Working Nights

New Research Shift Workers Should Be Aware of…….

Read on if you are interested in identifying whether you might have heart disease, learn about a possible new way to treat sleep apnea, or hear more about sleep disorders…….
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Preventing Cardiovascular Events

Cardiovascular disease is the most common cause of death in the United States and other developed countries. Cardiac events are more common in winter, at the beginning of each month, on Mondays (in working people), and during the early morning hours of each day. Between 6 a.m. and noon, there is a 40% higher risk of heart attack, a 29% increased risk of cardiac death, and a 49% increased risk of stroke (if these events were evenly distributed throughout the day).

Several studies have reported a higher prevalence of coronary risk factors among rotating shift workers, including increased cigarette consumption, higher blood pressure, and increased cholesterol and blood sugar levels. Each of these risk factors can be controlled with lifestyle adjustments.
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IS SNORING…….

………. keeping you or your partner awake night after night? We often joke and laugh about snoring but it can be a serious matter, especially for shift workers as they already get less sleep than daytime workers. Almost one half of the adult population snores at least occasionally, resulting in many sleepless nights for many people.

Snoring occurs when air flows over relaxed tissues in your throat causing the tissues to vibrate as you breathe; this creates those annoying sounds. The tissues may obstruct your airway making it narrower, so the airflow becomes more forceful and the snoring becomes louder. While snoring itself is not a health problem, it may indicate a more serious health condition, such as sleep apnea where your airways are so obstructed that you stop or nearly stop breathing as you sleep.

There are risk factors that may contribute to snoring. Some of them are:

• Being a man
• Being overweight
• Alcohol consumption close to bedtime
• Nasal problems
• Having a narrow airway

 

If you do suffer from plain old snoring, most doctors recommend making some lifestyle changes such as losing weight, reducing your consumption of alcohol near bedtime and sleeping on your side. These are all low cost or free. There are plenty of products (throat exercises, special pillows, mouth and nose devices) out there that do promise to eliminate snoring but their results have not yet been proven. If lifestyle changes do not help, doctors often recommend the mask or CPAP, oral appliances or surgery. Most insurance plans will not cover treatments for regular snoring, but will cover them if you are diagnosed with sleep apnea.

Do see a doctor if your snoring is disrupting your or anyone’s sleep or if you wake up gasping for air. A good night’s or day’s rest is essential to a happy and healthy you!

Come On…..Get up and Stretch or Walk Around a Little Bit

The results of two studies released in January will attack the couch potato tendencies present in many of us! Too much time in front of a TV or computer appears to dramatically increase the risk of heart disease and premature death from any cause, even regardless of how much exercise a person gets. Taking plenty of breaks, even if they are as little as one minute, appear to be good, both for people’s hearts and their waistlines. Read this article…

A Primer of Sleep Disorders for Shift Workers

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) won’t be published by the American Psychiatric Association APA) for a few years (May 2013).  However, developing the roadmap of psychiatric diagnoses is a huge initiative as feedback is being sought from over 600 global experts.  The DSM provides the standard classification of mental disorders used by mental health and other health professionals for diagnostic and research purposes.  In addition, insurance companies use the DSM diagnoses to determine which psychiatric conditions will be covered by health insurance.

Over the years since the last DSM was published (1994), new research has been published on many psychiatric conditions.  New research leads to new opinions on the identification and treatment of disorders. Sleep disorders, many of which often plague shift workers, have received a significant amount of attention in recent years and as a result, the current draft of the DSM-5 includes information that shift workers and their employers should be aware of.  The recommendations for revisions to the DSM are posted on the APA’s web site for the manual – www.DSM5.org.  Public review and written comments are welcome. Comments will be reviewed and considered by the DSM-5 Work Groups.

 The sleep disorder work group is recommending greater inclusion of sleep disorders. This is being proposed primarily as a way to educate non-expert sleep clinicians (such as psychiatrists and general medical physicians) about sleep disorders that have mental as well as medical/neurological aspects.

