Sustained work, fatigue, sleep loss and performance: A review of the issues

The physiological and psychological stressors associated with sustained work, fatigue, and sleep loss affect worker performance. This review describes findings relating to sustained work stresses commonly found in our advancing technological world. Researchers report decrements in sustained performance as a function of fatigue, especially during and following one or more nights of complete sleep loss, or longer periods of reduced or fragmented sleep. Sleep loss appears to result in reduced reaction time, decreased vigilance, perceptual and cognitive distortions, and changes in affect. Sleep loss and workload interact with circadian rhythms in producing their effects. These interactions are a major source of stress in work situations requiring sustained work in continuous operations and have implications for theoretical models of sustained perceptual and cognitive functioning.     

Behavioural techniques for enhancing alertness and performance in shift work

This paper reviews behavioural and cognitive methods for increasing alertness, enhancing performance, and decreasing long-term negative consequences due to shift work. Methods having the most potential for effective intervention include the short-term alerting effects of the optimal timing of work breaks, social activity during breaks, and sensory stimulation. Stress coping techniques and sleep hygiene information for workers and their families have the most potential for addressing long-tcrm effects of shift work. Recommendations for areas requiring further investigation include the altering effects of bright light, fresh air, and cold water; performance enhanccmcnt through psychophysiological self-regulation and imagery; and the impact on performance of second jobs and family responsibilities.     

Using pharmacological aids to improve waking function and sleep while working at night

Non-refreshing or insufficient sleep, and impaired alertness on the job, are two nearly universal consequences of night work. The effects of drugs upon the sleep and alertness of night workers has only recently been studied and much work remains to be done. To date, it is clear that sleep during the day can be improved with sedative-hypnotic compounds, particularly the benzodiazepines. Despite improvement in sleep, alertness at night is improved only mildly, if at all, with short-acting sleeping agents and can be further impaired with long-acting drugs. The limited research examining alertness and performance during night shift hours after administration of CNS stimulants suggests significant benefits. The judicious use of CNS stimulants in this way needs further exploration. Precise pharmacological manipulation of the endogenous sleep/wake rhythm is primarily theoretical at this time but should be pursued.     

The benefits of a nap during prolonged work and wakefulness

Abstract

Prolonged work scenarios with demands for sustained performance are increasingly common. Because sleep loss inevitably compromises functioning in such situations, napping has been proposed as a countermeasure. The optimal timing of the nap relative to its benefits for performance and mood is not known, however. To address this issue, 41 healthy adults were permitted a two-hour nap at one of five times during a 56-hour period of intermittent work, with no other sleep. Naps were placed 12 hours apart, near the circadian peak (P) or trough (T), and were preceded by 6(P), 18(T), 30(P), 42(T), or 54(P) hours of wakefulness. Work test bouts occurred every few hours and consisted of a variety of psychomotor and cognitive tasks as well as mood scales completed at the beginning, middle and end of each bout. A total of eight performance and 24 mood parameters were derived from the bouts and compared between groups at all test points prior to and following the naps. An estimate of the extent to which each nap condition differed from the control (P54) condition was derived by totalling the proportion of test points that yielded statistically significant results relative to the total number of tests conducted both before and after naps.

Although all performance and most mood parameters displayed a circadian-modulated deterioration as the protocol progressed, a nap appeared to attentuate the extent of this change in all performance parameters but not in mood parameters. Overall, the timing of the nap across days and within the circadian cycle was irrelevant to its effect on performance, suggesting that it diminished the intrusion of sleepiness into behavioural functioning, even though subjects were phenomenally unaware of this benefit.     

The benefits of a nap during prolonged work and wakefulness

Prolonged work scenarios with demands for sustained performance are increasingly common. Because sleep loss inevitably compromises functioning in such situations, napping has been proposed as a countermeasure. The optimal timing of the nap relative to its benefits for performance and mood is not known, however. To address this issue, 41 healthy adults were permitted a two-hour nap at one of five times during a 56-hour period of intermittent work, with no other sleep. Naps were placed 12 hours apart, near the circadian peak (P) or trough (T), and were preceded by 6(P), 18(T), 30(P), 42(T), or 54(P) hours of wakefulness. Work test bouts occurred every few hours and consisted of a variety of psychomotor and cognitive tasks as well as mood scales completed at the beginning, middle and end of each bout. A total of eight performance and 24 mood parameters were derived from the bouts and compared between groups at all test points prior to and following the naps. An estimate of the extent to which each nap condition differed from the control (P54) condition was derived by totalling the proportion of test points that yielded statistically significant results relative to the total number of tests conducted both before and after naps.

