Sleep has a significant impact on a person’s health, well-being and coping at work. Shift workers have been found to have more sleep disturbances than those who do regular working hours.
The importance of sleep for wellbeing
The effect of sleep on wellbeing is recognized but often underestimated. Sleep has the function of restoring and revitalizing the functioning of the brain and thus the whole body. During sleep, the brain’s energy stores are replenished, data processing and memory functions are strengthened, and cell damage is repaired. Regular night sleep is essential for normal brain function, as sleep maintains the brain’s ability to learn, sleep keeps memory recordings in order, organizes and preserves them, and ensures that recordings are available when needed.
The importance of sleep for well-being can also be viewed from the perspective of the effects of sleep deprivation. Sleep deprivation refers to the amount of sleep that is missing from a sufficient amount of sleep. Sleep deprivation can occur during one night or over a longer period of time. The sleep deprivation of parents of young children often develops gradually. Sleep deprivation also reduces the secretion of thyrotropin, a thyroid hormone that affects the way your metabolism works. Sleep deprivation also increases the amount of cortisol, a stress hormone. Sugar tolerance also decreases with lack of sleep. Staying up all night also increases appetite and often the person who’s been awake all night wants to eat sugary and fatty foods. Prolonged inadequate sleep can predispose the body to various diseases such as type 2 diabetes, heart attack and abdominal obesity.
A project led by a doctor of psychology examined how a week-long sleep deficit affects functions and how long it takes to recover from a sleep deprivation. A sleep deficit lasting a full working week is a probable risk to occupational safety and health. Cumulative sleep deprivation predisposes to cardiovascular disease, and the study found that a recovery period of a couple of days is not enough to correct the situation to normal. In working life, a short night’s sleep may occur as a difficulty in learning how to use new tools if they require motor skills.
Fatigue affects a person’s ability to receive, process, and produce information. As fatigue increases, it is common for mental performance to become variable: the level of performance may suddenly decline and return momentarily to near normal. Maintaining attention becomes more difficult, which in turn causes challenges in brain information processing, such as slowing of reasoning and memory problems.
Shift work affects sleep
Many animals, such as bats and owls, have adapted to be awake at night. However, human is a day animal and therefore humans are clearly better suited to work during the day and sleep at night. According to a 2002 survey, a quarter of employed people worked shifts, a third of whom also worked at night.
Doing shift work shortens normal sleep and thus accumulates sleep deprivation. Almost all shift workers sometimes experience short-term insomnia. As many as 25% of three-shift workers constantly feel sleepy or tired. In the healthcare sector, in a typical shift work, there are three shifts in the system: morning, evening and night. About 50% of shift workers experience poor sleep quality. Sleep disorders are also most common in regular shift work than in day work.
The efficient and appropriate organization of activities must be taken into account when planning shifts. Periodic working hours are often used in the health care sector. Periodic working hours allow for flexible shift planning, as well as working time arrangements and overtime compensation that deviate from the general rule. Good shift planning develops operations that are balanced and support the well-being and resilience of the staff.
What is Ergonomic Shift Planning?
In terms of working time ergonomics, the concept of shift work can be broadly understood: A fixed shift system of about eight hours, where most of the working hours are done outside 8.00 and 17.00, for example, two-shift work, three-shift work or regular evening or night work. Many shift workers find the current shift arrangements, especially coming from evening to morning and individual day offs strained. At their best, good work time solutions support the well-being of staff and the functioning of the work community.
Ergonomic shift planning and through this the ability of the staff to influence their own shifts also increase the well-being of the staff. Ergonomic shift planning is a recommended shift planning model in health care. It is as favorable as possible for the employee’s health, ability to function and wellbeing.
Ergonomic shift planning should take into account:
- fast forward system (morning-evening-night-free)
- 8-10 hour shifts
- 10 to 12 hours free between shifts
- no more than 5 to 7 consecutive working days
- as few consecutive morning shifts as possible (maximum three)
- as few consecutive evening shifts as possible (maximum three)
- as few consecutive night shifts as possible, preferably 1 to 3
- coherent periods of leave, individual day offs should be avoided.
