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COPINGWITH
SHIFTWORK
Neil LewisBusiness Support Manager
LINPAC Packaging
What do I want to cover today?
- Our learning experience- The “basics” of human fatigue- Some of the Health & Safety issues- Some tips for getting the issue right- How to educate your employees
What I will not cover
- What is the best shift pattern for you?
Fatigue a big but underrated safety issue
Some high profile accidents where fatigue has been cited as a potential issue in their cause
- Exxon Valdez- Three Mile Island- Bhopal- Chernobyl- USS Vincennes- Challenger Space Shuttle
Clearly something not to be ignored
The LINPAC Packaging St Helens experience
- Site acquired from another Division 1997- Aimed at being Food Service centre of excellence- “Brown field site, Green field mentality”- Shift pattern included annualised hours- Aimed to give complete flexibility with minimal to
zero overtime i.e. Business not human centred
The chosen shift pattern
- 8.5 hours in length, half hour for shift handover- M M A A N N O O rotating pattern- Seven rotations then 16 days leave- Annualised hours to be paid back in 16 day break
- Was it successful? NO- People resigning cited it as a reason on exit interviews- Complained of sleep deprivation - Burnout at the end of the pattern etc, etc
Challenged to find new shift pattern in 1999
- Initially spent a lot of time locked away looking at shift pattern books and flipcharts
- Lots of ideas but no real solution- Flyer received from a company called
Circadian Technologies for two day course on “Shiftwork scheduling”
- Attendance an epiphany on shiftwork fatigue leading to new ways of working including staff training and awareness
Did it work?
- Shiftworkers voted 97% for new pattern
- Shift pattern now seen as an attractive part of employment package
- Working hours change gave more quality time at home
- Fatigue no longer cited as “serious” issue
- Introduction of “Coping with shifts” unit on induction as follows;
WHY DO WE HAVE PROBLEMS WORKING SHIFTS?
L I N
P A C
Your body is conditioned to be awake during the day and asleep at night
CerebralCortex
SpinalCord
SCN
Hypothalamus
Brain Stem
(Suprachiasmatic Nucleus)
NORMAL CIRCADIAN RHYTHMS WRONG?
What are circadian rhythms?
Definition: Circa = around Dies = day
Around daily rhythms of your body clock, for example
TEMPERATURE
L I N
P A C
Sleep No Sleep
BodyCore
Temperature
ThermostatDown
ThermostatUp
ThermostatDown
ThermostatUp
11 pm 7 am 11 pm 7 am
98.5
96.5
Other examples include growth hormone, cortisol, urination
Whether we are awake or asleep, body functions
continue to follow their circadian
rhythms
CIRCADIAN PROFILE OF HUMAN ALERTNESS VERSUS TIME OF DAY
L I N
P A C
TIME OF DAY
Full Alertness
Moderate Alertness
Reduced Alertness
Drowsy
20
15
10
5
0
12 15 18 21 24 03 06 09 12
L I N
P A CCIRCADIAN PROFILE OF HUMAN ALERTNESS
WITH SUSTAINED WAKEFULNESS
Successive Hours of Sleep Deprivation
Full Alertness
Moderate Alertness
Reduced Alertness
Drowsy
20
15
10
5
0
0 5 10 15 20 25
Time of Day09 12 15 18 21 24 03 06 09
AlertnessLevel
(MSLT)
L I N
P A CFACTORS DETERMINING SHIFT WORKER ALERTNESS
Time of day (phase of circadian rhythm)
Circadian profile (morning or evening type)
Hours since last consolidated sleep
Duration of last consolidated sleep
Quality of last consolidated sleep
Cumulative sleep deprivation
Stimulation/monotony of job task
Stimulation/monotony of job environment
Day of shift
Consecutive hours on duty
Consecutive shifts on duty
Amount of overtime
Speed or frequency of shift changes
Content and timing of last meal
Ingested stimulants or depressants
Age of shift worker
Physical inactivity
L I N
P A CWHY DO SHIFT WORKERS HAVE SLEEP PROBLEMS?
