Sleep hygiene practices and sleep duration in rotating-shift shiftworkers

Alcohol, caffeine and tobacco intake, exercise, activities on going to bed, and sleep-enhancing measures were assessed in 72 rotating-shift shiftworkers to determine whether these variables differ following day shifts and night-shifts, and which are related to sleep duration. Only alcohol intake and exercise prior to sleep, and feeling drowsy when retiring, differed following the night-shift. Workers generally followed recommendations concerning alcohol intake, sleeping immediately on retiring, and exercising, but acted contrary to recommendations concerning caffeine and nicotine intake. The only behaviour clearly associated with poor sleep was smoking, which reduced sleep duration.     

Effects of age and domestic commitment on the sleep and alertness of female shiftworkers

Abstract

In this study, the combined effects of age and domestic commitment on sleep duration, sleep difficulties and alertness in a sample of female shiftworkers were studied. A total of 572 nurses working in general hospitals in England completed a questionnaire. Two main shift systems were worked by the nurses: permanent nights or rotating shifts. Initial analysis revealed significant differences between these two groups of nurses, resulting in separate analysis of each group. Regression analysis showed that although older nurses had shorter sleep duration they did not report more sleep difficulties, in addition, their overall on-shift alertness was higher compared to younger nurses. Domestic commitment, defined as the number of dependants in the household and the level of perceived work-home conflict, not only reduced sleep duration, but also resulted in more sleep difficulties and lower on-shift alertness for most of the shifts. Two implications with regards to the relationship between age and sleep are discussed. First, the study points to the relevance of considering both biological and social factors when looking at age and sleep. Secondly, the study shows that the effects of age on sleep duration and sleep difficulties are not similar. This finding requires further research, especially in the light of the higher levels of alertness reported by older nurses.     

Sleep and napping in young shiftworkers: A 5-year follow-up

Abstract

The present study examined sleep characteristics in young workers who entered rapidly rotating shiftwork for the first time and stayed on shifts for 5 years. Data were collected when the subjects had shiftwork experience of approximately 1.5, 3.5 and 5.5 years and a mean age of 22, 24 and 26 years. Data are presented showing significant differences in the main sleep durations between situations within the shift cycle and a small reduction in overall sleep over the observed period, primarily due to a sleep reduction on afternoon shift days. Data on sleep quality did not show any change over this early period of shiftwork exposure. In addition, napping strategies did not change, with the exception of a small increase in those taking naps on night-shift days between 1.5 years and 3.5 years of shiftwork exposure. At all the observed phases there were more young shiftworkers taking a nap on the morning shift days than on the night-shift days. The data suggested that reduced sleeps on morning and night-shift days were not compensated by taking a nap, but rather with an increase in main sleep duration on afternoon shift days and days off. A weak tendency for individuals to be relatively long or short sleepers irrespective of sleep conditions could be seen.     

Effects of sleep inertia on cognitive performance following a 1-hour nap

Abstract

This study investigated the effects of a 1-h nap on subsequent performance in spatial memory (SM) and logical reasoning (LR) tasks. The objective was to evaluate the duration of the effects of sleep inertia (SI). The performance was measured in two independent groups of subjects. The 1-h nap took place at 00:00 h in group 1 and at 03:00 h in group 2. In each task, the experimental design comprised one no-nap condition in which subjects had no sleep before the night tests, and a nap condition that comprised the 1-h nap followed by the test sessions. To measure the duration of SI effects, the subjects were tested in two 30-min sessions and the data in each session were analysed in sub-units of time of 3 min each. In each task the results showed no effects on accuracy, and no circadian effects of napping were found. In each task, analyses of pooled data of the two groups showed that the performance in the 1-h nap condition exhibited significant reductions of speed immediately following awakening, when compared with no-nap, reflecting SI effects. In SM, the slowing lasted 24 min, and 27 min in LR. Practical implications of the results are discussed.     