According to the experience of the employees involved in one development and research project, ergonomic working time arrangements improved endurance and alertness, reduced sleep disturbances, increased well-being at work and leisure, and the work was felt to be physically lighter.
A study completed in 2015 examined the effect of work stress on nurses ’sleep. In the study, the effect of stress was evident in the awkward shift combinations of nurses. Nurses still have many consecutive morning-evening combinations. The shift ends at 10 pm to 11 pm in the evening, and the next shift starts at 7 am to 8 am. Stressed people had more difficulty falling asleep after the evening shift, as it was more difficult for them to reset the previous shift.
What is Autonomous Shift Planning?
Autonomous Shift Planning refers to the community practice of shift planning, where each employee plans his or her own shifts within the framework of common rules, in collaboration with other employees. In working time autonomy, employees and the work community have autonomy in shift planning, although employment contracts and organizational activities set limits to independent shift planning. Autonomous working time planning does not change entry times to work, nor the length of working hours.
Planning your own shifts makes it easier to combine work and private life. The goal is for each employee to be able to plan shifts that serve their own life situation, if possible. In strenuous shift work, this has been found to improve coping at work. In addition to jointly agreed rules, working time autonomy requires knowledge of the principles of ergonomic shift planning, knowledge and understanding of how working hours in shift work affect employee well-being, employee responsibility and the identification of one’s own working time needs.
How does shift work affect sleep?
In different shifts, the sleep-wake rhythm changes in different ways. Early morning shifts that begin before seven o’clock require that the sleep-wake rhythm be brought forward. It is easier for more people to delay than to advance their sleep-wake rhythm. Before going to bed early in the morning, there may be a lot of pressure to fall asleep quickly, to get enough sleep. This predisposes to difficulty falling asleep and intermittent sleep. Many feel tired after waking up and at the beginning of a shift.
Evening shifts are usually easiest to adjust to. Sleeping after evening shifts is pretty good quality. However, in the case of late evening shifts, the sleep rhythm is clearly delayed, as time is needed to calm down after the shift and thus sleep is delayed.
Night shifts are defined as work in which at least three hours take place at night between 11 pm and 6 am. As a result of the night shift, the sleep-wake rhythm is clearly delayed. During successive night shifts, the body’s adaptation to night rhythms is desirable. Night rhythm means sleeping during the day and being awake at night. Adaptation is difficult in practice because sunlight tends to synchronize the night worker back to the day rhythm. In continuous night work, the problem is usually the free period after night shifts. In this case, the employee usually returns to the day rhythm, which in turn slows down the return to the night work rhythm.
From the point of view of the adjustment of the sleep-wake rhythm, it would be best to stay at least partially in the night rhythm on holidays. The day-oriented circadian rhythm of society and the surrounding area also does not promote adaptation to night shifts.
How does shift work affect social life?
Different working hours have advantages and also disadvantages. The irregular rhythm of life revolving around evening and night work is in conflict with the day-oriented rhythm of family and society. Irregular working hours, in which shifts are known only for a short period ahead, make it difficult to combine work and other life. Periodic work in the health care sector complicates, for example, hobbies and meeting friends as a regular shift system, where, for example, one week is done in the morning and the next week in the evening.
One of the biggest challenges in shift work is how to combine work and family life, and the difficulties in these areas of life are linked to declining job satisfaction and a less happy relationship. A shift worker is well when, for example, a spouse, children and friends are positive about shift work and provide social support. Likewise, the support of the supervisor is important.
What are the health effects of shift work?
The health disadvantages associated with shift work have been extensively studied, and on average, long-term shift work is to some extent a health risk. The suitability of shift work is personal and for some shift work is well suited without significant health hazards. Common disadvantages of shift work include fatigue, difficulty falling asleep, intermittent sleep, and short daily sleep, especially after night shifts. The level of alertness in all people is at its lowest in the morning hours, and in connection with this, the number of accidents, various errors and traffic accidents is clearly higher in the morning hours compared to day work.
