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…….
Read this article…

Beware of the Brownies!

Baked World, a company based in Memphis, TN markets a brownie called Lazy Larry, but BEWARE-these are not your mother’s brownies! They are filled with melatonin, a naturally occurring compound often used to treat sleep disorders. As a result, the Food and Drug Administration has sent Baked World a warning letter ordering them to stop marketing Laxy Larry as simply a “brownie”. Dr. Lloyd Sederer reports in the Huffington Post that the misuse of melatonin can result in numerous side effects and serious consequences. To learn more about these brownies, click here.

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!

It’s Time to Think about Seasonal Affective Disorder Again

Now that it’s December 1st, and we’ve adjusted our clocks, some of us will find their circadian clock more out of order than others. Seasonal affective disorder strikes this time of year. We’ve written on this in the past. See our earlier post which highlights a Wall Street Journal article written by health editor, Melinda Beck.

For a newer article, read Seasonal Affective Disorder: How to Beat ‘Winter’ Depression.

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’

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…

New Shift Work Information on Weight Loss and Apnea, Craving a Smoke, and the Combined Effects of Caffeine and Alcohol

During the last month three new studies potentially impacting a number of shift workers have been released. Here are the top level findings:

1. A dramatic weight loss can improve moderate to severe sleep apnea in obese men.

2. Craving a cigarette while performing a cognitive task increases the chances of a person’s mind wandering and they don’t even realize it is happening.

3. Drinking a cup of coffee may actually make it harder for people to realize they’re drunk.

Read on to understand why these are important studies for shift workers.
Read this article…

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?
Read this article…

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…

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.
Read this article…

Ten Secrets to Good Communication

Have you ever had to talk with someone about a topic that you just knew would cause either you or the other person to be very uncomfortable? Unfortunately at work, home, or in other personal settings, personalities may clash, or issues that need to be discussed are so “hot” that it’s almost like a volcano errupting. Discussing safety issues at work can be one of these topics that causes angst in communication between otherwise very calm and relaxed people. But, safety problems have to be addresses, so we need to learn how to talk about them. 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…

Mental Health Conditions are on the Increase…and Shift Working Companies Should Take Notice

According to a report in the August 2009 issue of Archives of General Psychiatry, one of the JAMA/Archives journals, treatment for mental health conditions is becoming more common in the US. The article has several explanations for why this may be, including patient and medical providers having a broader understanding of the need for mental health treatment, recent significant outreach by nonprofit groups promoting mental health care, and the growing public acceptance of mental health treatments. A related outcome – antidepressants are now the most commonly prescribed class of medications in the US. Read this article…

Serotonin, the Happiness Holy Grail

Happiness has been an elusive goal ever since the beginning of humanity, but the idea that we can find happiness inside ourselves may be based on scientific fact. Serotonin is a chemical in our brains that strongly affects our mood, appetite, sleep, and sexual desire. Low levels of serotonin have been linked to depression, schizophrenia, and certain mental disorders, while normal and higher levels improve your mood and make you more relaxed. Many easy daily habits can increase your serotonin levels- take happiness into your own hands! 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…