Working With One Eye Closed : The effects of shiftwork and coping with its consequences
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Working With One Eye Closed : The effects of shiftwork and coping with its consequences. David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN. Program Objectives:. To explain how circadian rhythm and shift adjustment are related to performance & health

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Working With One Eye Closed : The effects of shiftwork and coping with its consequences

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Program Objectives: coping with its consequences

  • To explain how circadian rhythm and shift adjustment are related to performance & health

  • To Recognize the signs and symptoms of shiftwork adjustment

  • To describe personal, family, and organizational techniques for coping with shiftwork & overtime concerns

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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True or False? coping with its consequences

  • People can lose up to one hour of sleep per day with no adverse effects

  • People can learn to completely adjust to night work

  • Older experienced people can adjust faster to shifts than younger

  • Women show more shift adjustment signs than do men

  • Exercise, cold water, and fresh air can remove fatigue effects

  • Most people are good judges of their alertness

  • The average amount of sleep people really need is between 6-7 hours

  • Overtime has no effect on health or performance so long as a person wants to do it

  • Caffeine is not effective and should not be used to maintain alertness

  • Napping is an ineffective way to cope with shift fatigue


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Hazards coping with its consequencesof Shiftwork

Shiftwork-Related Disasters

  • Three-Mile Island (1979)

  • Bhopal chemical spill (1984)

  • Chernobyl Nuclear Plant (1986)

  • Challenger Space Shuttle (1986)

  • Exxon Valdez tanker (1989)

  • Star Princess ship grounding (1995)

  • American Airline 1420 (1999)

  • Canadian National train wreck (2001)

  • 100,000 traffic accidents & 1500 deaths annually (sleep 2nd only to alcohol)

…all had fatigue-related contributing factors

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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When every day is Labor Day— coping with its consequences

Work, Work, Work…

  • About 25% of the workforce now works nonstandard schedules

  • annual work hours are 4% higher than in 1980

  • The average person works 150 more hours/year than in 1910

  • 1/3 of workforce regularly works more than 40-hour week; 20% work 50+

  • Even after four eight hour sleep sessions following sleep debt, people continue to make judgment, attention, and other cognitive errors

  • The Japanese even have a medical diagnosis– Karoshi– death from overwork!


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Overtime costs coping with its consequences

Overtime cost$

  • Extended hours lead to 15-fold increase in worker compensation claims

  • Higher rates of absenteeism (5.8%)

  • Higher rates of turnover (healthcare—12.4%, services & processing 11.6%, )

  • 60% moderate to severe fatigue (processing– 68%, healthcare– 60%, transportation 54%

  • Number of facilities disciplining napping rose from 38% in 2002 to 57% in 2003

  • Increase in accident rates (after 9 hours; 2x as high at 12 hours)

  • Costs $150 billion per year in fatigue related accidents

  • Exacerbated health problems cost $28.1 billion in higher insurance costs


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Personal Impact of Shiftwork coping with its consequences

Personal Impact of Shiftwork

  • 79% of casino workers complain of sleep disturbance & fatigue (GMB Union, Scotland)

  • 83% of night shift feel tired (4% of dayshift)

  • Work capacity declines 5-10% during nights

  • Higher incidence of drug & alcohol abuse

  • Higher relationship problems & divorce rate (2x day shift)

  • Higher medical & emotional problems

  • Feel career “capped” during 3rd-10th year

  • 20-30% leave SW within the first 2-3 years

  • Reduced job alertness costs $70 billion/year

  • Overtime workers 2x as likely to report jobs as stressful

  • Retired persons report SW as more negative

  • Low control of work increases adverse effects

  • Increase in customer complaints

  • 17-19 hours w/o sleep is equivalent to DUI (BAC .05); 24 hours sustained wakefulness (BAC .10)

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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More effects on workers… coping with its consequences

