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To Dream of Sleep

Shift workers pay the price for keeping irregular hours

Author: Mary Keating

For:  Family Living Magazine

Date:  June 2005

            1020 words (including sidebar stories)

Keeping the schedule of a vampire takes commitment and resourcefulness. Mike Hardy, a physician’s assistant at Portneuf Medical Center, begins his day at 7pm and ends his shift at 7 am.  A couple of days a week, he sleeps for almost two hours before racing to the hyperbaric chamber to work another 6 hours during the day. On those days, he grabs another nap before heading back to work at 7pm. Not only does he play the role of provider, Hardy wears a number of other hats.  He is a father, a husband, friend and community member.

Hardy is one of more than 25 million Americans doing shift work: evening, night or rotating shifts.  In a 24 hour society, millions of workers must sleep when the rest of the world is awake.

Although, shift workers perform critical functions in emergency and hospital settings and are instrumental in most manufacturing, retail and transportation industries, virtually all of these workers have some sleep complaints.

 “Typical complaints are insomnia when attempting to go to sleep, difficulty in adjusting to new shift rotations, sleepiness and fatigue on the job, mild to severe irritability and family troubles,” says Mike Brennen,

registered polysomnographic technologist at the SE Idaho Sleep Disorder Center.

Some shift work problems can be catastrophic.  The grounding of the Exxon Valdes in Alaska and  the Three Mile Island nuclear accident both occurred between the hours of 1 am and 4 am and were due to errors by fatigued, sleep-deprived crew members and operators.

 “When it comes to sleep, most shift workers average 2 hours less per day than ‘normal’ people,” commented Dr. Cary Jackson during a Lunch and Learn presentation at PRMC. “Why?  The human body follows a natural 24-hour cycle of wakefulness and sleepiness which is regulated by an internal circadian clock.”

The circadian clock is a biological clock that locks every creature on the planet into a rhythm set by the rising and setting of the sun.   The clock regulates cycles in body temperature, hormones, heart rate, and a variety of other functions.  When a shift falls during the night, 11pm to 7am, the worker is fighting the natural wake-sleep cycle. It may not only be difficult to stay alert at night due to the natural low in alertness, but problematic to fall asleep and stay asleep during the day caused by the rise in alertness in the morning and again in the late afternoon, says Jackson.

 “This cycle is inborn and happens whether we want it to or not,” says Jackson.  And, some people have more difficulty than others when interruptions occur in their natural sleep cycles.

The lark versus the night owl

Scientists have long divided people into two genetically determined groups: Owls (who do better at night) and Larks (early risers). 

 “Some people are genetically better suited for working the graveyard shift than others,” says Brennen. 

In fact, Denis Walsh, a former engineer at INL and Mike Hardy both have experience working the graveyard shift. During the interviews, it was evident; Hardy is more of a night owl and seems to be less troubled by sleep disorders than his graveyard counterpart, Walsh, who discussed multiple sleep issues and frustrations.

For Walsh, the lack of sleep was downright painful. 

 “It felt like I had been hit in the stomach.”

Walsh talked openly about his growing irritability toward the end of his shift and his troubles getting to sleep and staying asleep during the day.

 “I often felt like I was in a fog and out of things when I was awake,” he said. “Problems were often compounded by the lack of understanding by family and friends.”

Hardy is comfortable with the night shift. 

 “I often miss out on activities and it can be rough on the family, but I like it and the pay is better,”  he said.

Hardy encourages night shift workers to learn their sleep patterns and establish a routine.

 “Just get your own sleep cycle and keep moving,” he said.

Understanding sleep needs and cycles, developing a routine and a quiet environment plus careful planning can be assets for the shift worker, says Brennen.

How much sleep do we need?

 “It depends, enough to function at optimal performance,” says Brennen. “Experts recommend a minimum of six-hours during the day for night shift workers. However, the vast majority of adults need between 7 and 9 hours of sleep.”

Effects of lack of sleep

What happens when quality sleep is more of a daydream than a reality?