Is there an optimum number of night shifts? Relationship between sleep,health and well-being

Abstract

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health: i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Interactive effect of individual factors on nurses' health and sleep

Abstract

There is a tendency in studies concerning individual diferences in shiftwork tolerance to analyse the moderating effect of individual factors separately as if they acted independently. The aim of this study was to examine the interactive effect of individual factors (i.e. morningness, flexibility, languidity, neuroticism, extroversion) on nurses' health and sleep. A hundred female nurses (mean age 25.9 years, SD = 3.7 years) working a 2 × 12-h shift system were chosen from a larger study conducted among Intensive Care Unit staff. All subjects completed the Standard Shiftwork Index. Multiple regression analyses show that interactions of neuroticism and other factors (languidity, morningness) predict the majority of health and sleep complaints rather than neuroticism itself. Correlation analyses revealed that the interaction of neuroticism and languidity correlates higher with some indices of impaired health and sleep disturbances than when these factors are taken separately. The contribution of flexibility together with extroversion in interactions with neuroticism, and with neuroticism and languidity weaken the relations of languidity and neuroticism with health and sleep indices. The results show that some individual features tend to strengthen or counteract one another in relation to symptoms of shiftwork intolerance.     

Nutrient intake in day workers and shift workers

Abstract

The 24-h dietary intake, nutritional status parameters and psychosomatic factors of two-shift, three-shift and day workers were compared. Estimations of the dietary intake (across a work cycle) were made by use of a nutrient database. No significant differences were found between the groups for a large number of nutritional variables: intake of energy; intake and percentage of energy from protein, fat, total carbohydrates and sucrose; intake of coffee; and intake and density of vitamins and minerals. Only minor differences were found between the groups with regard to the quantitative intake of alcohol and calcium, and with regard to the quality of the diet (percentage of energy from alcohol, density of calcium). The groups differed significantly with respect to attitude towards work hours (three-shift workers being most negative in their attitude) and sleep disturbances (shift workers being most negative). The three-shift workers were more evening-oriented and they had higher concentrations of glucose in their blood. It was concluded that work hours not related to nutritional intake—at least not when total amounts across time are considered. It was also concluded that work hours were not related to Body Mass Index or blood lipids: triglycerides, total cholesterol, LDL (low-density lipoprotein) cholesterol and HDL (high-density lipoprotein) cholesterol.     

Editorial: Women and work

Abstract

When compared to day workers, night-shift workers report that they eat fewer meals, have poorer appetites, are less satisfied with their eating habits, and eat at different times of the day. When demographic variables are held constant, there do not appear to be any significant differences between experienced day and night-shift workers in caffeine or alcohol consumption. Exceptions to and variations in these findings are probably due to the background influences of social and cultural variables. Eating and drinking behaviours do effect human performance and mood, but little relevant data have been gathered from experienced night-shift workers. There are no shiftworker data evaluating the effectiveness of the special diets or dietary recommendations that have been proposed for use by night-shift workers. Thus, attempts to manipulate night-shift worker eating and drinking habits require experimental test.     

Effort-reward imbalance,overcommitment and sleep in a working population

The relationship between workplace characteristics and nocturnal sleep in a working population was investigated. Data from 709 employees (mean age=39 years; 87% men) from two German companies were analysed at the entry of the longitudinal cohort study (overall accrual 73%). We investigated the association between the effort-reward imbalance model at work (Siegrist, ) and self-reported sleep quality and sleep disturbances, as assessed by the Jenkins Sleep Quality Index. Effort and overcommitment were found to be higher, and reward was lower in participants with lower (N=328) vs. higher sleep quality (N=381), as well as in participants with (N=217) vs. without (N=492) disturbed sleep (all ps<.001). In regression analyses, lower sleep quality (R ²=.33) and sleep disturbances (R ² _Nagelkerke=.33) were predicted by older age, female gender (only significant for sleep disturbances), shift-work, lower physical and mental health functioning, and higher overcommitment. Individuals were 1.7 times more likely to report disturbed sleep per standard deviation increase in overcommitment. Gender-stratified analyses revealed that higher overcommitment was associated with unfavourable sleep in men, while in women poor sleep was related to lower reward. The findings suggest that overcommitment at work interferes with restful sleep in men, while in women disturbed sleep may be associated with the amount of overcommitment and perceived job reward and sleep quality associated with the perceived reward.     