Among the changes being recommended the significant ones impacting shift workers include:

1.  Adding obstructive sleep apnea hypopnea syndrome to the DSM-5 – this disorder was previously contained under the sleep disordered breathing category.  Obstructive sleep apnea is associated with snoring, obesity, increased waist girth, and male gender. Central sleep apnea is most strongly associated with advanced age, heart failure, and diabetes.  Cardiac problems associated with obstructive and central apnea are different.  

• Obstructive sleep apnea is associated with ventricular ectopy which is often experienced as a strong or skipped heart beat resulting from abnormal electrical activation originating in the ventricles (heart’s lower chambers) before a normal heartbeat would occur.  Studies have indicated that sleep apnea promotes ventricular ectopy. 
•  Central sleep apnea is more strongly associated with atrial fibrillation. During atrial fibrillation, the heart’s two upper chambers (the atria) quiver instead of beating effectively. Blood isn’t pumped completely out of the chambers, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.

People with coronary artery disease whose blood oxygen is lowered by sleep disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death. CPAP treatment may reduce this risk. Sleep disordered breathing, including apnea, may cause coronary artery disease and hypertension.

2.  Adding primary central sleep apnea to the DSM-5.  See 1. above. Point is to separate obstructive and central sleep apnea as the risk factors and outcomes for each are different. 

3.  Adding restless leg syndrome to the DSM-5.  According to the DSM web site the rationale is that “RLS is a sufficiently common syndrome to merit elevation to an independent category. In national and international studies the prevalence of RLS appears to be between 7-10% of the population, depending upon age and gender.”

4.  Including circadian rhythm, delayed sleep phase, advanced sleep phase, irregular sleep wake rhythm and free-running sleep disorders in the DSM-5 as separate subtypes.  The rationale for this proposed change is based on new data indicating not only the differences in clinical characteristics, but also the underlying pathophysiology and in some cases, genetic basis for the different types of circadian rhythm sleep disorders.

To read more about other primary sleep disorders, follow the links below: 

Primary Sleep Disorders 307.42 Primary Insomnia 307.44 Primary Hypersomnia   347.00 Narcolepsy   327.3x Circadiam Rhythm Sleep Disorder   307.47 Nightmare Disorder  

©2010 Circadian Age, Inc. ‘Working Nights’

Employee Health and Shift Work Lifestyle Training Leads to a Happier and Healthier Workforce….and to Increased Company Profits!

Is employee morale low at your company? Employee morale is higher when companies provide shift work lifestyle training.  Nearly 60% of employees at companies providing shift work lifestyle training rank their morale as good or excellent compared 35% without shift work training.[i] 

Some shift workers are at a greater risk for cardiovascular disease.  Want to save upwards of $6,500 for each of these at-risk employees per year?  And, protect your employees from this number one killer!

Workers in shift work operations generate, on average, more health care costs than other workers.  How about reducing overall company health care costs by 17% to 37% by targeting this population and helping them improve their health?[ii] Other cost savings may also be possible, including safety incident and workers’ compensation costs. Worker productivity may increase, possibly even up by 39%.[iii]

In extended 24-hour operations, a well-designed shift schedule or roster is unlikely to provide adequate protection from worker fatigue.  An integrated risk management system incorporates data analysis and training towards an effort of reducing fatigue and reducing a company’s costs, risks, and liabilities.[iv]

Among the shift worker population, 71% of men and 53% of women are overweight, 54% of workers have smoked or currently smoke, only 27.5% workers report having good nutritional practices, and 77% report not exercising regularly.  Add to this the sleep deprivation statistics, 27% of shift workers report making mistakes of inattention several times per month, and it’s clear that both shift workers and their employers would benefit from worker health and lifestyle training.[v]  In addition, a fatigue management program would help target the reasons shift workers aren’t always as attentive and productive as day-time workers and help companies and employees develop some initiatives to reduce employee fatigue levels. 

Each of the examples above show the overwhelming benefits to a company and its employees when an employee health and shift work lifestyle training program tailored to the company’s needs is implemented……..It’s all in the details, so read on for more information about targeting a program for your operation….. Read this article…

What’s Green and Beige and Eaten All Over?

Pistachios! 

