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					                                  Shiftwork

                    Implications for Your
                   Health As Well As Your
                          Work life

                    Municipal Health & Safety Association
                              October 27, 2008

             Michelle Tew                 Steve Macdonald
             Occupational Health Nurse    Ergonomist

Occupational Health Clinics for                 Centres de santé des travailleurs
Ontario Workers Inc                             (ses) de l’Ontario Inc.
    Occupational Health Clinics
       for Ontario Workers
            (OHCOW)
      • an inter-disciplinary occupational
        health team:
                 • occupational physicians
                 • occupational health nurses
                 • ergonomists
                 • occupational hygienists
                 • occupational health coordinators
                 • administrative staff

      • funded by WSIB Prevention Services
Occupational Health Clinics for                Centres de santé des travailleurs
Ontario Workers Inc                            (ses) de l’Ontario Inc.
          Occupational Health Clinics for
              Ontario Workers Inc.




Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                 What OHCOW does:
         Exposure                                              Medical
         • to what                                           • symptoms
         • how much                                          • tests results
         • how long                                          • physical exam
         • toxicology                                        • diagnosis


                                  Work Relatedness
                                  • epidemiological review
                                  • strength of association




Occupational Health Clinics for
                                        Prevention Centres de santé des travailleurs
Ontario Workers Inc                                       (ses) de l’Ontario Inc.
                             Clinic Services:

      1.      individual client (clinical)
      2.      answer questions (work/health related)
      3.      educational presentations & outreach
      4.      workplace visits
            requested by co-chairs of JH&SC

      5.      exposure/health investigations/research
            medical/hygiene/ergonomic combined

Occupational Health Clinics for              Centres de santé des travailleurs
Ontario Workers Inc                          (ses) de l’Ontario Inc.
   Shiftwork - Overview
   •   Background
   •   Biological clocks
   •   Health effects
   •   Coping strategies
        – individual
        – family
        – workplace

Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Shiftwork is more than a work
       schedule - it is a way of life. When
       our schedules change, our entire
       life changes. It impacts on us as
       individuals, our family, our social
       life as well as our health.




Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Why do we work
      shifts?
      •   Good pay
      •   Educational opportunities
      •   Seeing children during daylight
      •   Savings in childcare expenses
      •   Moonlighting
      •   More time for leisure activities
      •   Providing vital services
Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
     What is Shiftwork? :
       Regularly outside 7 am - 6 pm

           Weekends
                                                  Night shifts
                                  Shift
       Overtime                                   Compressed
                                  Work             work week
          Split shifts                            ( 10/12 hr shifts)


  • 25 % of workers in Ontario work shifts - 3 million
    Canadians

Occupational Health Clinics for           Centres de santé des travailleurs
Ontario Workers Inc                       (ses) de l’Ontario Inc.
          Factors Affecting
       Adaptation to Shiftwork
                                  (External)
          Shift Schedule
                                                     Psycho-social Factors

Rotational Schedule                                              Nutrition
                                                              Caffeine    Smoking
Individual
Motivation
for Shiftwork                                              Political Factors


                                                        Environment
       Job Requirements

                                               Shiftwork Like Clockwork
Occupational Health Clinics for                Centres de santé des travailleurs
Ontario Workers Inc                            (ses) de l’Ontario Inc.
          Factors Affecting
       Adaptation to Shiftwork
                                    (Internal)

                                        Circadian Rhythms
                                  Age
                    Sex                           Morning/Night
                                                     Person
            Previous Shiftwork
            Experience
                                                 Health Status

                  Contentment
                                                Fitness Level
                  with Job