 “People become irritable, impatient, anxious and often depressed when sleep deprived,” says Brennen.

All of which can upset job and family life, relationships, spoil social activities, and cause unnecessary suffering.              Lack of sleep also impairs memory and reaction time. Tired people are less productive at work, less patient with others and less interactive in relationships.

Here are a few signs pointing to lack of shut-eye or a more serious sleep disorder.

  • Ignoring the alarm clock or snatching a few extra minutes to snooze before getting up.
  • Hoping to catching up on sleep during the weekend.
  • Fighting to stay awake during long meetings, in overheated rooms or after a heavy meal.
  • Irritability with co-workers, family and friends.
  • Difficulty concentrating or remembering.
  • Taking more than 30 minutes to fall asleep at night.
  • Waking repeatedly throughout the night.
  • Waking up groggy and not well rested.
  • Your spouse or partner complains about your snoring or fitful sleep.

            Shift workers and others suffering from sleep deprivation may benefit from a combination of the following hints and tips.

Make sleep a priority

In the hectic world of juggling family, household chores, friends and a career, sleep is often move down on the list to accommodate other activities. 

 “Simply making sleep a priority and a goal, can put a person on the right track for a good nights rest,” says Brennen.           

Set the Stage

As Walsh discussed, the rest of the world is awake when shift workers are trying to sleep and often friends and family unintentionally interrupt daytime sleepers.

The shift worker faces multi problems trying to maintain family relationships and social and community commitments.  It is difficult to balance work, sleep and personal time.  Sleeping during the day means the shift worker often misses out on family activities, entertainment, and other social gatherings.  Given the problems, it is important to have a family approach.  With help from family members, special times as well as regular times with spouse, children and friends can be scheduled. 

 “Remember that sleep loss and feeling at odds with the rest of the world can make a person difficult to be around.  However, remember to blame the shift work – not your family or your children,” says Brennen.

Take a moment to ask family and friends to create a quiet peaceful setting during the day, suggests Brennen. Give children headphones to listen to the TV or to music, request phones be switched to silent ring tones, set limits on vacuuming, dish washing and noisy games during the day and place a note over the doorbell.

For the sleeper, consider blocking out external noises by wearing earplugs and placing a Do Not Disturb sign on the door.  Take steps to darken both the bedroom and the bathroom and consider using some form of white noise such as a fan. Try not to agonize over falling asleep. 

 “Stress will only prevent sleep,” says Brennen. “If you don’t fall asleep in 30 minutes, get up and do something else.  Go back to bed when you are tired.  Trouble sleeping can turn into a vicious cycle.  People who have trouble sleeping begin to expect problems and this can lead to anticipation and worry about sleep.”

Back to the Basics

As any parent knows, bedtime rituals and routines help lull a child to sleep. Similar rituals and routines may also help shift workers. Try dimming the lights, indulging in a warm bath and drinking a glass of warm milk.  Milk contains tryptophan, a chemical that may promote sleep in some people.

Experts suggest shift workers get to sleep as soon after work as possible.

 “Don’t over stimulate the brain by balancing a checkbook, reading a thriller, or watching TV prior to going to sleep,” says Brennen.

Finally, consider lowering room temperature (a cool environment improves sleep) This mimics your internal temperature drop during sleep. And try some form of relaxation or meditation.

Take a Nap

It is important to keep a regular sleep schedule, even on days off and weekends.  However, if you cannot get enough sleep or feel drowsy, a 20 minute nap can be helpful.  Naps can maintain or improve alertness, performance and mood.  The benefits from a nap may last for many hours.  Studies show that napping at the workplace is especially effective for workers who need to maintain a high degree of alertness, attention to detail, and who must make quick decisions. 

Things to Avoid

 “Avoid caffeine 3-5 hours before going to sleep,” says Brennen.

