When “Pulling All Nighters” is Part of Your Job Description

by Ashley Cummings on October 16, 2012

Photo courtesy of photostock/FreeDigitalPhotos.net

Doctors, nurses, paramedics, police officers, emergency dispatchers, firefighters, retail workers, and home health aids all have one thing in common — shift work. Shift work includes jobs where individuals are needed around the clock, generally consisting of hours outside of 9:00am-5:00pm. Approximately one in five individuals hold a job with rotating shifts, often including overnights.

3 weeks ago, Lindsay discussed the importance of getting adequate sleep, and Sheela addressed the implications of pulling an all nighter. But what about those individuals who have rotating sleep schedules and have to stay up all night? Are night shifts dangerous to health?

The Journal of Neural Transmission published an article which reviewed studies that looked at the implications of rotating between work schedules and more specifically, working night shifts. Major findings include:

Mental Health

  • Small likelihood of developing a depressive mood in shift work over 10 years, most often seen in men over 45 years of age.
  • Nurses working night shifts were significantly more apt to report symptoms of somatization, obsessive-compulsiveness, interpersonal sensitivity, anxiety, and paranoia compared to day shift workers.
  • Poorer mental health was associated with shift work, however, it is unclear whether this has to do with long shifts (11-12 hours) or actual shift work.

Social Life

  • Difficulty maintaining a social life, due to free time that is misaligned with others working 9:00am-5:00pm.
  • Reduced spouse satisfaction and an increase in divorce was found in 2 studies reviewed.
Physical Health
  • Chronic effects included moderately increased prevalence of intestinal, metabolic, and cardiovascular diseases.
  • Gastrointestinal problems, such as ulcers were found widely inconsistent between studies.
  • Increased risk of breast cancer in women and increased risk of prostate cancer in men, however, studies show low correlation between cancer and shift work.
  • Possible increase in fatal effects on unborn children.
  • Increased risk of traffic accidents after night shifts.

So, what are the possible reasons for seeing these potential health effects in shift and night workers? One reason may be due to offsetting the body’s circadian rhythm, the control of psychological and physiological functions, such as sleep, temperature, and digestion.

Humans are programmed to sleep when it’s dark out and be awake and alert when it is light out. This cycle is what makes it difficult to flip the switch and be alert at night, and have quality sleep during the day. An article published in Clinical Medicine describes the cumulative loss of sleep resulting from night shifts as, “sleep debt” and is also associated with:

  • fatigue which may lead to reduced performance
  • sleep deprivation
  • low levels of alertness, vigilance, and cognitive reasoning
  • decreased judgement on performance
  • impaired knowledge that has recently been acquired

The circadian rhythm releases melatonin at night in order to assist with sleeping. Offsetting the processes of the circadian rhythm due to irregular sleep and activity may be associated with the above findings. However, keeping sleep debt to a minimum and receiving social support from family, friends and co-workers may assist in making shift work more bearable and less harmful to health.

Additional tips from the article in Clinical Medicine for shift work and balancing circadian rhythm include:

In order to ease transitioning to a night shift…

  • Repay as much sleep debt as possible before switching to a night shift.
  • Sleep in later the morning before your first night shift.
  • Take at least a 2 hour late afternoon nap to benefit from deep sleep.
Improve transition and sleep while on a night shift…
  • In your bedroom, avoid watching TV, using a computer or playing video games.
  • Sleep in your bed and not on the couch or in a chair.
  • Try not to worry about the previous or upcoming shift.
  • If after 30 minutes, you still cannot fall asleep, try getting up and listening to relaxing music or take a bath. Don’t stress about not being able to fall asleep in bed.
While on a night shift…
  • If possible, take a 20-45 minute nap in a quiet and dark place to improve alertness.
  • Try to nap before feeling tired.
  • Maximize bright light, even if its from a desk or overhead lamp.
  • Try to maintain a similar eating schedule to the one you have during day shifts.
  • If you consume caffeine, have it in small doses and not within 4 hours before your shift is over to allow for being able to sleep during the day.
After a night shift…
  • Wear dark sunglasses driving home so the light doesn’t trigger alertness.
  • Keep sleep debt under control.
  • Avoid distractions and try going to bed right when getting home.
  • If you are hungry, have something easy to digest before laying down.
Since the findings on physical health from most studies are inconsistent, more research must be done on the health effects of shift work. Additionally, individuals differ in their job satisfaction and adaptability to rotating shifts or night schedules.

 

Sources:
Horrocks, N. & Pounder, R. (2006). Working the night shift: preparation, survival and recovery — a guide for junior doctors. Clinical Medicine, 6(1), 61-67.

 

Kantermann, T., Juda, M., Vetter, C. & Roenneberg, T. (2010). Shift-work research: Where do we stand, where should we go? Sleep and Biological Rhythms, 8, 95-105. doi:10.1111/j.1479-8425.2010.00432.x

 

Vogel, M., Braungardt, D., Meyer, W. & Schneider, W. (2012). The effects of shift work on physical and mental health. Journal of Neural Transmission, 119, 1121-1132. DOI 10.1007/s00702-012-0800-4

Marcia October 16, 2012 at 11:22 am

Then there are those people who naturally feel awake and alert later in the day or at night but have to force themselves to conform to society’s traditional 9-5 schedule.

Lindsay Miller October 16, 2012 at 2:13 pm

Thanks for linking back to my sleep post!

I would be curious to know if the body can adjust fully to a nocturnal pattern, and if so, how long this transition would take.

Margaret October 16, 2012 at 4:45 pm

Ashley,
Very awesome! I have learned a lot about the importance of sleep and sleep schedules from you and your classmates. This article was filled with all sorts of new medical vocabulary, that you were nice enough to link to in your posts. It would have been nice to have a small definition of Somatization as well as the link, since it is so unknown to most people.

This was an easy read, and though I think bullet points are sometimes used more often then needed, they helped your post a lot.

Did this look at any Shift workers who only work night shifts? I have known a few people who are night security guards and they don’t change their schedules and just have night shifts.

Thanks,
Margaret

Ashley Cummings October 17, 2012 at 4:33 pm

Margaret,

Thank you for your comment! I am glad I was able to teach you a few new terms!

From what I understand, the more consistent any work schedule is, the better. This way the individual can get into more of a routine rather than accumulating sleep debt. Though most individuals are sleep deprived no matter what shift they are working!

Ashley

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