Although all performance and most mood parameters displayed a circadian-modulated deterioration as the protocol progressed, a nap appeared to attentuate the extent of this change in all performance parameters but not in mood parameters. Overall, the timing of the nap across days and within the circadian cycle was irrelevant to its effect on performance, suggesting that it diminished the intrusion of sleepiness into behavioural functioning, even though subjects were phenomenally unaware of this benefit.     

Dealing with shift work: Physical fitness, temperature, and napping

This paper reviews the effects of generally controllable factors such as physical conditioning, ambient temperature, and amount of prior sleep in adjustment to night work periods and shift work. One can expect a 5-10% decline in capacity for work in nocturnal work periods as compared to daytime work periods. This decreased capacity would dissipate if workers maintained a consistent sleep-wake routine for 8-16 days after moving to a new shift. Proven means for accelerating this adaptation are currently not available. The ability to perform work also declines as the length of the work period increases but depending upon individual tasks. Physical conditioning improves mood and general well-being, but no strong evidence currently indicates that conditioning increases tolerance or adjustment to shift work.

Increased ambient temperature increases the stress of work, although studies do not address heat as a factor in adjustment to shift work. While lower nocturnal temperature would be assumed to reduce heat stress during night shifts, supporting data does not exist. Studies have not addressed the negative consequences of cold stress or of rotating from night to day shifts with added heat stress.

The proper use of short sleep periods either as preparation for or as a response to a shift change can ameliorate some effects of shift rotation. Data indicate that performance on 'graveyard' shifts can be maintained close to baseline levels following true prophylactic naps while performance may decline by up to 30% when such naps are not taken. While there is evidence that naps or even rest periods without sleep are beneficial in improving mood in normal young adults, these data do not apply to 'replacement' naps. Studies of interjected naps imply that such naps do reduce sleep debt but do not imply that such naps are more beneficial than longer sleep periods. Naps appear to be most advantageous when the accumulated sleep debt is least.     

Shiftwork locus of control: Scale development

Shiftwork is a significant feature of occupational life for many people. It can have disruptive effects on sleep, health, social activity and performance. It is likely that beliefs about personal control will influence the individual-shiftwork relationship. This paper has two aims; first, to put forward the thesis that shiftwork-specific personal control expectancies may moderate the disruptive impact of shiftwork, and second, to report the development and preliminary validation of a shiftwork-specific locus of control scale. The scale demonstrated satisfactory psychominary qualities in terms of factor structure, internal reliability, construct validity and test-retest reliability. Variables associated with better coping with shiftwork such as alertness, flexibility of sleeping habits and the structured use of time correlated positively with shiftwork locus of control. In contrast, shiftwork locus of control was found to be inversely related to shiftwork problems such as sleep disturbance, poor mental well-being and work stress.     

Auditory evoked potentials as a function of sleep deprivation

Event-related brain potentials (ERPs) were studied in subjects deprived of sleep over a 48-h test period to assess the effects of different durations of continuous wakefulness on ERP components and to determine whether changes in the ERP components were related to changes in performance. Forty subjects were randomly assigned to either an experimental (sleep deprived) group (n = 30) or a control (not sleep deprived) group (n = 10). For the experimental subjects, ERP and performance measures were obtained in four-h test blocks throughout the 48-h period. Performance was assessed using the Walter Reed performance assessment battery. The control subjects were tested at the same times except during designated sleep periods. Both performance and evoked potential measures showed systematic changes over the experimental test period in association with sleep deprivation, time of day, and repeated testing. The latency of the N2 component of the evoked potential covaried with throughput measures on the performance assessment battery across the 12 four-h test blocks of the experiment. These data suggest that ERPs reflect central processes that change across the sleep deprivation period and that ERP measures might be useful in assessment and prediction of performance degradation under adverse conditions such as sleep loss.     

Shiftwork locus of control: Scale development

Abstract

Shiftwork is a significant feature of occupational life for many people. It can have disruptive effects on sleep, health, social activity and performance. It is likely that beliefs about personal control will influence the individual-shiftwork relationship. This paper has two aims; first, to put forward the thesis that shiftwork-specific personal control expectancies may moderate the disruptive impact of shiftwork, and second, to report the development and preliminary validation of a shiftwork-specific locus of control scale. The scale demonstrated satisfactory psychominary qualities in terms of factor structure, internal reliability, construct validity and test-retest reliability. Variables associated with better coping with shiftwork such as alertness, flexibility of sleeping habits and the structured use of time correlated positively with shiftwork locus of control. In contrast, shiftwork locus of control was found to be inversely related to shiftwork problems such as sleep disturbance, poor mental well-being and work stress.     

