Dr Neil Stanley Independent Sleep Expert
© Dr. Neil Stanley 2013-2022
How to make shift work tolerable? Shift work can only ever be made ‘tolerable’; it is never going to be able to be made good. But it can be made better. A more enlightened approach to shift work will almost certainly save the company money, making it more productive and competitive. Scheduling shift work needs to, as far as possible, eliminate or minimise the risk to health and safety. Most experts agree that a forward shift rotation should be used (i.e. mornings, then evenings then nights) to minimise individual adaptation problems. However, there is an argument about the ideal length of the rotation period (the number of days on any one shift before switching to the next shift). A typical shift system has a rotation period of one week, with five to seven consecutive night shifts. However, from a chronobiological view, this is probably the least ideal system. As it is known to take at least seven days for adjustment of the circadian rhythms, it is argued that just as adjustment starts to occur, it is time to rotate to the next shift. For this reason, some researchers believe a longer shift rotation with two weeks to one month on the same shift would be beneficial as that would allow sufficient time for the circadian rhythms to adjust. However, problems may occur if the worker reverts to a "normal" day/night schedule on their days off, thus, negating any adaptation. Others suggest a rapid shift rotation where different shifts are worked every two to three days. It is argued that this system may reduce disruption to body rhythms because the readjustment of circadian rhythms is minimized. Some people advocate extended workdays of ten or twelve hours; this has the advantage of fewer consecutive night shifts and longer blocks of time off; however, the additional fatigue from long work hours may also have adverse effects. Lighting that mimics daylight can provide benefits in terms of alertness and vigilance, in many industries light levels are reduced at night making it even harder for the workers to focus on their tasks, or stay awake. In most organisations, shift patterns are developed by middle-management people who work 9 to 5 and who have little if any understanding of human factors. The CEO and management of a company are even further removed from the reality of round the clock operations. The last time, if ever, they were on the shop-floor in the middle of the night was so long ago they don’t even remember what it was like. Workers should be involved in the development of rosters as a crucial part of risk control, as schedules and workloads will impact on individuals differently. It is essential to make sure that this input is candid, so confidential surveys, anonymous feedback or risk-free focus groups are a crucial mechanism to gain valuable information as regards to what actually happens in an organisation in the middle of the night. For employees, it is important that they find a job that suits their individual physiology in terms of morning/eveningness. Early morning types would be unwise to take a job that forces them to stay up late; owls shouldn’t become a milkman. Because some people may be more suited scheduling at specific periods in a shift cycle, it would be beneficial to measure an employee’s morningness/eveningness and where possible assign them hours that are in harmony with their chronotype. These characteristics may not be as important as broader work/life balance issues but reinforce the need for active staff involvement in work scheduling. I know of a night sister in hospital who loved working nights as, for whatever reason, it suited her life; however she was told that she would have to start working days because she was ‘deskilling’ by just working nights, this is pure stupidity, her skills were as a ‘night sister who was willing and able to cope with night shift there was no ‘deskilling’ rather her skillset was ideally suited to this critical role. Why muck up her life and the life of her replacement, who may not be as happy, or capable, at working nights. It is also important to remember that our ability to work shifts changes as we get older, in your twenties and thirties you may adapt relatively easily to rotating shifts while this may become increasingly problematic in your forties. Ideally, workplaces should also provide: Rest areas in which workers can take short breaks from duty, these should be proportionate to the number of staff working, and the timing of breaks should be scheduled Healthy food. In too many workplaces, only junk food is available to the workers working overnight, even though day workers have access to fresh, nutritious food. Therefore, access to suitable catering facilities providing nutritional food and beverages consistent with diet guidelines that maximise the ability to work shifts and extended hours. Access to counselling services to assist in any issues arising from the disruption to individual, family or social patterns caused by shifts or extended hours. Access to advice on sleep, diet and physical fitness. Many shift workers rely on caffeinated beverages to stay awake during the night but this could actually be making matters worse if the caffeine subsequently disturbs their sleep. They should avoid caffeinated drinks at least 5 hours before their intended bedtime. The use of caffeine in workers doing the evening shift is also problematical as they will be going to sleep just a few hours after their shift finishes and the short-term benefits of the caffeine improving alertness will be more than offset by poorer subsequent sleep. Shift workers should also avoid the use of alcohol to ‘help them get to sleep’ as getting to sleep is usually not the problem, it is getting good quality sleep and staying asleep that is the issue in night workers and alcohol is going to make the problem worse. It is an unfortunate truism that society places less value on protecting the day sleep of night workers than it does protecting the night sleep of the majority, it is impossible to make society care about your sleep, but you can get your family and friends to respect you daily sleep opportunity. Shifts should be structured with strategically placed rest and meal breaks. Shift workers should avoid the situation in which long, unbroken periods of work stretch in front of them, particularly in the early morning when alertness and vigilance are at their lowest. Ideally, it should be possible for them to take short breaks every couple of hours; to walk around, get something to eat and drink or visit the bathroom. Unless the shift worker is on a rapidly rotating shift patter it is probably best for them to avoid napping during the ‘lunch break’ of a night shift 1) because it will confuse the circadian system in believing that it is still OK to sleep at night and 2) they will probably experience sleep inertia, that feeling of grogginess that people feel after being awoken from a short sleep. Studies have found that sleep inertia is particularly severe at 4am, so a nap at this time may actually reduce safety. A simple rule for shift work is that a correctly set body clock is the single most important factor in ensuring good sleep and fewer negative effects. Thus, within the limits of what is possible given their work and domestic routines, shift workers should be highly regular in their sleeping patterns and should consciously avoid ‘snacking’ on sleep whereby they grab it wherever and whenever they can. The process of taking naps should only be regarded as an emergency catching-up process, coping with acute sleep decrements as they occur, rather than as an integral part of the shift worker’s overall sleep strategy. The only exception to this might be an afternoon or evening nap before the first night shift. If you work shifts, particularly night shifts, try to use public transport, if at all possible. Driving home after working a night shift significantly increases your risk of an accident.