A new quantitative method for assessing sleepiness: The alpha attenuation test

Abstract

Sleepiness interferes with the ability of night-workers and shiftworkers to safely and effectively perform their jobs, and has been increasingly recognized as a major cause of industrial and transportation accidents. Current methods for the assessment of physiological sleepiness levels, such as the Multiple Sleep Latency Test (MSLT) have several limitations and are particularly impractical in field or occupational studies. In this study, the effectiveness of the Alpha Attenuation Test (AAT) for the quantification of sleepiness has been evaluated and compared to the MSLT during a 40-h sleep deprivation protocol. The AAT, a 12-min eye closed/open protocol, is a quantitative method based on the fact that EEG alpha (8-12 Hz) activity tends to increase with eyes open as individuals get sleepier, while it decreases with eyes closed. In this validation study, the AAT proved to be a sensitive measure of sleepiness induced by sleep deprivation, and it also correlated well with the MSLT. Relative to the MSLT, the AAT has the advantages of being objective, minimally intrusive, and more practical especially in industrial or field studies.     

A 14-h night-shift in the control room of a fire brigade

Abstract

All 29 operators in the control room of a fire brigade performed test sessions during work and leisure time at 2-h intervals on a day with a 14-h night-shift, a day off and a day with a 10-h morning shift. The test sessions consisted of a visual search choice reaction time test and two Sternberg memory search tests (1 or 5 letters had to be memorized). Furthermore, the operators recorded their oral temperature and their subjective alertness before each test session. The subject also kept a diary of work and sleep times for 14 days. The circadian rhythm of body temperature was hardly changed by a single night-shift. Parallel to the body temperature, the subjective alertness fell significantly during the night-shift reaching a minimum value at 06:00 h. The mean reaction times increased non-significantly at the end of the night-shift and the results of the two Sternberg memory search tests showed no significant trends. The sleep of the operators after the night-shift was on average reduced to 5 hs 34 min. The results of subjective rating of alertness and reaction time test are interpreted as effects of the combined influences of circadian rhythmicity, sleep loss and time on professional task. Most results support the conclusion that a 14-h night-shift without extensive breaks is not acceptable.     

On-shift and daily variations in self-report and performance measures in rotating-shift and permanent night nurses

Abstract

An intensive study was conducted of the influence of type of shift system, type of shift, and time-into-shift on a battery of on-shift and daily measures obtained from 61 female nurses over a 28-day period. Thirty-two rotating-shift nurses and 28 permanent night nurses recorded data on a hand-held computer at the start and end of each day, and every 2-h during their shifts. The measures included a sleep diary, self-ratings of mood, workload, and personal disruption, and two cognitive performance tasks. These results suggest that the permanent night nurses were no worse off and for some measures were actually better off than the rotating-shift nurses after controlling for differences in age and shiftwork experience; the night-shift was problematic for the rotating-shift nurses but so was the early shift; mood deteriorated and reaction time got slower over the course of the night-shift but extra long responses (which may correspond to lapses of attention) and rated workload were lower on the night-shift. The relatively large number of consecutive night-shifts worked by the rotating-shift nurses, the uneven distribution of workload between shifts, and the long night-shift may have contributed to these results.     