Occupational Health Clinics for                       Shiftwork des Clockwork
                                                  Centres de santéLiketravailleurs
Ontario Workers Inc                               (ses) de l’Ontario Inc.
 Chronobiology - Circadian
 rhythms
      • We are a day oriented species
      • The diurnal rhythm (internal clock)
        governs our sleep wake cycle as well as
        all other body functions:
           – temperature, BP, Heart rate, alertness, GI
             secretions, hormone levels, urine output
             etc….
           – synchronize metabolism with behavioral
             demands and external time cues
Occupational Health Clinics for         Centres de santé des travailleurs
Ontario Workers Inc                     (ses) de l’Ontario Inc.
      When we sleep ….
      • Body temperature declines
      • Heart rate and blood pressure 
      • Hormones for tissue restoration
        increase
      • Hormones that maintain wakefulness
        decrease
      • Kidney & bowel function are suppressed
      • Brain activity changes
Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                         1000     1400   1800   2200   0200    0600    1000      1400
Occupational Health Clinics for                           Centres de santé des travailleurs
Ontario Workers Inc                                       (ses) de l’Ontario Inc.
   • Body uses cues from its processes
     and from the environment (e.g.
     clock time, social activities,
     light/dark cycle, meal times) to
     keep various rhythms on track
   • Some rhythms adapt in 2 - 3 days -
     others longer
   • People adapt at different rates


Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Sleep patterns
      • Brain does not rest when sleeping -
      • Two types of sleep - NREM - 4
        stages - first two are light - 3 & 4
        delta sleep (physical recuperation)
      • REM - brain waves identical to
        wake state - psychological well
        being

Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Perceptions of sleep
      quality (National Sleep
      Foundation Poll(USA 2001)
      • 69% Americans feel they have frequent
        sleeping problems
      • having children, medical conditions, being a
        caregiver, marital disharmony are associated
        with poor sleep
      • responders feel the situation is worsening
      • 33% of adults sleep < 6.5 hrs
      • 33% of young adults have daytime sleepiness
                                  www.sleepfoundation.org
Occupational Health Clinics for          Centres de santé des travailleurs
Ontario Workers Inc                      (ses) de l’Ontario Inc.
                     Health Effects of
                        Shiftwork



Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Chronic sleep
      problems (60-80%)                                             Less access to
                                                                      good food
                                  Headaches
 Chronic fatigue                                                         Poor eating
                                   respiratory
                                                                           habits
                                  infections
Social isolation
                                  Stomach                                   Caffeine
                                  disorders X 5
    Family
                                  Muscle pain
   tension                                                               performance
                                  Mood swings                            alertness &
                                  Depression                            productivity
  ++ stress
                                  5-15 Xs more likely

                                                           Job Dissatisfaction

Occupational Health Clinics for                         Centres de santé des travailleurs
Ontario Workers Inc                                     (ses) de l’Ontario Inc.
   Further Effects of Shiftwork
     •      alcohol & drug abuse
     •      rate of industrial accidents
     •      motor vehicle accidents
     •      rates of divorce & spousal abuse
     •      cardiovascular disease

     • IARC has just classified shiftwork that involves
       circadian disruption as a 2A carcinogen
       (probably carcinogenic to humans)

Occupational Health Clinics for         Centres de santé des travailleurs
Ontario Workers Inc                     (ses) de l’Ontario Inc.
                                                       December 5, 2007



   • Nearly 1.3 million Ontarians fell asleep or nodded off while driving
     at least once in the past year.
        • Of these drivers, more than 100,000 did so on five or more occasions →
          5.5 million trips

   • May be as many as 167,000 Ontario drivers involved in a fatigued or
     drowsy driving collision in past year
        – Over a half-million fatigued and drowsy driving trips occurred in which
          the driver had to brake or steer to avoid a collision.

   • Only 14.8 per cent of drivers used the most effective tactic -
     stopping to nap or sleep. Ironically, Ontarians also rated this tactic
     as one of the most effective.
   • Ontario drivers aren’t as worried about this traffic concern because
     they feel they can control it


                                            Traffic Injury Research Foundation
Occupational Health Clinics for                        Centres de santé des travailleurs
Ontario Workers Inc                                    (ses) de l’Ontario Inc.
   Women and Shiftwork
   • 60% increase in heart disease
   • sleep disturbances at increased rate
        – increased use of tranquilizers & sleeping meds
   •  menstrual cycle problems
   •  risk for miscarriage, prematurity & low
     birth rate



Occupational Health Clinics for       Centres de santé des travailleurs
Ontario Workers Inc                   (ses) de l’Ontario Inc.
   1996/97 Ontario Health
   Survey data (n=14,347)
   • Shiftworkers differed significantly from day
     workers in 7 health related outcomes:
        – smoking, use of pain relievers, weight status,
          back problems, bronchitis, depression & injury
          limiting normal activity




