Archive for the ‘shiftwork’ category

Reducing Night Nurse Fatigue

March 30, 2014

Lately it’s been a pleasure to provide an intervention program for night-shift nurses to help them sleep well during the day, and thereby improve their alertness at night. For many nurses working nights a typical shift is 12 hours, often from 7pm to 7:30am. This requires them to function well during the hours that human beings are designed for sleep. Many of these employees like to sleep during the night on a similar schedule to their loved ones when not working, which keeps them in a perpetual state of circadian misalignment, making it even more difficult to function well at night.

In December 2011 the Joint Commission issued Sentinel Event Alert #48 on the effect of extended work hours and cumulative work hours on patient safety and nurse health. They summarize the extensive research on the performance effects of working at night. Some of the results of fatigue include:
- impaired information processing and judgement
- inability to focus attention
- reduced motivation
- loss of empathy
Fatigue among healthcare workers increases the risk of adverse events, decreases patient safety, and negatively impacts the health of the night shift workers.

The Commission report goes on to suggest steps organizations take to improve employee alertness and thereby improve patient safety. Fatigue management typically includes steps for both individual employees and the administration. Sleep training for employees so they can sleep well during the day, and entrain their circadian rhythm to the schedule, is one step. Another is fatigue reducing strategies such as precisely-timed caffeine and light to increase alertness on the job. Administrations can optimize their scheduling practices, and provide an alerting work environment. You can see the full Sentinel Event Report of the Joint Commission here: http://www.jointcommission.org/sea_issue_48/

Over the next 6 months I hope to continue this work for Seattle-area hospitals, and expand to help other public safety organizations that are providing 24/7 service, including the police and fire departments. Around the clock service is a must for public safety, and helping these night-shift staff to sleep well during the day, so they can be alert and healthy during the night is extremely rewarding!

Sleepy Transportation Workers – Scary!

March 15, 2012

Last week was National Sleep Awareness Week, and the time each year that the annual Sleep in America Poll is unveiled. This year it is all about sleep health in the transportation industry. This data raises concerns about public safety, and the health of the transportation workers. Here’s what pilots, train operators, and professional drivers of all types reported about their sleep.

Sleepiness and Safety
When asked about sleepiness, 1 in 4 pilots and train operators said that sleepiness has impacted their job performance once a week. Even more concerning is the number of professionals who say that sleepiness caused safety issues: 20% of pilots, 18% of train operators, and 14% of truck drivers.

These safety issues persist during transportation employees personal time: 6% were in an auto accident due to sleepiness compared to 1% of those who work in other industries.

The Sleep Schedule
Almost half of transportation workers are dis-satisfied with their sleep. Many say their work schedule does not allow enough time for sleep (44% train operators, 37% pilots). This compares to 27% of non-transportation workers.

Transportation professionals tend to work longer shifts, with less time off between shifts. They also tend to have longer commute times, and irregular shiftwork type schedules.

Adequate Sleep for Transportation Professionals
It’s been a pleasure in my office to help transportation professionals get healthy, natural sleep. This is primarily about strategically using our body’s sleep systems to promote alertness during work hours and sleep during sleep times.

First, create a window of time for sleep that can be as consistent as possible. Also put into place a routine of meal times, exercise, activity – all those things that signal time to the body. Second, reduce the commute as much as possible. Third, use precisely timed melatonin and light therapy to promote sleep at sleep times and increase alertness during the work day. This is a very individualized approach which takes into account the irregular work schedule, commute time, sleep environment, and lifestyle.

Summary

“The margin of error in these professions is extremely small. Transportation professionals need to manage sleep to perform at their best,” said David Cloud, leader of the National Sleep Foundation.  His comment really sums this up, that sleep health is so important for transportation professionals and the safety of the public they serve.

 You can read the report here: http://www.sleepfoundation.org//article/press-release/sleepy-pilots-train-operators-and-drivers

Top 10 Online Influencers Helping America Sleep Better

January 27, 2012

It was a good morning to open my inbox and see that I’ve been named one of ‘The Top 10 Online Influencers Helping America Sleep Better’ by SharecareNow.  See their announcement here  http://www.sharecare.com/static/sharecare-now-shift-work-sleep-disorder

There are some great resources among this list for people wanting healthy sleep and it’s many benefits. Here’s a run-down of the Top 10, with the links to their sites. Enjoy!

Understanding Circadian Rhythms at the Molecular Level

March 16, 2011

We’ve talked in the past about circadian rhythms, how there is a daily rhythm of hormone fluctuations that make us more alert during the day, and more sleepy during the night. There are also changes in organ function by time of day. Shiftworkers’ health suffers for being up and active at a time their body is programmed to sleep.

What we haven’t discussed is how these rhythms are established in the first place. Just this week, there was an article published in Science by Lazar and Feng about the circadian rhythm of fat metabolism in the liver.

During the day, molecules modify the liver DNA to reduce fat production. Those molecules leave during the night (so there are 100 at 5am, as opposed to 15000 at 5pm). With those molecules absent, more fat is produced and stored in the liver. The authors conclude “This leads to a circadian rhythm of metabolism that is important, because disruption of this rhythm leads to fatty liver. This may explain in part why altered circadian rhythms in people who do shift work is associated with metabolic disorders.”

There are molecular changes like this happening in many organ systems, multiplying the effect of being out of sync with the natural light-dark cycle.  As our understanding of circadian physiology develops, we’ll be better able to improve the health of shiftworkers.

Are you an Owl or Lark?

October 25, 2010

An ‘Owl’ is someone whose body clock is set to sleep later than average, and a ‘Lark’ is someone whose set to sleep earlier than average. It is your inherent melatonin rhythm and temperature rhythm that determine when you sleep.

