Occupational Health Clinics for Ontario Workers Inc

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Shiftwork

• Implications for Your Health As Well As Your Work
  life
• Municipal Health Safety Association
• October 27, 2008
• Michelle Tew Steve Macdonald
• Occupational Health Nurse Ergonomist

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Occupational Health Clinics for Ontario Workers
(OHCOW)

• an inter-disciplinary occupational health team
• occupational physicians
• occupational health nurses
• ergonomists
• occupational hygienists
• occupational health coordinators
• administrative staff
• funded by WSIB Prevention Services

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Occupational Health Clinics for Ontario Workers
Inc.
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What OHCOW does

• Medical
• symptoms
• tests results
• physical exam
• diagnosis

• Exposure
• to what
• how much
• how long
• toxicology

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Clinic Services

• individual client (clinical)
• answer questions (work/health related)
• educational presentations outreach
• workplace visits
• requested by co-chairs of JHSC
• exposure/health investigations/research
• medical/hygiene/ergonomic combined

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Shiftwork - Overview

• Background
• Biological clocks
• Health effects
• Coping strategies
• individual
• family
• workplace

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• Shiftwork is more than a work schedule - it is a
  way of life. When our schedules change, our
  entire life changes. It impacts on us as
  individuals, our family, our social life as well
  as our health.

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Why do we work shifts?

• Good pay
• Educational opportunities
• Seeing children during daylight
• Savings in childcare expenses
• Moonlighting
• More time for leisure activities
• Providing vital services

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What is Shiftwork? Regularly outside 7 am - 6
pm

• 25 of workers in Ontario work shifts - 3
  million Canadians

Weekends
Night shifts
Shift Work
Overtime
Compressed work week ( 10/12 hr shifts)
Split shifts
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Factors Affecting Adaptation to
Shiftwork(External)
Shift Schedule
Psycho-social Factors
Rotational Schedule
Nutrition
Smoking
Caffeine
Individual Motivation for Shiftwork
Political Factors
Environment
Job Requirements
Shiftwork Like Clockwork
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Factors Affecting Adaptation to
Shiftwork(Internal)
Circadian Rhythms
Age
Sex
Morning/Night Person
Previous Shiftwork Experience
Health Status
Contentment with Job
Fitness Level
Shiftwork Like Clockwork
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Chronobiology - Circadian rhythms

• We are a day oriented species
• The diurnal rhythm (internal clock) governs our
  sleep wake cycle as well as all other body
  functions
• temperature, BP, Heart rate, alertness, GI
  secretions, hormone levels, urine output etc.
• synchronize metabolism with behavioral demands
  and external time cues

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When we sleep .

• Body temperature declines
• Heart rate and blood pressure ?
• Hormones for tissue restoration increase
• Hormones that maintain wakefulness decrease
• Kidney bowel function are suppressed
• Brain activity changes

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1000 1400 1800 2200 0200
0600 1000 1400
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• Body uses cues from its processes and from the
  environment (e.g. clock time, social activities,
  light/dark cycle, meal times) to keep various
  rhythms on track
• Some rhythms adapt in 2 - 3 days - others longer
• People adapt at different rates

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Sleep patterns

• Brain does not rest when sleeping -
• Two types of sleep - NREM - 4 stages - first two
  are light - 3 4 delta sleep (physical
  recuperation)
• REM - brain waves identical to wake state -
  psychological well being

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Perceptions of sleep quality (National Sleep
Foundation Poll(USA 2001)

• 69 Americans feel they have frequent sleeping
  problems
• having children, medical conditions, being a
  caregiver, marital disharmony are associated with
  poor sleep
• responders feel the situation is worsening
• 33 of adults sleep lt 6.5 hrs
• 33 of young adults have daytime sleepiness

www.sleepfoundation.org
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Health Effects of Shiftwork
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Chronic sleep problems (60-80)
Less access to good food
Headaches ? respiratory infections Stomach
disorders X 5 Muscle pain Mood swings
Depression 5-15 Xs more likely
Chronic fatigue
Poor eating habits
Social isolation
? Caffeine
? Family tension
? performance ? alertness productivity
stress
Job Dissatisfaction
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Further Effects of Shiftwork

• ? alcohol drug abuse
• ? rate of industrial accidents
• ? motor vehicle accidents
• ? rates of divorce spousal abuse
• ? cardiovascular disease
• IARC has just classified shiftwork that involves
  circadian disruption as a 2A carcinogen (probably
  carcinogenic to humans)

