Gender,ageing, and shiftwork intolerance

The study investigated the hypothetical differences between male and female shiftworkers in their susceptibility to shift work-related health and social problems, with the special reference to the role of the age factor. The comparison concerned two matched-for-age-and-occupation groups of men and women, each of 83 persons, selected from the larger studied population of more than 700 workers in a Polish steel plant. The subjects were crane-operators employed in the same forward-rotated, three-shift, four-team shift system, 4:4:4 with shift changes at 06:00, 14:00, 22:00; and 48 h off following each shift block. The investigation comprised a battery of questionnaires on demographic characteristics, sleep quantity and quality, subjective health complaints, and opinions on shiftwork. The analysis of data revealed that men slept more than women, especially when working on the afternoon and night shifts. The differences became more striking and significant for all work shifts and days-off when related to declared individual sleep requirements. Women experienced more sleep disturbances than men and suffered more frequently from drowsiness during work, especially when working the morning shift. The ratings of subjective health were lower in women, with exception of respiratory complaints. Women generally suffered more than men from symptoms considered as specific to the ‘intolerance syndrome’, i.e. psychoneurotic, digestive, circulatory, and those of chronic fatigue. However, after passing the ‘critical decade’ of 40–50 years their subjective health generally improved, whereas in males one observed the consequent deterioration of health with advancing age. Women more often complained about their health and went to see the doctor, but on the other hand, they did not tend to quit shiftwork as often as did their male counterparts.     

Tolerance of shift work

This study aimed to explore criteria for shift work tolerance and to investigate the relationships between personality traits and states and shift work tolerance. Eighty-nine policemen and police women completed a questionnaire, once during consecutive night shifts and again during rotating shifts, and their responses were used to assess anxiety, emotional control, positive and negative affect, health complaints, sleep quality, difficulties in social and domestic life, and perceptions about shift work. Both the criteria for tolerance and the relationship between tolerance and personality varied according to shift type. Night shift tolerance involved four factors--somatic health, flexibility, sleep and sleep need--while rotating shift tolerance involved three factors--somatic health, flexibility and fatigue. Tolerance of shift work was associated with anxiety, repressive emotional style and mood. During night shifts, anxiety was the most influential personality factor for the somatic health and sleep dimensions of shift tolerance. During rotating shifts, positive and negative moods, rather than trait personality factors, were important predictors of the somatic health and fatigue shift tolerance dimensions. These results suggest a mechanism for more effective matching of workers to suitable shift schedules.     

Worktime control-dependent reductions in fatigue, sleep problems, and depression

We investigated the association between worktime control and fatigue, sleep problems, and depressive symptoms in a sample of daytime and shift workers. A total of 3681 permanent daytime workers and 599 shift workers completed a questionnaire designed to assess the above variables. Worktime control was evaluated in terms of both “control over daily working hours” and “control over days off”. Worktime control × work schedule × gender analysis of covariance, adjusted for age and employment status, showed overall reductions in incomplete recovery, insomnia symptoms, daytime sleepiness, and depressive symptoms with increasing levels of worktime control. However, no associations between control over daily working hours and insomnia symptoms were observed in women. The reductions appeared to be more evident for control over days off. These results remained consistent after adjustments for other potential covariates. The present findings indicate that increased worktime control and enhanced control over days off in particular, may be associated with favorable health outcomes.     

A quantitative model of work-related fatigue: background and definition

Fatigue has been identified as a major risk factor for shiftworkers. However, few organizations or governments currently manage work-related fatigue in any systematic or quantitative manner. This paper outlines an approach to managing fatigue that could improve shiftwork management. Using shift start and finish times as an input, the outlined model quantifies work-related fatigue on the basis of its known determinants; that is shift timing and duration, work history and the biological limits on sleep length at specific times of day. Evaluations suggest that work-related fatigue scores correlate very highly with sleep-onset latency, neurobehavioural impairment and subjective sleepiness. The model is useful in that it allows comparisons to be made between rosters independent of shift length and timing or the total number of work hours. Furthermore, unlike many models of sleepiness and fatigue, individual's sleep times are not required as hours of work are used as the input. It is believed the model provides the potential quantitatively to link the effects of shiftwork to specific organizational health and safety outcomes. This simple approach may be especially critical at a time when many organizations view longer and more flexible hours from their employees as an immediate productivity gain.     

