Visual Rota

Shiftworkers & Health

Visual Rota Website Index Page

What are the health effects on Night Shiftworkers'?

Problems include;
short term;
sleep disruption

long term;
gastrointestinal disorders;
loss of appetite,
stomach pains,
peptic ulcers,

The above are caused by changes in central nervous system & endocrine mechanisms.(meal time change causation).

More diabetes?? Possibly caused by irregular food intake and timing of medication.

Epilepsy?? Possibly caused by sleep deprivation increasing the chance of a seizure.

Coronary heart disease.

Mortality?? maybe, very few articles with comparison data, but maybe rather than a definate no.

Psychiatric Disorders, shiftworkers have more.

Divorce?? I haven't seen that mentioned yet, but intuitively I would guess shiftworkers have more marriage breakdowns.

Social isolation from family & friends.

Good Points

Working shifts does have many good points which go a long way to mitigate any effects of shift work at nights. Examples. Children related duties and child care is easier when both parents are working shifts. Similarly, looking after aged or infirm relatives. Hobbies and activities that require day light, such as playing golf, fishing, gardening. Commitments such as doctor & dentist visits would not need a day off work

Alleviating the Effects of Shiftwork

Plan the shifts to avoid abrupt changes in routine and plan the eating arrangements to give the minimum distruption in routine food intake. We are often asked questions such as; 'is it better to have a day(s) off between days and night shifts, or can they follow on so that you can more days off together?' and 'is a pattern that goes Early shifts, then late shifts, then night shifts better than Nights, Lates, Earlies.?' We don't know, because the former seems 'common sense' but the latter gives more time off to adjust between them. I think the most important thing is to find which shift pattern does not agree with you, health-wise, and try not to work it.

Meal times, should you keep the current meal times and adhere to them as much as possible, or, should you adjust the meal times to the new shift times? is another question we get asked. Food, fluids and times of intake are important. The body requires regular supplies of both and everyone is different in what they eat and how it is processed. When a body is hungry it goes into mood swings, growls and howls, when it is thirsty, it affects the electric circuits. We dehydrate by breathing out moisture, urinating and exercise. Dehydration causes constipation, dry and itchy skin, acne, nose bleeds, repeated urinary tract infections, dry and unproductive coughs, constant sneezing, sinus pressure and headaches.
Water is required by every cell in the body as nourishment and to remove wastes. When water becomes scarce, the body tries to limit the amount it loses through breathing, mucous production, urination, perspiration and bowel movements. The body has to moisturize the air before it reaches the lungs and does so through the mucous membranes lining the nasal passages and the bronchi. As available fluid decreases, the mucous lining becomes drier. This in turn irritates the lungs, causing them to become more reactive to dust, mold particles, cigarette smoke and other irritants, and less resistant to viruses and bacteria. The result: dry cough and bronchitis.
The mucous membranes of our gut are an important component of our resistance to disease. They provide an effective barrier to bacteria, viruses and pollutants when intact. But a number of substances (such as aspirin) are known to harm this barrier. A lack of water in the body makes the mucous less viscous and can cause constipation, irritable bowel syndrome and a slowed movement of the bowels contents. These problems in turn increase ones risk of other long term disease including hemorrhoids and colon cancer. The mucous lining in the sinus passages is similarly vital as a defense against disease. When it becomes drier, sinusitis, nose bleeds and allergic symptoms worsen.
Obviously, we all lose some water through urination and urination is required for the removal of various toxins from the body. When fluid volume is diminished, the ability of the body to remove toxins through urination is also diminished. These toxins then must be eliminated in other ways such as through the skin. The increase in body toxin levels can cause headaches and fatigue. The attempt by the body to remove excess levels of unwanted chemicals through the skin can cause acne and will aggravate eczema.
The easy solution to all these problems is to drink more water. (I prefer to drink my water diluted with English beer at my local) Coffee, tea and soda all contain caffeine which is a known diuretic and will actually accentuate the symptoms of fluid loss. Fruit juices are more concentrated in sugar than your body's fluids and so the body will attempt to dilute them in the gut thereby causing a loss of water from other areas of the body. Pregnant women need to drink more water daily than they would while not pregnant.
Next. Our bodies need salts called electrolytes, such as sodium, potassium, magnesium, and calcium, in order for energy conversion to take place at a cellular level. Electrolytes are depleted along with loss of water. As a result, dehydration disrupts the body's normal functions. Initially, dehydration stimulates the part of the brain that tells you you're thirsty, causing you to drink more liquids. Brain cells are particularly sensitive to water loss, so mental confusion may result in severe cases. Blood pressure can fall, causing lightheadedness and overall weakness.

