A field study of sleep and fatigue in a regular rotating 12-h shift system

The aim of this study was to examine a regular rotating 12-h shift system (2D2N4Off) at an Australian Smelter. Sleep behavior, subjective fatigue and neurobehavioral performance were investigated over a 14-day period for 20 employees. Activity monitors, sleep/wake diaries, and 5-min psychomotor vigilance tasks were used. Sleep data showed differences between day and night shifts. While sleep prior to night1 was increased relative to day shifts, a reduced sleep length carried into the period leading to night2. Total wakefulness at the end of shift, and subjective fatigue were increased for night shifts, particularly night1. Decrements in performance data supported these findings. Both prior wakefulness and prior sleep are important in a 12-h shift system. Employees may “sleep in” after day shifts, rather than taking extra sleep prior to night work. Thus, sleep between day and night shifts is based on recovery rather than preparation.     

Post-lunch nap as a worksite intervention to promote alertness on the job

A worksite study was conducted to examine whether a 15-min nap during a post-lunch rest period would affect subsequent alertness, performance, and nocturnal sleep in eight factory workers under a 3-week protocol. Subjects were asked to take the nap at 12:30?h on a reclining chair during the nap week, and to remain awake during the no-nap week. The order of these 2 weeks was counterbalanced between the subjects. During the third, follow-up week, each subject determined whether or not she/he would nap. Alertness on the job and nocturnal sleep were assessed using a sleep diary. Wrist activity was also recorded during sleep at night. Choice reaction time task (RT) was performed at 10:00 and 15:00?h every day of the nap week and every other day of the no-nap and follow-up weeks. Perceived alertness was significantly higher in the afternoon after nap than after no nap at the end of the week. Similar effects were observed during the follow-up week where almost half of the subjects napped. No significant differences between the three weeks were found for RT performance or nocturnal sleep. Workers' attitudes toward the nap were favourable. Although further intervention research is required, our results suggest that post-lunch napping may have the potential to promote daytime alertness at work.     

Post-lunch nap as a worksite intervention to promote alertness on the job.

A worksite study was conducted to examine whether a 15-min nap during a post-lunch rest period would affect subsequent alertness, performance, and nocturnal sleep in eight factory workers under a 3-week protocol. Subjects were asked to take the nap at 12:30 h on a reclining chair during the nap week, and to remain awake during the no-nap week. The order of these 2 weeks was counterbalanced between the subjects. During the third, follow-up week, each subject determined whether or not she/he would nap. Alertness on the job and nocturnal sleep were assessed using a sleep diary. Wrist activity was also recorded during sleep at night. Choice reaction time task (RT) was performed at 10:00 and 15:00 h every day of the nap week and every other day of the no-nap and follow-up weeks. Perceived alertness was significantly higher in the afternoon after nap than after no nap at the end of the week. Similar effects were observed during the follow-up week where almost half of the subjects napped. No significant differences between the three weeks were found for RT performance or nocturnal sleep. Workers' attitudes toward the nap were favourable. Although further intervention research is required, our results suggest that post-lunch napping may have the potential to promote daytime alertness at work.     

Frequency of sickness absence and worksite clinic visits among nurses as a function of shift

The records of 1219 nurses on permanent day, afternoon, night and rotating shifts were examined to assess the effects of shift schedule on sick leave and frequency of worksite clinic visits. Relative to nurses on permanent shifts, rotators exhibited a significantly higher rate of clinic visits and took more sick days for serious illnesses.     

Alertness of night nurses: two shift systems compared

The alertness of hospital trainee nurses during their night shift work was assessed by recording performance at night on an arousal-sensitive unprepared simple reaction time task. One group carried out a number of separate weeks on night shift throughout their three-year course. Here performance fell from first to seventh day of the week on night shift, implying progressive sleep deprivation. Another group covered their night work by a single three-month 'permanent' night shift of four (or three) nights on and three (or four) days off each week. Here initial performance level fell by the 45th night but had returned to normal by the last (90th) night. In both systems individuals varied considerably in their ability to maintain performance during sustained night work. These results strengthen the case for permanent night shifts, with careful selection of personnel, as a means of organizing night nursing in hospitals.     