Occupational Health Clinics for       Centres de santé des travailleurs
Ontario Workers Inc                   (ses) de l’Ontario Inc.
      Comparison of three shift patterns with
      day workers (1996/97 Ont Health Survey data
      cont’d)
         Nightshift               Rotating            Non-regular


         Twice as likely to:      Increased rate of   More likely to :
          Smoke                  depression           Be Overweight
          Be Depressed                                Report injury
          Be Overweight                                that would limit
                                                        their activity in
           pain relievers                             past 12 months
          Lower social
           support




Occupational Health Clinics for                       Centres de santé des travailleurs
Ontario Workers Inc                                   (ses) de l’Ontario Inc.
   Comparison of four work
   sectors
   (1996/97 Ontario Health Survey data cont’d)
                  Health care Protection Transportation Manufact/
                                                        Processing

Smoking                           +                - ve                          - ve
Social support                    +                                              - ve
Physical Activity                 +    +             +
(LT)
Distress                          +
Binge drinking                    +
Overweight                            - ve         - ve                          - ve
Self reported                                                                    - ve
health
Restrictive injury                                                               - ve

                                                   + = positive health finding
Occupational Health Clinics for                     -ve = negative des finding
                                             Centres de santéhealth travailleurs
Ontario Workers Inc                          (ses) de l’Ontario Inc.
                         Coping with
                          Shiftwork
          Strategies to Improve Adaptation for:

                                   Individual

                                    Families

                                   Workplace

Occupational Health Clinics for                  Centres de santé des travailleurs
Ontario Workers Inc                              (ses) de l’Ontario Inc.
   Strategies for the
   individual
                         •   Good sleep/ bed habits
                         •   Nutrition
                         •   Personal fitness
                         •   Good health habits




Occupational Health Clinics for              Centres de santé des travailleurs
Ontario Workers Inc                          (ses) de l’Ontario Inc.
    Develop Good Sleep Habits

   • Acknowledge that • How much sleep do you
     you require a        need?
     certain amount of     – > 9 hrs associated with
     sleep - Respect your    adverse outcomes and
     bedtime                 no increased sense of
                             well being
   • Develop regular       – < 7 hrs associated with
     sleep habits            adverse outcomes

Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
 Getting ready for bed -
 suggestions for your routine
      • Keep room cool            • Go to bed early
      • relax                     • Get cooperation from
      • avoid stimulants &          family & friends
        depressants               • Keep sleep area as
           – no caffeine for 4      dark as possible
             hours before         • White noise
           – no alcohol
                                  • Minimize disturbances
           – no sleeping
                                    (disconnect phone,
             medication
                                    ear plugs)
           – nicotine is a
             stimulant
Occupational Health Clinics for         Centres de santé des travailleurs
Ontario Workers Inc                     (ses) de l’Ontario Inc.
                        Night Workers
   • Greatest challenge as work is during
     lowest part of circadian rhythm
   • get as much sleep as possible
   • sleep in morning - sleep is longer/better
   • supplement with evening nap
   • try to keep job as varied as possible



Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Sleeping in the am (after
      nightshift)
      Advantages:                 Disadvantages:
      • possible to avoid         • not enough wind
        daylight                    down time
      • likely to sleep longer    • morning family
      • will be awake in            commitments
        afternoon & evening       • breaks normal
                                    pattern of work
                                    personal time
                                    sleep

Occupational Health Clinics for         Centres de santé des travailleurs
Ontario Workers Inc                     (ses) de l’Ontario Inc.
      Sleeping in the pm (after
      nightshift)
      Advantages:             Disadvantages:
      • fresh & well rested   • early evening is one
        for work                of the natural alert
      • easier transition to    times dictated by
        sleeping all night on   the body clock
        days off              • family & social
      • easier to make this a   demands are
        normal sleep pattern    highest


Occupational Health Clinics for      Centres de santé des travailleurs
Ontario Workers Inc                  (ses) de l’Ontario Inc.
       Personal Fitness: mind &
                                     body
                                  Physical (body)

                                              • strengthen bones &
      •  heart rate                            muscles
      •  blood pressure                      • Improve circulation
      • burn fat, calories -                  •  constipation
           – weight control
                                              • contributes to “mind
      •  cholesterol                           fitness”


