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Copyright BSS 1
Fatigue Management and Fitness for
Work
SHIFT WORK AND FATIGUE
MANAGEMENT
CAMMY [email protected]
082 899 9461
www.bsspsych.com.au
Fatigue Management
and Fitness for WorkOverview
� Fatigue introduction
� Understanding sleep
� Impact of shift work
� Managing shift work and fatigue
� Organisational strategy
Copyright BSS 2
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Fatigue Management
and Fitness for WorkCauses of Fatigue
Fatigue is a loss of alertness & performance caused by…
• Too little
• Poor quality sleep
• Working at times you should be asleep
• Mentally or physically demanding work
www.bsspsych.com.au
Fatigue Management
and Fitness for Work
CAUSES OF FATIGUE
COMMUTING• Daily• Start / end cycle
ENVIRONMENT• Temperature• Noise• Light levels• Vibration• Humidity• Dust• Chemical exposure
WORK CULTURE• Work pressure• Support for self
management• Work practices
• job rotation• napping
TYPE OF WORK• Mental load• Physical load
SHIFT / ROSTER• Night work• Hours worked• No. consecutive
shifts• Rotation direction• Breaks• Cycle lengths• No. shift changes
INDIVIDUAL CHARACTERISTICS• Suitability for night
work• Age• Fitness• Chronic illnesses• Sleeping disorders
PRIVATE
COMMITMENTS• Family• Social activity• Study / other jobs
LACK OF SKILLS &
KNOWLEDGE• Sleep habits• Ability to nap• Alcohol / drug use• Nutrition• Stress Management• Preparation for
night shift
SLEEPING
ENVIRONMENT• Temperature• Noise control• Light control• Inside toilets
Copyright BSS 3
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Fatigue Management
and Fitness for Work
Fatigue …
� Impacts on quality of decisions
� Impairs short term memory
� Increases reaction time
� Impairs coordination
Effects on Performance
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Fatigue Management
and Fitness for Work
HIGH AROUSAL
LOW AROUSAL
FATIGUED RESTED
Arousal, Fatigue & Risk
High risk* Fatigued* High arousal
Safe * Rested* Mod. arousal
Extreme risk* Fatigued* Low arousal
Low - mod risk* Rested* Low arousal
Copyright BSS 4
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Fatigue Management
and Fitness for Work
HIGH AROUSAL
LOW AROUSAL
FATIGUEDRESTED
RESTED BUTNOT ALERT• Alerting triggers
EXTREME FATIGUE•••• Danger•••• Stimulant drugs
SAFE ZONEWell rested with a moderate level of arousal
DANGER ZONEVery fatigued with a high level of arousal•••• Mistakes•••• Risk taking•••• Aggression•••• Exhaustion•••• Crash and burn
MODERATE FATIGUE• Alerting triggers
• Nap
ALERTING TRIGGERS• Mental activity• Physical activity• Caffeine•••• Noise•••• Light•••• Temp. & humidity•••• Drink water • Food• Deep breathing
www.bsspsych.com.au
Fatigue Management
and Fitness for WorkThe Signs of Fatigue
� Alert appearance� Normal eye blinks� Attends to surroundings� Coordinated movements
� Irritable, impatient� Wandering thoughts� Rubs eyes� Restless
� Tired appearance� Quiet, withdrawn� Long blinks (1-2 seconds)� Trouble following instructions� Yawning
� Little or no activity� Fixed staring� Unresponsive� Long blinks (2 or more seconds)� Sudden startle responses� Micro sleeps
ALERT
SLIGHTLY
FATIGUED
MODERATELY
FATIGUED
DANGEROUSLY
FATIGUED
Copyright BSS 5
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Fatigue Management
and Fitness for Work
� Fatigue accumulates over time (back-pack)
� Individuals may not be good judges of own fatigue
� You do not learn to cope - just get used to poorer performance
� Fatigued individuals at risk of micro-sleeps
Important Facts
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Fatigue Management
and Fitness for Work
• Females (45% vs. 34%)
• Parents (50% vs. 32%)
• Shift workers (52% vs. 36%)
• Those with low levels of marital satisfaction (52% vs.
35%)
• Those with depression (58% vs. 32%)
• Caregivers of child or person who is not able to live
independently (50% vs. 34%)
Who is Fatigued?
