COPING WITH SHIFT WORK

Several million Indians work a shift other than a regular day shift and must face the problems of sleeping during the day and being alert on the job at night. Working a schedule different from most of the world can be challenging, but following some simple guidelines may help make shift work easier to live with - and safer, too.

Two particular sleep-related problems are associated with the shift work: difficulty sleeping during the day, and difficulty staying alert and night. There is evidence that shift work can result in significant social and family problems, and in an increased incidence of illness. Shift workers most affected are those who work nights (generally between 11:00 p.m. and 7.00 a.m.), and those who rotate shifts.

The body's circadian rhythm is its alternating cycle of sleeping and waking. In healthy adults, sleep tends to occur during a particular phase of the circadian rhythm. Those who work the night shift must attempt to sleep when their bodies want to be awake, resulting in a contradictory relationship between sleep time and circadian rhythm.

Some researchers believe that complete adjustment to permanent irregular shifts may take as long as three years, and others believe the body never fully adjusts to an abnormal sleep/wake schedule. Whichever is true, night workers tend to be continually sleep-deprived. The average sleep cycle for a night shift worker sleeping during the day is two to four hours shorter than that of a day worker sleeping at night. Day sleep is light, fragmented, and more likely to be disrupted. Sleep deprivation and insomnia can be severe in shift workers.

Also, the sleep problems of shift workers are sometimes complicated by a sleep disorder (such as narcolepsy or sleep apnea) and/or a schedule that does not allow for sufficient sleep. A visit to a healthcare provider is required if you suspect you may have a sleep disorder.

Consequences of circadian rhythm disorder
The circadian rhythm affects job performance, since people are generally sleepiest between 2:00 and 5:00 a.m., even after years of working nights. Numerous laboratory studies, as well as field studies, demonstrate that sleepiness affects an individual's performance, memory, intellectual capacity, motor coordination, and mood.

Example abound of serious accidents that appear to be secondary to insufficient sleep and consequent sleepiness among night workers: the Three Mile Island nuclear power plant incident and the Exxon Valdez grounding are among these. The cost of sleep-related accidents to society is enormous. The consequences of shift work are clearly not trivial.

Shift workers must also cope with the social problems that result from working while the rest of the world is in bed, and sleeping while the rest of the world is at work or engaged in leisure activities. Many night workers complain that they don't have enough time to spend with family and friends, to relax, make appointments, run errands, and so on. Since most activities are planned according to the schedule of a typical day worker, a shift worker may feel alienated and frustrated by the differences between his or her personal schedule and that of the rest of the world.

Treatment Strategies
A variety of treatment strategies are necessary because work settings vary considerably, and the ideal strategy for workers in a hospital, for example, may not be desirable for workers on an assembly line. Also, some people are better suited to shift work than others. "Night people" adjust to the night shift better than "morning people". Older workers on the whole find it increasingly difficult to work nights and rotating shifts. Several strategies appear to benefit the problems of shift work; the approach likely to be most helpful depends upon the individual worker and the circumstances.

Work Schedules
A work schedule that allows employees to sleep when they are off duty and be alert when on duty is ideal. The best distribution of schedules for shift work operations varies by industry and by job within an industry.

Work scheduling changes that accommodate the circadian rhythm by rotating clockwise from day to evening to night - are helpful. Studies have shown that changes in the work schedule that consider circadian factors are likely to lead workers to be more productive and feel more satisfied, and to reduce accidents. An ideal schedule in a particular situation must be individually determined.

Breaks schedule during work may enhance alertness
Breaks scheduled during work hours may enhance alertness. There is some evidence that brief rest periods in certain types of jobs may reduce fatigue without reducing output; in fact, breaks may actually increase productivity and worker satisfaction. Employers are encouraged to investigate scheduling changes that may benefit employees and productivity.

Sleep Schedules
Permanent night workers should maintain a regular (day) sleep schedule seven days a week, even on days off work. Reverting to a typical day schedule during time off will simply make it harder to sleep during the day after returning to work.

Those who rotate shifts can adjust sleep schedules so that they will be able to adapt more easily to the new shift. On the last few days of the evening shift, for example, bedtimes and arise times should be delayed one to two hours. Workers can then begin their stint on the night shift already well on the way to being adapted to the new schedule. Family and social considerations, of course, may make it difficult or impossible to follow these suggestions to delay sleep. Returning to a normal day/night schedule on days off can lose any advantage gained by using this technique.

