A polysomnographic study of morning and afternoon sleep quality during simulated night shift work

Shiftworkers differ as to scheduling their day sleep between night shifts. An experimental study was carried out to compare the effects of morning and afternoon sleep behaviour on sleep quality within and after a period of seven night shifts. Twelve young males participated in a repeated–measures design, six sleeping in the morning and six in the afternoon after night shifts. Sleep quality was evaluated by polysomnographic and subjective measures. Morning and afternoon sleepers showed some differences in the trend of sleep changes over successive sleep periods. However, at the end of the night shift week, there were no marked differences in sleep quality. Both morning and afternoon sleep were characterized by deep sleep, and short sleep onset latencies.     

Does the ‘forbidden zone’ for sleep onset influence morning shift sleep duration?

Shiftwork researchers have concentrated on the problems on the night shift, and have tended to neglect the truncation of sleep that can occur before morning, or ‘early’, shifts. We examined the sleep timing and duration between morning shifts of shiftworkers on a variety of shift systems. The extent of morning shift sleep truncation depended very largely on the time at which individuals had to leave home. Further, there was some suggestive evidence that the failure of individuals to compensate by going to sleep earlier was not simply due to social pressures to stay up. Rather it would appear to have depended, at least in part, on the biological clock determined ‘forbidden zone’ for sleep that occurs shortly before habitual sleep onset.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Shiftwork and work injuries in an iron and steel mill

A study on work injuries that occurred over a five-year period was conducted in an iron and steel mill employing over 1000 workers. Of all the 921 injuries which required more than one day's sick leave, over 40% (383 cases) happened during the morning shift (0700-1500 hours), 210 cases occurred in the afternoon shift (1500-2300 hours) and only 150 cases were reported during the night shift. There were two injury peaks throughout the day, one at mid-morning (between 0900 and 1000 hours) and the other towards the mid-afternoon (1400-1500 hours). It was observed that hand injuries were more common during the morning and afternoon shifts and foot injuries normally occurred at night. 'Fall' was one of the main causes of accidents at night, whereas 'struck by' heavy objects and 'burn' were more common during the day. Although there were more accidents during the morning and afternoon shifts, work injuries which occurred at night generally required a longer duration of sick leave. This suggests that accidents which happened at night were more serious. It is believed that the work habits, shift systems and work environment have a substantial influence on these accidents.     

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.     

An experimental change of the speed of rotation of the morning and evening shift

Eighty-five Dutch railway traffic controllers were studied before and after a change in their continuous shift schedule. The original schedule was slowly rotating, while the experimental schedule had a moderately rapid rotating morning and evening shift, but a slowly rotating night shift. Before and 6 months after the change, questionnaires and a diary were filled in. A decrease in sleep complaints and weekly workload was found. No reduction in the amount of complaints regarding leisure time in the evening was registered; only an increase in satisfaction with leisure time in the evening.     

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.     

Systematic review of the relationship between quick returns in rotating shift work and health-related outcomes

A systematic literature search was carried out to investigate the relationship between quick returns (i.e. 11.0 hours or less between two consecutive shifts) and outcome measures of health, sleep, functional ability and work–life balance. A total of 22 studies published in 21 articles were included. Three types of quick returns were differentiated (from evening to morning/day, night to evening, morning/day to night shifts) where sleep duration and sleepiness appeared to be differently affected depending on which shifts the quick returns occurred between. There were some indications of detrimental effects of quick returns on proximate problems (e.g. sleep, sleepiness and fatigue), although the evidence of associations with more chronic outcome measures (physical and mental health and work–life balance) was inconclusive.

Practitioner Summary: Modern societies are dependent on people working shifts. This study systematically reviews literature on the consequences of quick returns (11.0 hours or less between two shifts). Quick returns have detrimental effects on acute health problems. However, the evidence regarding effects on chronic health is inconclusive.     

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.     

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.     

Performance and alertness on 8 h and 12 h rotating shifts at a natural gas utility

Abstract

An 8 h/5-7 day shift schedule was compared with a newly instituted 12 h/2-4 day schedule in this, our second worksite study of extended workshifts. Workers completed a performance/alertness test battery, and a questionnaire on sleep patterns and other personal habits, 2-4 times a week on all shifts. After 10 months adaptation to the 12 h shift schedule, there were decrements in performance/ alertness attributable to the extra 4 h on the extended shift. There were also reductions in sleep across the workweek which were most apparent on 12 h night shifts. The results are consistent with our first worksite study of 12 h shifts and indicate extra caution should be exercised when scheduling critical activities for extended workshifts, especially extended night shifts.     

How fast should the night shift rotate?

Claims are frequently made that changing from morning to afternoon to night shift at about two- to three-day intervals (rapid rotation) is the best way of organizing 24h staffing. A critical analysis is made of the grounds for these assertion, followed by a review of evidence bearing upon the issue of whether longer periods of rotation are to be preferred. The conclusion is that permanent (zero rotation), fixed-night systems are superior on most counts, and should be implemented for night work, leaving the option of rapid rotation to cover the two (morning and afternoon) day shifts. This said, the multiplicity of shift systems and settings means that this will not always be the method of choice. Furthermore the recommendation should be regarded as provisional pending a search for more data directly comparing the two systems.     

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.     

How fast should the night shift rotate?

Claims are frequently made that changing from morning to afternoon to night shift at about two- to three-day intervals (rapid rotation) is the best way of organizing 24h staffing. A critical analysis is made of the grounds for these assertions, followed by a review of evidence bearing upon the issue of whether longer periods of rotation are to be preferred. The conclusion is that permanent (zero rotation), fixed-night systems are superior on most counts, and should be implemented for night work, leaving the option of rapid rotation to cover the two (morning and afternoon) day shifts. This said, the multiplicity of shift systems and settings means that this will not always be the method of choice. Furthermore the recommendation should be regarded as provisional pending a search for more data directly comparing the two systems.