SHIFTWORK

1. SLEEP and SHIFTWORK

2. Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders • Sleep loss and sleep disorders affect : • 1. Individual’s performance, • 2.safety, • 3.quality of life • Almost 20 percent of all serious car crash injuries in the general population are associated with driver sleepiness, independent of alcohol effects.

3. رئیس پلیس راهنمایی و رانندگی کشور با اشاره به وقوع ۱۵ درصد تصادفات در استان اصفهان گفت: خواب‌آلودگی و خستگی، اصلی‌ترین علت وقوع حوادث رانندگی استوی تصریح کرد: در تصادفات روز گذشته فقط یک مورد مربوط به نقص فنی خودرو ها بوده و سایر تصادفات ناشی از خستگی و خواب آلودگی رانندگان بوده است. • رییس پلیس راه استان زنجان از وقوع یک فقره تصادف در کمربندی ابهر به خرم دره خبر داد و گفت: بامداد امروزپنجشنبه خواب آلودگی راننده کامیون، جان۶ کارگر شرکت خرم دره ای را گرفت. • به گزارشگروه استانهای باشگاه خبرنگاران "آرش رحمتی"، گفت: با بررسی‌های صورت گرفته در خصوص دلایل حوادث رانندگی مشخص شده است که بیشترین آمار تصادفات در ساعت دو الی پنج صبح و در حالت خواب آلودگی رانندگان اتفاق می‌افتد.

6. Some of the most devastating human and environmental health disasters have been partially attributed to sleep lossand night shift work-related performance failures : 1.Bhopal, India, chemical plant • 2.Chernobyl & ….

8. Direct Costs of Sleep Loss and Sleep Disorders • Include doctor visits, hospital services, prescriptions and medications. • In 1995 the direct cost of insomnia in the United States was estimated to be $13.9 billion. • costs associated with a laboratory-based polysomnogram, cost over $17.5 billion to test . • $3 billion to treat every person who has sleep apnea

9. Indirect Costs of Sleep Loss & Sleep Disorders • Including costs associated with : • 1. Illness-related morbidity and mortality • 2.Absenteeism • 3.Disability • 4.Reduction or loss of productivity • 5.Industrial and motor vehicle accidents , hospitalization • sleep-related fatigue costs businesses $150 billion a year in • absenteeism, workplace accidents, and other lost productivity. • A 1994 analysis of automobile accidents estimated the cost of accidents attributed to sleepiness to be between $29.2 to $37.9 billion .

11. Why is sleep so essential?? Sleep is an opportunity for our bodies to repair themselves: • Some forms of sleep are associated with physical repair (e.g. torn muscles, organ cleansing, etc.) • Other forms of sleep are associated with psychological repair (e.g. laying down memories, working though anxiety etc.). • Physical repair is associated with slow brain wave patterns, whereas psychological repair is associated with active dream states. The brain waves of a dreaming person look very similar to someone who is awake.

12. On average, adults cycle through all forms of sleep every 90 minutes. Therefore if a person sleeps for 8 hours, he or she will have 5 opportunities to repair both the physical and psychological systems. If sleep is disrupted over a long period of time, necessary physiological and psychological repair cannot take place, which can lead to pain, fatigue, and memory and thinking difficulty.

13. Health consequences of sleep loss and sleep disorders Increased risk of disease : 1.Hypertension 2.Diabetes 3.Obesity 4.Heart attack 5.Stroke 6.Depression 7.Sleep-related injuries and fatalities 8.Shift work that involves circadian disruption is probably carcinogenic to humans

15. Highly fatigued workers were 70 percent more likely to be involved in accidents than were workers reporting low fatigue levels. • In a large 20-year prospective study in Sweden of nearly 50,000 individuals, those reporting disturbed sleep were nearly twice as likely to die in a work-related accident. • workers who report snoring and excessive daytime sleepiness, indications of sleep apnea, are twice as likely to be involved in workplace accidents.

18. PERFORMANCE AND COGNITION DEFICITS • Nearly all types of sleep problems are associated with performance deficitsin occupational, educational, and other settings. • Performance deficite is due to deficite in : • 1.Attention • 2.Vigilance • 3.Memory • 4.Complex decision making

19. Sleep physiology • There are two components of sleepiness that drive you to bed: • 1.Circadian component - sleepiness comes back to us in cycles which are usually about one day long. • 2.Homeostatic component - sleepiness increases with the length of time we stay awake. • A combination of these two components determines the optimum time for sleep. • Strong sleepiness resulting from the homeostatic component may not be sufficient to get good sleep if the timing goes against the greatest sleep propensity determined by the circadian component.

27. There are around 90 distinct sleep disorders, according to the International Classification of Sleep Disorders (AASM, 2005) • Most are marked by one of these symptoms: • -Excessive daytime sleepiness, -Difficultyinitiating or maintaining sleep -Abnormal movements, behaviors, and sensations during sleep.

28. The most common sleep conditions including : • sleep loss, • sleep-disordered breathing, • insomnia, • narcolepsy, • restless legs syndrome(RLS), • parasomnias, • sleep-related psychiatric disorders, • sleep-relatedneurological disorders, • sleep-related medical disorders, and • circadian rhythmsleep disorders

29. Rotational shiftwork • Covers a wide variety of work schedules and implies that shifts rotate or change according to a set schedule . • The definition of rotational shiftwork in this document does not include fixed shifts like straight nights, straight afternoons or straight days. • Nearly 20% of the population in the industrialized nations is involved in shift-work

30. Shift-workers suffer from various gastrointestinal and cardiovascular problems. • Many have problems with achieving refreshing sleep. • Substance abuse among shift-workers is also much higher than average. • Minor problems such as headache, inattention, decline in libido, fatigue, irritability and chronic fatigue. • shiftwork disrupts the family and personal life. • Shiftwork that involves circadian disruption is probably carcinogenic to humans (IARC 2A).