In shift work, a night worker in particular may experience functional symptoms of the digestive system, such as abdominal pain, heartburn, and flatulence. This is because the digestive system follows a regular circadian rhythm. This occurs itself in such a way that at night the function of the smooth muscles of the intestinal wall slows down and the secretion of digestive enzymes in the intestine decreases and the absorption of food becomes more difficult. Due to the disturbance of the circadian rhythm and the stress associated with night work, up to 20–70% of shift workers who work at night often or continuously have various of the above-mentioned gastrointestinal symptoms.
It has also been studied that shift work is one of the risk factors for coronary heart disease. Shift work increases the risk of coronary heart disease in both men and women by about 40%. It is estimated that 7% of coronary heart disease is due to shift work. In particular, smoking and being overweight are more common in some shift work communities than in day work. Due to coronary heart disease, health surveillance of shift workers over the age of 45 should be accompanied by monitoring of risk factors for coronary heart disease.
Shift work has also been found to cause some reproductive health problems for women. Menstrual disorders have been described in some studies by women in shift work more than by women in day work, and fertility has also been described as declining. Pregnant women who work at night have also been found to have more miscarriages. Newborn children of women who work regularly at night during pregnancy are also more likely to be underweight and are born before the calculated time. Women who work at night also increase their risk of breast cancer by more than three times that of day workers. The danger appears to be related to night light exposure. Night work prevents the secretion of dark hormone, which is linked to female sex hormones and thus to some hormone-sensitive cancers.
Studies also show that shift workers also have more diverse psychosomatic symptoms than day workers, such as chronic fatigue, depression, and nervousness. This, in turn, can lead to an increased risk of developing severe psychiatric illnesses, such as depression.
Older shift workers have more permanent health problems than day workers. Among other things, the incidence of clinical sleep disorders, sleep apnea, and respiratory disorders increases with age. These diseases greatly complicate the sleep-wake disorder caused by shift work. With age, the ability to adapt to night work decreases and the risk of long-term illnesses such as heart disease increases.
What is shift worker’s sleep maintenance?
Sleep maintenance refers to what you can do yourself to fall asleep and have a good night’s sleep. Trying and finding a suitable way to fall asleep and take care of your sleep is worthwhile. Sleep maintenance is often part of overall treatment, with little information on its effectiveness alone.
Sleep maintenance aims to support the basic conditions for falling asleep and staying asleep. Its key mechanisms are regularization of sleep rhythm, adequate recovery, calm and relaxation, and lifestyles and sleeping conditions that support sleep and the vibrancy it brings. In addition, sleep maintenance supports good bed-sleep association.
This means that bedtime and related activities, as well as the bedroom and bed, are conditioned to sleep and thus help with falling asleep. Any activity that increases alertness, such as work and, for example, worries related to sleep, is detrimental to the association. The bed is for sleeping and sex only.
What are good sleeping conditions?
Good sleeping conditions promote sleep. The sleeping environment should be as calm as possible. A person suffering from ambient noise can benefit from the use of earplugs, can also try sleeping between two pillows so that the pillows attenuate ambient sounds. Soothing music or listening to a relaxation CD can also effectively remove the sounds of the environment.
It has been found that when the room temperature is too warm, sleep is more intermittent, the amounts of REM sleep and deep sleep are lower and there is more movement during the night, while sleeping in a cool state promotes good sleep. A suitably darkened room promotes good sleep, the room can be darkened with blackout curtains or eye patches can be worn during the daylight hours.
How to prepare for the night shift?
Night shift workers try to delay their rhythm in advance by sleeping as long as possible the morning before the shift. Some also take a nap before the start of the first night shift. Despite these means, drowsiness is often most intense during the first night shift and especially in the morning. People usually go to sleep about an hour after the end of the work shift.