  • 66% fatigue makes stress harder to deal with

  • 68% sleepiness interferes with concentration

  • 68% of shiftworkers had sleep problems

  • 58% decision making & problem solving harder

  • 57% listening to others was a chore

  • 51% say sleepiness interferes with amount of work done

  • 30% decline in quality and quantity of work when fatigued

  • 27% sleepy at work two or more days a week

  • 19% frequent work errors due to fatigue (sales 35%, retail 33%, finance & real estate 29%

  • 14% late to work due to sleepiness

  • 7% have changed jobs to get more sleep

Sleep Foundation study, 2000, 1154 adults


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Casino-Specific Fatigue Problems coping with its consequences

  • Cognitive skills

    • Inattention, distractibility, poor concentration

    • Impaired memory, recall (forgetting key steps & procedures)

    • Slower decision making (shortcuts)

    • slower counting and calculation errors & microsleep (miscounting errors, miss details, surveillance errors)

    • Less fluent communication skills (conflict management)

  • Physical

    • slower reaction time, slower finger dexterity, poor coordination

  • Emotional

    • Irritability (over-reaction, impatience, hypersensitivity, lower frustration tolerance), depression (apathetic)


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Species coping with its consequences

Opossum

Tiger

Sloth

Cat/Mouse

Dolphin

Dog

Chimpanzee

Human

Shift/night wk

Cattle

Elephant

Horse

Giraffe

Daily Total Hours

18

15.8

14.4

12.5

10.4

10.1

9.7

8

6.4

4

3.3

2.9

1.9

Mammal Sleep: No Playing ‘possum for Shiftworkers

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Zeitgebers coping with its consequences:Circadian Cues for sleep & alertness

Zeitgebers:Circadian Cues

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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The Circadian Cycle: Physiological Basis of Shift Adjustment coping with its consequences

Day

SCN

x

Pineal Body

Blood Chemistry

Glandular Activity

Digestion

Brain Waves

Arousal

Night

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Raise heart rate coping with its consequences

Raise blood pressure

Raise body temp

Increase muscle Tone

Increase breathing

Stimulate alertness

Lower heart rate

Lower blood pressure

Lower body temp

Decrease muscle tone

Decrease breathing

Induce sleep

Effects of the Circadian Cycle:A Balancing Act

Typical Rest Time

Typical Activity Time

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Alertness & Temperature coping with its consequences

Peak Alertness

Lowest Alertness

40

35

30

25

20

15

10

Wide

Awake

Warmer

Temperature

37.2

37.0

36.9

36.8

36.7

36.6

Alertness

Body Temp Deg. C

Alertness

Cooler

Sleepy

10pm 7am 4pm 1am 10am 7pm 4am 1pm

Time of Day

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Abilities by hours coping with its consequences

Around the Clock Performance:

Peak times for abilities

Noon—

Eyesight

Early Afternoon—

math, long term memory, physical flexibility, manual dexterity, grip strength

Late Mid-Morning—

alertness, thinking

Late Afternoon—

Gross physical coordination, athletic ability

Early Mid-Morning—

short term memory

Early Evening—

sense of smell and taste

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Lights are on, but no one’s home… coping with its consequences

  • Under high fatigue, people experience bouts of microsleep for 3-10 seconds

  • Sleep progresses from front of brain to back– judgment to motor to vision areas fail

  • People are not aware when they microsleep

  • People are not good judges of their level of alertness

  • Driving and actions can continue when judgment is disabled

ZZZZZZZZ


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Fatigue and the brain coping with its consequences

Brain activity in the brain on a counting problem after a normal night of sleep (top) and following sleep deprivation (bottom). Yellow and red show areas of activation

…in some cases, the lights aren’t even on!


