COPING WITH SHIFTWORK Neil Lewis Business Support Manager LINPAC Packaging

1. COPINGWITHSHIFTWORK Neil Lewis Business Support Manager LINPAC Packaging

2. What do I want to cover today? • Our learning experience • The “basics” of human fatigue • Some of the Health & Safety issues • Some tips for getting the issue right • How to educate your employees What I will not cover • What is the best shift pattern for you?

3. Fatigue a big but underrated safety issue • Some high profile accidents where fatigue has been cited as a potential issue in their cause • - Exxon Valdez • Three Mile Island • Bhopal • Chernobyl • USS Vincennes • Challenger Space Shuttle Clearly something not to be ignored

4. The LINPAC Packaging St Helens experience • Site acquired from another Division 1997 • Aimed at being Food Service centre of excellence • “Brown field site, Green field mentality” • Shift pattern included annualised hours • Aimed to give complete flexibility with minimal to zero overtime i.e. Business not human centred

5. The chosen shift pattern • 8.5 hours in length, half hour for shift handover • M M A A N N O O rotating pattern • Seven rotations then 16 days leave • Annualised hours to be paid back in 16 day break • Was it successful? NO • People resigning cited it as a reason on exit interviews • Complained of sleep deprivation • Burnout at the end of the pattern etc, etc

6. Challenged to find new shift pattern in 1999 • Initially spent a lot of time locked away looking at shift pattern books and flipcharts - Lots of ideas but no real solution • Flyer received from a company called Circadian Technologies for two day course on “Shiftwork scheduling” - Attendance an epiphany on shiftwork fatigue leading to new ways of working including staff training and awareness

7. Did it work? • Shiftworkers voted 97% for new pattern • Shift pattern now seen as an attractive part of employment package • Working hours change gave more quality time at home • Fatigue no longer cited as “serious” issue • Introduction of “Coping with shifts” unit on induction as follows;

8. WHY DO WE HAVE PROBLEMS WORKING SHIFTS? Your body is conditioned to be awake during the day and asleep at night (Suprachiasmatic Nucleus)

9. NORMAL CIRCADIAN RHYTHMS WRONG? • What are circadian rhythms? • Definition: Circa = around • Dies = day • Around daily rhythms of your body clock, for example • TEMPERATURE Whether we are awake or asleep, body functions continue to follow their circadian rhythms Other examples include growth hormone, cortisol, urination

10. CIRCADIAN PROFILE OF HUMAN ALERTNESS VERSUS TIME OF DAY

11. CIRCADIAN PROFILE OF HUMAN ALERTNESS WITH SUSTAINED WAKEFULNESS AlertnessLevel(MSLT)

12. FACTORS DETERMINING SHIFT WORKER ALERTNESS • Time of day (phase of circadian rhythm) • Circadian profile (morning or evening type) • Hours since last consolidated sleep • Duration of last consolidated sleep • Quality of last consolidated sleep • Cumulative sleep deprivation • Stimulation/monotony of job task • Stimulation/monotony of job environment • Day of shift • Consecutive hours on duty • Consecutive shifts on duty • Amount of overtime • Speed or frequency of shift changes • Content and timing of last meal • Ingested stimulants or depressants • Age of shift worker • Physical inactivity

13. WHY DO SHIFT WORKERS HAVE SLEEP PROBLEMS? • Daytime sleeping is out of synchrony with biological rhythms • Daytime sleep is out of synchrony with family and social schedules • Daytime sleep is out of synchrony with the timing and content of food • There is more ambient light during the daytime • There is more ambient noise during the daytime

14. SHIFT WORKERS’ MOST COMMON SLEEP DIFFICULTIES • Insufficient sleep during the day before the first night shift • Poor daytime sleep when working night shifts (frequent awakenings, ‘light’ sleep) • Early afternoon awakenings after the first night shifts, inability to go back to sleep • Less total sleep time per 24 hours when working night shifts, causing cumulative sleep debt • Inability to fall asleep at regular bedtime when coming off the night shift