After the night shift, one should go to sleep as soon as possible after the end of the shift. When making consecutive night shifts, you should avoid exposure to morning light at the end of the night shift and after, as the light signals to the biological central clock that it’s daytime and this prevents the rhythm from shifting. A good way to avoid morning light is to wear sunglasses on sunny post-night shift mornings. After the last night shift, you should not sleep too long for the recovery to begin.
You should not go to bed until you are sleepy
Everyone has a typical time when it’s best to fall asleep. As a result of various factors, falling asleep may be more difficult than usual at some times. For example, after an evening shift, there may be pressure to fall asleep as quickly as possible, especially if you have to go back to work the next morning. However, if you go to bed too early, falling asleep is often delayed or sleep becomes intermittent because not enough sleep pressure has accumulated and trying to sleep increases your level of alertness. Fatigue alone does not always mean that you can still fall asleep, and that is why it is important to learn to recognize how drowsiness feels in your own body.
When going to bed, it is advisable to avoid trying to fall asleep, as it raises the level of alertness and again makes it harder to actually fall asleep. So if you don’t fall asleep, it’s good to do something that shifts the focus away from trying. For some, a short moment of reading helps, for some relaxation, but if these don’t help, it’s better to get out of bed and only return when you’re sleepy again.
Good nutrition is important for sleep
In shift work, the right kind of eating is crucial, as there is a risk of gaining weight in shift work. Nutrition has a significant impact on the prevention of diseases that cause premature disability. Despite an irregular sleep rhythm or poor sleep, a regular eating rhythm should be followed. Often, following a regular meal rhythm is a challenge for a shift worker. Moderately sized meals and snacks rhythm the day and maintain alertness as well as attentiveness. The shift employee’s diet should be varied and colorful as well as heart-friendly. It is important to eat accordingly and adequately. Heavy meals are tiring and when tired, occupational safety is also compromised. Too little eating at night may affect the quality of sleep in the main sleep period after the night shift, if a night shift wakes up due to a feeling of hunger, you may want to eat a little more before going to bed. After the night shift, you should eat a light snack before going to bed. In addition, you can book a small snack on the bedside table if you happen to wake up too early.
Adequate intake of fluids must also be ensured. Drinking cold drinks or sucking on a piece of ice, as well as eating lightly, may help fight fatigue. After the night shift, just before going to bed, drinking should be reduced so that the sleep period is not interrupted by going to the toilet. Caffeinated beverages such as coffee, tea, cocoa, and cola should be avoided after the early evening and night shifts, as this can significantly affect sleep quality and length due to their invigorating effect.
What to eat at night shift?
One licensed nutritionist states that it is a good idea to eat meals or snacks regularly every 3-4 hours during shifts. At night, instead, you should eat lighter, but still enough. It is advisable to prefer high-fiber bread as the bread, but the night worker can also choose white bread, if at rye bread causes more stomach upset. During the night shift, raw vegetables can cause stomach upset. Vegetables should be made into vegetable puree soup. Dairy products should be chosen low-fat and cheeses should be selected with a maximum fat content of 17%.
How do intoxicants affect sleep?
It has been found that smokers have significantly more difficulty falling asleep and staying asleep than non-smokers. Nicotine acts on the acetylcholine system in the central nerve through nicotinic receptors, momentarily increasing the concentrations of several neurotransmitters. Activation of the receptors releases, among other things, the pleasure hormone dopamine, which, together with the other effects of nicotine, feels refreshing and pleasurable. However, the pleasure produced by tobacco is very short-lived, as the receptors begin to return to baseline quite quickly after smoking, while inhibiting the functioning of the pleasure pathway.
In the long run, quitting smoking improves sleep so that falling asleep is faster and nocturnal awakening are reduced. However, during withdrawal symptoms, most suffer from sleep difficulties and, for example, some users of nicotine patches may also experience nightmares, at least initially. If smoking cannot be stopped, it would be important to try to reduce smoking before going to bed and to stop any smoking at night, because then sleep will be more intermittent.