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December 5, 2007

• Nearly 1.3 million Ontarians fell asleep or
  nodded off while driving at least once in the
  past year.
• Of these drivers, more than 100,000 did so on
  five or more occasions ? 5.5 million trips
• May be as many as 167,000 Ontario drivers
  involved in a fatigued or drowsy driving
  collision in past year
• Over a half-million fatigued and drowsy driving
  trips occurred in which the driver had to brake
  or steer to avoid a collision.
• Only 14.8 per cent of drivers used the most
  effective tactic - stopping to nap or sleep.
  Ironically, Ontarians also rated this tactic as
  one of the most effective.
• Ontario drivers arent as worried about this
  traffic concern because they feel they can
  control it

Traffic Injury Research Foundation
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Women and Shiftwork

• 60 increase in heart disease
• sleep disturbances at increased rate
• increased use of tranquilizers sleeping meds
• ? menstrual cycle problems
• ? risk for miscarriage, prematurity low birth
  rate

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1996/97 Ontario Health Survey data (n14,347)

• Shiftworkers differed significantly from day
  workers in 7 health related outcomes
• smoking, use of pain relievers, weight status,
  back problems, bronchitis, depression injury
  limiting normal activity

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Comparison of three shift patterns with day
workers (1996/97 Ont Health Survey data contd)
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Comparison of four work sectors (1996/97 Ontario
Health Survey data contd)
positive health finding -ve negative health
finding
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Coping with Shiftwork

• Strategies to Improve Adaptation for
• Individual
• Families
• Workplace

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Strategies for the individual

• Good sleep/ bed habits
• Nutrition
• Personal fitness
• Good health habits

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Develop Good Sleep Habits

• Acknowledge that you require a certain amount of
  sleep - Respect your bedtime
• Develop regular sleep habits

• How much sleep do you need?
• gt 9 hrs associated with adverse outcomes and no
  increased sense of well being
• lt 7 hrs associated with adverse outcomes

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Getting ready for bed - suggestions for your
routine

• Keep room cool
• relax
• avoid stimulants depressants
• no caffeine for 4 hours before
• no alcohol
• no sleeping medication
• nicotine is a stimulant

• Go to bed early
• Get cooperation from family friends
• Keep sleep area as dark as possible
• White noise
• Minimize disturbances (disconnect phone, ear
  plugs)

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Night Workers

• Greatest challenge as work is during lowest part
  of circadian rhythm
• get as much sleep as possible
• sleep in morning - sleep is longer/better
• supplement with evening nap
• try to keep job as varied as possible

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Sleeping in the am (after nightshift)

• Disadvantages
• not enough wind down time
• morning family commitments
• breaks normal pattern of work ?personal time
  ?sleep

• Advantages
• possible to avoid daylight
• likely to sleep longer
• will be awake in afternoon evening

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Sleeping in the pm (after nightshift)

• Advantages
• fresh well rested for work
• easier transition to sleeping all night on days
  off
• easier to make this a normal sleep pattern

• Disadvantages
• early evening is one of the natural alert times
  dictated by the body clock
• family social demands are highest

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Personal Fitness mind body

• Physical (body)
• ? heart rate
• ? blood pressure
• burn fat, calories -
• weight control
• ? cholesterol

• strengthen bones muscles
• Improve circulation
• ? constipation
• contributes to mind fitness

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Personal Fitness mind body

• Well publicized connection between physical
  fitness and physical health effects
• Mind Fitness
• ? stress
• ? self esteem
• ? urge to smoke, drink or take drugs
• improved sense of well being

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Shift strategies to minimize fatigue

• Strategic naps
• Before new night shift
• At time of maximum expected fatigue
• 15-20 minutes 200mg caffeine gives good results
• Caffeine - limited as above
• Brightly light environments to facilitate phase
  changes

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Nutrition
Good eating habits contribute to general wellbeing
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Nutrition - Healthy Eating

• Eat regularly - at least three meals
• Do not go more than five hours without eating
• If working nights have at least one meal during
  the first half of shift
• Evening workers -meal at beginning second half of
  shift

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Healthy Eating - other tidbits

• During second half of shift - reduce fluids,
  avoid caffeine
• Eat as soon as wake up
• Eat small healthy snacks

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About caffeine ...
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Healthy Eating - To stay alert

• Protein can help to make you more alert - start
  day with high protein foods and gradually shift
  to carbohydrates as bedtime approaches
• Eat high protein snacks if you become sleepy
  during your shift e.g. cheese, eggs.
• Drink caffeine-containing beverages only when you
  need to be alert

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Healthy Eating - To promote sleep

• No caffeine at least 4 hours before going to
  sleep
• avoid alcohol cigarettes before bedtime -
  reduces quality of sleep
• carbohydrates (grain products, cereals, fruits)
  can make you feel sleepy
• decrease fluid intake for several hours before
  bedtime so that sleep not interrupted going to
  bathroom

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Healthy Eating - To control stomach problems

• To reduce digestion problems
• eat food high in fibre (whole grains, fruits,
  vegetables)
• drink 6-8 glasses of water throughout early part
  of awake time