Copyright BSS 6
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Fatigue Management
and Fitness for Work
• Night shift 66%
• Pre-night shift no sleep 26%
• Trouble staying asleep after night shift 33%
• Sleep less when on night shift (2 hrs +) 44%
• Less than 5.5 hrs sleep
• Night shift 28%
• Day shift 17%
• Off days 10%
SA Statistics 2011 - 2015
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Fatigue Management
and Fitness for Work
CRASH TYPE ALCOHOL FATIGUE
All 5% 5-10%
Serious injury 20% 20-30%
Fatality 40% 25-35%
Fatigue and Accidents
Copyright BSS 7
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Fatigue Management
and Fitness for Work
� Can’t remember last few kilometres
� Trouble keeping head up
� Drift across lanes / onto verge
� Few but large steering corrections
� Forget to dip lights
� Speed varies without noticing
What are your early warning signs?
Fatigue When Driving
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Fatigue Management
and Fitness for Work
� Obstructive Sleep Apnea
� Narcolepsy
� Gastro-esophageal Reflux
� Restless Legs
� Insomnia
Sleeping Disorders
Copyright BSS 8
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Fatigue Management
and Fitness for Work
� Humans perform best during day & want to sleep at night
� Main “low period” occurs between midnight and dawn
� Another “dip” occurs mid afternoon
� In high periods (mid morning, early evening) it is hard to get to sleep
Sleep / Wake Cycle
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Fatigue Management
and Fitness for WorkSleep & Wake Up Signals
� In the evening: Sleep signals
– Sun goes down
– Core body temperature goes down
– Melatonin levels rise (hormone that helps you get to sleep & stay
asleep)
– Alertness decreases
� In the morning: Wake up signals
– Sun comes up
– Core body temperature goes up
– Melatonin levels decrease
– Alertness increases
These are “fixed” cycles in the body – Circadian rhythms
Copyright BSS 9
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Fatigue Management
and Fitness for Work
Melatonin
Body temp.
Sun
Sleepsignals
Wake up
signals
FIRST
NIGHT
SHIFT
LAST
NIGHT
SLEEP
10 PM 6 AM 10 PM 6 AM
Core Body Temperature
Alertness Level
Melatonin level
Melatonin
Body temp.
Sun
Circadian Rhythm, Sleep & Alertness
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Fatigue Management
and Fitness for Work
Core body temp. falling
Melatonin level rising
Hunger / thirst down
Urine production down
Light levels falling
Night time temp. falling
… at night time
Core body temp. rising
Melatonin level falling
Hunger / thirst up
Urine production up
Light levels rising
Day temperature rising
… in the day time
Getting To Sleep
Copyright BSS 10
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Fatigue Management
and Fitness for Work
� Sleep loss
� Irritability
� Social and family problems
� Minor illnesses
� Gastrointestinal disorders
� Cardiovascular illnesses
� Obesity and low level of fitness
Personal Cost of Shift Work
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Fatigue Management
and Fitness for Work
� Shift workers are often “grumpy”
� Reduced opportunity for quality family time
� Sex suffers due to fatigue and reduced opportunity
� Partners have most of parenting responsibilities
� Family routines disrupted when shift worker is “off”
� Conflict if children disrupt daytime sleep
� Family occasions missed
� Normal social life hard to maintain
� Children miss out on attention from shiftwork parent
Impact of Shift Work on Families
Copyright BSS 11
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Fatigue Management
and Fitness for WorkWomen and Shiftwork
� 2007 study by the USA National Sleep Foundation: 70% of women
report sleep problems – Why?
– Higher rates of insomnia (higher rates of stress, anxiety &
depression)
– Multiple roles (mother, wife, worker) – ignore fatigue
– Early motherhood and beyond: Sensitivity to sounds of children
– Show all shiftwork related problems seen in men (digestion, CV
disease, chronic fatigue)
– Higher rate of restless leg syndrome
– Partner disturbance
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Fatigue Management
and Fitness for Work
� Mental stimulation
� Physical activity
� Job rotation
� Sleep Bank
� Time of day
� Light
� Temperature & humidity
� Sound
Staying Alert
� Smell / Sniffing
� Chewing
� Drink water
� Eat for alertness
� Use caffeine strategically
� Breathe deeply
� Napping
� Take care at high risk times
� Act responsibly
Copyright BSS 12
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Fatigue Management
and Fitness for Work
Caffeine
FIRST
NIGHT
SHIFT
LAST
NIGHT
SLEEP
20 HOURS
AWAKE
6 AM 6 AM
Sleeping After Night Shift Is Difficult
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Fatigue Management
and Fitness for Work
Must address …
� Excessive caffeine use
� Exposure to sunlight on way home
� Falling melatonin level
� Rising core body temperature
Plan To Sleep After Night Shift
Copyright BSS 13
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Fatigue Management
and Fitness for Work
6 AM 6 AM3 PM
BODY
TEMP.