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REM coping with its consequences

  • Awake

    • 1

    • 2

    • 3

    • 4

Stages

0 1 2 3 4 5 6 7 8

Hours of Sleep

Stages and Levels of Sleep

Most REM sleep missed

Insufficient REM sleep  emotional fatigue

Insufficient deep sleep  physical fatigue

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Sleep debt assessment coping with its consequences

Sleep Debt Assessment

How likely are you to doze off or fall asleep in the following situations? Score yourself using this scale:

  • Sitting and reading

  • Watching TV

  • Sitting, inactive in a public place, e.g., a theater or meeting

  • As a passenger in a car for an hour without a break

  • Lying down to rest in the afternoon when circumstances permit

  • Sitting and talking to someone

  • Sitting quietly after a lunch without alcohol

  • In a car while stopped for a few minutes in traffic

0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing

0-5 Slight or no sleep debt

6-10 Moderate sleep debt

11-20 Heavy sleep debt

21-25 Extreme sleep debt


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Age & Gender Effects coping with its consequences

Shift intolerance increases after age 40

After 40, women’s health improves, men’s declines

Women have higher injury rate than men*

Women report more shift adjustment problems*

Men quit shift work more often than women

Older experienced staff have much shift adjustment knowledge to share

Flattening of circadian rhythms and shift toward fragile sleep and morningness

Sleep durations declines during aging

Aging accentuates digestive, musculo-skeletal, and respiratory problems

* Often due to dual demands of homemaker and worker

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Shift Work coping with its consequences

& Overtime

Stress

Poor Performance

Poor Coping

Symptoms:

Physiological

Cognitive

Emotional

Interpersonal

PoorShift

Adjustment

The Vicious Cycle of Shiftwork

Poor Sleep

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Shiftwork Variations: coping with its consequencesNo one size fits all

  • Forward vs. Backward

  • 8, 10, or 12- hour shifts

  • Rotating vs. Permanent

  • Time on, off, & between shifts

  • Overtime, overlap, & extended duty

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Shift Scheduling Design: coping with its consequencesWhat we Know

  • Rapid shift minimizes readjustment

  • Long rotations require off-duty consistency

  • Permanent shifts do not produce fixed sleep

  • Hourly & Weekly rotations are worst

  • 8 to 10 or 12 hour shift not a problem

  • Shift should move forward or clockwise

  • Shifts work better in metropolitan areas

  • 60% prefer days, 30% nights, 10% rotation

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Family & Social Adjustments coping with its consequences

Perceptions of Shiftworker’s Family

  • Shift & recovery out of phase with diurnal society, necessities, & family activities

  • Insufficient companionship, intimacy, support, sharing, and protection

  • Recovery time on rest days reduces quantity and quality of family time

  • Less time for home maintenance & chores

  • Fatigue & mood affects interaction

  • Conflicts have cumulative effect

  • Spouses feel resentment & guilt

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Spouse Survey coping with its consequences

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Shift-Proofing the Home coping with its consequences

  • Disturbance Reduction:

  • Relocate the bedroom, 68-72 temp

  • Double glazed, sound resistant windows

  • Wall insulation, rugs, curtains

  • Doorbell and phone off

  • White sound or ear plugs

  • No domestic machinery

  • Heavy curtains or sleep mask

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Shift-Proofing the Home coping with its consequences

  • Behavioral Changes:

  • Discuss importance of quiet time

  • No visitors (or quiet ones)

  • Develop sleep preparation routine

  • Develop sleep facilitative skills

  • Use bed for sleep and intimacy only

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Family & Social Adjustments coping with its consequences

Recommendations

  • Training & preparation for the employee

  • Orientation & education for the family

  • Social networking

  • Support groups

  • Family meetings

  • Quality family activities

  • Post a calendar schedule

  • Consultation & counseling

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Start with proteins coping with its consequences

Add legumes and low fat dairy products

Broil/boil/raw rather than fry

Eat light after midnight

Minimize caffeine & tobacco

Available healthy snacks

Start with carbohydrates (sugars & starches)

No caffeine, tobacco, or alcohol five hours before sleep period

Avoid heavy, spicy, hard to digest food

Nutritional Considerations (?)