Leadership of highly creative people in highly creative fields: A historiometric study of scientific leaders

In recent years there has been a marked increase in the study of the influence of leadership on creativity, and the effects of this relationship on organizational performance. While a number of explanations have been broached with regard to the positive effects of leadership on creativity, many of these studies propose different, and often contradictory, methods for leaders to achieve these positive effects on creativity within their organizations and work groups. Additionally, little work has been done examining the effects of leadership on highly creative people in fields requiring creativity. The purpose of this study is to examine two existing leadership theories with regard to their viability as models to explain creative performance of eminent scientists. Eminent scientists represent a population of leaders of highly creative individuals in a field that values the production of innovative ideas and products as a marker of performance. Ninety-three excerpts from the biographies of scientists were content coded for leader behaviors and performance criteria. The results of this analysis indicate that a model based on strategic planning and product championing may serve to explain the positive effects of leadership on creativity in a highly creative population.     

Relationships between psychological,physical, and behavioural health and work performance: A review and meta-analysis

The relationships between health and job performance problems have received increased attention in business and scientific communities. This paper attempts to synthesize theoretical and empirical work in this arena. First, the theoretical links between health and work performance are presented. This is followed by a meta-analysis of the relations between psychological, physical, and behavioural health variables and work performance criteria. Meta-analytic results from 111 independent samples obtained from a search of the literature indicate that psychological health, in the form of psychological well-being, depression, general anxiety, and life satisfaction, is a moderate-to-strong correlate of work performance. Associations between physical health, particularly somatic complaints and hypertension, and performance were weak-to-moderate. Regarding health behaviour, alcohol consumption, and smoking were weakly and sleep problems moderately associated with performance problems. Effect sizes sometimes differed across performance dimensions and data sources. The results are consistent with the notion that ill-health is associated with substantial reductions in work performance. This implies that interventions to improve health may have an impact on performance. However, as most of the research in this area has been cross-sectional, more longitudinal research is needed to test theoretical and alternative causal explanations for the relations summarized in this review.     

Changes in the practice of medicine

In constructing this report, the author interviewed physicians to ask them how the practice of medicine has changed and what changes bother them most. She also talked to physician executives to find out how they were managing an increasingly disgruntled group of doctors. Four changes in the professional environment that physicians face dominated these conversations--lowered income, loss of control, the threat of litigation, and greatly increased paperwork. This article is a summary of comments in these four areas.     

Polyphasic sleep strategies improve prolonged sustained performance: A field study on 99 sailors

In situations where continuous prolonged work demands exist, the habitual nocturnal monophasic (6-8h duration) sleep pattern can rarely be accomplished, and performance effectiveness may sometimes be severely compromised by accumulation of sleep debt. Several studies have shown that naps can be disproportionately effective in recovering functioning during continuous work (CW).

In this study, sleep-wake patterns and their relationship to performance were studied for 99 sailors involved in solo and double-handed ocean sailing races (a model of a highly demanding CW situation). Most sailors spontaneously adopted multiple nap sleep-wake schedules and adapted without major difficulties to such polyphasic patterns. 66.5% had mean sleep episode durations (SEDs) ranging from 20 min to 2h. Overall mean Total Sleep Time (TST) per 24h was reduced from a baseline of 7.5 to 6.3h. Race performance correlated negatively and significantly with mean SEDs and TSTs. Best performance results were obtained by those sleeping for periods of between 20 min and 1 h and for a total of 4.5 to 5.5h of sleep per day.

The results are discussed together with several chronobiological, phylogenetic and experimental studies and issues, all of which suggest that adult humans may have a damped polyphasic sleep-wake tendency. It is also proposed that polyphasic sleep schedules could become promising and feasible solutions for the management of sleep requirements under prolonged CW situations.     

