Adapting to the Stress of Shift Work
 

John M. Violanti, Ph.D.

Another night shift. I feel tired all the time-- out of touch with the rest of the world. I go home after nights and try to sleep. The kids are screaming, my spouse is on the phone, the neighbors are cutting the lawn. It seems like all those little noises of the day keep me awake. Finally, I fall asleep. Two or three hours later, I'm up again and I can't fall back asleep. For the rest of the day, I feel fatigued, depressed and irritable. I can't eat. I trudge through the day looking like a zombie. That night, back to work I go, starting the whole thing over again.

This is a typical statement of police officers who work night shifts. Shift work takes a costly toll on many aspects of officer's lives. This article will discuss some personal as well as performance related effects of shift work. In addition, suggested solutions to the problems of shift systems will be explored.

Physical Effects Of Shift Work

The continual disruption of body chemistry causes physiological complications among shift workers. Everyone has a "biological clock" known as the Circadian cycle. This cycle is based on a 24 hour schedule and, if disrupted by abnormal time activity, can lead to bodily dysfunctions. Recent studies demonstrate that rotating shift work causes major difficulties with sleep, appetite, and bowel habits. Workers report that they are fatigued most of the time, have dull appetites, and are constipated. Table 1 illustrates the effects of a three shift system:

Table 1. Shifts and Time-Oriented Body Functions

Complaint ..............................................Shift

	Days	Afternoons	Nights	Rotating Shifts
Trouble getting asleep	Moderate	Moderate	High	High
Trouble Staying	Moderate	Moderate	High	High
Appetite	Moderate	Moderate	Poor	Poor
Constipation	Moderate	Moderate	High	High
Diarrhea	Moderate	Moderate	High	High

Other health related complaints of shift workers included frequent colds and headaches, high rates of infectious disease, high rates of ulcers, and rheumatoid arthritis. Available evidence shows that these workers may also be at additional risk for heart disease as they become older. A majority report highly stressful feelings, including being "trapped" on undesirable shifts.

A common belief is that workers will eventually adjust to their shifts. According to recent research by Mott, et.al, this is not true. They found no relationship between age, length of service, and adapting to shift work. This means that regardless of time on the job, workers still could not regulate their bodies to rotating shifts.

The Psychological Effects Of Shifts

Shift work appears to create a great deal of stress among individuals. Stress in turn may lead to perceptions of low self- esteem and social conflict. In general terms, stress and shift work seem to be related to "blockage"; the underlying feeling that work interferes substantially with life behaviors and activities. Mott, et.al. found that the greater this perceived blockage, the lower the self-esteem and the higher the experienced stress. Difficulty in assuming family roles or engaging in social activities were the problems most mentioned. Life activity stress was greatest for young workers, those with higher education, those who had small children, and those who had short lengths of service.

Equally stressful for the shift worker is the process of continual change. Change, even though it may be small, can significantly affect one's life. Changes in the daily routine of living calls for a "re-synchronization" of the self-- how one views his/her relationship to the rest of the world. Each shift change brings a new set of relationships and requires a new way for the individual to deal with those relationships.

Effects on Family And Social Life

Shift work seems to cause a degree of "imbalance" between the usual set of family activities and the work schedule. The greatest difficulty seems to be with the afternoon shift. These workers report strained relations with spouse, not seeing their children on some days, and missing important social events. Night shift workers report problems with late evening hours: sexual relations and protection of spouse from possible harm. Both wives and husbands report displeasure with being alone at night. Both also report that they have fewer friends due to limited socializing. In short, there is a strong negative effect on family interaction and communication due to shift work. High divorce rates and problems with children often result.

Shift Work And Performance

Our biological clock determines alertness during the 24 hour cycle. At certain times of the day we may be fully alert, while at other times our reactions drop to a low point. This "low point" generally occurs between 3-5 a.m., a time of day when most day workers are asleep. On night shift, however, the worker is awake and performing a task. Attention drifts and trivial little errors begin to occur. Workers start to miss things they would normally have no problem with.

Accident statistics reflect this loss of attention. Truck drivers, for example, are 8 times as likely to have an accident at 5 a.m.. Other studies show a pattern of errors occurring during night shifts. In one study surveying night shift meter readers at a gas company, results showed 75,000 mistakes in 125,000 readings. Other studies indicate that the seriousness of mistakes and accidents increases significantly on night shifts. Three Mile Island nuclear facility is a good example, where an error made at 4 a.m. caused a disaster. Absenteeism is also common on night shifts. Sick calls appear to increase significantly on nights and tend to increase more as the cycle progresses.