A quantitative model of work-related fatigue: background and definition

Fatigue has been identified as a major risk factor for shiftworkers. However, few organizations or governments currently manage work-related fatigue in any systematic or quantitative manner. This paper outlines an approach to managing fatigue that could improve shiftwork management. Using shift start and finish times as an input, the outlined model quantifies work-related fatigue on the basis of its known determinants; that is shift timing and duration, work history and the biological limits on sleep length at specific times of day. Evaluations suggest that work-related fatigue scores correlate very highly with sleep-onset latency, neurobehavioural impairment and subjective sleepiness. The model is useful in that it allows comparisons to be made between rosters independent of shift length and timing or the total number of work hours. Furthermore, unlike many models of sleepiness and fatigue, individual's sleep times are not required as hours of work are used as the input. It is believed the model provides the potential quantitatively to link the effects of shiftwork to specific organizational health and safety outcomes. This simple approach may be especially critical at a time when many organizations view longer and more flexible hours from their employees as an immediate productivity gain.     

Police officers attitude to different shift systems: association with age, present shift schedule, health and sleep/wake complaints

It is often claimed that shift workers give priority to long series of days off and therefore prefer compressed work schedules at the expense of what is optimal for long-term health. The aim of the present study was to evaluate the attitude to six new shift systems among a randomly selected sample of police officers. The results showed that the most popular shift system was a rapidly, forward, rotating schedule with at least 16 h of rest between shifts, despite that it had fewer days off compared with some of the compressed shift systems. However, the individual differences were large and many individuals (32%) disliked the rapidly rotating shift system. Young age was associated with a positive attitude to the rapidly rotating shift system. The attitude to the shift system was also influenced by the present schedule, and shift systems that were similar to the present work hours received more positive evaluation. Sleep and health complaints showed no association with the attitude to the shift systems. In conclusion, the shift workers attitude to the new schedules was partly in agreement with the ergonomic recommendations of the design of three-shift systems that will facilitate sufficient sleep and minimize negative health consequences.     

Locomotive engineers and their spouses: coffee consumption,mood, and sleep reports

Locomotive engineers (train drivers) on irregular work schedules reported a general coffee consumption rate higher than that reported by a comparison sample of permanent shift factory workers. The present study examines the impact of this consumption on workday and non-workday sleep behaviour and mood ratings. Twenty-seven engineers and their spouses each completed daily logs for 30 consecutive days. Daily logs were then sorted into workday and non-workday categories. Workday sleep length was significantly shorter than non-workday sleep length for both engineers and spouses. For the engineers only, coffee consumption on workdays was higher than on non-workdays. This increased coffee consumption was correlated with longer sleep latency, increased negative mood, and decreased positive mood on both work and non-workdays. This was not true for spouses. These results may be related to a days-off carry-over effect of caffeine or a general consumption behaviour characteristic.     

What is the evidence for less shift work tolerance in older workers?

This paper explores the suggestion that older people would be less tolerant to shift work. Field studies on age-shift work interaction effects on sleep, fatigue, performance, accidents and health were reviewed. Studies on age-shift (morning, afternoon, night) and age-shift system (roster) interactions were also reviewed. In nine studies, shift and day workers were compared and interactions with age were addressed. Two studies reported more problems in older people, four studies reported opposite results, while in five studies no significant age-shift work interaction was observed. From across-shift comparisons (six studies), it was deduced that older compared with younger workers have more sleep problems with night shifts, while the opposite is true for morning shifts. This review did find some differences between older and younger workers, but did not find evidence for the suggestion of more shift work problems in older workers. STATEMENT OF RELEVANCE: This systematic review reveals the limited evidence that exists concerning shift work tolerance in older workers, highlighting an area for future research. Some interactions between age and shift type and shift system have been found, however. In view of these, it is argued that age-specific aspects should be considered in shift work planning.     

The impact of shift and night work on health

Shift work, in particular night work, can have a negative impact on health and well-being of workers as it can cause: (a) disturbances of the normal circadian rhythms of the psychophysiological functions, beginning with the sleep/wake cycle; (b) interferences with work performance and efficiency over the 24 hour span, with consequent errors and accidents; (c) difficulties in maintaining the usual relationships both at family and social level, with consequent negative influences on marital relations, care of children and social contacts; (d) deterioration of health that can be manifested in disturbances of sleeping and eating habits and, in the long run, in more severe disorders that deal prevalently with the gastrointestinal (colitis, gastroduodenitis and peptic ulcer), neuro-psychic (chronic fatigue, anxiety, depression) and, probably, cardiovascular (hypertension, ischemic heart diseases) functions. Besides, shift and night work may have more specific adverse effects on women's health both in relation to their particular hormonal and reproductive function, and their family roles. It has been estimated that about 20% of all workers have to leave shift work in a very short time because of serious disturbances; those remaining in shift work show different levels of (mal)adaptation and (in)tolerance, that can become more or less manifest in different times, and with different intensity. In fact, the effects of such stress condition can vary widely among the shift workers in relation to many 'intervening variables' concerning both individual factors (e.g. age, personality traits, physiological characteristics), as well as working situations (e.g. work loads, shift schedules) and social conditions (e.g. number and age of children, housing, commuting).     