Researchers report that up to 95% of people do not get enough potassium.  Failing to meet the standard recommended daily intake levels can lead muscular cramps, twitching, and weakness, poor reflexes, fatigue, kidney failure, lung failure, and cardiac arrest. Also, too little potassium can result in insomnia, cognitive processing delays, and depression.  Getting enough potassium is important for shift workers who are already susceptible to sleep disorders, such as insomnia and restless leg syndrome, as well as fatigue.  When working shift work, it’s important to pay attention to eating nutritiously, which isn’t always easy to do.  Planning meals ahead is often the only way to guarantee a balanced diet when working nights, in particular.

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A Great Book to Read over the Holidays – “My Stroke of Insight,” by Jill Bolte Taylor

Book Review – My Stroke of Insight – a Brain Scientist’s Personal Journey, by Jill Bolte Taylor, Ph.D.,

Taylor’s book provides a unique education about our brains, in particular, about how the two different hemispheres of our brains work – together and independently.  Taylor provides insight into the impact of impaired brain functioning, something that is critical to the health and safety of shift workers and to the success of shift work operations.  Shift workers are known to exist on less than the optimal amount of sleep ~ typically 5 hours versus 7-8 hours; while obviously not as severe as a stroke, sleep deprivation has been shown to have a significant negative impact on the brain’s ability to perform.

There have been many studies on the impact of sleep deprivation on the brain.  In one study (Dai-Jin Kim et al, International Journal of Neuroscience, 2001), sleep deprived subjects showed no differences in distractibility, physical and visual functioning, reading, writing, arithmetic, and intellectual processes when compared to study participants who were allowed to sleep.  However, cognitive functions such as motor skills, rhythm, receptive and expressive speech, memory and complex verbal and arithmetic functions were decreased after sleep deprivation.  In another study (Drummond et al, Nature, 2000), researchers found “dynamic, compensatory changes in cerebral activation during verbal learning after sleep deprivation.” The researchers found that the prefrontal cortex (controls decision making and following through with thoughts and actions) and the parietal lobes (sensory integration) were key factors in allowing the subjects to function after sleep deprivation.  In other words, our brains work hard to compensate when we are sleep deprived and this may explain why some people claim they can exist on very little sleep – something we don’t recommend.

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Can Music Calm a Shift Worker’s Soul – and Improve Sleep as Well?

Where can you find Coldplay, Betty Buckley, The Beastie Boys, Bruce Hornsby, and Vanessa Carleton all working together? Seems like an unlikely group, doesn’t it?

These musicians and many other creative types are big supporters of the Institute for Music and Neurologic Function (IMNF). Created in 1995, IMNF was founded “to restore, maintain and improve people’s physical, emotional and neurologic functioning through the systematic use of music.” IMNF collaborates with researchers and practitioners around the world to advance the understanding and application of the power of music to promote healing and wellness. Some of IMNF’s most significant research and startling findings are in the areas of music and its impact on language, memory, and recovery from nerve injury.

How does music affect shift workers? Should it be listened to at work? Does it help you fall asleep? Can it lower stress when coping with variable schedules?
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WSJ Covers Heart Risk at Work and Seasonal Affective Disorder

There were two articles in the Wall Street Journal today that are significant to shift workers. One story is about Seasonal Affective Disorder (SAD), and the other’s about a new study reporting that men who didn’t confront colleagues or bosses who treated them unfairly doubled their risk of heart attack.

Seasonal Affective Disorder – the article states that SAD “affects an estimated 6% of Americans, causing depression, lethargy, irritability and a desire to avoid social situations. It can also create an urge to overeat, particularly carbohydrates. As many as 15% of people in the U.S. may have a milder version that includes only some of these symptoms.” What the article leaves out, that all shift workers know, is that SAD symptoms are routinely felt by workers at jobs outside the normal day-time hours of 7 a.m. to 7 p.m. See more about this in our articles on Vitamin D and Serotonin.

Reducing Heart Risk with Confrontation – the lead researcher from Stockholm University and her research partners asked 2,755 men how they typically responded to unfair treatment at work. Those who said they just let it pass and said/did nothing had significantly more heart attacks during the next ten years. After adjusting for age, socio-economic factors, risk behaviors, job strain, and biological risk factors, the risk of heart and death from a cardiovascular event was 2.3 times greater than it was for those who said they confronted those treating them unfairly. Read more about how shift workers can manage stress on the job and about controlling bullying at work.

