1. Business Support Manager
COPING WITH SHIFTWORK
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. Shiftworkers voted 97% for new pattern
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. Alertness Level (MSLT)
CIRCADIAN PROFILE OF HUMAN ALERTNESS WITH SUSTAINED WAKEFULNESS
Alertness Level (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: Light snack Draw curtains Shower or bath Brush teeth Read or watch TV (15 minutes) 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 ( 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. OTHER ISSUES 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

32. OTHER ISSUES 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

33. OTHER ISSUES 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)

34. FAMILY AND SOCIAL ISSUES
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

35. FAMILY AND SOCIAL ISSUES
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

36. IT’S NOW DOWN TO YOU CONCLUSION
Circadian rhythms have been considered for our shift pattern BUT It’s only half the battle . . .
IT’S NOW DOWN TO YOU

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 (
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 (
Watch this space for more research!

39. Sources of information
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