Is there an optimum number of night shifts? Relationship between sleep, health and well-being

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health: i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Effects of sleep inertia on cognitive performance following a 1-hour nap

This study investigated the effects of a 1-h nap on subsequent performance in spatial memory (SM) and logical reasoning (LR) tasks. The objective was to evaluate the duration of the effects of sleep inertia (SI). The performance was measured in two independent groups of subjects. The 1-h nap took place at 00:00 h in group 1 and at 03:00 h in group 2. In each task, the experimental design comprised one no-nap condition in which subjects had no sleep before the night tests, and a nap condition that comprised the 1-h nap followed by the test sessions. To measure the duration of SI effects, the subjects were tested in two 30-min sessions and the data in each session were analysed in sub-units of time of 3 min each. In each task the results showed no effects on accuracy, and no circadian effects of napping were found. In each task, analyses of pooled data of the two groups showed that the performance in the 1-h nap condition exhibited significant reductions of speed immediately following awakening, when compared with no-nap, reflecting SI effects. In SM, the slowing lasted 24 min, and 27 min in LR. Practical implications of the results are discussed.     

Editorial statement: Stress and work compensation

Shift work has been reported to predict health problems, and a possible explanation is that shift work may lead to poorer health habits, thereby increasing a person's vulnerability to illness. This study examined the association between shift work and health habits, as indicated by smoking, alcohol intake, physical activity and by being overweight. A questionnaire was sent to all 2795 female nurses working in the 10 hospitals of two Finnish health care districts. From the 2299 respondents, we selected those 506 shift workers who reported having always done shift work and those 183 day workers who had never done shift work. Shift workers were found to smoke more and to be overweight more often than day workers. These differences gradually increased in each successive age group, being 1.94 pack-years in smoking and 0.9 kg m^-2 in body mass index among nurses over 45 years of age. Shift work was not associated with alcohol intake or sedentary lifestyle. This evidence is compatible with the possibility that shift work in nurses increases smoking and being overweight to a degree that contributes to health problems, including coronary heart disease.     

Perceived physical work capacity,stress, sleep disturbance and occupational accidents among firefighters working during a strike

Fire-fighting and rescue work are arranged in such a way that various kinds of accidents and catastrophes can be handled. In an understaffed situation, such as a strike, this goal may not be met. The objective of this study was to investigate factors associated with perceived physical work capacity, stress, sleep disturbance, and occupational accidents among firefighters who remained at work during an extended strike. A cross-sectional questionnaire study was carried out among 543 firefighters (83% of the target group) in 71 fire brigades in Finland. After the strike had lasted for 9 to 11 weeks, most of the firefighters perceived their physical work capacity to be rather good or very good. Stress increased along with a decreasing number of personnel in a crew (OR= 2.3, CI= 1.0-5.3, for less than 75% of a normal crew vs. normal crew) and with decreasing number of personnel in a shift (OR= 2.4, CI= 1.1-5.4, for less than 25% of normal shift vs. normal shift). Sleep disturbance was reported to occur as soon as the total working time exceeded 50 h/week. Working more than 70 h/week increased the risk of occupational accidents almost 4-fold compared with working no more than 50 h/week. These results suggest that exceptional situations, such as a strike, are a challenge to human capacity. With time, increased stress and sleep disturbance may lead to serious consequences.     

Appropriate use of bright light promotes a durable adaptation to night-shifts and accelerates readjustment during recovery after a period of night-shifts

Abstract

The present study examines the stability of bright light circadian readjustment during two consecutive dim light night-work periods and circadian synchronization during the recovery after a night-shift period. A sample of 10 subjects was divided into 2 groups (control group: 6 subjects; experimental group: 4 subjects). All subjects worked during 5 days, between 23:00 and 07:00 h and then went to sleep. Subjects received 2500-3000 lux between 02:00 and 05:00 h during 5 days for the control group and 3 days for the experimental group. During recovery after the night-shift periods, three cycles of bright light were administered at two different times: 12:00-15:00 h for two of six subjects from the control group and 10:00-13:00 h for all subjects (4) of the experimental group. By the fifth cycle of night-work the maximum of urinary aMT6s excretion that occurs at 05:00 h in the baseline condition was shifted to 12:00 h for the control and experimental groups (delay in hours: 7±1.6 (control); 7±1 (experimental)). This result suggests that three cycles of bright light are sufficient to induce a significant phase delay and that this delay remained stable when night-work proceeded under dim light. The phase delay of the circadian aMT6s excretion by exposure to bright light was accompanied by an improvement of the quality of day sleep and level of cognitive and psychomotor performances for control and experimental groups. No significant difference was observed in the two groups for daytime sleep and nocturnal performance. The two bright light periods used during the three days of recovery induced a complete synchronization in five of six subjects. One subject showed a partial synchronization probably because he remained at the laboratory under dim light during the day and had few family and social contacts.     

