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Understanding Sleep Deprivation in Shift Workers: Impacts and Recommendations

Explore the effects of disrupted sleep patterns on shift workers, using the Epworth Sleepiness Scale to measure alertness and providing insights on coping with sleep disturbances. Read about the study on sleep deprivation among shift workers at DSP.

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Understanding Sleep Deprivation in Shift Workers: Impacts and Recommendations

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  1. Sleep-Wake Cycle Sleep is a dynamic process Sleep wake rhythm is Synchronized with day night cycle Danger Stay awake too long makes one sleepy

  2. Suprachiasmatic Nucleus: The SLEEP PACEMAKER Melatonin Supresses Cerebral activity & Produces sleep Light supresses Suprachiasmatic Nuclei Darkness activates Suprachiasmatic Nuclei, which sends Signal to Pineal To secrete MELATONIN

  3. Intolerance to shift work Make mistakes Accident prone Vicious Cycle Ill tempered Source-Factors that are known to modulate coping ability of workers to shift work (based on Monk)

  4. Intolerance to shift work 60-80% of shift workers complain of chronic sleep disturbances Source :Shift Work, Circadian Rhythm and Satisfaction–Surviving Your Month in Emergency Medicine Walter Kuhn, M.D., FACEP

  5. “Study of Sleepiness Score among Workers Involved in Different Duty Patterns” - A study in DSP works Dr.Tapas Mandal Durgapur Steel Plant

  6. Aim • To study the sleep deprivation amongst the employees working in various shifts at DSP by Epworth sleepiness scale

  7. Materials & Methods Epworth Sleepiness Scale How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation: 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing It is important that you answer each question as best you can. Situation Chance of Dozing (0-3) Sitting and reading ________________________________________ Watching TV ________________________________________ Sitting, inactive in a public place (e.g. a theatre or a meeting) _______ As a passenger in a car for an hour without a break ______________ Lying down to rest in the afternoon when circumstances permit_____ Sitting and talking to someone_____________________________ Sitting quietly after a lunch without alcohol______________________ In a car, while stopped for a few minutes in the traffic_____________ Total Score- Epworth sleepiness scale 0-10 11-12 13-24 Questionnaire in regional language Normal range Borderline Abnormal

  8. Illustration of scoring in ESS Activity Score Sleep scale (Chance of dozing) 1. Reading, Watching TV 2. In a public place (e.g. a theatre or a meeting) 3. As a passenger in a car (for an hour without a break) 4. Lying down to rest (e.g. in the afternoon) 5. Sitting and talking (to someone) 6. Sitting quietly (after a lunch without alcohol) 7. In a car, while stopped (for a few minutes in the traffic) 1 0 = never 1 = slight chance 2 = moderate chance 3 = high chance 2 2 3 0 1 1 10 Total

  9. Methods Study design • Sample – all age groups from different departments • Comparison –fixed shift workers(without night shift) and rotating shift workers(with night shift) • Comparison between different shift patterns • Sample size-372(randomly selected across all departments) • Exclusion – Overweight(BMI>25), sleep disorder, habitual alcohol user

  10. Duty Patterns Normal Sleep Wake Cycle Altered Sleep Wake Cycle (night duty) 6Days rotating shift C B A Off Off Office(O) 10AM-5PM 2Days rotating shift B A C A C B Off General(G) 8.30AM-5PM 3Days rotating shift C B A B A C Off Off ABG(AB)

  11. The Box Plot 25th Percentile Q1 75th Percentile Q3 Median value Q2 Maximum value Minimum value Range of values 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1`6 17 18 19 20 Worse Better

  12. Analysis AGE vs. ESS score No relationship between age and ESS score

  13. Analysis Comparison of ESS scores : No Night shift vs. Night shift No night shift Night shift Mean ESS score of Individual not involving in night shift duty =5.0625 Mean ESS score of Individual involving in night shift duty =7.44898 p =0.0002 Individuals involving in night shift duty show high ESS score

  14. Mean ESS score of Individual with h/o IOW =6.80303(N=151,SD=4.671706) Analysis Comparison of ESS scores :Effects on IOW Shift pattern Mean ESS score of Individual with noh/o IOW =5.610526(N=221,SD=4.081524) Injury On Works vs. No Injury On Works IOW reported less in 3 days patterns Difference is significant t =2.301 p =0.011345 Confidence level 95% Individuals with the history of injury on works show high ESS score. Sleep deprived worker is accident prone.

  15. Analysis Multiple comparison analysis by Student t test for 2 independent Mean scores (95% confidence level)

  16. Summary • Epworth sleepiness scale is useful to measure dozing behavior. • Age plays no role on sleepiness score. • Rotating shift duty workers involving in night shift show high score of sleepiness. • Highest ESS score in 6 days rotating shift group. • High ESS score found among workers reporting with injuries on works. • Lowest ESS score seen in 3 days rotating shift pattern among all rotating shift patterns. Affect of sleep cycle disturbance is less.

  17. Recommendation: Tips to get a good sleep Source: A shift in the right direction ,RCN short guidance on the occupational health and safety of shift working nurses and health care assistants

  18. Conclusion • Sleepy person is accident prone, judgment impaired and more likely to make mistakes and also ill tempered. • Pilot study reveals 3 days rotating shift pattern can reduce the effect of sleep deprivation amongst shift workers. • Multi centric study with larger study group may further help to establish this aspect of different patterns of shift duty.

  19. “….cognitive impairments may have consequences for the safety of shift workers and the society that they serve, as well as for shift workers’ quality of life” * Fleming says. "Even if your eyes are closed, the sunlight coming into the room tells your brain that it's daytime. Yet your body is exhausted and you're trying to sleep. That discrepancy ... is not a healthy thing for the body to be exposed to." -Wesley Elon Fleming, MD, clinical assistant professor at Loma Linda University and director of the Sleep Center Orange County in Southern California Thank You • Sleep-Deprived Neurons May Shut Down, Even When You’re Awake • By Brandon Keim http://www.wired.com/2011/04/sleep-deprivation/ 

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