 “Using alcohol may not impair ones ability to fall asleep, but will effect the quality of sleep,” says Brennen. Alcohol can disrupt healthy sleep patterns. In healthy sleep, we experience different kinds of sleep and we experience them in a particular sequence of stages.  There are two primary sleep stages.  Non-rapid eye movement (NREM) accounts for longer periods of sleep during which our brain activity and bodily functions slow down.  Rapid-eye movement (REM) happens in brief spurts of increased activity in the brain and body.  REM is considered the dreaming stage of sleep.  The cycle usually begins with a period of about 80 minutes of NREM sleep followed by about 10 minutes of REM sleep.  This 90 minute cycle is repeated four to six times each night.  If the sequence is interrupted, the quality of our sleep suffers.

If you exercise at work, consider doing it in the early part of the shift, otherwise, exercise after you sleep. Exercise raises the body temperature and causes a rise in alertness

Understand Sleep Medications

 “It is important to note, sleeping pills cannot cure sleep problems,” says Dr. Jackson. “And they are a bad idea.”

Sleep specialists warn that many over-the-counter drugs can be counterproductive, interfering with sleep and causing hangover like effects the next day. 

Danger to Your Health

Shift workers are at an increased risk for a number of health problems.  The continuous and constant disruption of the circadian clock appears to throw off the body’s natural rhythm enough to lead to chronic sleep disturbances, gastrointestinal problems, high blood pressure and even heart disease.  Shift workers have an increased risk for depression, emotional instability, memory impairment, learning and even immunity to other diseases.

Shift workers experience more stomach problems (especially heartburn and indigestion), menstrual irregularities, colds, flu, and weight gain than day workers. 

The risk of workplace and automobile accidents rises for shift workers, especially on the drive to and from work.

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Staying alert on the job

Signals such as yawing, frequent blinking, a sense of tiredness or failure to make routine safety checks may put you and others at risk.  If you are one of the many shift workers who must operate heavy equipment, handle patients or drive a vehicle during the shift, be aware of the signs of fatigue and sleepiness.

If you feel sleepy or drowsy, stop your work as soon as safely possible.  Contact your supervisor and request a break or nap, or have a caffeinated product in order to help increase alertness.  Remember, caffeine is not a long-term substitute for sleep.

It is often important to take a number of short breaks throughout the shift.  And, if possible, work with a partner.  Talking with a co-worker can help maintain a level of alertness.  And you can watch each other.

A bit of exercise, a short walk, hoops in the parking lot, or climbing stairs can raise alertness levels. Eat three normal meals per day.  Eat healthy snacks and avoid food that may upset the stomach.

Don’t leave the tedious or boring tasks to the end of the shift when you are most apt to feel drowsy.  Night workers hit the lowest period at around 4 am.

Exchange ideas with colleagues on way to cope with shift work – possibly set up a work support group so you can learn from each other.

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For the employer

There are a number of ways to make the workplace more productive for the shift worker.

  •  Install bright lights in work areas.  A well lit place signals the body that it is time to be awake and alert. 
  • Have vending machines that offer healthy eating alternatives and a microwave.
  • Schedule shifts to allow sufficient breaks and days off, especially when workers are re-assigned to different shifts.  Plan enough time between shifts to allow employees to not only get enough sleep, but to attend to their personal lives.  Don’t promote overtime among shift workers.
  • Develop a napping policy.  Encourage napping by providing a sleep friendly space and time for scheduled employee naps.  A short break for sleep can improve alertness, judgement, safety, and productivity.
  • Be concerned about safety going to and from work.  Encourage the use of carpools, public transportation, rested drivers and even taxis.

            These simple steps can make a difference in the workplace and on the bottom line.

            It is estimated that at least $18 billion is lost due to the negative effects of sleep deprivation.

From the National Sleep Foundation

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For more information

If you have tried the tips and are still having sleep difficulties, it may be time to seek professional help.  If problems are persistent, talk to your doctor.  Remember, when you are not getting enough sleep, you are at risk and so are those around you.

Local professional resources:

Mike Brennen, PRMC Sleep Lab www.portmed.org

Cary V. Jackson, M.D. Pocatello

James Christon, M.D. Pocatello

Robert Kennedy, M.D. Pocatello

Online resources:

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