Fatigue-Related Shift Work

By Karla Smith
St. Alexius Sleep Center Director

Fatigue Related Shift WorkMore than 22 million Americans work schedules that involve some type of shift work, including evening and night shifts, rotating shifts and on-call time. These types of shifts pose an interesting dilemma in regards to sleep quality and sleep quantity, which cause serious sleep-related accidents, putting not only the employee at risk but also their co-workers.  Some examples of fatigue-related problems that may put a patient at risk can include: lapses in attention and inability to stay focused, reduced motivation, irritability, diminished reaction time and indifference and loss of empathy. You can imagine that any these can put a person at serious risk for harm.

In order to understand what exactly is going on with shift workers, you must understand that everyone has a circadian rhythm. This means that we are all meant to be awake during daytime hours and sleep during night time hours. Shift workers are exactly the opposite, and this may be what causes inadequate sleep quality and quantity.

So, how can shift workers make their lives easier, assuring the safety of themselves? Here is a list of a few things that may help:

  • Breaks:  Breaks during work hours also may increase your alertness. Get up and move around, perhaps walk some laps around the workplace. There is evidence that brief rest periods in certain types of jobs may reduce fatigue without reducing productivity and may increase job satisfaction.
  • Sleep Schedules:  Permanent night shift workers should keep a regular schedule seven days a week. Employees working rotating shifts may need to delay bedtimes and arise times by two hours during the last few days of the evening shift when moving to nights.
  • Naps:  While getting one’s sleep during one stretch of time is highly recommended, naps can be helpful when sleep time is fragmented. Napping can be especially helpful when naps are taken off-shift in the appropriate point in your circadian rhythm. It is important to note that brief naps at work may only increase your job performance due to sleep inertia (the body’s tendency to want to remain at rest 15 minutes or longer after awakening). This means, taking a nap during a break may decrease your ability to react quickly.
  • Prescription Medication:  Certain medications can be used to override the circadian rhythm in order to sleep during the day.  However these should be used with caution due to some side effects as well as the problems associated with the medication’s effectiveness wearing off.
  •  Diet:  Foods eaten at work should be healthy. Meals high in protein and carbohydrates are recommended.
  • Workplace Conditions:  Lighting levels and temperature should be considered. The work environment should be bright and cool. Also, engaging in conversation will keep the employee alert.
  • Sleep Hygiene:  The best treatment of all may be to practice good sleep hygiene. These steps can help MOST people sleep better. Here are some helpful guidelines:

~ Sleep in a dark, cool, quiet comfortable room.
~ Maintain a regular wake time, even on days off work.
~ Use the bedroom for sleep (not for watching TV or balancing the checkbook.)
~ Keep the room cool and comfortable.
~ RELAX before bedtime and maintain a regular bedtime routine. Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or ten minutes of reading.
~ Exercise regularly, however, try not to exercise vigorously 4-6 hours before bedtime.
~ Avoid caffeine if already alert and within six hours of bedtime.
~ Cover windows with room darkening curtains or wear eyeshades.
~ Use some type of “white noise”…run a fan or tune the radio to the far end of the dial
~ Turn off the ringer on the telephone, disconnect the doorbell or put up a “Do Not Disturb” sign.
~ While a light snack before bed can help promote sleep, avoid large meals.
~ Don’t drink alcohol when sleepy. Even a small dose of alcohol can have a potent effect when combined with tiredness
~ Sleeping pills should be used only conservatively. Most doctors avoid prescribing sleeping pills for periods longer than three weeks.
~ Avoid the use of nicotine close to bedtime or during sleep time.