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.     

Productivity on a weekly rotating shift system: circadian adjustment and sleep deprivation effects?

Abstract

There is little doubt that productivity and safety can be impaired on the night shift. Two main factors have been identified that may be responsible for this. On the one hand, the circadian rhythm in performance on at least simple tasks is at a low ebb at night, and adjusts only slowly over a span of night shifts. On the other, the day sleeps of shift workers taken between night shifts are of a reduced duration, and thus a cumulative sleep debt may accrue over successive night shifts. The former thus predicts that productivity should improve over a span of night duty, while the latter predicts that it should decline. We have examined the productivity of 53 female shift workers, and the sleeping habits of a sub-sample of 30 of them, on a weekly rotating shift system in order to assess the relative contribution of these two factors. Our results suggest that circadian adjustment to night work is the dominant factor for the first three or four successive nights shifts, but that sleep deprivation effects may then result in a decrease in productivity over subsequent nights. They also indicate that sleep deprivation, but not circadian adjustment, may affect the productivity of some workers when on the morning shift.     

Re-entrainment of Body Temperature in Experimental Shift-Work Studies

In a series of experimental shift work studies six subjects worked on continuous night shift for three weeks, four subjects worked on a 1-1-1 shift system (1st day morning shift, 2nd day afternoon shift, 3rd day night shift, 4th day off), and two subjects worked on an 2-2-2 shift system (the ‘metropolitan rota’). Rectal temperature was continuously recorded in each experiment.

The greatest changes in the circadian rhythm of body temperature occurred on the second night shift day, and during the first week of continuous night shift working. The changes involved both shifts in the phasing of the rhythm, and alterations in its form. The re-entrainment of the rhythm to its normal phasing took two or more days after two or more successive night shifts, but only one day after a single night shift. Considerable individual differences in the rhythm adjustment to night work were observed.

In a field validation of these findings, 34 shiftworkers in municipal gas and water supply undertakings measured their oral temperature every 2h both on and off duty. Although only very few temperature readings were obtained during sleep periods, the results confirmed, in general, those of the experimental studies.     

Experimental Studies of Shift-Work II: Stabilized 8-hour Shift Systems

Abstract

Thirty-one subjects were employed in an experiment to determine whether the relationship between efficiency at mental tasks and the circadian rhythm of body temperature observed in an earlier study was affected by an increase in the length of the duty-spell from 4 to 8 hours. Subjects wore assigned either to a control ‘ day ’ shift (O800–1600), a ‘ night ’ shift (2200–0600) or a ( morning ) shift (0400–1200), and were tested for a period of 12 consecutive days on the same shift. The control shift-workers showed no consistent effects of fatigue due to the increased length of the duty-spell. Adaptation of temperature rhythm to work on the night shift was only partial, but was relatively closely reflected in the recorded performance trends. Very little adaptation to work on the morning shift was observed, and performance was thought to have been affected by partial sleep deprivation. It was concluded that body-temperature was as effective a predictor of overall mental efficiency in most industrial-type shifts as in the special 4-hour shift system previously investigated.     

The effects of a self-selected nap opportunity on the psychophysiological,performance and subjective measures during a simulated industrial night shift regimen

This study compared the effects of a 1 h self-selected recovery period to those of a standard night shift arrangement (with a total break time of 1-h) over a simulated three-day night shift schedule in a laboratory setting. Results showed that the inclusion of the flexible nap scheme resulted in higher performance output, improvements in physiological strain responses and reduced sleepiness during each night shift and generally over the three-night cycle. Certain variables also revealed the impact of napping compared with the standard rest break condition on the circadian rhythm. The sleep diary records show that the inclusion of the current intervention did not significantly reduce daytime recovery sleep. The results suggest that the potential benefits of flexible napping may outweigh the logistical effort it requires in a workplace environment.

Practitioner summary: Consensus on appropriate napping strategies for shift work remains a challenge. This simulated night shift laboratory study sought to determine the effects of a 1-h self-selected nap opportunity relative to a normal shift set-up. The nap improved performance and decreased sleepiness, without affecting daytime sleep.     