Daytime sleeping is out of synchrony with biological rhythms
Daytime sleep is out of synchrony with family and social schedules
Daytime sleep is out of synchrony with the timing and content of food
There is more ambient light during the daytime
There is more ambient noise during the daytime
L I N
P A CSHIFT WORKERS’ MOST COMMON SLEEP DIFFICULTIES
Insufficient sleep during the day before the first night shift
Poor daytime sleep when working night shifts (frequent awakenings, ‘light’ sleep)
Early afternoon awakenings after the first night shifts, inability to go back to sleep
Less total sleep time per 24 hours when working night shifts, causing cumulative sleep debt
Inability to fall asleep at regular bedtime when coming off the night shift
L I N
P A CHOW TO COPE WITH SHIFTSThe Nine Controls of Human Alertness
H L
Interest, opportunity, orsense of danger
H L
Muscular activity
H L
Time of day oncircadian clock
H L
Sleep bank balance
H L
Ingested nutrients andchemicals
H L
Environmental light
H L
Environmental temperature
H L
Environmental sound
H L
Environmental aroma
You need to learn how to switch all these controls to high
L I N
P A CHOW TO PLAN SLEEPSleep at the same time each day
Always do the same thing before you sleep (read, bathe, etc)
Keep room cool and completely dark
Use white noise (fan, air conditioner, etc)
Turn off the phone and turn down the answering machine volume
Turn off the television and radio
Put a “Do Not Disturb” sign on the door
Make arrangements with your family and friends - Sleep time: do not disturb - Family time: after sleep
Beware of caffeine, alcohol and sleeping pills
Try to anchor sleep with an overlap period
Wear wraparound sunglasses when driving home in the morning
L I N
P A CPREPARING FOR SLEEP
Develop a bedtime routine
Follow the same routine every time you retire
Follow the same routine even when preparing for naps or daytime sleep
Examples: 1. Light snack 2. Draw curtains 3. Shower or bath 4. Brush teeth 5. Read or watch TV (15 minutes) 6. Turn out lights
L I N
P A CPREPARING FOR NIGHT SHIFT
Start adjusting ahead of time
Stay up late for a few nights before the first night shift
Sleep in progressively later
Take a nap before shift
Get exposure to bright light before and during shift
L I N
P A CBETWEEN CONSECUTIVE NIGHT SHIFTS
Avoid caffeine during last four hours of shift
Wear wraparound sunglasses during drive home (avoid bright light)
Eat light meal if needed
Plan to sleep as soon as possible
Try to get 6-7 uninterrupted hours of sleep
Supplement with nap before shift
L I N
P A CRECOVERY AFTER NIGHT SHIFTS
Try to avoid going completely back to daytime schedule
Stay up late and sleep in late
Take short naps as needed
RECOVERING METHOD 1: NAP AFTER LAST NIGHT SHIFT
Nap for 2-4 hours after last shift Don’t sleep too long, or it will be difficult to sleep later that
night Eat a light meal after waking Try to get bright light exposure during the day Plan afternoon activities Retire at normal bedtime
RECOVERING METHOD 2: UP ALL DAY AFTER LAST NIGHT SHIFT
Try to stay awake all day and retire at normal bedtime Avoid motorway driving Eat a protein-filled breakfast to provide energy for the day Avoid sedentary activity Take a short nap if feeling overly tired during the day Try to get bright light exposure during the day Expect some irritability Do not over-exert yourself on this recovery day
NAPPING - THE KEY TO ALERTNESS
00 01 02 03 04 05 06 07 08
W
1
2
3
4
SleepStage
Time of Night
REM Sleep
Sleep consists of distinct brain activity cycles, with several clearly defined stages within each cycle:Stage W (Waking) Stage 3/4 (Deep Sleep)Stage 1 (Transitional) REM Sleep (Dream State)Stage 2 (Light Sleep)
Quality sleep requires 4-5 uninterrupted sleep cycles of approximately 90 minutes each in length.Quantity of sleep needed is 6 to 8 hours for most people.Cumulative sleep debt occurs from insufficient quantity or quality of sleep over several consecutive days.Daytime sleep is less restful than night-time sleep because it does not provide the same quality of sleep architecture
SHORT versus LONG NAPS
Ultra-short (5-20 minutes) naps are very effective at restoring alertness and giving a critical boost for 3-4 hours.
Longer (40-60 minutes) naps result in groggy-headed sleep inertia upon waking, with some impaired performance due to waking from deep stages of sleep.
Very-long naps (90-120 minutes) restore sleep debt and are often associated with little sleep inertia, due to waking from lighter stages of sleep.
SHIFT WORK AND NUTRITION
Nutrition-related disorders of shift workers
High cholesterol/cardiac risk factors Chronic heartburn/indigestion Gastrointestinal disorders (constipation, diarrhoea) Weight gain Loss of appetite/overeating Ulcers
FOODS TO AVOID ON NIGHT SHIFT
Foods that promote gastric secretion: Tomato juice Spicy foods/strong seasonings Excessive coffee Alcohol
High fat/hard to digest foods: Fatty meats (including chicken and turkey skin) Red meat (steak/hamburger) High-fat burgers and pizza Fried foods Crisps and chips Pastries Whole milk and dairy products
SO WHAT SHOULD I EAT ON NIGHT SHIFT?
