Wednesday, March 11, 2009

The Night Shift Isn’t Called Graveyard for No Reason

Often the night or graveyard shift, usually 10:00PM to 6:00AM, 11:00PM to 7:00AM, or 10:00PM to 8:00AM with variations, is the entry level shift at large 24-hour companies, social service care facilities, prisons, medical facilities and for emergency service personnel and first responders.  But it is also the shift of choice, in many cases, for working students, working moms and single parents, people that work two jobs or for some who just like the perks it sometimes brings including more time off or the extra time during conventional waking or productive hours.  But this shift comes with a grave cost.

I came from 5-years at a job like this and have several friends who are still working that job and shift; some 5-days a week and some long 4-day a week shifts, but none with special time off benefits or shorter work weeks so I know the hazards first hand. It took me almost 3-years to physically get off that shift and get back to a semi-normal sleep pattern, and after 5-years, I still don’t sleep as soundly as I used to.

Another friend, Jack Reeder, has worked the same shift at a local hospital for 18-years because it allows him to work one week on and one week off and he likes the flexibility to travel and pursue his hobbies, but it still comes with a price.  He and most of my friends working these shifts are now chronic insomniacs.  According to the American Heart Association, weekly changes of sleep time affect the cardiac sympathetic and parasympathetic autonomic controls in our bodies.  The sympathetic nervous system accelerates body functions, including heart rate and digestion. The parasympathetic nervous system slows down some of these systems causing what some researchers say afflicts many people who work a shift schedule – higher rates of accidents and cardiovascular disease. 

What this means is that the natural circadian, or daily, rhythms of your biological clock are constantly wrestling with your work schedule if you are required to work during the hours when your body and brain would normally be resting.  The tug-of-war happens because your circadian rhythm and your lifestyle are not in sync. Circadian rhythms are, in part, tied to the 24-hour cycle of the Earth’s rotation and the amount of daylight to which you are exposed.

According to Raffaello Furlan, MD, a professor at the University of Milan and the lead author of their sleep study, “This resistance of the body’s internal ‘clock’ to change with varied work schedules indicates that people don’t adapt as easily as we think to shift work.”  Certain processes like cell division and DNA repair happen at regular times while we sleep and are missed by shift workers.  Circadian rhythms also seem to control the amount of and time when various hormones are released in the body, such as cortisol, growth hormone, melatonin and testosterone, which control weight, energy, and reaching the ‘deep sleep’ state among many other processes.  Because the release time of these substances might not match your schedule, it can lead to health problems say Furlan and other Italian researchers.

The researchers believe that the higher rate of sleep disturbances, gastrointestinal and cardiovascular diseases, and accidents that shift workers experience may be due to the stress that the frequent changing of sleep and awake periods place on the body’s nervous system.

Max Hirshkowitz, PhD, director of Baylor College of Medicine sleep research center in Houston, and the author of Sleep Disorders for Dummies says that the biological clock is a strong force in determining people’s sleep habits.

“These are three basic processes that govern and regulate sleep patterns – circadian rhythms, homeopathic rhythms, and anything that activates the sympathetic nervous system and can interfere with sleep”, says Hirshkowitz, “For most people, it’s more difficult to sleep during the day.  Light is a stimulant, and there is more noise during the day.”

Your biological clock tells you that the sleepiest time of the day is 4:00AM, Hirshkowitz says, yet many shift workers drink coffee around that time to stay awake. “Then they can’t go to sleep, or they sleep but wake up a short time later,” he says.  “It’s equivalent to drinking coffee after dinner.”

Shift workers also often develop destructive habits like trying to change their sleep patterns on the weekends or their days off because they want to be with their friends or families.  But according to Dr. Hirshkowitz, this is the wrong thing to do!  “It creates a cycle of sleep deprivation”, he says.  He advises that if you have to work a night shift, you should keep your sleep patterns the same on your off days, and you should protect the time slot when you’re supposed to sleep.  If you have to change shifts constantly and it involves the night shift, you should do whatever you can to protect your sleep time.  Don’t exercise within two hours of trying to sleep, but do exercise, and use blackout curtains and earplugs.  In other words, practice what Hirshkowitz calls “sleep hygiene”.  More sleep rather than “less”… which shift workers tend to get is also critical; 8 hours during the day under ‘ideal’ conditions is like 5 ½ or 6 during the night, 6 hours of day time sleep is like getting about 4 at night, and so on down the scale.  And broken sleep, a hazard of day-sleepers, is almost worse than no sleep.

Hirschkowitz says it’s easy to see these effects.  What happens if you haven’t had enough sleep?  With sleep deprivation, your balance is off; you have gastrointestinal upset, your eyes ache, and you are more prone toward colds, headaches and whatever else is going around.

Most shift workers know that they need more sleep.  Some chose not to take the step to correct their chronic sleep deprivation because of activities or because they like the extra money. Others have no choice because of family responsibilities, childcare or because it is the only option for them to afford to go to school.

The schedule is the worst for day people who naturally like to go to bed early and get up early”.  Evening or night owls do better but eventually the shift affects everyone. Night people will often say the first five years they worked this shift, they didn’t have a noticeable problem with going from night sleep to day sleep or sleeping day hours in general.  But eventually it takes its toll.  Studies show that extended graveyard shift work, can affect longevity.  It’s not called “graveyard shift” for no reason.

Studies have shown links to graveyard workers or shift change workers that include the night shift to increase breast and prostrate cancer, diabetes, weight shifts and obesity, mood swings, forgetfulness, chronic fatigue and a weakening of the immune system in general for years.  In 2007, the International Agency for Research on Cancer, the cancer arm of the World Health Organization, added overnight shift work as a probable carcinogen, just like UV rays and diesel exhaust fumes.  It is a surprisingly positive step validating a concept once considered wacky or at least improbable.. And, it is based on research that finds higher rates of breast and prostate cancer among women and men whose work day starts after dark.   

Many companies and organizations in the U.S. and worldwide have begun to recognize the sacrifice of night shift workers and have compensated them for their sacrifices, as well as trying to cut-down the related increases in their accident and sickness ratios with shorter shifts for 40-hours pay, shorter work weeks, and non-traditional rotations including flextime and the options of part-time and job-share types of positions. Graveyard workers are generally compensated with 10% higher wages than their day-worker counterparts. They are also often compensated with additional sick or compensatory time or allowed extra time off without pay, but also without attendance penalties. Perks like areas for naptime on break or between shifts or recreational facilities are also common. In New York, some companies are supplying sleep capsules for 20-minute naps for both shift workers and day workers in high stress positions. New studies suggest the use of ‘light boxes’ in a special area where shift workers work or in the break room will make them sharper. Workers who do not have physically or mentally challenging positions or are in an observation capacity with lots of sitting should always work with a partner and be allowed access to television, radio, a computer or something that interests them to keep them alert, between or after their duties are done. Eating healthy foods rather than excessive amounts of caffeine and sugar is advised and wearing sunglasses in the morning, from sunrise until bedtime to cut out a lot of the blue light which tells the body that it is morning, is also helpful.

Let us hope that these and additional balancing measures will become common knowledge, uniform in practice and mandatory before more people end up far too young in the graveyard for which their shift is nicknamed.

By: Marion AlgierAsk Marion 

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