Sleep in a live-in mining operation: The influence of start times and restricted non-work activities

The amount of sleep obtained between shifts is influenced by numerous factors including the length of work and rest periods, the timing of the rest period relative to the endogenous circadian cycle and personal choices about the use of non-work time. The current study utilised a real-world live-in mining environment to examine the amount of sleep obtained when access to normal domestic, family and social activities was restricted. Participants were 29 mining operators (26 male, average age 37.4 ± 6.8 years) who recorded sleep, work and fatigue information and wore an activity monitor for a cycle of seven day shifts and seven night shifts (both 12 h) followed by either seven or fourteen days off. During the two weeks of work participants lived on-site. Total sleep time was significantly less (p < 0.01) while on-site on both day (6.1 ± 1.0 h) and night shifts (5.7 ± 1.5 h) than days off (7.4 ± 1.4 h). Further, night shift sleep was significantly shorter than day-shift sleep (p < 0.01). Assessment of subjective fatigue ratings showed that the sleep associated with both days off and night shifts had a greater recovery value than sleep associated with day shifts (p < 0.01). While on-site, participants obtained only 6 h of sleep indicating that the absence of competing domestic, family and social activities did not convert to more sleep. Factors including shift start times and circadian influences appear to have been more important.     

Performance on a simple response time task: Is sleep or work more important for miners?

The purpose of the current study was to investigate the impact of work- and sleep-related factors on an objective measure of response time in a field setting. Thirty-five mining operators working 12-h shift patterns completed daily sleep and work diaries, wore activity monitors continuously and completed palm-based psychomotor vigilance tests (palmPVT) at the start and end of each shift. Linear mixed models were used to test the main effects on response time of roster, timing of test, sleep history and prior wake. The time at which the test occurred was a significant predictor of response time (F_3,403.4 = 6.72, p < .01) with the end of night shifts being associated with significantly slower response times than the start of night shifts, and the start or end of day shifts. Further, the amount of sleep obtained in the 24 h prior to the test was also a significant predictor of response time (F_3,407.0 = 3.05, p < .01). The results suggest that, as expected, the end of night shift is associated with changes in response time indicative of performance impairments. Of more interest however is that immediate sleep history was also predictive of changes in response time with lower amounts of prior sleep related to slower response times. The current data provides further evidence that sleep is a primary mediator of performance, independent of roster pattern.     

The effects of frequently rotating shiftwork on sleep and the family life of hospital nurses

The effects of three frequently rotating shifts in an irregular sequence on the daily activities of 239 Japanese female hospital nurses were studied by the time-budget method. The nurses recorded their daily activities for several consecutive days. The questionnaire was returned by 80·8% of the participants, and recordings of 1016 days were analysed. A two-way analysis of variance clarified that the shift combination influenced the daily activities. The most distinct result was that nurses spent significantly more time on free-time activities on the day when they worked the night shift followed by the evening shift than they did on the day when they worked any other shift combination. Nurses offset sleep deprivation either by sleeping during the day before and after working the night shift (82–100%) or by sleeping 2 to 4?h later in the morning after working the evening shift and on days off. There was a strong positive correlation between total sleep time (including day sleep) and the length of the interval between two consecutive shifts (r = 0·95, p < 0·001). This result suggests that more than 16 h between work shifts is required to allow more than 7?h of total sleep time. In an analysis by household status, nurses who had young children (average age, 2·8 years) slept less and spent less time on free-time activities than did other nurses.     

Innovative working schedule: introducing one short nap during the night shift.

