QIPS TIPS Optimizing Work at Night
Shari Welch, MD, FACEP
There is no arguing that fatigue and working against one’s circadian rhythm are associated with medical errors and are costly to the provider in terms of personal health. Are there recommended strategies to make night shifts “more healthful”? One of the largest studies of shift work and scheduling strategies was reported in Ergonomics in 2010 and it involved 4600 steel workers. A number of scheduling models were tested and the model that rotated shift workers forward (day to evening to night) with extra time allotted after the night shift was associated with decreased illness and absenteeism. Night workers tend to catch up on sleep on their nights off so this also helped the workers to catch up on overall sleep deficits. Of particular note, the older workers demonstrated the most benefit from the new model and this has implications for the aging workforce.
Other strategies to help workers manage the difficulties of the night shift include trying to get some “prime sleep” out of the schedule. It turns out that the most restful sleep is Stage 4 REM sleep, and this is the hardest to come by when challenging normal circadian rhythms. Stage 4 REM sleep tends to be most prevalent in sleep studies between 9 pm and 3 am and this has been dubbed “prime sleep.” This has led to experimentation with schedules that involve shorter shifts staggered around the prime sleep hours. Night workers should be encouraged to get as much sleep as possible when off shift. Avoiding caffeine, using room darkening shades and earplugs to limit sensory interruptions can help facilitate sleep. If the worker will be switching back to a normal circadian sleep pattern, he or she should be encouraged to rise from sleep by noon the next day to “reset” his or her clock.
Other wisdom relative to successful night shift work is to make exercise central to the night shift lifestyle. This will have positive effects in terms of weight management, and high blood pressure, and endorphin release associated with vigorous exercise can counterbalance the mood disorders and dysphoria that many people experience after sleep deprivation. Simply parking in the lot farthest from the workplace can make the shift begin and end with some vigorous exercise. Though night workers have a tendency to eat fast food and sugars, a low carbohydrate diet has been reported to be associated with higher energy levels and the postprandial lipolysis that causes drowsiness can be avoided.
Night shift work is part and parcel of a career in healthcare at large and emergency medicine in particular. Research in this area should get our attention both in terms of human error at work and personal well-being. Night shift workers should be given incentive pay. Models that let them work less hours because of incentive pay, allow more off time to close the gap on the sleep deficit that takes such a toll on individual health. Physician groups and hospitals should educate all night workers regarding the strategies that can make night shift work healthier.
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