15. HOW TO COPE WITH SHIFTS

16. HOW TO PLAN SLEEP • Sleep at the same time each day • Always do the same thing before you sleep (read, bathe, etc) • Keep room cool and completely dark • Use white noise (fan, air conditioner, etc) • Turn off the phone and turn down the answering machine volume • Turn off the television and radio • Put a “Do Not Disturb” sign on the door • Make arrangements with your family and friends - Sleep time: do not disturb - Family time: after sleep • Beware of caffeine, alcohol and sleeping pills • Try to anchor sleep with an overlap period • Wear wraparound sunglasses when driving home in the morning

17. PREPARING FOR SLEEP • Develop a bedtime routine • Follow the same routine every time you retire • Follow the same routine even when preparing for naps or daytime sleep • Examples: 1. Light snack 2. Draw curtains 3. Shower or bath 4. Brush teeth 5. Read or watch TV (15 minutes) 6. Turn out lights

18. PREPARING FOR NIGHT SHIFT • Start adjusting ahead of time • Stay up late for a few nights before the first night shift • Sleep in progressively later • Take a nap before shift • Get exposure to bright light before and during shift

19. BETWEEN CONSECUTIVE NIGHT SHIFTS • Avoid caffeine during last four hours of shift • Wear wraparound sunglasses during drive home (avoid bright light) • Eat light meal if needed • Plan to sleep as soon as possible • Try to get 6-7 uninterrupted hours of sleep • Supplement with nap before shift

20. RECOVERY AFTER NIGHT SHIFTS • Try to avoid going completely back to daytime schedule • Stay up late and sleep in late • Take short naps as needed

21. RECOVERING METHOD 1: NAP AFTER LAST NIGHT SHIFT • Nap for 2-4 hours after last shift • Don’t sleep too long, or it will be difficult to sleep later that night • Eat a light meal after waking • Try to get bright light exposure during the day • Plan afternoon activities • Retire at normal bedtime

22. RECOVERING METHOD 2: UP ALL DAY AFTER LAST NIGHT SHIFT • Try to stay awake all day and retire at normal bedtime • Avoid motorway driving • Eat a protein-filled breakfast to provide energy for the day • Avoid sedentary activity • Take a short nap if feeling overly tired during the day • Try to get bright light exposure during the day • Expect some irritability • Do not over-exert yourself on this recovery day

23. NAPPING - THE KEY TO ALERTNESS Sleep consists of distinct brain activity cycles, with several clearly defined stages within each cycle: Stage W (Waking) Stage 3/4 (Deep Sleep) Stage 1 (Transitional) REM Sleep (Dream State) Stage 2 (Light Sleep)Quality sleep requires 4-5 uninterrupted sleep cycles of approximately 90 minutes each in length.Quantity of sleep needed is 6 to 8 hours for most people.Cumulative sleep debt occurs from insufficient quantity or quality of sleep over several consecutive days.Daytime sleep is less restful than night-time sleep because it does not provide the same quality of sleep architecture

24. SHORT versus LONG NAPS • Ultra-short (5-20 minutes) naps are very effective at restoring alertness and giving a critical boost for 3-4 hours. • Longer (40-60 minutes) naps result in groggy-headed sleep inertia upon waking, with some impaired performance due to waking from deep stages of sleep. • Very-long naps (90-120 minutes) restore sleep debt and are often associated with little sleep inertia, due to waking from lighter stages of sleep.

25. SHIFT WORK AND NUTRITION • Nutrition-related disorders of shift workers • High cholesterol/cardiac risk factors • Chronic heartburn/indigestion • Gastrointestinal disorders (constipation, diarrhoea) • Weight gain • Loss of appetite/overeating • Ulcers

26. FOODS TO AVOID ON NIGHT SHIFT • Foods that promote gastric secretion: • Tomato juice • Spicy foods/strong seasonings • Excessive coffee • Alcohol • High fat/hard to digest foods: • Fatty meats (including chicken and turkey skin) • Red meat (steak/hamburger) • High-fat burgers and pizza • Fried foods • Crisps and chips • Pastries • Whole milk and dairy products