In order to test the possible long-term effects of the implementation of a short nap during night shifts, an experiment was conducted over a period of 1 year with 12 volunteer shiftworkers operating in an industrial plant. They were authorized, under certain conditions, to use individual sleeping areas, for a maximum of 1 hour, between 23h30 and 3h30. The participants were asked to fill in a short questionnaire every day during the entire study. The questions concerned the schedule of the main sleep period, the afternoon nap and the night-time nap, if any, as well as the evaluation of mood and the quality of work. This daily questionnaire was supplemented by an extensive questionnaire applied every 2 months in order to assess the main changes introduced in the life of the participants by this new working schedule. Results showed that this new organization introduced a general satisfaction about the quality and the easiness of the work at night. The vigilance level was considered to be higher during the hours following the nap. The efficacy of the nap time progressively increased for most subjects. The general quality of life improved for most subjects. While a few of them considered that falling asleep was less easy on the following morning at home, the statistical analysis did not show any detrimental effect of the short rest period on the length of the immediately consecutive main sleep period. However, different statistical analyses allow us to reveal significant differences between the main sleep durations following the night shift compared with those following both the afternoon shift and the resting period. The main sleep duration following the night shift was not statistically different from that of the morning shift. These results are very encouraging. A short nap during the night shift can be considered as a positive way to counteract the low level of vigilance that normally occurs during the late part of the night.     

Time-budget studies of policemen in weekly or swiftly rotating shift systems

For 8 days 120 policemen kept special diaries including working time, travelling to and from work, leisure time and sleeping time. By analysing the data of leisure and sleep in relation to the time of day and the type of shift it is possible to find out critical points within a shift system.

The mean duration of sleep was reduced before morning shifts, between night shifts and after a morning shift that was followed by a night shift on the same day. The leisure time was limited in connection with afternoon shifts and between the combined morning and night shift. It is recommended not to have double shifts on one day.

Rapidly rotated shift systems had more advantages referring to the total amount of night sleep than weekly rotated shift systems. The backward rotation of shifts was unfavourable because of the short time off between the last afternoon shift and the first morning shift. Furthermore, short nightwork periods and a start of the morning shift which is not too early seem to be preferable.     

Innovative working schedule: introducing one short nap during the night shift

In order to test the possible long-term effects of the implementation of a short nap during night shifts, an experiment was conducted over a period of 1 year with 12 volunteer shiftworkers operating in an industrial plant. They were authorized, under certain conditions, to use individual sleeping areas, for a maximum of 1 hour, between 23h30 and 3h30. The participants were asked to fill in a short questionnaire every day during the entire study. The questions concerned the schedule of the main sleep period, the afternoon nap and the night-time nap, if any, as well as the evaluation of mood and the quality of work. This daily questionnaire was supplemented by an extensive questionnaire applied every 2 months in order to assess the main changes introduced in the life of the participants by this new working schedule. Results showed that this new organization introduced a general satisfaction about the quality and the easiness of the work at night. The vigilance level was considered to be higher during the hours following the nap. The efficacy of the nap time progressively increased for most subjects. The general quality of life improved for most subjects. While a few of them considered that falling asleep was less easy on the following morning at home, the statistical analysis did not show any detrimental effect of the short rest period on the length of the immediately consecutive main sleep period. However, different statistical analyses allow us to reveal significant differences between the main sleep durations following the night shift compared with those following both the afternoon shift and the resting period. The main sleep duration following the night shift was not statistically different from that of the morning shift. These results are very encouraging. A short nap during the night shift can be considered as a positive way to counteract the low level of vigilance that normally occurs during the late part of the night.     

Sleep and circadian rhythms in mining operators: limited evidence of adaptation to night shifts

Cumulative sleep deprivation is often associated with work patterns involving night shift or early morning shifts. Adaptation of the circadian system to the shift pattern is reported to promote improved duration and quality of sleep and a concurrent improvement in performance. The current study followed twenty-nine operators at a live-in mining operation working to a seven-day, seven-night shift pattern who collected saliva samples for melatonin measurement, recorded sleep using activity monitors and diaries, and underwent performance testing (psychomotor vigilance task) for one complete roster cycle. The time of onset of melatonin secretion changed significantly (P=0.022) across the week of both Day and Night shifts (2104 h ± 16 min versus 2130 h ± 16 min, respectively), but the small magnitude of the change indicates a lack of true circadian rhythm adaptation to the lifestyle. Total sleep time was longer following the seventh Day shift (associated with a period of 24 h off prior to the commencement of Night shifts). There were no other changes in total sleep time. Further, there were no improvements in sleep onset latency or sleep efficiency on Day or Night shifts. However, reaction times recorded at the end of the shifts slowed across the seven Day and seven Night shifts indicative of impairments in psychomotor performance (F(6,168)=6.087, P<0.001). The results suggest that previous reports of adaptation to consecutive night shifts cannot necessarily be applied to onshore or Australian environments. Adaptation is dependent on factors such as light exposure, environmental conditions, shift parameters such as wake-up, work start and work end times and individual characteristics.     