• To avoid heartburn
• eat smaller nutritious snacks
• avoid fried food, added fats, nuts, junk food
• avoid spicy foods, alcohol, coffee citrus
  juices

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Good health habits

• Take control of your health
• Be aware of how shiftwork (or other parts of
  life) are affecting you
• See your physician if having problems
• Especially important with known health problems
  e.g. diabetes, epilepsy, sleep disorders,
  hypertension, psychiatric illnesses. Medication
  effects are different at different times of day

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Good health habits contd

• Resist frenetic shift choices
• Resist working overtime
• Let go of things that do not matter

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Strategies for Families
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Strategies for families

• Educate whole family about shiftwork and ways to
  deal with it
• Involve family in planning around activities and
  sleep/quiet times
• Schedule at least one meal a day as a family
• Socialize with other shiftworkers and their
  families

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Strategies for families contd

• Share schedule with outside family friends
• Use multiple communication strategies - notes,
  calendars, email
• Acknowledge cooperation support

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Strategies for the Organization
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Shiftwork Friendly Workplace
Good lighting
Good ventilation/ temperature control
Parking security
Nap areas after night shift
Exercise facilities
Accessibility to healthy foods/ food prep
Access to health care counseling
Social opportunities shiftworkers
On site day care esp for shiftworkers
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Shift schedule design

• Is there a best shift schedule?
• No optimum shift design decided on
• Worker satisfaction and sense of control may be
  very important overall.
• The best shift system is the one which is best
  for the organization, production and the
  workforce. By design, therefore, there cannot be
  one system which is best for all.

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Comparison of work schedule designs
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Key principles in shiftwork schedule design

• Involve shiftworkers where possible in developing
  and choosing shift schedules
• Avoid permanent (fixed or non-rotating) night
  shift
• Keep consecutive night shifts to a minimum
• Avoid quick shift changes
• Plan some free weekends
• Avoid lots of days of work followed by 4-7 day
  mini-vacation
• Keep long shifts overtime to a minimum (or
  eliminate)

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Key principles in shiftwork schedule design contd

• Consider different lengths for shifts
• Examine start--end times
• Keep the schedule regular predictable
• Examine rest breaks
• Shifts rotating forward (days, afternoon, night)
  cause fewer problems than going the other
  direction
• Reduce or eliminate overtime

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Work design considerations.

• Organize workloads so that the toughest and most
  dangerous tasks are completed early in shift
• Avoid scheduling demanding or dangerous tasks at
  the beginning of early morning shift
• Adjust workload during shift to prevent boredom
• Break schedules that allow exercise social
  interactions
• Reduce chemical, physical, biological hazards -
  exposure limits are designed for 8 hour day
  must be adjusted for extended work shifts

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Beyond scheduling .

• Establish a no working alone policy
• Avoid isolating workers - regularly communicate
  with people who work in isolation
• Available health information - education
  regarding coping with shiftwork for worker
  their family

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What can you do?

• Take back control
• Delegate
• Negotiate
• Let go of the things that dont matter

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Resources (Internet)

• Occupational Health Clinics for Ontario Workers
  Handout on Shiftwork
• http//www.ohcow.on.ca/resources/handbooks/shiftwo
  rk/shiftwork.pdf
• Plain Language on Shiftwork Booklet with
  information on shiftwork impact and coping with
  working shiftwork. Printable at
  http//www.cdc.gov/niosh/pdfs/97-145.pdf
• Educational information on workplace hazards and
  prevention http//www.ohcow.on.ca/english/handboo
  k_mf.htm
• National Sleep Foundation www.sleepfoundation.or
  g
• A site for people who work at night general
  information and communication forum for night
  shift workers.
• http//www.workingnights.com
• Government of Saskatchewan Information on
  managing the impact of shift work.
  http//www.labour.gov.sk.ca/safe
• Canadian Center for Occupational Health and
  Safety Work schedules information
  http//www.ccohs.ca/oshanswers/work_schedules/
• Shiftwork information
• http//www.ccohs.ca/oshanswers/work_schedules/shif
  twrk.html
• http//www.ccohs.ca/headlines/text2.html

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Any questions ???
Contact Information mtew_at_ohcow.on.ca
smacdonald_at_ohcow.on.ca
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6 Questions to ask(re sleep problems)

• Do you snore loudly?
• Have you or others noticed gasping for breath
  during sleep?
• Do you feel sleepy or doze off during work,
  reading, driving or daily activities?
• Do you have difficulty sleeping 3 or more nights
  a week?
• Do you feel unpleasant tingling, creeping or
  restlessness in legs while trying to sleep?
• Do you have interruptions to your sleep.(Pain,
  heartburn,noise, family members, temperature)