Experimental Changes in Shift Schedules—Their Effects on Well-Being

A questionnaire was given to 400 workers on different shift schedules (day, 2 shift, 3 shift (weekly rotation) and 4 shift (2-3 day rotation)), shortly before, and in the year after the work schedules of 131 of them had been changed to accommodate an overall reduction in the total amount of shift working. Those workers who had to change from 3 or 4 shift working to 2 shift working (without night work) showed a significant increase in well-being with respect lo sleep/mood, gastrointestinal functioning, and social factors, along with an improvement in attitude to their work schedules. Those who were switched from shift to day work reported greatly increased social well-being, a shortening of sleep-length during free days, and considerably improved altitudes towards their work schedule; their sickness absence rates were also reduced. Attitudes towards the change from fast rotation to slow rotation of shift cycles in those whose schedule was altered from 4 shift to 3 shift working were mainly negative. Questionnaire scores remained at their original levels in the 269 workers whose schedules were left unchanged, It is concluded that the abolition of night work results in a substantial improvement in mental, physical and social well-being.     

Sleepiness,alertness and performance during a laboratory simulation of an acute shift of the wake-sleep cycle

Monitoring the presence of sleepiness on the job and its effects on performance is of primary importance for improving schedule systems of shiftworkers. Shiftworkers, often involved in night-time operations and irregular work schedules, frequently complain of nocturnal sleepiness especially in conditions of abrupt shift of the wakesleep cycle. In this study, the authors evaluated the effects of a laboratory simulation of acute night-shift changes on sleepiness, vigilance and performance, using Maintenance of Wakefulness Test,Multiple Sleep Latency Test and three pencil and paper tests: Digit Symbol Substitition Test, ‘Deux Barrages’ Test and a 3-Letter Cancellation Task. All of the tests were administered four times at 2-hourly intervals during the night after daytime sleep. Results showed that the ability to maintain wakefulness and to perform simple visuo-attentive tasks is substantially spared during the night. On the other hand, sleep tendency and performance on a more complex and monotonous task (Letter Cancellation Task) reveal, respectively, increasing sleepiness and degrading performance.     

Sleep and errors in a group of Australian hospital nurses at work and during the commute

There is a paucity of information regarding Australian nurses' sleep and fatigue levels, and whether they result in impairment. Forty-one Australian hospital nurses completed daily logbooks for one month recording work hours, sleep, sleepiness, stress, errors, near errors and observed errors (made by others). Nurses reported exhaustion, stress and struggling to remain (STR) awake at work during one in three shifts. Sleep was significantly reduced on workdays in general, and workdays when an error was reported relative to days off. The primary predictor of error was STR, followed by stress. The primary predictor of extreme drowsiness during the commute was also STR awake, followed by exhaustion, and consecutive shifts. In turn, STR awake was predicted by exhaustion, prior sleep and shift length. Findings highlight the need for further attention to these issues to optimise the safety of nurses and patients in our hospitals, and the community at large on our roads.     

The effect of night-time naps on recovery from fatigue following night work

Abstract

A questionnaire was performed in order to investigate the effect of naps during duty on recovery from fatigue. Studies were performed on 12 male computer operators in each of two chemical plants working a four-team three-shift system. In one of the plants, the shift workers were able to take a 2 h nap during the night shift (nap group). In the other plant, no nap was taken (no-nap group). Before and after the two consecutive night shifts, both the nap and no-nap groups greatly extended their night sleeps, but the daytime sleep taken by the no-nap group during this period was significantly longer than that of the nap group on both the first and second days. No significant difference was found when comparing the length of the day sleep of the no-nap group with the total sleeping time (night-time nap plus subsequent day sleep) of the nap group. Therefore a night-time nap enables part of the essential sleep to be taken in advance of the day sleep following night work. During night work, both tbe nap and no-nap groups exhibited an increase in the sleepiness scores and also in the subjective feelings of fatigue concerning the complaints related to drowsiness, dullness and difficulty in concentration. However, it was found that for the no-nap group these effects continued for a large part of the recovery period following night work. It can therefore be surmised that naps taken during night-time work can be to a certain extent aid recovery from the fatigue caused by that work.     