Operational assessment of the 5-h on/10-h off watchstanding schedule on a US Navy ship: sleep patterns,mood and psychomotor vigilance performance of crewmembers in the nuclear reactor department

We assessed sleep patterns, psychomotor vigilance performance, work demands and mood of 77 crewmembers of USS NIMITZ (CVN-68) on the rotating 5-h on/10-h off (5/10) watchstanding schedule. Within the 3-day cycle of the 5/10, sleep occurred at distinctly different times each day. On two of these days, sailors typically received only brief, 4-h sleep episodes followed by periods of sustained wakefulness (approximately 22 and 20 h). Crewmembers received approximately seven hours of sleep daily, but reported excessive fatigue and dissatisfaction with their schedule. Crewmembers’ mood worsened significantly over the course of the underway phase. Psychomotor vigilance performance (reaction times, lapses) was significantly degraded compared to performance when working circadian-aligned schedules. Overall, standing watch on the 5/10 schedule, combined with other work duties, resulted in poor sleep hygiene. Crewmembers on the 5/10 experienced periodic bouts of sustained wakefulness and accrued a significant sleep debt due to extended workdays and circadian-misaligned sleep.

Practitioner summary: We assessed crewmembers’ sleep patterns, psychomotor vigilance performance and work demands when working a rotating 5-h on/10-h off (5/10) watchstanding schedule. The 5/10, combined with other work duties, resulted in poor sleep hygiene. Crewmembers experienced periodic bouts of sustained wakefulness and accrued a significant sleep debt due to extended workdays and circadian-misaligned sleep.     

What is the preferred number of consecutive night shifts? results from a crossover intervention study among police officers in Denmark

Among police officers in Denmark, we studied (i) how many consecutive night shifts participants preferred at baseline; (ii) preferences regarding three intervention conditions (two, four, and seven consecutive night shifts followed by the same number of days off/day shifts: ‘2 + 2’, ‘4 + 4’, ‘7 + 7’) at follow-up; (iii) characteristics of participants preferring each of these intervention conditions. Questionnaire data from a crossover intervention study were used (baseline: n = 73; follow-up: n = 68). At baseline, 49% preferred four consecutive night shifts. At follow-up, 57% preferred ‘4 + 4’, 26% preferred ‘2 + 2’ and 26% preferred ‘7 + 7’. Participants, who preferred longer spells of night work experienced that night work was less demanding, found it easier to sleep at different times of the day, and were more frequently evening types compared with participants who preferred shorter spells of night work. The participants’ preferences are likely to be influenced by their previous shift work experience.

Practitioner Summary: We investigated police officers’ preferences regarding the number of consecutive night shifts. The majority preferred four consecutive night shifts. Those who preferred the longer spells of night work found night work less demanding, found it easier to sleep at different times of the day, and were more frequently evening types.     

Fatigue assessment among onshore oil rig shift workers in Thailand

This study aimed to assess fatigue among onshore oil rig shift workers in a petroleum company working in swing shifts. The work schedule consisted of 12 h of night shifts for one week followed by 12 h of day shifts for one week. Fatigue was assessed using both subjective and objective measurements which were visual analogue fatigue scale (VAFS) and simple reaction time (SRT) test, respectively. A total of 38 male onshore oil rig shift workers participated in this study. Fatigue assessment was conducted at the start and at the end of workdays on nights 1, 4 and 7, and days 1, 4 and 7. The results showed that there were significant differences of VAFS and SRT at the end of workdays, compared with at the start of workdays (p < 0.001). The fatigue level assessed by both SRT and VAFS was highest on the rotating day (p < 0.001). In conclusion, swing shifts might affect fatigue levels in shift workers. The fatigue level increased over the two-week work period. Further studies on fatigue assessment and management among onshore oil rig shift workers are still needed.