End Shift

Begin Shift

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Caffeine Mounts Up! coping with its consequences

  • One 7-oz cup has 65-175 mg. caffeine

  • Coffee: Drip (115-175mg), brew (80-135), instant (65-100), tea (30-70), decaf (2-4)

  • Soda: Jolt (100), Mr. Pibb (58), Mt. Dew (54), Mellow Yellow (53), 7-Up (0)

  • Medications: Vivarin 200, No Doz 100, cold relief tablets (30), Execedrin (65)

  • Other: Chocolate (30)

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Just one more for the road: coping with its consequencesCoffee & caffeine effects

  • Benefits: Increased alertness & mental stimulation, reduced fatigue, increased metabolism, manual skills

  • Caffeine reaction: appetite loss but gastric secretion, irritability, anxiety, irregular heart rate, insomnia

  • Recommendations: Minimize; monitor intake; none 5 hours before off shift

  • Heavy caffeine use during sleep deprivation elevates stress hormones

  • Don’t take caffeine 4 hours (men) or 6 hours (women) before planning sleep

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Medication Effects: coping with its consequencesMany change the quality of sleep

  • Antidepressants(MAO-Inhibitors): sleepless, habit forming, suppress REM sleep, REM rebound, fast pulse, dry mouth

  • Amphetamines:high risk of abuse & withdrawal

  • Antihistimines & Bronchodilators: sleep but side effects

  • Caffeinecontaining meds (e.g., Excedrin): upset stomach & sleep

  • Sleep Aids(e.g., Sleep-Eze, Nytol): composition changes, risk of long term use

  • Tranquilizers(e.g., Valuim, Librium): daytime sedation, possibly related to irritability & temper

  • Somethyroid preparations, high blood pressure meds, birth control pills (rare)

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Melatonin & Provigil: coping with its consequences

Magic Bullets?

  • Melatonin: (1-10 mg)alleviates jet lag, facilitates shift adjustment, improves daytime sleep, decreases insomnia. Few side effects or dependency/withdrawal. Long term effects not studied.

  • Provigil: (200mg) alleviates fatigue, enhances alertness, improves mood and memory. Less likely to cause jitteriness/anxiety. Widely used off-label, but not well understood mechanism

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Seasonal Affective Disorder coping with its consequences

(SAD) & Winter Blues

SAD: A seasonal disorder of mood

and energy related to decreased exposure to natural light in northern climates; 6% clinical, 10-20% sub-clinical

OCCURRENCE: Sept/Nov to March/April, mild reaction on persistent cloudy days, nightshift & indoor work. Women more than men, after age 30,

SIGNS: depression, low energy, fatigue, apathy, irritability, anxiety, lower stress tolerance, sleep disturbance, overeating, craving sweets, poor concentration, slower reaction, lowered immune function, decreased sex interest, mood swings.

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Another Bright Idea! coping with its consequences

Light Regulates Circadian

  • Bright light (min 2500 lux) suppresses melatonin to help reset circadian rhythm

  • 1-4 hours of bright light is required on awakening or beginning of shift

  • Better sleep & sleep pattern, performance, physical and emotional well-being result

  • Rated as highly effective in promoting adjustment to shift work

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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En coping with its consequenceslightening the treatment of SAD

  • may not be insurance covered

  • 30 minutes to two hours exposure

  • 2,500-10,000 lux lightbox or lightvisor ($100-$300)

  • requires regular use (evening use may disturb sleep)

  • fluorescent and full spectrum lights (not tanning bed Uv)

  • 1-hour daily outside daylight walking/exercise

  • SSRI antidepressants (e.g., Prozac)


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Light arrays can increase shift entrainment coping with its consequences

Portable light goggles can be used to suppress melatonin during night shift

FIT Workplace Safety Screener: Measurement of pupillary response to flashing and moving light and eyelid fluttering can indicate shift fatigue

Computerized assessment of visual perception, information processing, hand-eye coordination, reaction time, and decision making

