Senior Lecturer Sheri Scott with practical advice for employers and employees on how to best manage mental and physical health while undertaking shift work.
In the April issue of the Biomedical Scientist, I took a look at the potential health effects of night shifts and the disruption of our circadian rhythms. In this article I explore preventative measures that employer and employee can take to mitigate those risks. By following the recommendations of the Health and Safety Executive (HSE) in combination with findings of the recent literature on shift-work risk we can adopt a mix of existing best practices, common-sense lifestyle changes and practical measures from the employer to the working environment, the serious health risks of shift work can be significantly reduced.
Helping ourselves: travel
In total, 20% of accidents are caused by fatigue. Driving can be risky after a long shift, a night shift or before an early start. The HSE provides several strategies to help make driving safer (see below).
Food and drink
It comes as little surprise that consuming stimulants, such as caffeine and nicotine, before going to sleep is not recommended. Caffeine is a drug that acts as both a mental and physical stimulant. We should try to avoid consumption of caffeine for at least four hours prior to going to bed.
The HSE also recommend that we restrict our energy intake between midnight and 6am. We should try to eat at the beginning and end of the shift and, although a small bedtime snack is fine, it is recommended that you should allow two to three hours between the last main meal of the day and heading off to bed. You should avoid sugary foods as these provide a short-term energy boost followed by a dip in energy levels. Alcohol should be avoided for at least four hours before going to bed, as this will also disrupt your sleep during the day.
It is recommended that employees stick as closely as possible to a normal day and night pattern of food intake, with the dividing of daily food into three main meals, with each contributing about a third to the overall intake.
The more energy demanding the tasks, the more frequent any meals and snacks should be. However, where possible, sugar-rich products should be avoided and employees should choose vegetables, salads, fruit, lean meat, poultry, fish, dairy products, grains, vegetable soups, wholegrain bread, boiled nuts and green tea, which are more easily digested.
Eating and drinking patterns should be adapted according to the shift pattern. Afternoon/evening shift workers should consider having their main meal in the middle of the day, rather than during their shift, and night workers should eat lightly throughout the shift, with a moderate breakfast. Sufficient time is needed for digestion and it is important that plenty of water/fluids are consumed to avoid dehydration. Other foods to avoid are those with high fat and salt content.
It is important to avoid the excessive use of antacids, tranquilisers and sleeping pills to try to combat some of the ill effects of shift work, as these will have a negative effect on health.
Activities and environment
Before we settle down for the day, we need to make sure that family and friends are aware and considerate of our sleep hours and needs. You can put a notice in your window to alert potential callers, unplug the doorbell and change your phone to settings that are less likely to disrupt your sleep. Try to ensure your environment is comfortable and quiet and at an appropriate temperature. Voicemail, foam earplugs, eye masks and good blinds or curtains are all worthwhile investments.
Preparation
Preparing for a day rest should follow the same principles as preparing for bed at night – you need to make time for quiet relaxation. It is best to try to establish a pattern to facilitate sleeping during the day.
The HSE and others recommend avoiding activities such as strenuous exercise before sleeping as this elevates the body’s metabolism, which can remain elevated for several hours.
Age can also be a factor, with studies showing that sleep problems become more exaggerated from the age of 40.
Employees need to try to avoid doing 10 consecutive years of shift work and maintain a healthy lifestyle with exercise, regular mealtimes and good sleeping habits when not working.
Top Tips for Travel
Driving to and from work:
- Use public transport or taxis rather than driving.
- Exercise briefly before your journey.
- Share driving, if possible.
- Drive carefully and defensively and try not to hurry.
- Stop if you feel sleepy and take a short nap if it is safe to do so.
- Make occasional use of caffeine or “energy” drinks.
Alertness at work
On nights and very early mornings employees often find it difficult to remain alert, which can affect their performance. It can increase the risk of errors, injury and accidents. Tips to increase alertness include:
- Moderate exercise before the start of work and keeping the light bright.
- Regular short breaks during the shift, if possible.
- Moving and walking during breaks.
- Conducting more stimulating work at the times you feel most drowsy.
- Communication with co-workers.
Employer steps
The are several steps employers can take to mitigate the health risks and these should be considered when implementing a shift pattern. When planning the shift rota, this should be considered as far in advance as possible. Schedules need to be flexible to allow workers to trade shifts, allowing for time off as required. Firstly, there needs to be an evaluation of the shift schedule design – does the duration of the shift contain sufficient number and length of break? Do the start and finish times allow adequate time between the shifts for sufficient sleep and meal preparation? Quick returns need to be avoided (<11 hours) and the schedule of work should consider that the most demanding work is early into the shift when workers are most alert. Ideally, no more than five to seven shifts should be scheduled in a row, and it is recommended that no more than two nights in a row.
In addition to the night shifts, excessive overtime, split shifts and excessive 12-hour shifts should be avoided. If a shift pattern includes rotation, this rotation should rotate forward (morning – afternoon – night) wherever possible and there should be at least 48 hours between shift changes to allow the body to adjust.
It is important for the employer to consider individual differences and needs. It is important that day employment for workers who can’t work shifts for medical reasons is available. Employees suffering with shift work disorder often experience a reduction of symptoms if they move back to a more traditional work schedule. If this is not the case, it is important they are encouraged to seek medical help, especially if symptoms persist for two weeks or longer. It is also important that the evaluation of sleep problems is considered during regular health checks, and that employees are educated to ensure that these health checks become more frequent from age 40 and in those who have been shift workers for 10 years or more. It is considered good practice to provide workshops and information sessions on stress management and healthy living.
Employers need to make sure the demands on the workers are reasonable. Mental and physical health need to be considered and employers should consider offering facilities for social activities, such as recreation and relaxation.
It is recommended that a 24-hour cafeteria where night workers can obtain a hot, nutritious meal and appropriate dining facilities are available and that allow a meal to be eaten away from the workplace, with colleagues, in as pleasant a surrounding as possible, with the inclusion of regular meal breaks factored into the shift schedule.
Top Tips for sleep
- Identify a suitable sleep schedule.
- Most adults need 7–8 hours sleep a day, although this may decrease with age. If you cannot do this, try to rest, as this is still beneficial.
- Have a short sleep before your first night shift.
- If coming off night shifts, have a short sleep and go to bed earlier.
- Once you have identified a suitable sleep schedule, try to keep to it.
Conclusion
Although many of these suggestions are considered best practice and/or essential requirements, in reality they are not always adopted. Staffing levels, facilities and financial implications all play a part in what is feasible. However, it is hoped that increasing awareness of the implications on health and the NHS working towards sustainability development goals (which include SDG3, Good Health and Well-being), means there will be a move towards supporting these recommendations and requirements in the future.
Sheri Scott is a Senior Lecturer in Biomedical Science at Nottingham Trent University
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