Transcript from podcast in which Dr Louise Kuegler from The Good Fellow Unit – Interviews director of Shiftwork Services, Fiona Johnston.
Overview of Podcast:
At some point in a health professionals, training or career shift-work will be required. 50% of shift workers will leave their position within the first six months, as they are unable to adapt to the demands of the roster. Sleep disruption, fatigue, and mood changes are all commonly reported. More worryingly is the increased prevalence of the metabolic syndrome in those who continue to work shifts and the impact of this has on their long term health. We will discuss how to thrive when working shifts using the four pillars of shift work success which include:
- Strategies to optimise your sleep quality and quantity.
- Alertness strategies – including power napping, nutrition, hydration and exercise.
- The importance of keeping active – benefits of exercise to physical and mental well-being and guidelines to help you get started.
Managing a work-life balance by setting goals and making time for yourself, family, friends and leisure.
We will discuss briefly optimising the roster to optimise worker well-being.
Fiona – I remember vividly working shift work when in the hospital system. Not only did we work rotating shifts, we worked long days and many days in a row- up to 12 in some cases, often with multiple shifts with in that stretch. It was a recipe for disaster both for our patients and ourselves.
How does shift work differ from day work and why is it so challenging?
Shiftwork involves working when we would usually be sleeping and so this interferes with our body clock or circadian rhythms. These are all the bodily functions and systems that take about a day to go through their cycle and include core body temperature, sleep-wake patterns and digestive system. These all synchronise to enable us to be active during the day and then later sleep at night. When we are working shifts we are often active and needing to concentrate when the body is in fact hard wired to be resting and sleeping.
Each consecutive night worked exacerbates the disruption of the body clock increasing fatigue and increases the likelihood of mistakes.
Let’s discuss sleep disturbance- firstly, how is the architecture of sleep disrupted?
When sleeping in the daytime shiftworkers often have less deep sleep due to the effects of light and sleeping when the body clock is hard wired to be awake. One of the roles of deep sleep is maintaining physical health. Also, REM sleep is disrupted and this is important for mental wellbeing. This in part explains why shiftworkers often get physically run down and their stress tolerance declines – they easily become grumpy.
What ways can one improve their sleep when working shifts?
- Set up the bedroom – cool / dark and quiet
- Sleep ASAP after the night shift
- Have a sleep-friendly roster ie one that minimises body clock disruption. Minimise consecutive night shifts.
Overwhelming fatigue was a familiar feeling and is often complained about when working shifts. Even when you had a good stretch of continuous sleep you often would wake fatigued. Why is this?
Over time many shiftworkers build up a sleep debt – which can’t easily be recovered. Let’s face it if at the end of the week you have accumulated a sleep debt of 12 or more hours that time will never be recovered. Over a period of time, this accumulated sleep debt can cause extreme fatigue and eventually lead to health problems. EG – hypertension, diabetes, obesity, depression, heart attack, and stroke.
4 What are the risks in the workplace of fatigue and what tips have you got to enhance wellbeing and alertness?
The main risks of being fatigued at work are accidents and incidents. This may not matter too much if your job is low risk and sedentary but for many a moments loss of concentration can result in serious incidents for example:
- Incidents involving machinery
- Errors giving out medication
- Car accidents
Tips for shiftworkers
- Use the 4 pillars of shiftwork success which are get plenty of sleep, use alertness strategies such as caffeine and power napping strategically, keep active and find ways of maintain work/life balance
- Make sure you have a sleep-friendly roster
Tips for managers
- Make sure your roster is not the main cause of fatigue
- Use a recognised method to scientifically measure the impact of hours of work.
- Provide staff training about managing sleep patterns and occupational alertness
- Review your fatigue management policy
Metabolic syndrome increases in shift workers this is a great concern- why is this risk increased and what can one do about it?
Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. The reason it is increased is a combination of obesity, sleep deprivation, circadian desynchronization and changes in when we eat our meals and when we are active and working. To help reduce the risk of this occurring suggestions include:
- Minimal body clock disruption – so no more than three consecutive nights
- Keeping your mealtimes as close as possible to your usual day time mealtimes and have a light breakfast in the morning after a night shift.
- During the night shift – snacking helps keep energy up without overloading the digestive system when it is least optimal for digesting food.
Rostering- is there an optimal roster? What makes it optimal? How can one suggest an optimal roster?
Yes, there is an optimal roster – it is the one that best meets staff needs with business and healthy and needs. To assess the quality of the roster I recommend using a biomathematical approach with is scientifically validated and can predict how fatigued staff are likely to be, what time and how long for.
If a colleague is struggling with shiftwork- who can they get help from?
The Good Sleep Forum
8 Conclusion: And to conclude our podcast today- What are you take home messages for our listeners?
- Make sleep a priority and learn to use 4 Pillars of shiftwork success
- Make sure your roster allows time to gain adequate sleep which is 7 – 9 hours for most of us
- Run a health check on your roster – make sure it is optimised to meet staff needs, business needs, and health and safety recommendations.