Video monitoring of the percentage of eyelid closings over time

Alerting devices can sound off when dozing

Computer scheduling programs can optimize shifts

Technological Developments

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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The A-B-Zzzzzzzz’s of Napping coping with its consequences

What we know about napping:

  • 70-80% admit falling asleep anyway

  • Shorter main sleep but same total sleep

  • Naps & rest periods are beneficial to mood

  • First 20-30” of sleep is best quality

  • Best time is noon to 6 pm, with peak from 1-3 pm

  • Without naps, up to 30% performance decline

  • Benefits not uniform, some sleep worse

  • Sleep Inertia may occur

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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The A-B-Zzzzzzzz’s of Napping coping with its consequences

Recommendations for Napping

  • Should be taken before sleep debt occurs

  • Nap prior to night shift/continuous operation

  • Schedule during expected quiet periods

  • Nap 10- 30 minutes

  • Limit naps to prevent partner isolation

  • Provide appropriate nap areas

  • Keep a notebook to monitor effects

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Management Considerations coping with its consequences

1. Involve employees

2. Set shift rosters early

3. Minimize overtime & extra duty

4. Allow 6-12 months trial period

5. Orient & educate all stakeholders to understand shiftwork

6. Conduct risk assessment of tasks and monitor accidents, illness & absentees, errors, complaints

7. Managers might take a night shift during the year

8. Conduct research to find out what works and what doesn’t

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Recommendations for coping with its consequences

Shiftwork Supervisors

  • Use sound shiftwork principles for designing schedules (e.g., forward rotation, days off, short shifts, etc.)

  • Use overtime time sheet to be submitted with regular time sheet to identify potential overtime problems before they occur

  • Ask and coach employees in their use of shift coping techniques

  • Ensure classes and training opportunities for night shift

  • Keep work areas brightly painted, clean, well lit & ventilated

  • Provide vending machines with healthy products

  • Maintain high contact with night workers

  • Videotape mandatory meetings to allow viewing during regular shift

  • Negotiate better suited meeting schedules for night workers


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Healthier Organizational Culture coping with its consequences

Organizational Shiftwork Schedule

Good Performance

Employee & Family Orientation & Training

Better Shift adjustment

  • Integration of skills & practices into lifestyle

The Better Cycle of Shiftwork

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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For more information contact: coping with its consequences

David X. Swenson Ph.D. LP

Management Department

College of St. Scholastica

1200 Kenwood Ave

Duluth, MN 55811

Phone: (218)723-6476

Email: [email protected]

FAX: (218)723-6290

http://faculty.css.edu/dswenson/web/sitemap.html

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Schedule coping with its consequences

Shift

headaches

restlessness

reflexes

microsleep

weight

insomnia

Graphics


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Napping Potential coping with its consequences

  • Can you easily nap during the daytime when you are not particularly sleep-deprived?

  • Can you easily nap during the daytime to "catch up" on lost sleep, such as after one or more late nights?

  • On days off, do you take a daytime nap?

  • Do you feel refreshed after a daytime nap?

  • Do you use brief naps (less than 30 minutes) to sustain your alertness during an extended monotonous task (for example, driving a long distance) or when staying up all night?

The more you answer affirmative, the more napping may work for you to deal with shift stress


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Keeping A Journal coping with its consequences

A journal is the most effective way of discovering what works! How are these related to each other?

Food

Exercise

Stress

Naps

Alcohol

Medication

Performance

Sleep time

Level of Rest

# Times Awake

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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Day Larks & coping with its consequencesNight Owls (15-20%)

1. Arise early easily or with difficulty?

2. Stay up late with difficulty or easily?

3. Would rather exercise in morning or evening?

4. Does your efficiency/energy peak early in the day or evening?

5. Things look better in the morning or evening?

6. Favorite meal is breakfast or dinner?

7. Prefer physical/outdoor activities or night life or quiet?

8. Compensate for sleep loss by going to bed earlier or sleeping later?

9. Nap in afternoon (about 2:00) or nap in evening (about 7:00?

David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN


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