I feel like a bit lightheaded now, so I shall have a break, how about you?
When the doc says take this pill and 2 glasses of water, it makes you wonder if its the water he is treating you with!

Adverse effects of sleep deprivation on the health ability to function in a clinical area. Also ways in which individuals have attempted to compensate for the effects of sleep deprivation, whilst working in a clinical position, now this an interesting question asked by a nurse.

I think that if you are working in a hospital, you must see the mistakes that people make all the time, car accidents, accidents in the home, wrong decisions, arguements between spouses, friends, workmates. Many of theses are caused by lack of sleep and dietary effects.
There are some very interesting books about the way the brain works by people like Steven Pinker and Carl Sagan, their research is fascinating.
On a personal basis, I use a quick 5 min catnap anywhere I have the time. It can be in my car waiting for my children to come out of school, at home during the tv ads. But, I have developed that ability over the years, I am still 'awake' as I know what is going on, but I am also asleep. My brother meditates and my daughter at uni drinks 'red bull', so there are several ways to try and restore 100% functionality to the brain. If we knew why the brain needed sleep, we could teach ourselves to compensate/react/avoid/use/whatever, to mitigate the effects.
On a more general theme of brain function, I am fascinated by the effects of certain types of brain illness, namely the common cold and flu. Our patients in our NH often had colds. The first signs were not sneezing, etc, but a decrease in memory function(not that we know what memory is!). The effects are very similar to a stroke, where the patients 'forgets' important alecrmation. The very first sign is that they typically forget who their children are, and they halluciate, they imagine things which no longer exist or don't exist. So, on the one hand, they forget memories, on the other, they recall either long lost memories or none existant memories. The important part of this is that one consequence of sleep deprivation is hallucination, the inability to distinguish between imagination and reality. To the person concerned it is real either way.
When our patients get over their cold, their memory is back to normal.
As for the cause, the only similarity which our patients with colds or stokes have in common with sleep deprivation is a lack of oxygen supply to some parts of the brain, but that is only an opinion on my part. Strokes are caused by part of the brain not being supplied with oxygen. One effect of a stroke is loss of certain memories, which would be regarded as a mild effect compared to the devastating physical and mental effects of a severe stroke. But, the loss of certain memories, permanently, is very similar to the loss of the same memories, temporarily. It must affect identical portions of the brain in very similar ways. Colds restrict breathing, by blocking airways and in lung capacity, hence the exchange of oxygen into the body and carbon dioxide out of the body, drops. We all feel muggy, or thick-headed, or not as sharp as usual when suffering from a cold and this could be due to the restricted oxygen supply reaching the brain. Doctors advise staying in bed as the best relief, with nasal sprays, decongestants, etc. Staying in bed reduces our need for oxygen to the rest of the body for walking, or even staying warm. Hence, there is more oxygen for the brain. Your usual brain is 'sharp' because it can call on a lifetimes experience and teaching at any time. If you have a cold and part of the brain shuts off temporarily you no longer have all your experiences and teaching to call on. But you have not lost the memories of previous occasions when you had produced solutions. Isn't the reason why you feel 'thick headed' because you can remember the fact that you know the answer, but you can't recall the answer.
Thinking uses up large amounts of the available oxygen in the body, hence the ability to scan the brain in action. If the same amount of oxygen was used in exercise, you might well be huffing and puffing (I don't know the relative volumes of oxygen used in different activities, if you know, please tell me), but I have never seen anyone acting 'out of breath' in an exam! and they all come out feeling exhausted! Hence, the conclusion might be that the body never developed a mechanism to register lack of oxygen in the brain.
