Shift Work

It is no longer in question that shift work is bad for you, the question now is: how bad is shift work for your health and what can I do to lessen the risks?

It’s been two weeks you’ve worked on the night shift, your eyes are bleeding, you can’t think properly, you’ve made a few small mistakes already and there’s still five hours left on the clock.

‘Are you getting enough sleep? You look terrible,’ a co-worker comments.

You would have slept the last two days but you had several phone calls, the kids wouldn’t be quiet and it was just too hot to sleep through the day.

Starting shift work for the first time can be very tiring and even dangerous for someone who is not used to working outside of normal working hours. A lack of awareness of how to manage sleep during odd hours and working outside the body’s natural circadian clock increases the risk of becoming fatigued and possibly sustaining an injury.

The time of the day ordinary hours are worked is called the spread of hours. Shift work is defined as work that starts before 7.00am and finishes after 7.00pm. Time worked outside the spread of ordinary hours can attract overtime rates which are probably one of the only benefits to waking up at ungodly hours of the night to start work.

According to a 2000 report by the Australian Council of Trade Unions (ACTU), the largest peak body representing workers in Australia, it is estimated that about 25% of employees are involved in work outside of regular daytime hours. In 2012 there were about1.5 million people working some kind of shift-work as part of their main occupation and this grew to 1.7 million by 2015.

The move to 24 hour, 7 day continuous operations is increasing as is pressure from employers to do without traditional penalty rates for night work, overtime and weekend work, treating all hours the same. This is something to be aware of next time you sign an EBA or AWA.

So here you are, sleepless on the night shift and not sure what to do about it. In an effort to retain your employment you keep a lid on it and whine to your co-workers about how tired you are. You are not sure you will be taken seriously if you complain to the supervisor anyway. If you don’t sleep again today you will have tomorrow night off. The first of many sick days.

After many months and even years of working shift work and long hours workers are at risk of suffering from Burnout, a debilitating condition which research shows is increasingly affecting nurses and midwives.

These are all the signs you are suffering from Burnout:

• Stress
• physical and emotional exhaustion
• irritability
• loss of motivation
• reduced productivity
• detachment
• skipping work
• using food, drugs or alcohol to cope.

It is important in working environments where people are suffering from Burnout to receive rest days and not to have those days as periods of recovery but as opportunities to experience social and domestic activities without tiredness. Quality of life is essential to our experience as humans and being worked to the point of fatigue without rest affects our ability to stay motivated and healthy.

The ACTU document titled Health and Safety Guidelines for Shift Work and Extended Working Hours states that:

‘Under occupational health and Safety legislation, the employer has a duty of care to provide a healthy and safe workplace and safe systems of work. This includes work organisation and working hours. Employers must identify the hazards and levels of risk associated with shift work, night work and extended working hours, and take action to control them’.

This can be achieved by talking to employees and health and safety representatives, providing adequate training and information as well as supervision. Monitoring working conditions for risks and hazards to health, making sure they are eliminated or controlled. Monitoring the health of employees and maintaining records about working conditions.

The Cost

The number of studies conducted on the health effects of working shift work are numerous and proving to be conclusive. Working shift work is bad for your health.

At the top of the list is the increased risk of having a car crash.

A recent study of medical interns found that every extended shift of more than 24 hours they worked in a month significantly increased their risk of a car crash while commuting to or from work.

In the US, it has been estimated that fatigue contributes to between 20 and 40 per cent of all commercial vehicle crashes. These incidents are estimated to cost more than 15,000 lives in the USA and $12 billion a year in lost productivity and property damage.

The Sleep Health Foundation lists the total cost if inadequate sleep in Australia as an estimated $66.3 billion in 2016-17, this total is made up of $26.2 billion in financial costs and $40.1 billion in the loss of wellbeing.

A research article titled The Cost of Inadequate Sleep Among On-Call Workers in Australia: A Workplace Perspective states the resulting cost of injury is estimated at $2.25 billion per year($1.71–2.73 billion). This equates to $1222 per person per incident involving a short-term absence from work; $2.53 million per incident classified as full incapacity, and $1.78 million for each fatality.

The Circadian Clock

How do we manage our sleep?

Humans have natural body rhythms which are regulated by a ‘circadian clock’ in the brain. These are called circadian rhythms.

Over a 24 hour period, the circadian clock regulates sleep/wake patterns, body temperature, hormone levels, digestion and many other functions. Depending on the time of day or night, the body is programmed for periods of wakefulness and sleep, high and low body temperature, high and low digestive activity and so on.

Body temperature is at its lowest between 2 am and 6 am. The ability to concentrate and perform tasks is also at its lowest in these early hours of the morning, as is the fall in core body temperature.