Interactive effect of individual factors on nurses' health and sleep

There is a tendency in studies concerning individual diferences in shiftwork tolerance to analyse the moderating effect of individual factors separately as if they acted independently. The aim of this study was to examine the interactive effect of individual factors (i.e. morningness, flexibility, languidity, neuroticism, extroversion) on nurses' health and sleep. A hundred female nurses (mean age 25.9 years, SD = 3.7 years) working a 2 × 12-h shift system were chosen from a larger study conducted among Intensive Care Unit staff. All subjects completed the Standard Shiftwork Index. Multiple regression analyses show that interactions of neuroticism and other factors (languidity, morningness) predict the majority of health and sleep complaints rather than neuroticism itself. Correlation analyses revealed that the interaction of neuroticism and languidity correlates higher with some indices of impaired health and sleep disturbances than when these factors are taken separately. The contribution of flexibility together with extroversion in interactions with neuroticism, and with neuroticism and languidity weaken the relations of languidity and neuroticism with health and sleep indices. The results show that some individual features tend to strengthen or counteract one another in relation to symptoms of shiftwork intolerance.     

Perceived exertion under conditions of sustained work and sleep loss

Abstract

The rated perceived exertion (RPE) for treadmill walking carrying a 22 kg pack was measured in two studies with heart rate, workload and psychological measures. Study 1 used an initial treadmill speed and grade producing 40% of maximal oxygen consumption. Exercise subjects walked 1/2-h, then did other tasks for 20-h for 16 sessions on two 20 h long days. Group I had a 4 h nap, while Group 2 had 4 h of rest between workdays. Subjects maintained the 40% workload throughout the two days with a 3 h nap between days, one group starting exercise at midnight and one at noon.

A steady increase in RPE over the sessions each day was found in each study. There were no differences in RPE between the Nap and Rest groups in Study 1 or between the midnight and noon groups in Study 2. RPE was higher on Day 2 in each study. RPE correlated significantly with heart rate, distance walked or elevation at most time periods on the first workday in Study 1, but not Study 2. RPE was positively correlated with fatigue, symptoms, sleepiness and negative mood, and negatively correlated with vigor at most of the time periods day 1 in Study 2; with similar significant correlations at only one time period on day 1, Study 1. RPE was lower the first session Day 2 as compared to the last session Day 1 in both studies. This pre-post break recovery did not differ between groups in either study.     

Psychophysical conditions of air traffic controllers evaluated by the standard shiftwork index

Abstract

In the ambit of a large epidemiological survey on the Italian population of air traffic controllers, an evaluation of their health conditions was carried out using the Standard Shiftwork Index (SSI). The study took into consideration 572 male air traffic controllers, aged between 23 and 59 years, of whom 301 were engaged in three large Regional Centres, 189 in thirteen Airport Towers and 82. formerly active controllers, were working in administrative offices. The former controllers showed worse health levels, in particular minor psychological disorders and chronic fatigue. Sixteen of them had been transferred to administrative jobs because of health impairment, owing to severe diseases of the nervous, gastrointestinal and cardiovascular systems. Such disorders, and musculoskeletal ones, were mostly reported by the active controllers. The controllers engaged in Regional Centres showed more sleep disturbances than those engaged in towers. Beside age, some personal characteristics appeared to influence health and well-being. Neuroticism was correlated with chronic fatigue, digestive and cardiovascular complaints, minor psychological disorders, cognitive and somatic anxiety. On the other hand, morningness was correlated negatively with sleep disturbances on morning shift, and positively with sleep duration both on morning shift and rest days.