The next step is hallucination, to the person having the hallucination, it is as real as, well, as real as real can be! I can't tell you why people imagine none reality when they have a cold, except in the sense that they 'skip over' certain connected memories and instead connect unassociated memories, very similar to dreams. To them, at the time, it is perfectly logical. The difference between an hallucination and a dream, would then be, that the person hallucinating is awake and the person dreaming is asleep.
When it comes to sleep. It could be that the brain needs to restore the oxygen it uses up in thinking and rather than carry on ineffectually, closes down all unnecessary functions (hiberates?) until the crisis passes. Hence a 5 min nap is adequate if breathing is unrestricted. Alternately, maybe an increase in oxygen levels in work areas would have the same affect, fire problems notwithstanding.
If lack of sleep causes part of the brain to close down because it runs out of oxygen, the question is, which part? I think the answer is - the part you have used most, or last. Hence, if you have set of similar mental tasks, you will lose your sharpness as time goes on. This would explain one phenomenum. Many times I have been concentrating on one subject and eventually hit a mental block, the type of block varies, but phrases such as 'it is on the tip of my tongue' describe it quite well. At this point, if I switch to another task, the answer 'pops' up unbidded, if I stick to the task it doesn't appear. If this is caused by resting the part of the brain being previously used, then the block was caused by over using it and it shut down.
If we then look at the effects of sleep deprivation, we conclude, based on the above, that concentration disappears, and logical reasoning stops and disjointed reasoning is accepted as normal. The consequence is that mistakes happen, accidents happen.
The next question is 'how long can a person concentrate on one task?'. I think that the length of a school exam, a school lesson, a meeting is a good indicator. Exams, they usually last for an hour and a half, and I can remember coping fairly well with that time span and yet feeling tired as well. School lessons last around 30-40 minutes. Meetings are scheduled as 30 or 60 minutes. If we accept these limits, which are inflicted daily on a billion children every day at school, and the same number of people at work then for learning we could set a limit of 40 minutes per task, and for using the task we would set a limit of 90 minutes. This would be repeatable after a break, for coffee, lunch, or tea and we could start again. Another way of breaking the concentration is to start another task, either in parallel so that you can swap between tasks as your mental ability faded in one, or in series. So you could spend an hour at each task and still feel fresh at the end of the day. When I teach my speciality of Staff Rostering, I do it in chunks of ~20-30 minutes for each topic and call a halt when eyes start to glaze over. I can teach the subject for far longer than you could be taught before exhaustion stopped us. So in reality we have to set 2 limits depending on what we are doing, teaching or learning.
Visual Rota has a webpage showing an example of task scheduling showing a library staffed in rotation with some tasks having maximum times.

* * *

Tel: +44 1 636 816466

Alec Jezewski CDT (C-Desk Technology)

* * *

More alecrmation about Visual Rota

user guides,help & video

record keeping using VR

calculating holiday entitlements

shifts overlapping pay rates

creating new schedules with VR

shift pattern generator

changing over to VR

hotels and staffing

See your staffing costs as you prepare the schedule

EC Worktime Directive

Frequently asked questions

Using Visual Rota Statistics to make decisions

Managing Change. How to introduce changes

use annual hours in planning schedules

What is Whatif analysis?

too many staff can affect quality

Continually short staffed-fact or myth

How to reduce staff painlessly

please email us

Theory and creating the staffing schedule

Staffing resource consultancy

Large organizations staff records Careplans