Who is sleepier on the night shift? The influence of bio-psycho-social factors on subjective sleepiness of female nurses during the night shift

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift.

Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.     

Work hours, workload, sleep and fatigue in Australian Rail Industry employees

Research suggests that less than 5 h sleep in the 24 h prior to work and/or more than 16 h of wakefulness can significantly increase the likelihood of fatigue-related impairment and error at work. Studies have also shown exponential safety declines with time on shift, with roughly double the likelihood of accident or injury after 10 h relative to the first 8 h. While it is acknowledged that reduced sleep, increased wakefulness and longer work hours produce work-related fatigue, few studies have examined the impact of workload on this relationship. Studies in the rail industry have focused on drivers. This study investigated fatigue in a large sample of Australian Rail Industry Employees. Participants were from four companies (n = 90: 85m, 5f; mean age 40.2 ± 8.6 y). Data was analysed for a total of 713 shifts. Subjects wore wrist actigraphs and completed sleep and work diaries for 14-days. They also completed the Samn–Perelli Fatigue Scale at the beginning and end of shifts, and the NASA-TLX workload scale at least twice during each shift. Average (±SD) sleep length (7.2 ± 2.6 h), prior wake at shift end (12.0 ± 4.7 h), shift duration (8.0 ± 1.3) and fatigue (4.1 ± 1.3, “a little tired, less than fresh”) were within limits generally considered acceptable from a fatigue perspective. However, participants received 5 h or less sleep in the prior 24 h on 13%, were awake for at least 16 h at the end of 16% and worked at least 10 h on 7% of shifts. Subjects reported that they felt “extremely tired, very difficult to concentrate,” or “completely exhausted, unable to function effectively” on 13% of shifts. Sleep length (OR = 0.88, p < 0.01), shift duration (OR = 1.18, p < 0.05), night shift (REF = morning shift, OR = 2.12, p < 0.05) and workload ratings (OR = 1.2, p < 0.05) were significant predictors of ratings of extreme tiredness/exhaustion (yes/no). While on average, sleep loss, extended wakefulness, longer work hours and work-related fatigue do not appear problematic in this sample, there is still a notable percentage of shifts that are likely to be associated with high levels of work-related fatigue. Given the size of the Australian Rail Industry, with thousands of shifts occurring each day, this is potentially of operational concern. Further, results indicate that, in addition to sleep length, wakefulness and work hours, workload significantly influences fatigue. This has possible implications for bio-mathematical predictions of fatigue and for fatigue management more generally.     

Night shift paralysis in air traffic control officers

Abstract

In an earlier paper (Folkard et al. 1984) we reported on the incidence of a temporary but incapacitating paralysis known as ‘night shift paralysis’. This appeared to be a special form of sleep paralysis that occurs when night workers manage to maintain a state of wakefulness despite considerable pressures to sleep. The incidence of this paralysis might thus be assumed to reflect the level of sleep deprivation associated with different shift systems or individuals. The present survey was designed to examine this possibility in a sample of 435 Air Traffic Control Officers (ATCOs) from 17 different countries who were on a variety of different work schedules. The incidence of this paralysis was found to be affected by four main factors, all of which might reasonably be assumed to influence the night-worker's level of sleep deprivation or sleepiness. These were the time of night, the number of consecutive night shifts, the requirement to work both a morning and a night shift starting on the same day and individual differences in the flexibility of sleeping habits. These results suggest that the incidence of this paralysis may indeed prove to be a useful ‘critical incident’ for comparing the level of sleep deprivation associated with different shift systems or individuals.     

Sleep and need for recovery in shift workers: do chronotype and age matter?

This study examined associations of chronotype and age with shift-specific assessments of main sleep duration, sleep quality and need for recovery in a cross-sectional study among N = 261 industrial shift workers (96.6% male). Logistic regression analyses were used, adjusted for gender, lifestyle, health, nap behaviour, season of assessment and shift schedule. Shift workers with latest versus earliest chronotype reported a shorter sleep duration (OR 11.68, 95% CI 3.31–41.17) and more awakenings complaints (OR 4.84, 95% CI 4.45–11.92) during morning shift periods. No associations were found between chronotype, sleep and need for recovery during evening and night shift periods. For age, no associations were found with any of the shift-specific outcome measures. The results stress the importance of including the concept of chronotype in shift work research and scheduling beyond the concept of age. Longitudinal research using shift-specific assessments of sleep and need for recovery are needed to confirm these results.