Just as there is an increased risk for accidents and mistakes on night shifts, there is also decreased productivity. The problem is intensified by the worker's inability to get proper sleep during the day. Workers tend not to do their jobs as well on night shifts. Even conscientious persons cannot physically and psychologically manifest proper job skills under such conditions.

What Can Be Done? : Suggested Solutions

TIMING OF SHIFTS - A solution often proposed is to increase the length of the shift cycle. Instead of rapid rotation, where the worker is changing shifts two or three times a week, the cycle length should be made longer. Dr. Charles Ehret recommends that shifts be at least 6 weeks long. This gives the worker an opportunity to adjust to each of their prescribed shifts.

Another possibility concerns the night shift. This shift may be less disruptive to sleep if it were shorter. One suggestion is to allow persons to work only 6 or 7 hours on nights and longer on the other shifts. This would allow the night worker to get to sleep earlier. Disruptions in body temperature and chemistry balance would be less, since these tend to change later in the morning. Other proposals take into account the worker's family and social life. The number of consecutive days off, for example, seems to be a feature that many shift workers like. Thus, a suggestion would be to increase the number of consecutive days off. One organization employed such a system and found it to work well. Workers got 10 consecutive days off for every 13 weeks worked. Management stated that it cost them no more than the traditional weekly rotating shift system. Workers had one day off between each weekly segment of their shift and vacation days spread among four 10 day vacation periods. Production on night shifts increased and sick calls went down. This method is also useful for reducing the disruption of traditional 5-day night work and 2-day off routines.

Management should also give at least a 2 month advance notice of shift scheduling. This allows the worker to adequately plan his/her social and family activities.

PERSONAL SHIFT WORK SOLUTIONS - The best way to deal with shift work is to adjust one's sleep-wake cycle. There are a number of recommendations by Moore-Ede Associates, Inc. (1982) which may be helpful:

1. Try to keep as regular a schedule as possible. Your body will more readily adjust to shifts and you will feel healthier. This means that you should keep the same bedtimes when you are working a particular shift. Avoid naps or sleeping at random times during the day or night.

2. Before you go onto the night shift, prepare ahead of time. Stay up late and sleep in late for a couple of days before you start. This will help you adapt more readily when the actual shift begins.

3. Make sure the room you sleep in during the daytime is dark.
Use room-darkening shades or curtains to keep out all light. When you wake up, open the shades and switch on all the lights in the room. This will send a strong signal to your biological clock that it's time to wake up.

4. Provide yourself with the best conditions of sleep. Arrange a
quiet place to sleep with a comfortable room temperature. If noise is a problem in your own bedroom, find another location in the house, e.g. basement. Some people also use a "white noise" device such as a fan or heater to divert noise from the outside.

5. It is helpful to follow a relaxing routine before you go to bed. Take the time to do things you normally do before sleep. Brush your teeth, put on sleep attire, etc.. Make sure your bed is comfortable.

6. Monitor your eating habits. The digestive disorders of shift workers result from stress combined with irregular eating patterns. The body is not designed to digest food properly in the middle of the night. Avoid heavy, starchy or greasy foods on night shifts. Eat light. At the same time, keep your meals on a regular schedule. Your body responds best to a predictable lifestyle where meals occur at regular intervals.

7. Stay in touch with your family. Sometimes, shift workers may not see spouse or children for several days. Spouses may work day shifts and workers may be on evenings. If this is the case, set up some sort of "family communication" system. One good idea is a message board, where you may leave notes for your spouse and children. Call home and talk with your family while you are on a break at work. Don't become isolated from this important part of your life. If your spouse is home during the day, it is quality time to do things together. Go shopping, have lunch, or take in a movie.

In conclusion, it is the task of both organization and individual worker to solve the problems of shift work. It is clear that shift systems are deleterious to workers in terms of health and to organizations in terms of lost time and productivity. Instead of continuing to simply adopt the "old standard" idea of shifts, new patterns which include the worker's self, family, and social being must be initiated. Certainly, in the long range, both organization and worker will ultimately benefit.