Alcohol activates the GABA cannabisnoid and opiate systems in the central nervous system. In some cases, alcohol can even be invigorating in small amounts, but most commonly a small dose in the evening can speed up sleep. The amount of NREM sleep increases and the amount of REM sleep decreases in the first hours of the night. However, especially with more alcohol, when alcohol is removed from the body, sleep may become superficial and the amount of REM sleep may increase, leading to nightmares and visions. Prolonged and heavy alcohol consumption reduces the quality of sleep, which prolongs the sleep delay, shortens the total duration of sleep and reduces REM sleep. Alcohol relaxes the muscles of the upper respiratory tract and pharynx, and even in relatively small amounts, alcohol may aggravate or cause respiratory failure, especially in people with sleep apnea. The use of alcohol as a sleeping pill should be avoided. The help it provides is illusory and can only exacerbate a possible cycle of insomnia.
Exercise is part of shift work sleep maintenance
Regular exercise is a natural way to improve a shift worker’s sleep, as it prolongs sleep duration and improves its quality. Exercise also makes it easier to maintain alertness and performance during night shifts. Exercise is also known to have a relaxing effect on the mind. Exercising improves self-esteem, and reduces depression, for example, and is an effective treatment for stress and mild depression. The positive effect of exercise on sleep is explained by its mood-enhancing mechanisms.
Exercise should be scheduled 2 to 4 hours before bedtime so that there is enough time to calm down. Heavy exercise should be avoided in the last hours of the evening, instead stretching and leisurely walking are suitable for later times as well.
Here are some general and shift work-related guidelines for exercising:
- Do moderate exercise (eg walking, jogging, swimming, gymnastics) 2-5 times a week for 20-60 minutes at a time.
- Whenever possible, engage in exercise activities such as commuting and walking up stairs.
- Avoid heavy exercise for less than 2 hours before bedtime.
- Preferably move immediately after morning and day shifts.
- Avoid exercising just before the evening shift.
- If you exercise between night shifts, take a short nap before the next night shift begins.
A worry moment in support of stress management
Stress and mental strain are common symptoms in shift workers. When the rhythm of life has to be changed due to working hours, fatigue and stress symptoms such as irritability, nervousness and tension follow. The difficulty of social life hinders a person’s activities as a whole. Mental wellbeing is also affected by how stress is responded to and what coping methods are used. It is therefore recommended that the employee seek social support for stress. Chatting with friends, family, and co-workers relieves stress, while withdrawing increases it. Mutual support from co-workers is invaluable because they know the working conditions and can share their experiences as well as concrete help.
Supervisors can also be an important source of support. Supervisors and co-workers help to cope with stress, especially when they encourage each other, and workplace collaboration is otherwise flexible and efficient. Joint planning of work and work practices and the opportunity for employees to participate in decision-making are one way of developing the work community and, at the same time, mutual interaction.
Sleeping can be disturbed by various worries and problems. For example, some work in progress and conflict situations in the workplace can revolve in the evening and at night, making it difficult to fall asleep. When tired, often nasty things come to mind and take on more meaning than reality and can be difficult to resolve. A moment of worry has proved to be a good way to calm the mind and treat insomnia. It is a good idea to start calming down at least two hours before going to bed. Any kind of physical, mental and social doing raises the level of alertness and delays falling asleep.
It’s good to reserve 15-60 minutes a day for a worry moment. It is a good idea to write down a concern or problem in your mind on paper. After that, you may start to think, among other things, why worry is important? Is there anything that can be done about it? Who could be asked for help? If, despite a moment of worry, worries return to bed or at night in the middle of a dream, it is a good idea to remind yourself that things have been dealt with in a moment of worry. If new thoughts or thoughts that require processing come to mind after a moment of concern, you should write them down and deal with them the next day in a moment of concern.