31. Decreases the levels of leptin and has an opposite effect on ghrelin (two appetite hormones) • Restricting sleep to 5 hours per night causes some 20% change in the levels of these appetite control hormones. This change corresponds to some extra 1000 kcal in free running feeding, or over 3 kg of fat per month in energy terms. • Working irregular shifts have been associated in some studies with preterm birth, and low birth weight. • Adverse effect in body immune system

32. Sleep restriction can easily halve insulin sensitivity leading to type 2 diabetes and significantly increases the risk of hypertension, stroke, heart attack or kidney failure • modification of shift rotation schedules by changing the direction of rotation of shifts to a forward direction (for example, days -> afternoons -> nights) can significantly decrease the levels of several coronary risk factors, e.g., triglycerides, glucose, and urinary excretion of catecholamines

33. Strategies for improvement 1.The organizational level - primarily through the design of shift schedules, education and better facilities. 2.The individual level - helping workers to get better sleep, a healthier diet, and the reduction of stress.

34. The organizational level 1. Shift Schedule Design : • Length of the rotation period • Direction of rotation of shifts • Start and Finish Times • Length of rest between shifts • Alternative forms of organizing work schedules

35. 2.Facilities • ( The provision of certain facilities can help the shiftworker cope better ) • Give attention to the work environment. For example, good lighting and ventilation • Provide rest facilities where possible. • Provide healthy cafeteria services so a balanced diet can be maintained. • Consider access to quality day-care for shiftworkers' children. 3.Education Educate employees on the potential health and safety effects of rotational shiftwork and what can be done to stop these effects.

36. The individual level 1.Guidelines for Diet and Eating Patterns • Maintain regular eating patterns as much as possible. • Time meals carefully. Afternoon workers should have the main meal in the middle of the day instead of the middle of the work shift. Night workers should eat lightly throughout the shift and have a moderate breakfast. This way they should not get too hungry while sleeping during the day and digestive discomfort should be minimal. • Careful attention to the type of food eaten : • Drink lots of water . • Eat crackers, nuts and fruit instead of pop and candy • Avoid greasy foods, particularly at night

37. 2. Sleep • Sleep on a set schedule to help establish a routine .Try different patterns of work and sleep to see which is best for you • Make sure that family and friends are aware of and considerate of the worker's sleep hours and needs • A comfortable, dark, quiet place to sleep during the day. good blinds on windows are recommended. • Make time for quiet relaxation before bed to help get better sleep.

38. 3.Other Important Considerations • Pay attention to general physical fitness and good health habits. • Find out about potential health and safety effects of shiftwork. • Learn how to recognize and reduce stress through physical fitness, relaxation techniques and so on. • Take leisure seriously.

40. sleep hygiene

41. What is insomnia? • Insomnia is a condition characterized by difficulty falling asleep and staying asleep. • About a third (27%) of Americans have occasional insomnia. Nine percent have chronic insomnia. • The most common cause of insomnia is a big change in daily routine. Other causes include pain, nausea, shortness of breath, depression and anxiety.

42. Sleep hygiene’ is the term used to describe good sleep habits. • These strategies can provide long-term solutions to sleep difficulties.

43. Sleep Hygiene Tips Get regular: go to bed and get up at more or less the same time every day, even on weekends and days off! Sleep when sleepy: Only try to sleep when you actually feel tired or sleepy, rather than spending too much time awake in bed.

44. Get up & try again : If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming or boring until you feel sleepy, then return to bed and try again. Avoid caffeine & nicotine: avoid consumingany caffeine (in coffee, tea, cola drinks, chocolate, and some medications) or nicotine (cigarettes) for at least 4-6 hours before going to bed.

45. Bed is for sleeping : If you use bed as a place to watch TV, eat, read, work on your laptop, pay bills, and other things, your body will not learn this connection. No clock-watching. Frequently checking the clock during the night can wake you up (especially if you turn on the light to read the time) and reinforces negative thoughts

46. The right space. Bed and bedroom must be quiet and comfortable for sleeping. A cooler room with enough blankets to stay warm is best, and make sure you have curtains or an eyemask to block out early morning light and earplugs if there is noise outside your room.

47. No naps : avoid taking napsduring the day. If you can’t make it through the day without a nap, make sure it is for less than an hour and before 3pm. Bathtime. Having a hot bath 1-2 hours before bedtime can be useful

48. Sleep rituals. some people find it useful to do relaxing stretches or breathing exercises for 15 minutes before bed each night Eat right : A very empty stomach at bedtime is distracting, so it can be useful to have a light snack, but a heavy meal soon before bed can also interrupt sleep. A warm glass of milk, which contains tryptophan, which acts as a natural sleep inducer.

49. Exercise. Regular exercise is a good idea to help with good sleep, but try not to do strenuous exercise in the 4 hours before bedtime. Keep daytime routine the same. Even if you have a bad night sleep and are tired it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities because you feel tired. This can reinforce the insomnia.

50. Have good Days and Nights