SHIFT WORK AND FATIGUE MANAGEMENT

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1 and Fitness for Work SHIFT WORK AND FATIGUE MANAGEMENT CAMMY ORREN Overview Fatigue introduction Understanding sleep Impact of shift work Managing shift work and fatigue Organisational strategy Copyright BSS 1

2 Causes of Fatigue Fatigue is a loss of alertness & performance caused by Too little Poor quality sleep Working at times you should be asleep Mentally or physically demanding work SHIFT / ROSTER Night work Hours worked No. consecutive shifts Rotation direction Breaks Cycle lengths No. shift changes TYPE OF WORK Mental load Physical load INDIVIDUAL CHARACTERISTICS Suitability for night work Age Fitness Chronic illnesses Sleeping disorders CAUSES OF FATIGUE PRIVATE COMMITMENTS Family Social activity Study / other jobs LACK OF SKILLS & KNOWLEDGE Sleep habits Ability to nap Alcohol / drug use Nutrition Stress Management Preparation for night shift WORK CULTURE Work pressure Support for self management Work practices job rotation napping ENVIRONMENT Temperature Noise Light levels Vibration Humidity Dust Chemical exposure SLEEPING ENVIRONMENT Temperature Noise control Light control Inside toilets COMMUTING Daily Start / end cycle Copyright BSS 2

3 Effects on Performance Fatigue Impacts on quality of decisions Impairs short term memory Increases reaction time Impairs coordination Arousal, Fatigue & Risk HIGH AROUSAL FATIGUED High risk * Fatigued * High arousal Extreme risk * Fatigued * Low arousal Safe * Rested * Mod. arousal Low - mod risk * Rested * Low arousal RESTED LOW AROUSAL Copyright BSS 3

4 DANGER ZONE Very fatigued with a high level of arousal Mistakes Risk taking Aggression Exhaustion Crash and burn HIGH AROUSAL SAFE ZONE Well rested with a moderate level of arousal FATIGUED EXTREME FATIGUE Danger Stimulant drugs MODERATE FATIGUE Alerting triggers Nap LOW AROUSAL RESTED BUT NOT ALERT Alerting triggers RESTED ALERTING TRIGGERS Mental activity Physical activity Caffeine Noise Light Temp. & humidity Drink water Food Deep breathing The Signs of Fatigue ALERT SLIGHTLY FATIGUED MODERATELY FATIGUED DANGEROUSLY FATIGUED Alert appearance Normal eye blinks Attends to surroundings Coordinated movements Irritable, impatient Wandering thoughts Rubs eyes Restless Tired appearance Quiet, withdrawn Long blinks (1-2 seconds) Trouble following instructions Yawning Little or no activity Fixed staring Unresponsive Long blinks (2 or more seconds) Sudden startle responses Micro sleeps Copyright BSS 4

5 Important Facts Fatigue accumulates over time (back-pack) Individuals may not be good judges of own fatigue You do not learn to cope - just get used to poorer performance Fatigued individuals at risk of micro-sleeps Who is Fatigued? Females (45% vs. 34%) Parents (50% vs. 32%) Shift workers (52% vs. 36%) Those with low levels of marital satisfaction (52% vs. 35%) Those with depression (58% vs. 32%) Caregivers of child or person who is not able to live independently (50% vs. 34%) Copyright BSS 5

SA Statistics 2011-2015 Night shift 66% Pre-night shift no sleep 26% Trouble staying asleep after night shift 33% Sleep less when on night shift (2 hrs +) 44% Less than 5.

6 SA Statistics Night shift 66% Pre-night shift no sleep 26% Trouble staying asleep after night shift 33% Sleep less when on night shift (2 hrs +) 44% Less than 5.5 hrs sleep Night shift 28% Day shift 17% Off days 10% Fatigue and Accidents CRASH TYPE ALCOHOL FATIGUE All 5% 5-10% Serious injury 20% 20-30% Fatality 40% 25-35% Copyright BSS 6

7 Fatigue When Driving Can t remember last few kilometres Trouble keeping head up Drift across lanes / onto verge Few but large steering corrections Forget to dip lights Speed varies without noticing What are your early warning signs? Sleeping Disorders Obstructive Sleep Apnea Narcolepsy Gastro-esophageal Reflux Restless Legs Insomnia Copyright BSS 7

