COPINGWITH

SHIFTWORK

Neil LewisBusiness Support Manager

LINPAC Packaging

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?

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

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

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

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

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;

WHY DO WE HAVE PROBLEMS WORKING SHIFTS?

L I N P A C

Your body is conditioned to be awake during the day and asleep at night

CerebralCortex

SpinalCord

SCN

Hypothalamus

Brain Stem

(Suprachiasmatic Nucleus)

NORMAL CIRCADIAN RHYTHMS WRONG?What are circadian rhythms?

Definition: Circa = around Dies = day

Around daily rhythms of your body clock, for example

TEMPERATURE

L I N P A C

Sleep No Sleep

BodyCore

Temperature

ThermostatDown

ThermostatUp

ThermostatDown

ThermostatUp

11 pm 7 am 11 pm 7 am

98.5

96.5

Other examples include growth hormone, cortisol, urination

Whether we are awake or asleep, body functions

continue to follow their circadian

rhythms

CIRCADIAN PROFILE OF HUMAN ALERTNESS VERSUS TIME OF DAY

L I N P A C

TIME OF DAY

Full Alertness

Moderate Alertness

Reduced Alertness

Drowsy

20

15

10

5

0

12 15 18 21 24 03 06 09 12

L I N P A C

CIRCADIAN PROFILE OF HUMAN ALERTNESS WITH SUSTAINED WAKEFULNESS

Successive Hours of Sleep Deprivation

Full Alertness

Moderate Alertness

Reduced Alertness

Drowsy

20

15

10

5

0

0 5 10 15 20 25

Time of Day09 12 15 18 21 24 03 06 09

AlertnessLevel

(MSLT)

L I N P A CFACTORS 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

L I N P A CWHY 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

L I N P A CSHIFT 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

L I N P A CHOW TO COPE WITH SHIFTS

The Nine Controls of Human Alertness

H L

Interest, opportunity, orsense of danger

H L

Muscular activity

H L

Time of day oncircadian clock

H L

Sleep bank balance

H L

Ingested nutrients andchemicals

H L

Environmental light

H L

Environmental temperature

H L

Environmental sound

H L

Environmental aroma

You need to learn how to switch all these controls to high

L I N P A CHOW 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

L I N P A CPREPARING 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

L I N P A CPREPARING 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

L I N P A CBETWEEN 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

L I N P A CRECOVERY AFTER NIGHT SHIFTS

Try to avoid going completely back to daytime schedule

Stay up late and sleep in late

Take short naps as needed

RECOVERING METHOD 1: NAP AFTER LAST NIGHT SHIFT

Nap for 2-4 hours after last shift Don’t 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

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

NAPPING - THE KEY TO ALERTNESS

00 01 02 03 04 05 06 07 08

W

1

2

3

4

SleepStage

Time of Night

REM Sleep

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

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.

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

FOODS TO AVOID ON NIGHT SHIFT

Foods that promote gastric secretion: Tomato juice Spicy foods/strong seasonings Excessive coffee AlcoholHigh 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

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

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

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: - Can’t get to sleep - Shorter sleep period - Lower sleep quality - Frequent awakenings

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

OTHER ISSUES

AlcoholShould not be used as a sleeping aidReduces the quality of sleepActs as a diuretic, flushing fluids from your bodyDon’t drink alcohol for at least four hours before planned sleep

NicotineYour body craves nicotine while you sleep, which disturbs sleepRelated health problems - Cancer - Heart disease - Hypertension - Emphysema, bronchitis

OTHER ISSUES

ExerciseGives you energyBurns off stressHelps you sleepProper approach:- - Start slowly - Find a routine you like - Exercise 3-5 times a week

OTHER ISSUES

Sleeping PillsMay initially help with sleep problemsTolerance creates the need for moreProlonged use can create the following: - Disrupted sleep - ‘Hangovers’ - Dependence

DrugsTranquillizersAntihistaminesAntidepressantsAntipsychoticsAntihypertensivesLong-acting hypnoticsStimulants (withdrawal effects)

FAMILY AND SOCIAL ISSUES

The Importance of Family/Social Issues

The shift worker is not viewed as a whole personDivorce rates are higher for shift workersSleep deprivation leads to irritability and family problemsThe entire family is disrupted by the shift schedule

Creates high turnover/absenteeism Decreases morale/motivationNegative attitudes affect job performance

FAMILY AND SOCIAL ISSUES

Improving Communication

Keep expectations realisticBe specific about your feelingsDon’t suppress emotionsCompromise on differencesBe 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

CONCLUSION

Circadian rhythms have been considered for our shift patternBUT

It’s only half the battle . . .

IT’S NOWIT’S NOWDOWN TODOWN TO

YOUYOU

What is our “new” shift pattern?

12.5 hours per day30 minutes handover

4 days, 7 off, 4 nights, 3 off, 3 days, 3 off, 3 nights, 3 off

Three rotations then 21 days off

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/rrpdf/rr132.pdf)

Watch this space for more research!

Sources of information

www.circadian.comwww.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-

EdeHSG 256: Managing Shift Work available from HSE

books

Thanks for listening and any questions