THE MIDNIGHT SUN: SHIFT WORK, SLEEP, AND HEALTH

Transcription

1 THE MIDNIGHT SUN: SHIFT WORK, SLEEP, AND HEALTH Annual PERMA Conference, Lake George, NY May 25 26, 2017 John M. Violanti, PhD Epidemiology & Environmental Health School of Public Health & Health Professions University at Buffalo, SUNY Buffalo, NY

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12 Microsleep 30 Seconds to Catastrophe..

13 What is a microsleep? A microsleep is a brief sleep episode that lasts up to 30 seconds, during which a person temporarily loses consciousness and external stimuli aren t perceived. Microsleeps are most commonly associated with sleep deprivation and driving; however, microsleep can also occur in the absence of sleep deprivation when completing monotonous, repetitive tasks. How dangerous are microsleeps? Microsleep episodes can increase on-the-job errors and can become extremely dangerous if episodes occur during tasks that require constant attention, such as operating heavy machinery or driving.

14 SHIFT WORK, SLEEP AND HEALTH

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17 The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study

18 Police officers in the United States are overly fatigued because of shift work, erratic work hours, and insufficient sleep. Unlike occupations in which shift work and long, erratic work hours tend to be limited to early years of one s career, police work while sleep deprived throughout their careers. Moreover, they do so in highly unstructured, variable, risky, and unpredictable situations that require both expert judgment and decision-making. (Vila, 2009)

19 Health Outcomes Subclinical CVD Increased Carotid Intima Media Thickness Decreased Flow Mediated Dilation Decreased Heart Rate Variability Impaired Ankle-Brachial Index Retinal Vessel Narrowing Metabolic Derangement Glucose Intolerance Metabolic Syndrome Psychological Disorders Depression PTSD

20 SLEEP DURATION AND CAROTID ARTERY INTIMA MEDIA THICKNESS (IMT) 257 police officers Sleep duration was estimated using actigraphic data Officers who had fewer than 5 hours of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers. Ma. C.C., Burchfiel, C.M., Charles, L.E., Dorn, J.M., Andrew, M.E., Gu, J.K., Joseph, P.N., Fekedulegn, D. Slaven, J.E., Hartle, T.A., Mnatsakanova, A., & Violanti, J.M. (2013). Associations of objectively measured and selfreported sleep duration with carotid artery intima thickness among police officers. American Journal of Industrial Medicine, 56, DOI /ajim

21 Shiftwork and Endothelial Function This longitudinal study was conducted in 188 police officers (78.2% men). Shiftwork was assessed objectively using daily Buffalo, NY payroll work history records. Brachial artery flow mediated dilation (FMD) was assessed using ultrasound. Mean change in FMD% between and was compared across shiftwork using analysis of variance/covariance. Overall, mean FMD% decreased from to over an average of 7 years among all officers; p< Conclusion: Larger declines in endothelial function were observed over time among men who worked afternoon or night shifts. Further investigation is warranted. Charles, L.E., Zhao, S., Fekedulegn, D., Violanti, J.M., Andrew, M.E., Burchfiel, C.M. (2016). Shift work and decline in endothelial function among police officers, American Journal of Industrial Medicine, 59,

22 SHIFT WORK AND INJURY Shift Work Index 10 item questionnaire how tired officers generally felt irrespective of sleep hours or workload. Injury prevalence showed a significant increasing trend across tertiles of total fatigue score: 19.6, 21.7, and 30.8% for lowest, middle and highest tertiles, respectively (trend p value = 0.037). Conclusion: Officers who do not feel active, full of vigor, alert, or lively had a significantly higher prevalence of non fatal work place injury compared to their counter parts. Fekedulegn, D., Burchfiel, C.M., Ma, C.C., Andrew, M.E., Hartley, T.A., Charles, L.E., Gu, J.K., & Violanti, J.M. (2106). Fatigue and on duty injuries among police officers: The BCOPS study. Journal of Safety Research, 60, 43 51

23 Component Abdominal Obesity Waist Circumference Elevated Triglycerides Serum Triglyceride Level or Self Report Medication Reduced HDL Cholesterol Serum HDL C or Self Report Medication Glucose Intolerance Fasting Serum Glucose or Self Report Medication Hypertension Systolic Blood Pressure or Diastolic Blood Pressure or Self Report Medication in Hypertensives Men Cutpoint Women 102 cm 88 cm 150 mg/dl Fibrates or Nicotinic acid < 40 mg/dl < 50 mg/dl Fibrates or Nicotinic acid 100 mg/dl Anti Diabetic Medication 130 mm Hg 85 mm Hg Anti Hypertensive Medication 2005 American Heart Association and National Heart, Lung, and Blood Institute Criteria

24 Shift Work and Metabolic Syndrome: Officers who worked nights and either had less than six hours of sleep or worked more overtime had a four-fold greater number of metabolic syndrome components than officers working the day shift. (Arch Environ Occup Health 2009;64: )