Shiftwork effects in nuclear power workers: A field study using portable computers

This field study of nuclear power shiftworkers reports the use of hand-held computers to record alertness levels, cognitive task performance and workload ratings. Subjective ratings and performance tasks (Search and Memory-5 (SAM-5); Choice Reaction Time (CRT) were completed on the computers at 2-h intervals during selected shifts in the work schedule by maintenance crews and reactor operators. Sleep duration and quality data were also obtained during the 35-day shift cycle. Workload remained relatively stable across shifts. The night-shift was associated with shorter sleep durations and poorer sleep quality. Significantly lower levels of alertness and poorer perforniance for components of the performance tasks were also observed on the night-shift. Tinic-on-shift effects on alertness were evident, where by for the night-shift, especially, alertness dropped dramatically during the early hours. Components of SAM-5 performance showed differential time-on-shift patterning relative to each shift whereas CRT was unresponsive to time-on-shift effects. Significant variations were observed in alertness and performance components during the 12-h night-shift. Perhaps paradoxically, performance on the 12-h night-shift appeared to improve rather than deteriorate during the early-hour period that was associated with the greatest drop in alertness. This was suggestive of extra effort expenditure during this critical period.     

Shiftwork effects in nuclear power workers: A field study using portable computers

Abstract

This field study of nuclear power shiftworkers reports the use of hand-held computers to record alertness levels, cognitive task performance and workload ratings. Subjective ratings and performance tasks (Search and Memory-5 (SAM-5); Choice Reaction Time (CRT) were completed on the computers at 2-h intervals during selected shifts in the work schedule by maintenance crews and reactor operators. Sleep duration and quality data were also obtained during the 35-day shift cycle. Workload remained relatively stable across shifts. The night-shift was associated with shorter sleep durations and poorer sleep quality. Significantly lower levels of alertness and poorer perforniance for components of the performance tasks were also observed on the night-shift. Tinic-on-shift effects on alertness were evident, where by for the night-shift, especially, alertness dropped dramatically during the early hours. Components of SAM-5 performance showed differential time-on-shift patterning relative to each shift whereas CRT was unresponsive to time-on-shift effects. Significant variations were observed in alertness and performance components during the 12-h night-shift. Perhaps paradoxically, performance on the 12-h night-shift appeared to improve rather than deteriorate during the early-hour period that was associated with the greatest drop in alertness. This was suggestive of extra effort expenditure during this critical period.     

Reciprocal relationships between psychosocial work characteristics and sleep problems: A two-wave study

Sleep problems are common and impair the health and productivity of employees. Work characteristics constitute one possible cause of sleep problems, and sleeping poorly might influence wellbeing and performance at work. This study examines the reciprocal associations between sleep problems and psychosocial work characteristics. The participants were 1744 full-time employed individuals (56% women; mean age 38 years in 2007) from the Young Finns study who responded to questionnaires on work characteristics (conceptualised by the demand–control model and effort–reward imbalance model) and sleep problems (Jenkins Sleep Scale) in 2007 and 2012. Cross-lagged structural equation models are used to examine the associations. The results show that low control and low rewards at baseline predicted sleep problems. Baseline sleep problems predicted higher effort, higher effort–reward imbalance, and lower reward. Sleep problems also predicted lower odds for belonging to the low (rather than high) job strain group and active jobs group. The association between work characteristics and sleep problems appears to be reciprocal, with a stressful work environment increasing sleep problems, and sleep problems influencing future work characteristics. The results emphasise the importance of interventions aimed at both enhancing sleep quality and reducing psychosocial risks at work.     

Pilot Study Sleepiness in physicians on night call duty

Little is known about how physicians' feelings of sleepiness and sleep patterns are affected by night call duties. In the present pilot study, the authors followed a group of staff (hospital) physicians during and following night call duties. They recorded feelings of sleepiness and sleep patterns every third hour. Results show measurable effects on the sleepiness scale with residual effects lasting up to two days after the actual night call duty. The authors suggest that increased attention should now be given to studies of the psychophysiological effects of both present and alternative work schedules for physicians.     

Combined work stresses: Effect of reduced air renewal on psychological performance during 72h sustained operations

Human tolerance limits for sustained operations under the combined stress of stale air and sleep loss were studied in two groups often male volunteers over a 72 h period, with only 1h of sleep permitted after 32, 48 and 60h. The experiment investigated whether such sustained performance might be additionally influenced by mild hypoxia (15 vol% O₂) together with correspondingly increased carbon dioxide levels (5 vol%).

Performance on various psychological tests showed the expected decrease with increasing duration of sleep loss. However, there were no clear cut differences in performance between the control and the hypoxia groups. There were, however, more pronounced decreases with time in either group in the more complex tasks as compared to simple reaction time and vigilance tasks. Short-term memory improved probably due to learning. The missing effect of hypoxia could be attributed to a hyperventilation response in the experimental subjects and an increase in cerebral blood flow initiated by the hypercapnia.     

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

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.     

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

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.