8 Sleep / Wake Cycle Humans perform best during day & want to sleep at night Main low period occurs between midnight and dawn Another dip occurs mid afternoon In high periods (mid morning, early evening) it is hard to get to sleep Sleep & Wake Up Signals These are fixed cycles in the body Circadian rhythms In the evening: Sleep signals Sun goes down Core body temperature goes down Melatonin levels rise (hormone that helps you get to sleep & stay asleep) Alertness decreases In the morning: Wake up signals Sun comes up Core body temperature goes up Melatonin levels decrease Alertness increases Copyright BSS 8

Circadian Rhythm, Sleep & Alertness LAST NIGHT SLEEP FIRST NIGHT SHIFT 10 PM 6 AM 10 PM 6 AM Melatonin Body temp. Sleep signals Core Body Temperature Alertness Level Melatonin Body temp.

9 Circadian Rhythm, Sleep & Alertness LAST NIGHT SLEEP FIRST NIGHT SHIFT 10 PM 6 AM 10 PM 6 AM Melatonin Body temp. Sleep signals Core Body Temperature Alertness Level Melatonin Body temp. Wake up signals Sun Melatonin level Sun Getting To Sleep at night time Core body temp. falling Melatonin level rising Hunger / thirst down Urine production down Light levels falling Night time temp. falling Core body temp. rising Melatonin level falling Hunger / thirst up Urine production up Light levels rising Day temperature rising in the day time Copyright BSS 9

10 Personal Cost of Shift Work Sleep loss Irritability Social and family problems Minor illnesses Gastrointestinal disorders Cardiovascular illnesses Obesity and low level of fitness Impact of Shift Work on Families Shift workers are often grumpy Reduced opportunity for quality family time Sex suffers due to fatigue and reduced opportunity Partners have most of parenting responsibilities Family routines disrupted when shift worker is off Conflict if children disrupt daytime sleep Family occasions missed Normal social life hard to maintain Children miss out on attention from shiftwork parent Copyright BSS 10

11 Women and Shiftwork 2007 study by the USA National Sleep Foundation: 70% of women report sleep problems Why? Higher rates of insomnia (higher rates of stress, anxiety & depression) Multiple roles (mother, wife, worker) ignore fatigue Early motherhood and beyond: Sensitivity to sounds of children Show all shiftwork related problems seen in men (digestion, CV disease, chronic fatigue) Higher rate of restless leg syndrome Partner disturbance Staying Alert Mental stimulation Smell / Sniffing Physical activity Chewing Job rotation Drink water Sleep Bank Eat for alertness Time of day Use caffeine strategically Light Breathe deeply Temperature & humidity Napping Sound Take care at high risk times Act responsibly Copyright BSS 11

12 Sleeping After Night Shift Is Difficult LAST NIGHT SLEEP FIRST NIGHT SHIFT Caffeine 20 HOURS AWAKE 6 AM 6 AM Plan To Sleep After Night Shift Must address Excessive caffeine use Exposure to sunlight on way home Falling melatonin level Rising core body temperature Copyright BSS 12

13 Getting To Sleep After Night Shift LAST NIGHT SLEEP FIRST NIGHT SHIFT BODY TEMP. Warm bath SLEEP Alerting strategies Awake 13 hours 6 AM 3 PM 4 AM 6 AM Staying Asleep After Night Shift Preventing hunger Food to promote sleep Thirst and urination Lazy bladder Smoking Copyright BSS 13

14 Eating for Alertness or Sleep Calm, alert state = protein, vegetables & carbohydrates Burst of energy / alertness = protein & vegetables, no carbohydrates Calm down, relax and promote sleep = carbohydrates with no protein Napping: Benefits And Risks BENEFITS Catch up on lost sleep Prepare for night shift To counter fatigue / loss of alertness RISKS Sleep inertia Impact on subsequent sleep Copyright BSS 14

15 Rules for Napping Practice! Pick the right time and keep to it Relax before your nap time Arrange suitable napping conditions Train yourself Don t nap late in the afternoon Wake up gradually Napping Before First Night Shift A nap before first night shift is very important to: Cut down the length of time continuously awake Prevent sleep debt Shift change = 36 hour day - you need 12 hours sleep in this time Copyright BSS 15