25 The incidence rate ratio (IRR) of first injury, by shift and number of days back to work after being off duty On the day shift, incidence of first injury on the first day back is about 37% to 40% higher than that on the 2 nd, 3 rd or 4 th day back On the afternoon shift, incidence of first injury on the first day back is nearly 70% higher than that on the 2 nd, 3 rd or 4 th day back On the midnight shift, incidence of first injury on the first day back is nearly 3 times larger than that on the 2 nd, 3 rd or 4 th day back

26 Incidence of first injury by shift and number of days back to work from being off duty

27 PREVENTIVE MEASURES

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33 SO, WHAT S THE BEST SHIFT TO REDUCE FATIGUE?? NO SUCH ANIMAL. THIS IS THE WRONG QUESTION!! THE BEST SHIFT IS WHAT IS BEST FOR YOU AND YOUR DEPARTMENT!!

34 THE MOVEMENT TOWARD EXTENDED SHIFTS

35 Major advantages for working EXTENDED schedules

36 MORE DAYS OFF!! On typical 12- hour shift schedules, shift workers can virtually double the number of days off per year, as compared to an equivalent 8-hour shift schedule. Thus the standard 2,184 work hours per year (42 hour average per week before factoring in vacations) can be accomplished: In 182 work days instead of 273 work days with 8-hour shifts, And 183 days off instead of 92 days off with 8-hour shifts.

37 FEWER CONSECUTIVE DAYS WORKED Shift workers on 12-hour shifts typically work 2, 3 or 4 days in a row. The problems of stress and cumulative fatigue are thereby reduced compared to typically working 6 or 7 days in a row on 8 hour shifts.

38 TWICE AS MANY WEEKEND DAYS OFF Shift workers typically have 2 out of 4 weekends off when working 12-hour shifts, vs. only 1 weekend off per month for most 8-hour schedules. Survey data shows that more weekend days off is a very high priority for shift workers

39 INCREASED UTILIZATION OF PERSONAL TIME With 12-hour shifts, shift workers have more consecutive days off and more total days off. Able to get more done at home, take care of more personal business and shopping during the week, and schedule more family and social events. With 8-hour schedules, there are seldom enough consolidated blocks of time for extended home projects and social activities.

40 DISADVANTAGES OF EXTENDED SHIFTS

41 REDUCED FAMILY AND SOCIAL TIME DURING WORKING DAYS Shift workers may have less opportunity to see their spouses and children on working days. Child care and day care conflicts may also occur Single workers may find it more difficult to schedule dates and activities with friends.

42 SLEEP SCHEDULE INFLEXIBILITY Hours away from work during a work day are limited, so a shift worker s optimal timing and amount of sleep may be a challenge Sleep schedule disruption can potentially occur because of the reduced flexibility for sleep time In contrast, on an 8-hour schedule, night shift workers can choose to sleep in the morning when they return home or stay up in the morning and sleep later in the day, depending on their sleep physiology.

43 DRIVER FATIGUE RETURNING HOME Fatigue when driving is always a concern The difficult task of driving home might be assumed to be even more difficult after working a 12-hour shift. However, this concern is linked much more strongly to the time of day of commuting than to the length of the shift.

44 REDUCING SHIFT WORK PROBLEMS Organization: Create a culture in which officers receive adequate information about the importance of good sleep habits, the hazards associated with fatigue and shift work, and strategies for managing them. Individual: Try to get 7 or more hours of sleep every day. Go to sleep at the same time every day as much as possible avoid alcohol just before bedtime Use room darkening curtains Make your bedroom a place for sleep, not doing work or watching TV Don't just doze off in an easy chair or on the sofa with the television on..

45 Problem summary Many SHIFT WORKERS are overly tired. Fatigue impairs parts of the brain used for: Clear thinking & problem solving Making difficult moral choices Using technology Dealing with people Dealing with stress Effective fatigue management protects workers and the communities they serve.

46 LAST WORDS The brain is the organ of behavior and the brain needs healthy sleep of adequate daily duration to prevent drowsy driving When sleep is inadequate the brain has a slower responsive and it unpredictably lapses into microsleep than result in waxing and waning of attention and slowed reactions these pose a very serious risk As sleepiness increases, lapse get more frequently and longer in duration, and there is an increasing loss of muscle tone (e.g. eyelids, hands) that contributes to an even greater risk

47 A sleepiness related lapse of attention of only two seconds with loss of steering input from muscle relaxation can result in a drift out of lane crash Such crashes often involve bodily injury or are fatal, due to drowsy driver failure to take corrective action in a timely manner. Since people are frequently unable to judge their vulnerability to drowsy driving, even when they are lapsing frequently, it is essential that people not drive when they have not slept sufficiently.

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