Practitioner Summary: Chronotype seems to better explain individual differences in sleep than age. In view of ageing societies, it might therefore be worthwhile to further examine the application of chronotype for individualised shift work schedules to facilitate healthy and sustainable employment.     

Personality factors related to shift work tolerance in two- and three-shift workers

This study aimed to investigate whether different personality variables were associated with shift work tolerance, and whether these potential associations were moderated by various types of shift work. The sample comprised 1505 nurses who worked either two or three rotating shifts. Personality traits were measured in terms of morningness, flexibility, languidity and hardiness. Morningness reflects the tendency to be alert relatively early in the morning and sleepy relatively early in the evening. Flexibility denotes the ability to both work and sleep at odd times of the day, while languidity concerns the tendency to become tired/sleepy when cutting down on sleep. Hardiness relates to resilience to stressful life events. The dependent variables in this study comprised of measures of insomnia, sleepiness, depression and anxiety. Hierarchical regression analyses, which controlled for demographic variables and work load, revealed that Morningness was significantly and negatively related to insomnia. The Morningness by Shift type interaction was overall significant for depressive symptoms. Morningness was near significantly associated with lower levels of depressive symptoms in three-shift workers, but unrelated to depressive symptoms in two-shift workers. Flexibility was associated with higher levels of depressive symptoms. Flexibility by Shift type interaction was significant for insomnia, indicating that flexibility was negatively associated with insomnia for three-shift workers and unrelated with insomnia for two-shift workers. Languidity was associated with higher levels of sleepiness, depressive and anxiety symptoms. Hardiness was associated with lower levels of all four dependent variables.     

Need for recovery from work: evaluating short-term effects of working hours,patterns and schedules

In this paper working hours, patterns and work schedules of employees were evaluated in terms of need for recovery from work. Self-administered questionnaire data from employees of the Maastricht Cohort Study on Fatigue at Work (n = 12,095) were used. Poisson regression analyses and multivariate logistic regression analyses revealed that higher working hours a day and working hours a week generally went together with more need for recovery from work. Overtime work was particularly associated with higher need for recovery from work in both genders. Both male and female three-shift or irregular shift workers had higher odds of elevated need for recovery compared to day workers. When additionally controlling for work-related factors, need for recovery levels among shift workers substantially lowered. This study clearly showed that working hours and schedules are associated with need for recovery from work, with different associations for men and women. Especially the associations between work schedules and need for recovery from work were very interrelated with other work-related factors. Future studies could further investigate the possibility that shift work might function as a proxy of other work-related factors that explain the different levels in need for recovery from work, or that job demands are perceived higher among shift workers and may therefore lead to more need for recovery from work.     

Work fatigue and physiological symptoms in different occupations of high-elevation construction workers

The objective of this study is to investigate whether work fatigue and physiological symptoms that high-elevation construction workers experience would be affected by the occupations. Questionnaires of demographic data and subjective fatigue symptoms as well as some physiological measurements were carried out, pre- and post-shift, on scaffolders, steel fixers, formworkers, electrician-plumbers, concreters and miscellaneous workers at a high-rise building construction site. This study found that some subjective fatigue symptoms coincide with the life style of some workers and that the extent of fatigue symptoms and physiological strains varies among different occupations of construction workers. Scaffolders, steel fixers and formworkers are categorized as physically demanding fatigue type of workers, while concreters, electrician-plumbers and miscellaneous workers as general type. The prevalence and occurrence of subjective fatigue symptoms indicate high-elevation workers have more complaints of “projection of physical impairment” than “drowsiness and dullness” and “difficulty in concentration”. Some unexpected changes (i.e., post-shift measurements are greater than pre-shift ones) in some strength tests in scaffolders and concreters were consistent with the observations of how they exercised their bodies during work shift. Considerable variation of average heart rate among occupations was found, with scaffolders the highest and concreters the lowest. This study concludes that questionnaires of subjective fatigue symptoms and some physiological measurements can be used as indicators to predict the extent of strains or hazards which construction workers encounter. In terms of management program of safety and health, more attention should be paid to those physically demanding workers, such as scaffolders, workers with lower sense of safety and health, such as miscellaneous workers, and workers with older age, such as concreters.