Eat healthier food, in smaller portions, more often. High Complex Carbohydrates
- Pasta, rice and potatoes- Whole grain breads and cereals- Fruits and vegetables (including juices)
Low Fat Protein- Lean meats, skinless chicken, fish and shellfish- Soya beans, tofu or other beans- Home-made/low fat pizza- Skimmed/low fat dairy products
WHAT ABOUT CAFFEINE?
Positive Aspects of Caffeine
Can increase alertness Improves reaction time Works quickly Can improve performance Can improve overall energy Promotes clear flow of thought
Negative Aspects of Caffeine
Remains in the body for a long time (half-life of 7 hours)
Can cause nervousness, anxiety and restlessness
Can cause gastrointestinal problems
Caffeine is addictive (tolerance develops, withdrawal symptoms)
Affects sleep and sleep stages: - Can’t get to sleep - Shorter sleep period - Lower sleep quality - Frequent awakenings
Caffeine suggestions
Use caffeine in moderation Time its use to when you need it most during your shift Avoid caffeine 3-4 hours before sleep Replace caffeine with other decaffeinated beverages Keep track of how much you use If you are a heavy user, cut back slowly
OTHER ISSUES
AlcoholShould not be used as a sleeping aidReduces the quality of sleepActs as a diuretic, flushing fluids from your bodyDon’t drink alcohol for at least four hours before planned sleep
NicotineYour body craves nicotine while you sleep, which disturbs sleepRelated health problems - Cancer - Heart disease - Hypertension - Emphysema, bronchitis
OTHER ISSUES
ExerciseGives you energyBurns off stressHelps you sleepProper approach:- - Start slowly - Find a routine you like - Exercise 3-5 times a week
OTHER ISSUES
Sleeping PillsMay initially help with sleep problemsTolerance creates the need for moreProlonged use can create the following: - Disrupted sleep - ‘Hangovers’ - Dependence
DrugsTranquillizersAntihistaminesAntidepressantsAntipsychoticsAntihypertensivesLong-acting hypnoticsStimulants (withdrawal effects)
FAMILY AND SOCIAL ISSUES
The Importance of Family/Social Issues
The shift worker is not viewed as a whole personDivorce rates are higher for shift workersSleep deprivation leads to irritability and family problemsThe entire family is disrupted by the shift schedule
Creates high turnover/absenteeism Decreases morale/motivationNegative attitudes affect job performance
FAMILY AND SOCIAL ISSUES
Improving Communication
Keep expectations realisticBe specific about your feelingsDon’t suppress emotionsCompromise on differencesBe sure spouse, partner, family and friends understand
your shift work schedule
Planning Ahead
Keep a schedule calendar
–Keep it in a central location, near the phone
–Write out shift schedule for the entire year
–Identify RECOVERY DAYS
–Identify QUALITY DAYS
–Plan at least 2/3 quality days per month
–Plan ahead as much as possible
–Consider making a second calendar for your best friends
CONCLUSION
Circadian rhythms have been considered for our shift patternBUT
It’s only half the battle . . .
IT’S NOWIT’S NOWDOWN TODOWN TO
YOUYOU
What is our “new” shift pattern?
12.5 hours per day
30 minutes handover
4 days, 7 off, 4 nights, 3 off, 3 days, 3 off, 3 nights, 3 off
Three rotations then 21 days off
Does shift work cause Cancer?
Some studies have suggested this link- The University of Occupational & Environmental
Health in Japan indicate prostate cancer four times more likely in rotating shift workers due to lower levels of melatonin which regulates sleep patterns (www.medicalnewstoday.com/articles/52127.php)
- HSE Research Report (RR132) on Shift work and breast cancer - “Appreciable but not definitive” evidence that breast cancer maybe due to altered light exposure at night (www.hse.gov.uk/research/rrpdf/rr132.pdf)
Watch this space for more research!
Sources of information
www.circadian.com
www.hse.gov.uk/humanfactors/shiftwork/
RR446 – Fatigue/risk index for shiftworkers (also available on the above link)
“The Twenty Four Hour Society” by Dr Martin Moore-Ede
HSG 256: Managing Shift Work available from HSE books
Thanks for listening and any questions