In 2007, the International Agency for Research on Cancer (IARC) classified shift work with circadian disruption as a probable human carcinogen. In the long term, the average amount of sleep needed for health and alertness is between 7 and 9 hours a night. Most people need at least 6 hours of unbroken sleep in any 24-hour period to remain alert, assuming a zero sleep debt.

Sleep Debt

Sleep loss is cumulative.

On average, shift workers lose1-1.5 hours of sleep for each 24-hour period. This builds up a sleep debt of 6 hours after four nights.  Working more than three or four night shifts in a row is likely to cause a significant sleep debt.

Errors made by shift workers in the early hours of the morning were critical factors in the disasters at Three Mile Island, Chernobyl, and Bhopal as well as the Exxon Valdez oil spillage.

A recent study from the National Institute for Occupational Safety and Health in the USA (NIOSH) analysed 52 published reports that examined long working hours in relation to illness, injuries, behaviour and performance.

The implications were that working long hours were associated with:

• People feeling less well, less alert, and more tired
• Lower cognitive function, poorer performances on psychomotor tests, and declines invigilance
• Increased injury rates, more illness, and increased mortality.

Fatigue

Good quality sleep is essential for maintaining and restoring full physical and mental functioning and is the only way of providing recovery from fatigue. Fatigue is a physical and/or mental state caused by overexertion. It reduces a person’s capabilities to an extent that may impair their strength, speed, reaction time, coordination, decision making, or balance.

Working long hours with intense mental or physical effort, or working during the natural time for sleep can cause excessive fatigue. This has implications for workplace and public safety. Fatigue can also have long-term effects on health.

Chronic inadequate sleep can cause heart disease, obesity, depression, cancer and a range of other serious health conditions which impacts on the health system.

The Health Effects

In Denmark, in 2008, 38 women with breast cancer who had worked the night shift obtained official recognition of the occupational causation of their illness and were awarded monetary compensation.

In a paper published in 1999, 17studies on shift work and cardio vascular disease were reviewed. It was concluded that shift workers had a 40% excess risk for CVD compared to day workers. Gastrointestinal disorders are also more common in shift workers than in day workers. Common complaints being pain and alteration in bowel habits, especially constipation and diarrhoea.

Laboratory studies have consistently found short-term sleep loss decreases glucose tolerance and insulin sensitivity. Research has also found that when sleep-deprived, people increase intake of comfort foods high in fat and sugar. These changes in body metabolism and eating behaviour tend to increase the risk of obesity and diabetes.

Short sleep also reduces natural immune function, increasing the risk of infections and possibly cancer. It is also likely to cause hypertension and heart disease, possibly by triggering overactivity in the body’s stress responses. Sleep disorders, other sleepproblems are linked to cognitive function and mental well-being. Disturbance in mood, thinking, concentration, memory, learning, vigilance and reaction times have been reported.

Conclusion

What should you do?

The Department of Labour recommends at least two consecutive full nights’ sleep (with a normal day between) in each week. Available research indicates that this is enough to allow performance to return to normal, at least in the short term.

Both workers and employers require good education about fatigue. Shift workers can be given strategies to improve their quality of life and sleep. Maintaining a dialogue with your supervisor on how you are coping with shift work will help them monitor the risks.

Training sessions should follow these topics:

• adjusting the sleeping area to promote good sleep
• good nutrition while working shifts
• use and avoidance of stimulants
• recognising fatigue
• getting to and from work safely
• fitness and exercise
• effective napping
• maintaining home and family life
• childcare arrangements
• equal facilities for shift workers
• Implications for employers

The Department of Labour recommends using the FAID fatigue safety system for rostering – see www.faidsafe.com

Working hours should be treated in the same way as other OHS hazards. Hazard or risk assessments should be conducted to identify the hazards and assess them with an aim to control or eliminate the risk.

Tips for Better Sleep

There is a long list of things you can do to manage your sleep and ensure you are adequately rested and ready for work.

• Switch away from blue light on screens at night, f.lux is a good app to use for computer screens.
• Use block-out curtains or blinds during the day
• Keep the temperature in the bedroom cool
• Soundproof your room using a fan, static or rain noise, heavy curtains and sound insulation on doors and windows
• Unplug the phone
• Let friends, family and neighbours know your work schedule
• Ask other household members to use headphones while you sleep
• Avoid smoking. Research suggests smokers have less restful sleep compared to non-smokers, this may be because nicotine is a stimulant.
• Don’t drink caffeine drinks – such as coffee, tea, cocoa and green tea – before bed.
• Figure out of you need to unwind before bed and either read a book or watch TV.
• Avoid napping during the night shift unless you are very sleepy. If you do nap, keep it short, no more than 20-30 minutes
• Try to avoid exposure to early-morning daylight on the way home perhaps by wearing sunglasses.
• Eat your regular meals during night shift including lunch.
• Get plenty of exposure to daylight on your days off as this will help adjust your body clock to a daytime setting.