as disruptive to sleep as going to bed too full; eat a light snack. Restrict your fluids before bedtime to help promote an uninterrupted night's sleep. Skip the nightcap. While alcohol may speed the beginning of sleep, it actually increases the number of times you awaken in the later half of the night.
Set up a schedule that will allow you to spend some time with your loved ones, such as maintaining at least one family meal together. Remember that sleep loss can cause you to feel at odds with the rest of the world, making you irritable, stressed and depressed. Blame the shift work, not your kids. Do not neglect friendships, social activities, exercise or hobbies. Take your leisure time seriously.
Many factors can prevent you from getting the most of your sleep time. Noises at levels as low as 40 decibels can keep you awake. Try to block out unwanted sounds with earplugs, or use "white noise" such as a fan or an air conditioner, unplug the phone, lower the doorbell ring, install carpeting and double-pane windows and drapes to absorb sound.
At bedtime, think dark. Try light-blocking curtains, drapes or an eye mask. Also, make sure to avoid or minimize light if you wake up in the middle of the night to go to the bathroom. The cause of frequent or early waking may actually be too little exposure to sunlight during the day. Find time for two hours of sunlight daily, or purchase a light box.
Temperatures above 75°F and below 54°F, as well as extremes in humidity, will disrupt sleep. In general, most sleep scientists believe that a slightly cool room that is neither too dry nor too moist contributes to good sleep.
Old mattresses can impede sleep and cause back pain. Pillows hold dust mite fecal matter and thousands of fungal spores, which can trigger allergies and compromise your immune system. It may be time to buy new sleeping surfaces.
The bedroom should only be used for sleep and sex; turn off televisions. Give yourself enough space to sleep. Bed partners with sleep disorders, as well as cuddly pets, can negatively affect your sleep. If you do not fall asleep within 15 minutes, get out of bed. When you are sleepy, go back to bed.
Find and keep a bedtime ritual that is right for you. Determine what works to help you fall and stay asleep: gentle music lull you to sleep, a soak in a warm bath or hot tub, cozy pajamas, cuddling with your partner, progressive relaxation techniques, walked imagery, meditation or a prayer.
If you are sleepy when your shift is over, try to take a nap before driving home. Avoid long commutes; they use up valuable time that could be spent sleeping. Whenever possible, avoid extended work hours, including excessive overtime.
There is no magic cure for SWSD. The best advice is to try the above-mentioned tips to prevent and recuperate from sleep deprivation. Work with your supervisor if SWSD is having a prolonged and/or negative effect on your life, health and happiness. Also, talk to your physician about your symptoms. Modafinil (used to treat narcolepsy) has been shown to improve vigilance to a limited extent in night shift workers. Antidepressants, which are used in the treatment of various sleep disorders, positively affect and can sometimes readjust circadian rhythms. Over-the-counter Melatonin, a sleep rhythm aid, may help modify an adjustment to new sleep schedules, especially when combined with strategic light and darkness exposure. Sedatives, hypnotics and tranquilizers can be prescribed by a physician to promote sleep, but require you have seven to eight hours to devote to sleep. These medications can be addictive and may be against department policy. If you still have problems, consider consulting with a sleep specialist. If all else fails, it may be time to transfer to a position within your department that requires day hours only.
Tips for Law Enforcement Agencies
Increasingly, the courts are laying the blame for accidents and poor health on employers, stating they have a duty of care to employees. There are two basic levels where improvements can be made to help shift workers: organizationally and individually.
- The most effective way of reducing health and safety problems for employees is to optimize the design of the shift schedule.
- Consider alternative forms of organizing work schedules. Extended workdays of 10 or 12 hours have the advantage of fewer consecutive night shifts and longer blocks of time off.
- Don't start a shift before 0600 hours Early morning shifts are associated with shorter sleep and greater fatigue. The body is at its lowest peak just before sunrise.
- Consider the direction of the rotation of shifts. Rotate shifts forward from day to afternoon to night, because circadian rhythms adjust better when moving ahead than backwards.
- Be as flexible as possible. Individual differences and preferences, in the end, play the most important role.
- Provide radios in patrol cars; music, talk shows and news can keep an officer more alert.
- Give attention to the work environment. Good lighting (more than 2000 lux), and ventilation at the station are important on all shifts.
- Keep workstations close to each other, so that night workers can remain in contact with one another. Encourage meets during down times.
- Provide healthy break room food so workers do not have to rely on the local fast food after hours.
- Consider offering facilities for exercise and social activities.
- Consider access to quality day care for shift workers' children.
- Increase contact with night shift officers by supervisors, especially between 0330 and 0530 when performance levels are at their lowest.
- Devise overtime limits. Overtime and shift work are the primary causes of fatigue for police officers. There is a direct link between the amount of overtime worked and the number of complaints filed against a police officer.
- Work with the court system to device better-suited court schedules for night shift officers.
- Videotape any mandatory meetings to be viewed on regular shifts for night officers.
- Offer trainings for officers related to the potential health and safety effects of shift work. Educate them on and what can be done to prevent these effects.