27. SO WHAT SHOULD I EAT ON NIGHT SHIFT? • Eat healthier food, in smaller portions, more often. • High Complex Carbohydrates- Pasta, rice and potatoes- Whole grain breads and cereals- Fruits and vegetables (including juices) • Low Fat Protein- Lean meats, skinless chicken, fish and shellfish- Soya beans, tofu or other beans- Home-made/low fat pizza- Skimmed/low fat dairy products

28. WHAT ABOUT CAFFEINE? • Positive Aspects of Caffeine • Can increase alertness • Improves reaction time • Works quickly • Can improve performance • Can improve overall energy • Promotes clear flow of thought

29. Negative Aspects of Caffeine • Remains in the body for a long time (half-life of 7 hours) • Can cause nervousness, anxiety and restlessness • Can cause gastrointestinal problems • Caffeine is addictive (tolerance develops, withdrawal symptoms) • Affects sleep and sleep stages: - Can’t get to sleep - Shorter sleep period - Lower sleep quality - Frequent awakenings

30. Caffeine suggestions • Use caffeine in moderation • Time its use to when you need it most during your shift • Avoid caffeine 3-4 hours before sleep • Replace caffeine with other decaffeinated beverages • Keep track of how much you use • If you are a heavy user, cut back slowly

31. Alcohol Should not be used as a sleeping aid Reduces the quality of sleep Acts as a diuretic, flushing fluids from your body Don’t drink alcohol for at least four hours before planned sleep Nicotine Your body craves nicotine while you sleep, which disturbs sleep Related health problems - Cancer - Heart disease - Hypertension - Emphysema, bronchitis OTHER ISSUES

32. Exercise Gives you energy Burns off stress Helps you sleep Proper approach:- - Start slowly - Find a routine you like - Exercise 3-5 times a week OTHER ISSUES

33. Sleeping Pills May initially help with sleep problems Tolerance creates the need for more Prolonged use can create the following: - Disrupted sleep - ‘Hangovers’ - Dependence Drugs Tranquillizers Antihistamines Antidepressants Antipsychotics Antihypertensives Long-acting hypnotics Stimulants (withdrawal effects) OTHER ISSUES

34. The Importance of Family/Social Issues The shift worker is not viewed as a whole person Divorce rates are higher for shift workers Sleep deprivation leads to irritability and family problems The entire family is disrupted by the shift schedule Creates high turnover/absenteeism Decreases morale/motivation Negative attitudes affect job performance FAMILY AND SOCIAL ISSUES

35. Improving Communication Keep expectations realistic Be specific about your feelings Don’t suppress emotions Compromise on differences Be sure spouse, partner, family and friends understand your shift work schedule Planning Ahead Keep a schedule calendar Keep it in a central location, near the phone Write out shift schedule for the entire year Identify RECOVERY DAYS Identify QUALITY DAYS Plan at least 2/3 quality days per month Plan ahead as much as possible Consider making a second calendar for your best friends FAMILY AND SOCIAL ISSUES

36. CONCLUSION • Circadian rhythms have been considered for our shift patternBUTIt’s only half the battle . . . IT’S NOWDOWN TOYOU

37. What is our “new” shift pattern? • 12.5 hours per day • 30 minutes handover • 4 days, 7 off, 4 nights, 3 off, 3 days, 3 off, 3 nights, 3 off • Three rotations then 21 days off

38. Does shift work cause Cancer? • Some studies have suggested this link • The University of Occupational & Environmental Health in Japan indicate prostate cancer four times more likely in rotating shift workers due to lower levels of melatonin which regulates sleep patterns (www.medicalnewstoday.com/articles/52127.php) • HSE Research Report (RR132) on Shift work and breast cancer - “Appreciable but not definitive” evidence that breast cancer maybe due to altered light exposure at night (www.hse.gov.uk/research/rrpdf/rr132.pdf) Watch this space for more research!

39. Sources of information • www.circadian.com • www.hse.gov.uk/humanfactors/shiftwork/ • RR446 – Fatigue/risk index for shiftworkers (also available on the above link) • “The Twenty Four Hour Society” by Dr Martin Moore-Ede • HSG 256: Managing Shift Work available from HSE books

40. Thanks for listening and any questions