Workers who are subject to on-call shifts will recognize that their sleep problems are somewhat different from those of night and rotating shift workers. Because on-call workers usually can't predict work schedules far enough in advance to plan an appropriate sleep/wake schedule, they should try to be well rested at all times. They may find naps helpful.

Although there is some evidence that sleep obtained in a single stretch is preferable to the same amount of sleep obtained in several segments, shift workers who can't maintain their sleep during the day may increase the overall number of hours they sleep by napping. Napping can benefit shift workers in terms of both the sleep problems and the performance difficulties associated with their schedules. Brief naps taken during a work shift may only temporarily enhance alertness, since performance can be hindered briefly as a result of sleep inertia. Sleep inertia is the body's tendency to want to remain at rest for 15 minutes to an hour after awakening. The effects of sleep inertia on the employee's responsibilities must be considered, especially if there is a need to wake up quickly and react immediately to a job situation.

Naps taken off-shift at an appropriate point in a worker's circadian rhythm can help offset the sleep loss associated with poor daytime sleep. While naps are not a substitute for a regular schedule of adequate sleep, they can help people who are sleep-deprived reduce their sleep debt and improve alertness, at least temporarily.

Prescription Medication
Shift workers to override the circadian rhythm in order to induce sleep, often use ‘Sleeping tablets’. There are disadvantages to using these medications, including side effects in some individuals. The long-term use of medication should be avoided because its effectiveness wears off over time and dependency on the drug may develop. Most important, however, is the evidence that improving daytime sleep with the use of hypnotics only marginally improves alertness and performance on the subsequent night shift. Although sleeping pills may provide relief, and may be appropriate in conjunction with other measures, they do not address the actual cause of the shift worker's sleep difficulties, since sleeping pills cannot reset the internal clock. If you think you may benefit from taking a sleeping pill occasionally, talk with your doctor.

Stimulants
Research has shown that the occasional use of stimulants such as caffeine, can significantly reduce sleepiness and improve your ability to be alert on the night shift. However, caffeine should be avoided within four hours of the desired bedtime since it can cause insomnia.

Melatonin
Our brain's natural production of melatonin also has a circadian rhythm that appears to affect our sleep/wake cycle. Melatonin is a chemical produced by the pineal gland in the brain at night during sleep. Research has recently begun to investigate the possibility that giving a synthetic form of melatonin to night workers in the morning may help shift their circadian rhythms so they can during the day and be alert at night.

Bright light therapy
There is some evidence that timed exposure to bright light can help adjust the sleep cycle quickly. Just as the sun helps set the body's clock, exposure to bright light may actually have the effect of shifting the circadian phase, reversing the sleep/wake schedule of night shift workers so that they are able to sleep during the day and be alert on the job at night. It is important to discuss the proper timing of light exposure with your doctor. Along the same lines, workers should wear sunglasses on the trip home from the night shift in order to minimize the effect of sunlight on their body clocks.

Sleep hygiene
All shift workers can benefit by following the guidelines of good sleep hygiene, especially the need to sleep in a dark, quiet room. Proper sleep hygiene requires using the bedroom only for sleep and sexual activity (nor for watching TV or balancing the checkbook), keeping the room temperature cool land comfortable, relaxing before falling asleep, and having a regular routine for bed preparations, such as brushing teeth, putting on pajamas, and so on. It may also be helpful to buy dark curtains for the bedroom windows and also block out external noise as best as possible. Turning off the phone (yes, that includes your cell phone which is usually on 24 X 7) and disconnecting the doorbell or putting up a "Do not disturb" sign can also help.

Workplace conditions
Lighting levels, temperature, and job responsibilities in the workplace are among the factors likely to play a role in the alertness levels of shift workers. The workplace should be cool rather than warm, and should be bright to promote worker alertness. Employers should be sure that night workers have plenty of affricated beverages available, and that they can choose foods other than those typically available form vending machines. The setup of the workplace will determine how best to control these factors to promote alertness on the job. In general employers and employees should education themselves about the effects of shift work in their workplace and should encourage safety and efficiency.

Other measures
Diet may also play a role in good sleep; shift workers should eat meals that are high in protein and carbohydrates, and should avoid fried or hard - to - digest foods. It is not advisable for a shift worker (or anyone else) to go to bed when hungry or immediately after eating a large meal.

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