To read the two Wall Street Journal articles:

Seasonal Affective Disorder
Reducing Heart Risk with Confrontation

©2009Circadian Age, Inc. ‘Working Nights”

The Problem of Migraines and Shift Work

Each year upwards of 90% of the U.S. population will feel headache pain and 13% will suffer from a migraine. Nearly 30 million Americans have migraines. Researchers from Johns Hopkins, after pooling results from 21 studies, involving 622,381 men and women, have found that migraine headaches are associated with more than double the likelihood of the most common kind of stroke – those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot.

The National Headache Association estimates that headaches cost up to $17 billion dollars in absenteeism, lost productivity, and medical expenses each year. Ninety percent of respondents to a NHA 2008 survey indicated that headaches affected their work performance. Migraines are triggered by many different issues such as stress, environmental factors (e.g. lighting and eye strain), depression, or certain foods and some medications. One major factor in the development of migraines is lack of sleep.

Are shift workers more likely to suffer from migraines?
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Shift Worker Liquid Intake Extremely Important!

Most shift workers admit they don’t have the best understanding of nutrition and that they find it challenging to follow good nutritional habits. It makes sense that sticking with good nutritional meals can be difficult when working shifts – most shift workers admit they eat what they can find with the least effort – which is often food from vending machines, 24/7 convenience stores, or fast food restaurants. What doesn’t make sense is that shift workers don’t have better knowledge about their own nutrition. Certainly with education, just as with everyone, shift workers’ nutritional awareness can be exponentially increased.

We often read about nutrition and relate it immediately to the food we eat. We’ve written in other posts about the importance of eating healthy food – see “Be Careful What you Eat When Working Shift Work.” However, liquid sustenance is a significant part of our daily intake as well. When we’re awake, we drink water, juice, soda, coffee, tea, alcoholic beverages, and some of us drink liquid nutritional supplements too. What’s important about the liquids we put in our body? The essential information to know is about hydration and dehydration, calories and caloric content, and how where you live, the job you perform and your overall activity level impacts your body’s need for liquids.
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Another Important Reason to Assess Levels of Vitamin D

Cardiovascular disease is the leading cause of death among those with diabetes. And, according to researchers at the Washington University School of Medicine in St. Louis, people with diabetes and low Vitamin D have more than double the risk of cardiovascular disease. One possible reason (according to the study’s authors) – diabetics who are deficient in vitamin D don’t process cholesterol normally, so it builds up in their blood vessels and increases the risk of heart attack and stroke. Why is this important to shift workers? Because some studies have shown that shift workers may have a greater risk of developing type 2 diabetes and shift workers are also are at a greater risk of having a vitamin D deficiency. This study may provide more support for why shift workers have a greater likelihood of suffering from cardiovascular disease. And, it also sheds some light on a possible way to reduce the risk of heart disease – besides exercise, good nutrition, and maintaining proper weight, make sure you get enough vitamin D.
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Feeling the Impacts of Chronic Stress Brings You Back to Old Habits

Do you feel frazzled and overwhelmed? Are you having trouble sleeping? Are you anxious and impatient? These are just some of the symptoms of chronic stress. According to a new study, the effects of chronic stress force us back into old habits. And this may actually cause us to make bad decisions because in some situations, we are better off inhibiting a habit and instead using a goal oriented strategy – an effort that will force us to approach the situation differently. But when we are stressed we are more likely to just fall back on our habitual approach to dealing with the situation as opposed to being creative and forging a new path.
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Untreated Sleep Apnea Outcomes Continue to be More and More Severe

Since shift workers are more likely to suffer from sleep disorders than day time workers, these workers and their family members, employers, insurance providers, and medical practitioners should be especially knowledgeable about the various types of sleep disorders. And, they should stay on top of new information that is released about chronic sleep issues that may impact them. Sleeping is fun – just think of all those wonderful dreams. Not dreaming, maybe you have a sleep disorder. Read here for information on sleep apnea. See other parts of our blog for insomnia, restless leg syndrome and other disorders.
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