Being an Owl or Lark can impact how well you do with different schedules. Generally speaking, Owls do better with later schedules and shift work like graveyard. Larks are the ones you’d want to open the shop in the morning. It’s important to know that alertness fluctuates over the 24 hours in almost the same curve as temperature. As your temperature drops you are less alert and more sleepy.   If you get into bed and try to sleep before your body is ready, you may experience this as insomnia.  About 10% of chronic insomniacs actually are Owls, and if they go to bed later have no problem sleeping.

To determine if you are an Owl or Lark you can do the Horne-Ostberg Morningness-Eveningness questionnaire, which was developed in 1976. You can find a modified version of it online at http://web.ukonline.co.uk/bjlogie/test.htm.

This information can help you develop a lifestyle that best suits your circadian rhythm.  If you are not able to shift the time of your commitments, a sleep specialist may be able to help shift your circadian rhythm.

How to Handle Shiftwork Well

January 6, 2010

You can learn to handle shiftwork as well as possible.  Here’s a few beginning steps:

  1. Educate your family or roommates about what you’ll need to sleep well.  This includes quiet without interruptions during your sleep time, a dark and cool room, and as regular a schedule as possible.  Sometimes family members are eager to see you and share their news.  When setting a sleep schedule, also schedule a predictable time that you’ll be available to them.
  2. Make your sleep schedule as consistent as possible over the entire week.
  3. If possible, take a short nap during the middle of your shift.  Be cautious to become fully alert before performing your job duties.
  4. Use caffeine strategically.  Caffeine is more effective as a stimulant if you don’t use it much.  During the night shift, take a serving of caffeine at the time when your alertness starts to dip.  The caffeine will take effect in about 20 minutes, and does improve measures of performance.  Be cautious not to take it so close to bedtime that it interferes with falling asleep.
  5. Limit light exposure on the commute home by taking public transit and wearing blue light blocking sunglasses.

With these strategies, shiftwork should be easier.  A special thanks goes out to all those folks who work nights, keeping the rest of us safe.

The Institute of Naturopathic Sleep Medicine focuses on natural care for sleep problems, including shiftwork.  More information is at www.naturalsleepmedicine.net.

Lessen the Effects of Shiftwork

December 11, 2009

About 20% of Americans do shiftwork, starting work either in the late afternoon or in the middle of the night.  Their health suffers, and their relationships can suffer too.  If you are on a shiftwork schedule, here are some strategies to manage the shiftwork lifestyle well.

- First, establish a wake / sleep schedule that you can maintain most days of the week.  Try to have some of your sleep hours the same, regardless of whether it is a work day or day off.

- Shiftworkers typically get less sleep than those who work during the day.  Adjust your schedule to allow enough sleep time, close to 8 hours each night is probably needed.

- To help you sleep those hours, make your bedroom ideal for sleeping.  It needs to be cool, dark, relatively quiet, no pets, and no lit clocks.  If you are trying to sleep during the day this can take more effort, but it will be worth it.  Get blackout shades, or use an eyecover.  Keep a fan running softly or earplugs to keep it quiet.  Train your pets that you are not available during your sleep time.  Set the alarm to wake you up, and then ignore the time, allowing yourself to be ‘off duty.’

In our 24 hour society people will need to work at all hours.  With a thoughtful strategy working shifts can be easier.

At The Institute of Naturopathic Sleep Medicine, Dr. Darley provides care for people of all ages who have sleep problems. More at http://www.naturalsleepmedicine.net/

Shiftwork and Your Health

December 9, 2009

High numbers of people in America do shiftwork – 20% of those who are employed. One definition of shiftwork is starting work after 6pm, and before 6am. “Swing shift” which often starts around 3-4pm is also included in some definitions of shiftwork. Whichever definition you use, it is clear that the health of people who do shiftwork suffers.

Shiftworkers experience symptoms such as stomach upset, moodiness, high blood pressure and elevated stress hormones. In the long term these employees also have higher rates of breast and colon cancer in women, and prostate cancer in men.   These problems are thought to be due to the fact that shiftworkers are awake and engaged during a time that our body clock and circadian rhythm are programmed to be asleep.

Although these symptoms and conditions are concerning, it’s clear that some industries must work around the clock. Especially industries such as public safety, healthcare, and transportation. Fortunately there are ways in which the negative effects of shiftwork can be minimized. Check back on Friday for info on how to lessen these effects.

At The Institute of Naturopathic Sleep Medicine, Dr. Darley provides care for people of all ages who have sleep problems. More at http://www.naturalsleepmedicine.net/

Sleep and Cancer

October 12, 2009

In honor of October being Breast Cancer Awareness Month, let’s look at the connection between sleep and cancer. This is a complex issue, as getting poor sleep increases the risk of cancer, and sleep in cancer patients is disturbed. Let’s look at each situation more closely.

Poor Sleep Increases the Risk of Cancer
In the last ten years research has been done looking at the life-long sleep histories of breast cancer patients. It’s been found that being awake at night (usually for shift work) increases the risk of developing cancer. This is thought to be because the light suppresses melatonin, which is highest during the dark night. In turn, when melatonin is low estrogen levels are increased, thus increasing risk of breast cancer. Colo-rectal cancer is also increased in women who have done shift work for 15 years or more. In addition to melatonin, cortisol patterns are irregular when a person is not sleeping well. Cortisol is important for our immune system.

It’s not only shift workers who suffer increased risk of cancer. Among physically active women, those who sleep less than 7 hours per night have a 47% increased risk of cancer compared to those who sleep more.

Sleep in Cancer Patients is Disrupted
Cancer patients experience sleep problems at a high rate. About 30-50% have insomnia, which worsens with repeat courses of chemotherapy. They also experience irregular sleep-wake patterns.


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