SLEEP
Alerting
strategies
FIRST
NIGHT
SHIFT
LAST
NIGHT
SLEEP
Awake
13 hours
Warm
bath
4 AM
Getting To Sleep After Night Shift
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Fatigue Management
and Fitness for Work
� Preventing hunger
� Food to promote sleep
� Thirst and urination
� Lazy bladder
� Smoking
Staying Asleep After Night Shift
Copyright BSS 14
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Fatigue Management
and Fitness for Work
� Calm, alert state = protein, vegetables & carbohydrates
� Burst of energy / alertness = protein & vegetables, no carbohydrates
� Calm down, relax and promote sleep = carbohydrates with no protein
Eating for Alertness or Sleep
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Fatigue Management
and Fitness for Work
BENEFITS
� Catch up on lost sleep
� Prepare for night shift
� To counter fatigue / loss of alertness
RISKS
� Sleep inertia
� Impact on subsequent sleep
Napping: Benefits And Risks
Copyright BSS 15
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Fatigue Management
and Fitness for Work
� Practice!
� Pick the right time and keep to it
� Relax before your nap time
� Arrange suitable napping conditions
� Train yourself
� Don’t nap late in the afternoon
� Wake up gradually
Rules for Napping
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Fatigue Management
and Fitness for Work
A nap before first night shift is very important to:
� Cut down the length of time continuously awake
� Prevent sleep debt
� Shift change = 36 hour “day”
- you need 12 hours sleep in this time
Napping Before First Night Shift
Copyright BSS 16
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Fatigue Management
and Fitness for Work
� Naps should be short (25 minutes or less) to avoid sleep inertia
� Naps should be away from work station / vehicle
� Supervisor must be notified
� Only one nap per shift
� Supervisor must check alertness before person returns to work
Rules For Napping On Shift
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Fatigue Management
and Fitness for Work
Assessed during:
• last 90 minutes of flight
• last 30 minutes (descent & landing)
• No. of involuntary micro-sleeps
FLIGHT TIMERest Group
(12 subjects)
No Rest Group
(9 subjects)
Last 90 minutes 34 120
Last 30 minutes 0 22
Source: Rosekind, M. R. et al (1995)
When Does Your Pilot Nap?
Copyright BSS 17
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Fatigue Management
and Fitness for Work
How do you sleep during the day?
1 2 3 4 5 6 7Number of night shifts
Sleepdebt
Poor day sleeper
Good day sleeper
If you are a poor day sleeper, you need to be at your best starting nights
Shift Change
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Fatigue Management
and Fitness for Work
It is better to return to day shift because:
�Easier to prepare for night shift on shift change day
�Reduces the no. of “shift changes” at work
�Avoids carrying fatigue from night shift to day shift
�Easier to reorientate to site on days
�Minimise shift change binge drinking
However there are costs:
�Most dislike sleeping on first day off after night shift.
�May have to drive home after last night shift
�Early wake up to start day shift can be fatiguing
Managing Shift Change
Copyright BSS 18
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Fatigue Management
and Fitness for Work
LAST DAY SHIFT
6 AM - 6 PMFIRST NIGHT
SHIFT
6 PM - 6 AM
24 hours
off
� Start of last day shift to end of first night shift = 36 hours
� Need 12 hours sleep in time off (2 hours awake, 1 hour
asleep)
� What is the plan to get this in the 24 hours off?
Shift Change Day
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Fatigue Management
and Fitness for Work
� Have a sleep before driving
� Share travel with others
� Schedule regular stops (and take them)
� Avoid alcohol / medications
� Address sleeping problems
� Dress warmly in cold weather (don’t use heater)
� Take coffee for trip
Safe Commuting - Preparing
Copyright BSS 19
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Fatigue Management
and Fitness for Work
� Avoid driving at times when fatigue is likely to be greatest
� Monitor your alertness levels
� Manage your alertness levels
– listen to chat show
– talk with passenger
– stop to walk and stretch
– have a coffee
– drink water
� breath deeply every 10 minutes
� Respond to a loss of alertness - stop!
Safe Commuting - Driving
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Fatigue Management
and Fitness for Work
� Make your family your first priority
� Make an effort to communicate with your partner
� Schedule regular time together with your partner
� Regularly “treat” you partner
� Discuss how you can help with the house and family
� Identify time for family activities
� Plan for family occasions / schedule work around these if possible
Protecting Your Family Life
Copyright BSS 20
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Fatigue Management
and Fitness for Work
� Discuss the demands of your work with your family
� Get enough sleep - no one likes a grump!
� Respect your partners decisions if he or she has primary responsibility
� Plan for regular holidays together and use this time to strengthen family relationships
� Let your partner have a sleep in once a week
� Seek help if you think a problem is developing.
� Make an effort to maintain a social life especially if your partner does not have an outside job.
Protecting Your Family Life
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Fatigue Management
and Fitness for Work
Legal Requirements
Best Practice
Overlaps and Duplicates
Policy and Procedures
Education and Awareness
Risk Factors
Performance Management
Disciplinary Action
Occupational Health EAP HR
Executive Wellness
Safety Industrial Relations
Organisational Strategy
Copyright BSS 21
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Fatigue Management
and Fitness for Work
� Night work
� Callouts
� Hours per 7 days (average)
� Number of nights shifts
� Total number of shifts
� Hours off after night shift
� Length of day (shift + travel)
� Rotation
� Start / finish time
� Number breaks / total break time
Roster assessment
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Fatigue Management
and Fitness for WorkImplementation plan
BUDGET
Pre
-E
mp
loym
en
t
Self
Man
ag
em
en
t o
f E
mp
loyees
Lin
e M
an
ag
em
en
t an
d S
up
erv
iso
rs
-C
ase M
an
ag
em
en
t
RESOURCE
Interventions Management
Occu
pati
on
al
Healt
h
EA
P
HR
Execu
tive
Well
ness
Safe
ty
Ind
ustr
ial
Rela
tio
ns
ACTION
Rep
ort
s a
nd
Evalu
ati
on
Measu
rem
en
ts
Copyright BSS 22
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Fatigue Management
and Fitness for WorkOverview Of Fatigue Training
Session 1:
Induction
* Overview
* Personal assessment / understanding
Session 2:
Employee
* Report on fatigue on site
* Individual fatigue plan
* Team fatigue plan
* Skills of “sleep preparation”
Session 3:
Supervisor Training
* Managing FFW
* Recognizing potential impairment
* Intervention strategies
* Management plans
* Use of EAP / medical facilities
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Fatigue Management
and Fitness for Work
LENGTH OF SLEEP 22.
Alcohol
use
Risk 1.
Sleep
profile
2.Days
off
3.
Day
shift
4.
Night
shift
5.
Inso-
mnia
6.
Sleep
apnoea
7.
Narco
-lepsy
8.
Gastric
reflux
9.
Rest-
less
legs
10.
Sleep
habits
11.
Sleep
enviro
-ment
12.
Sleep
disturb
-ance
by
partner
13.
Sleep
before
first
night
shift
14.
Travel
15.
Out-
side
activ-
ities
16.
Family
commi
tments
17.
Work
environ-
ment
18.
Work
stress
19.
Health
&
Self-
care
20.
Major
health
issues
21.
Caffeine
use
M F
23.
Is your
drinking
danger-
ous?
24.
Drugs
to
help
sleep
25.
Smoke
Before
sleep
26.
Exercise
1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2Low
Risk
3 3 3 3 1 1 1 1 1 3 3 2 2 3 3 3 3 3 3
1
3 3 3 3 3 3 3
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
5 5 5 5 2 2 2 2 2 5 5 3 3 5 5 5 5 5 5 5 5 5 5 5 5 5Mod
Risk
6 6 6 6 6 6 6 6 6 6 6 6
2
6 6 6 6 6 6 6
7 7 7 7 3 3 3 3 3 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
8 8 8 8 4 4 4 4 4 8 8 4 4 8 8 8 8 8 8 8 8 8 8 8 8 8High
Risk
9 9 9 9 5 5 5 5 5 9 9 5 5 9 9 9 9 9 9
3
9 9 9 9 9 9 9
A Sample Sleep Profile
