COPING WITH SHIFTWORK

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• COPINGWITHSHIFTWORK
• Neil Lewis
• Business Support Manager
• LINPAC Packaging

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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?

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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

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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

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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

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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

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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

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WHY DO WE HAVE PROBLEMS WORKING SHIFTS?
Your body is conditioned to be awake during the
day and asleep at night
(Suprachiasmatic Nucleus)
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NORMAL CIRCADIAN RHYTHMS WRONG?

• What are circadian rhythms?
• Definition Circa around
• Dies day
• Around daily rhythms of your body clock, for
  example
• TEMPERATURE

Whether we are awake or asleep, body functions
continue to follow their circadian rhythms
Other examples include growth hormone, cortisol,
urination
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CIRCADIAN PROFILE OF HUMAN ALERTNESS VERSUS TIME
OF DAY
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CIRCADIAN PROFILE OF HUMAN ALERTNESS WITH
SUSTAINED WAKEFULNESS
AlertnessLevel(MSLT)
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FACTORS DETERMINING SHIFT WORKER ALERTNESS

• Time of day (phase of circadian rhythm)
• Circadian profile (morning or evening type)
• Hours since last consolidated sleep
• Duration of last consolidated sleep
• Quality of last consolidated sleep
• Cumulative sleep deprivation
• Stimulation/monotony of job task
• Stimulation/monotony of job environment

• Day of shift
• Consecutive hours on duty
• Consecutive shifts on duty
• Amount of overtime
• Speed or frequency of shift changes
• Content and timing of last meal
• Ingested stimulants or depressants
• Age of shift worker
• Physical inactivity

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WHY DO SHIFT WORKERS HAVE SLEEP PROBLEMS?

• 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

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SHIFT WORKERS MOST COMMON SLEEP DIFFICULTIES

• 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

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HOW TO COPE WITH SHIFTS
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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

• 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

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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
• Dont 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

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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

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NAPPING - THE KEY TO ALERTNESS
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
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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.

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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

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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

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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

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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

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• 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 - Cant get
  to sleep - Shorter sleep period - Lower
  sleep quality - Frequent awakenings

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• 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

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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
• Dont 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

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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

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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)

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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

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FAMILY AND SOCIAL ISSUES

• Improving Communication
• Keep expectations realistic
• Be specific about your feelings
• Dont suppress emotions
• Compromise on differences
• Be sure spouse, partner, family and friends
  understand your shift work schedule

• Planning Ahead
• 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

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CONCLUSION

• Circadian rhythms have been considered for our
  shift patternBUTIts only half the battle . . .

ITS NOWDOWN TOYOU
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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

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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/r
  rpdf/rr132.pdf)
• Watch this space for more research!

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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
  Moore-Ede
• HSG 256 Managing Shift Work available from HSE
  books

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Thanks for listening and any questions