Transcript Coping with Shifts

COPING
WITH
SHIFTWORK
Neil Lewis
Business 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;
L
WHY DO WE HAVE PROBLEMS
WORKING SHIFTS?
Your body is conditioned to be awake during the day and
asleep at night
Cerebral
Cortex
Hypothalamus
SCN
(Suprachiasmatic Nucleus)
Brain Stem
Spinal
Cord
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NORMAL CIRCADIAN RHYTHMS WRONG?
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What are circadian rhythms?
Definition: Circa = around
Dies = day
Around daily rhythms of your body clock, for example
Sleep
TEMPERATURE
No Sleep
Whether we are
awake or asleep,
body functions
continue to follow
their circadian
rhythms
98.5
Body
Core
Temperature
96.5
Thermostat
Down
Thermostat
Up
11 pm
7 am
Thermostat
Down
11 pm
Thermostat
Up
7 am
Other examples include growth hormone, cortisol, urination
CIRCADIAN PROFILE OF HUMAN ALERTNESS
VERSUS TIME OF DAY
20
Full Alertness
15
Moderate Alertness
10
Reduced Alertness
5
Drowsy
0
12
15
18
21
24
03
TIME OF DAY
06
09
12
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CIRCADIAN PROFILE OF HUMAN ALERTNESS
WITH SUSTAINED WAKEFULNESS
Time of Day
09
12
15
18
21
24
03
06
09
20
Full Alertness
Alertness
Level
(MSLT)
15
Moderate Alertness
10
Reduced Alertness
5
Drowsy
0
0
5
10
15
20
Successive Hours of Sleep Deprivation
25
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FACTORS DETERMINING SHIFT WORKER
ALERTNESS
Time of day (phase of
circadian rhythm)
Day of shift
Circadian profile
(morning or evening type)
Consecutive shifts on duty
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Consecutive hours on duty
Hours since last consolidated sleep
Amount of overtime
Duration of last consolidated sleep
Speed or frequency of shift changes
Quality of last consolidated sleep
Content and timing of last meal
Cumulative sleep deprivation
Ingested stimulants or depressants
Stimulation/monotony of job task
Age of shift worker
Stimulation/monotony of job
environment
Physical inactivity
WHY DO SHIFT WORKERS HAVE SLEEP
PROBLEMS?
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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
N
SHIFT WORKERS’ MOST COMMON SLEEP
DIFFICULTIES
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P A C
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
HOW TO COPE WITH SHIFTS
L
H
Interest, opportunity, or
sense of danger
H
L
Sleep bank balance
H
L
Muscular activity
H
Environmental temperature
H
L
Time of day on
circadian clock
L
Ingested nutrients and
chemicals
L
H
L
Environmental sound
H
L
Environmental light
H
L
Environmental aroma
You need to learn how to switch all these controls to high
N
P A C
The Nine Controls of Human Alertness
H
I
HOW TO PLAN SLEEP
Sleep 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
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PREPARING 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
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PREPARING 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
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BETWEEN CONSECUTIVE NIGHT SHIFTS
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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
N
RECOVERY AFTER NIGHT SHIFTS
Try to avoid going completely back to daytime schedule
Stay up late and sleep in late
Take short naps as needed
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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
W
1
Sleep
Stage
2
3
REM Sleep
4
00
01
02
03
04
Time of Night
05
06
07
08
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
Alcohol
Should not be used as a
sleeping aid
Reduces the quality of sleep
Acts as a diuretic, flushing
fluids from your body
Don’t drink alcohol for at
least four hours before
planned sleep
Nicotine
Your body craves nicotine
while you sleep, which
disturbs sleep
Related health problems
- Cancer
- Heart disease
- Hypertension
- Emphysema, bronchitis
OTHER ISSUES
Exercise
Gives you energy
Burns off stress
Helps you sleep
Proper approach:- Start slowly
- Find a routine you like
- Exercise 3-5 times a week
OTHER ISSUES
Sleeping Pills
May initially help with sleep
problems
Tolerance creates the need for
more
Prolonged use can create the
following:
- Disrupted sleep
- ‘Hangovers’
- Dependence
Drugs
Tranquillizers
Antihistamines
Antidepressants
Antipsychotics
Antihypertensives
Long-acting hypnotics
Stimulants (withdrawal
effects)
FAMILY AND SOCIAL ISSUES
The Importance of
Family/Social Issues
The shift worker is not
viewed as a whole person
Divorce rates are higher for
shift workers
Sleep deprivation leads to
irritability and family
problems
The entire family is disrupted
by the shift schedule
Creates high
turnover/absenteeism
Decreases morale/motivation
Negative attitudes affect job
performance
FAMILY AND SOCIAL ISSUES
Improving Communication
Planning Ahead
Keep expectations realistic
Be specific about your
feelings
Don’t suppress emotions
Compromise on differences
Be sure spouse, partner,
family and friends understand
your shift work schedule
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 pattern
BUT
It’s only half the battle . . .
IT’S NOW
DOWN TO
YOU
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 MooreEde
HSG 256: Managing Shift Work available from HSE
books
Thanks for listening and any questions