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

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

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  1. Working With One Eye Closed : The effects of shiftwork and coping with its consequences David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN

  2. Program Objectives: • 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

  3. True or False? • 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

  4. Hazardsof 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

  5. When every day is Labor Day— 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!

  6. Overtime costs 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

  7. Personal Impact of Shiftwork 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

  8. More effects on workers… • 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

  9. Casino-Specific Fatigue Problems • 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)

  10. Species 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

  11. Zeitgebers:Circadian Cues for sleep & alertness Zeitgebers:Circadian Cues David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN

  12. The Circadian Cycle: Physiological Basis of Shift Adjustment Day SCN x Pineal Body Blood Chemistry Glandular Activity Digestion Brain Waves Arousal Night David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN

  13. Raise heart rate 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

  14. Alertness & Temperature 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

  15. Abilities by hours 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

  16. Lights are on, but no one’s home… • 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

  17. Fatigue and the brain 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!

  18. REM • 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

  19. Sleep debt assessment 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

  20. Age & Gender Effects 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

  21. Shift Work & 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

  22. Shiftwork Variations: No 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

  23. Shift Scheduling Design:What 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

  24. Family & Social Adjustments 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

  25. Spouse Survey David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN

  26. Shift-Proofing the Home • 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

  27. Shift-Proofing the Home • 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

  28. Family & Social Adjustments 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

  29. Start with proteins 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

  30. Caffeine Mounts Up! • 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

  31. Just one more for the road: Coffee & 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

  32. Medication Effects:Many 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

  33. Melatonin & Provigil: 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

  34. Seasonal Affective Disorder (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

  35. Another Bright Idea! 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

  36. Enlightening 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)

  37. Light arrays can increase shift entrainment 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

  38. The A-B-Zzzzzzzz’s of Napping 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

  39. The A-B-Zzzzzzzz’s of Napping 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

  40. Management Considerations 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

  41. Recommendations for 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

  42. Healthier Organizational Culture 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

  43. For more information contact: David X. Swenson Ph.D. LP Management Department College of St. Scholastica 1200 Kenwood Ave Duluth, MN 55811 Phone: (218)723-6476 Email: dswenson@css.edu FAX: (218)723-6290 http://faculty.css.edu/dswenson/web/sitemap.html David X. Swenson Ph.D., Licensed Psychologist, Duluth, MN

  44. Schedule Shift headaches restlessness reflexes microsleep weight insomnia Graphics

  45. Napping Potential • 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

  46. Keeping A Journal 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

  47. Day Larks & Night 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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