16 Rules For Napping On Shift Naps should be short (25 minutes or less) to avoid sleep inertia Naps should be away from work station / vehicle Supervisor must be notified Only one nap per shift Supervisor must check alertness before person returns to work When Does Your Pilot Nap? Assessed during: last 90 minutes of flight last 30 minutes (descent & landing) No. of involuntary micro-sleeps FLIGHT TIME Rest Group (12 subjects) No Rest Group (9 subjects) Last 90 minutes Last 30 minutes 0 22 Source: Rosekind, M. R. et al (1995) Copyright BSS 16

17 Shift Change How do you sleep during the day? Sleep debt Poor day sleeper Good day sleeper Number of night shifts If you are a poor day sleeper, you need to be at your best starting nights Managing Shift Change It is better to return to day shift because: Easier to prepare for night shift on shift change day Reduces the no. of shift changes at work Avoids carrying fatigue from night shift to day shift Easier to reorientate to site on days Minimise shift change binge drinking However there are costs: Most dislike sleeping on first day off after night shift. May have to drive home after last night shift Early wake up to start day shift can be fatiguing Copyright BSS 17

18 Shift Change Day LAST DAY SHIFT 6 AM - 6 PM 24 hours off FIRST NIGHT SHIFT 6 PM - 6 AM Start of last day shift to end of first night shift = 36 hours Need 12 hours sleep in time off (2 hours awake, 1 hour asleep) What is the plan to get this in the 24 hours off? Safe Commuting - Preparing Have a sleep before driving Share travel with others Schedule regular stops (and take them) Avoid alcohol / medications Address sleeping problems Dress warmly in cold weather (don t use heater) Take coffee for trip Copyright BSS 18

19 Safe Commuting - Driving Avoid driving at times when fatigue is likely to be greatest Monitor your alertness levels Manage your alertness levels listen to chat show talk with passenger stop to walk and stretch have a coffee drink water breath deeply every 10 minutes Respond to a loss of alertness - stop! Protecting Your Family Life Make your family your first priority Make an effort to communicate with your partner Schedule regular time together with your partner Regularly treat you partner Discuss how you can help with the house and family Identify time for family activities Plan for family occasions / schedule work around these if possible Copyright BSS 19

20 Protecting Your Family Life Discuss the demands of your work with your family Get enough sleep - no one likes a grump! Respect your partners decisions if he or she has primary responsibility Plan for regular holidays together and use this time to strengthen family relationships Let your partner have a sleep in once a week Seek help if you think a problem is developing. Make an effort to maintain a social life especially if your partner does not have an outside job. Organisational Strategy Legal Requirements Best Practice Overlaps and Duplicates Policy and Procedures Education and Awareness Risk Factors Performance Management Disciplinary Action Occupation al Health EAP HR Executive Wellness Safety Industrial Relations Copyright BSS 20

21 Roster assessment Night work Callouts Hours per 7 days (average) Number of nights shifts Total number of shifts Hours off after night shift Length of day (shift + travel) Rotation Start / finish time Number breaks / total break time Implementation plan BUDGET RESOURCE ACTION Pre - Employment Self Management of Employees Line Management and Supervisors - Case Management Occupational Health Interventions Management EAP HR Executive Wellness Safety Industrial Relations Reports and Evaluation Measurements Copyright BSS 21

22 Overview Of Fatigue Training Session 1: Induction * Overview * Personal assessment / understanding Session 2: Employee * Report on fatigue on site * Individual fatigue plan * Team fatigue plan * Skills of sleep preparation Session 3: Supervisor Training * Managing FFW * Recognizing potential impairment * Intervention strategies * Management plans * Use of EAP / medical facilities A Sample Sleep Profile Risk 1. LENGTH OF SLEEP Sleep Insomnia apnoea -lepsy reflux less habits enviro disturb before side commi environ- stress & health use use drinking to Before Sleep Narco Gastric Rest- Sleep Sleep Sleep Sleep Travel Out- Family Work Work Health Major Caffeine Alcohol Is your Drugs Smoke Exercise profile legs -ment -ance first activitiecare M F ous? sleep tments ment Self- issues danger- help sleep Days Day Night by night off shift shift partner shift Low Risk Mod Risk High Risk Copyright BSS 22

HEALTHY LIFESTYLE, HEALTHY SLEEP. There are many different sleep disorders, and almost all of them can be improved with lifestyle changes.

HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep disorders, and almost all of them can be improved with lifestyle changes. HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep