Total Worker Health: Shift Work and Sleep
OHSU studied the impact of shift work on sleep, understanding that adequate and high-quality sleep is imperative to health and well-being. Researchers were interested in the interplay of not only how much sleep we get but also when we sleep to investigate how lack of sleep relates to and places shift workers at risk for chronic diseases, such as hypertension, stroke, CVD, T2DM, obesity, decreased immunity, cancer, anxiety, and depression (Jehan et al., 2017). Researchers looked at the genetics and the physiological and behavioral consequences of shift work on sleep with hopes to better improve the third of the amount of time we spend sleeping to better optimize the 2/3rd of our lives we are awake.
Shift work disorder affects people who work shifts that fall outside the hours of 6 am and 7 pm, affecting those that work the night, early morning, and rotating shifts. Shift work disrupts circadian rhythms that regulate the sleep work cycle. Natural light and darkness guide circadian rhythm. During the day, natural light signals the brain to release wakefulness hormones, like cortisol, to keep you alert and energized. As darkness falls, melatonin is produced in the brain, inducing sleepiness.
Shift workers are working against this natural process. In opposition to their natural biological rhythms, shift workers are at risk of insomnia, excessive sleepiness while awake, and recurring sleep loss. Impairment varies depending on the shift and the person. Shift work disorder disrupts and complicates daily lives with individuals often struggling with mood disorders, marked by impatience, irritability, and lack of coping with stressors. A person may even avoid social interactions with friends and family or even suffer from depression. Work performance diminishes as they struggle with concentration, attention, and memory. Additionally, workers are at higher risk of on-the-job accidents as well as increased risk of vehicular accidents. In 2015, an estimated 5000 people died from crashes involving drowsy driving (NSC, 2021). Remember, drowsy driving, is impaired driving.
Total Worker Health is a program to investigate how work can be better designed for workers to reduce harm as well as enhance worker health. Occupation can impact long-term health of employees; therefore, it is important that employers play an active role in not only protecting workers from hazards and unhealthy exposures, but also by considering working conditions as a social determinant of health. The workplace then can be optimized for health and well-being. Part of that consideration is shift-work and how detrimental that can be for sleep specifically, which has a cascade effect when impacted, and overall health. Unfortunately, shift work is one of the more difficult work hazards to reduce or change.
One strategy for implementing Total Worker Health would be to redesign the work environment. From my personal experience as a Certified Nursing Assistant, nursing facilities are simply too big, allowing many older adults, who are often complex in their conditions, needs, and care to reside in one place, placing high demand on the workforce. Coupled with shift work, the environment is no longer healthy or conducive to well-being, and sleep among other things is affected. By redesigning work environments to be smaller and plentiful, it would allow for a better work environment and be more accommodating for shift work, since it is near impossible to eliminate.
But even simpler than that is to involve workers and employees in determining how they wish to work. It is easier to ask an employee which shift compliments their natural biological rhythm, their chronotype, and place them there. Additionally, providing education and training on sleep schedules and nutrition, what to eat before bed, how to sleep, and the impacts of shift work on personal and family life (Solomon, 1993). Workplaces should play an active role in the worker health when it comes to shift work, sleep, and health in general. There are also things that workers can do to protect themselves. There are many resources out there to educate people about sleep and why it is a crucial element of health and well-being. My favorites include:
- Audiobook: “Why We Sleep” by Matthew Walker, PhD -Such a good read/listen and very easy to fall asleep to!
- Book: The Power of When by Michael Breus, PhD -I encourage you to take the quiz on what your chronotype is so that you may feel empowered to take control of your life to optimize not only what you do but also when you do it.
- Podcast: Boring Books for Bedtime -as a night owl, it can be hard for me to fall asleep and operate during my shift work and so this helps me get to bed at night. My favorites include: “Utopia” by Thomas More; “Bicycling for Ladies” by Maria E. Ward; “Flatland” by Edward Abbot. These are classic books and beautifully boring that I am asleep within 15 minutes!
Image: NIOSH [20160. Fundamentals of total worker health approaches: essential elements for advancing worker safety, health, and well-being. By Lee MP, Hudson H, Richards R, Chang CC, Chosewood LC, Schill AL, on behalf of the NIOSH Office for Total Worker Health. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication №2017–112.