Working Nights

Have Heartburn during the Nightshift?

A team of researchers recruited 350 people to look at whether their nighttime eating habits predicted their risk of gastroesophageal reflux disease (GERD). Stomach contents (food or liquid) of people suffering from GERD leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This can irritate the esophagus, causing heartburn and other symptoms. Obesity, cigarettes, and possibly alcohol also increase the chance of GERD.

After controlling for smoking, body mass index and other things that influence heartburn, the researchers found that eating dinner within three hours of going to bed was associated with a sevenfold increase in the risk of reflux symptoms. As for why three to four hours is the threshold, researchers say that is roughly the amount of time it takes for food to clear the stomach.

Researchers from Mid Sweden University performed a systematic review of the medical literature noting studies that have reported gastrointestinal symptoms and diseases among shift workers by researchers from Mid Sweden University. Studies have indicated that shift workers appear to have increased risk of gastrointestinal symptoms and peptic ulcer disease. Workplace noise, increased work schedule variability, and working the evening shift may have the most adverse affect on gastrointestinal functioning.

Here are some suggestions of ways to minimize gastrointestinal discomfort by the National Center for Biotechnology Information, U.S. National Library of Medicine:
• Avoid bending over or exercising just after eating.
• Avoid garments or belts that fit tightly around your waist.
• Do not lie down with a full stomach. For example, avoid eating within 2 – 3 hours of bedtime.
• Do not smoke.
• Eat smaller meals.
• Lose weight, if you are overweight.
• Reduce stress.
• Sleep with your head raised about 6 inches. Do this by tilting your entire bed, or by using a wedge under your body, not just with normal pillows.
© 2011 Circadian Age, Inc. ‘Working Nights’

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’

Insomniacs with Nighttime Awakenings Have a Huge Impact on Health Care Costs and Workforce Management

Did you know that 30-40% of adults report some symptoms of insomnia within any given year?  But that’s nothing…..according to the National Sleep Foundation, over 60% of people who work shifts report that they suffer from insomnia.  And, 30% of shift workers claim that they’re excessively tired all the time.  People who work shifts are twice as likely to fall asleep at the wheel as those working during the day-time.  Read this article…

Restorative Sleep Improves Memory and Creativity

Johah Lehrer has written  a terrific summary pointing to what we gain and what we lose when we don’t get enough sleep.  Watching his wife sleep comfortably and soundly, while he lies awake with insomnia, Lehrer reviews the literature, touching on how the brain replays our own experiences over and over again, sketching them deeply into the neural networks of our brains.  This cements our long term memories.  Lehrer also points out that REM sleep helps make us more creative and lets us integrate new information into our problem solving. 

To read the entire article, click here.  

Jonah Lehrer is a contributing editor at Wired Magazine. He’s the author of “How We Decide” and “Proust Was A Neuroscientist” and blogs at The Frontal Cortex.

2010 Sleep in America Poll Released!

The National Sleep Foundation (NSF) has just released the 1st poll to examine sleep among four ethnic groups in the United States: Asians, Blacks/African Americans, Hispanics and Whites-the 2010 Sleep in America Poll. Although significant differences in the sleep habits and attitudes of each group are revealed, there are also a number of interesting similarities. The poll found that more than three fourths of respondents from each ethnic group agree that poor sleep is associated with health problems. It also showed that each group reports similar experiences missing work or family functions because of fatigue. This is of extreme significance to shift workers who routinely average less sleep than day workers.

The NSF is committed to understanding people’s sleep needs and giving them the tools necessary to get the optimum amount of rest. Read more about the poll and its findings at the NSF’s website…

Workplace Bullying Increases Sleep Disorder Risk – Already a Problem for Shift Workers

Bullying in the workplace can range from one extreme – physical violence and homicide, to verbal insults, threats, teasing, ridiculing, and making false accusations – at the other end. Sometimes bullies use name-calling, talking about a person behind their back, ignoring a person, and making false accusations to set a co-worker up for failure. The targeted person may be a boss, insubordinate, or peer. No matter who’s being targeted, bullying in the workplace has been proven to decrease morale amongst all workers, and if allowed to continue, bullying will detrimentally impact business results, possibly in a material way. A new study has found that current or past bullying is associated with increased sleep disturbances. Makes sense, right? A person who is being bullied is probably a nervous wreck, so having trouble sleeping seems logical. But, it turns out that bullying has detrimental effects on sleep even when it’s being experienced indirectly – by observing it as a co-worker.
Read this article…

Lowering Stress and Anxiety for Shift Workers (and for others too!)

Stress and anxiety are normal parts of life. Sometimes we all need a little angst to keep us going: to make the best presentation, ace the test, or get the job offer. But over time, the effects of too much tension can be mentally and physically taxing.

Extended periods of stress can cause destructive changes in the body, such as depression or a suppressed immune system, potentially leading to heart disease, stroke, or cancer. Stress and anxiety can be felt physically, appearing as an increased heart rate and high blood pressure, sweating, dry mouth, tight muscles, twitching, abdominal pain, and headaches. Emotional responses to stress may include feeling restless, being unable to concentrate, and talking negatively to yourself.

Shift workers experience unique challenges in their life and jobs that can lead to increased tension. Without proper planning, work/life/family balance can get completely out of synch as a result of working rotating shifts or long hours. As a result of the struggle to adapt to ever changing work schedules, shift workers often don’t get enough sleep.

While most sleep experts suggest seven to eight hours of sleep is needed to feel well-rested, most people don’t get this much, and shift workers get even less than the day time population. The National Institute of Health has reported that people who work at night or have frequent major shifts in their work hours, or who have inactive lifestyles, are at a greater risk of developing insomnia. Many shift workers also report that they don’t exercise frequently, so the problem only gets worse. Read this article…

Restless Legs Syndrome (RLS) – Update

Up to ten percent of the population may suffer from Restless Leg Syndrome, a misunderstood and often ignored disorder. It affects more women than men, and causes more discomfort at night than during the day. While some people who suffer from RLS may not realize it is a true disorder and avoid medical help, RLS harms sleep patterns and may be worsened by uneven sleep schedules of shift workers. Read this article…

Women and Sleep…Sleep Stress and Sleep Disturbances…Welcome to the Bedroom!

Kids and caffeine, stress and sleep apnea, menstruating giving way to menopause: women have a lot of unwanted guests in the bedroom when it comes to getting enough sleep. Studies have shown sleep makes a huge difference in concentration, memory, alertness, and even weight loss and happiness. Staying safe at work depends greatly on workers getting enough sleep. Over a quarter of shift workers report making mistakes from inattention several times a month, and almost half report having nodded off while driving to or from work. These tired mistakes can have sometimes fatal consequences. A healthy sleep schedule can save lives. Read this article…