Occupational Health Clinics for                 Centres de santé des travailleurs
Ontario Workers Inc                             (ses) de l’Ontario Inc.
      Personal Fitness: mind &
      body
      • Well publicized connection between
        physical fitness and physical health
        effects
                     Mind Fitness
      •    stress
      •    self esteem
      •    urge to smoke, drink or take drugs
      •   improved sense of well being


Occupational Health Clinics for        Centres de santé des travailleurs
Ontario Workers Inc                    (ses) de l’Ontario Inc.
                  Shift strategies to
                  minimize fatigue
   • Strategic naps
        – Before new night shift
        – At time of maximum expected fatigue
              • 15-20 minutes + 200mg caffeine gives good
                results
   • Caffeine - limited as above
   • Brightly light environments to facilitate
     phase changes
Occupational Health Clinics for             Centres de santé des travailleurs
Ontario Workers Inc                         (ses) de l’Ontario Inc.
        Nutrition




   Good eating habits contribute to general wellbeingdes travailleurs
Occupational Health Clinics for          Centres de santé
                                         (ses) de l’Ontario Inc.
Ontario Workers Inc
                 Nutrition - Healthy
                       Eating
     • Eat regularly - at least three meals
     • Do not go more than five hours without
       eating
          – If working nights have at least one meal
            during the first half of shift
          – Evening workers -meal at beginning
            second half of shift


Occupational Health Clinics for        Centres de santé des travailleurs
Ontario Workers Inc                    (ses) de l’Ontario Inc.
   Healthy Eating - other tidbits

   • During second half of shift - reduce fluids,
     avoid caffeine
   • Eat as soon as wake up
   • Eat small healthy snacks




Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
   About
   caffeine ...




Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Healthy Eating - To stay
      alert
   • Protein can help to make you more alert - start
     day with high protein foods and gradually shift
     to carbohydrates as bedtime approaches
   • Eat high protein snacks if you become sleepy
     during your shift e.g. cheese, eggs.
   • Drink caffeine-containing beverages only when
     you need to be alert


Occupational Health Clinics for     Centres de santé des travailleurs
Ontario Workers Inc                 (ses) de l’Ontario Inc.
Healthy Eating - To promote
sleep
   • No caffeine at least 4 hours before going to
     sleep
   • avoid alcohol & cigarettes before bedtime -
     reduces quality of sleep
   • carbohydrates (grain products, cereals, fruits)
     can make you feel sleepy
   • decrease fluid intake for several hours before
     bedtime so that sleep not interrupted going to
     bathroom

Occupational Health Clinics for     Centres de santé des travailleurs
Ontario Workers Inc                 (ses) de l’Ontario Inc.
      Healthy Eating - To control
      stomach problems
   • To avoid heartburn              • To reduce digestion
        – eat smaller nutritious       problems
          snacks                       – eat food high in fibre
        – avoid fried food,              (whole grains, fruits,
          added fats, nuts, junk         vegetables)
          food                         – drink 6-8 glasses of
        – avoid spicy foods,             water throughout early
          alcohol, coffee & citrus       part of awake time
          juices


Occupational Health Clinics for            Centres de santé des travailleurs
Ontario Workers Inc                        (ses) de l’Ontario Inc.
     Good health habits
      • Take control of your health
           – Be aware of how shiftwork (or other parts
             of life) are affecting you
           – See your physician if having problems
           – Especially important with known health
             problems e.g. diabetes, epilepsy, sleep
             disorders, hypertension, psychiatric
             illnesses. Medication effects are different
             at different times of day

Occupational Health Clinics for         Centres de santé des travailleurs
Ontario Workers Inc                     (ses) de l’Ontario Inc.
   Good health habits cont’d

   • Resist frenetic shift choices
   • Resist working overtime
   • Let go of things that do not matter




Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                       Strategies for
                          Families



Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Strategies for
      families
      • Educate whole family about shiftwork
        and ways to deal with it
      • Involve family in planning around
        activities and sleep/quiet times
      • Schedule at least one meal a day as a
        family
      • Socialize with other shiftworkers and
        their families
Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
      Strategies for families cont’d
      • Share schedule with
        outside family &
        friends
      • Use multiple
        communication
        strategies - notes,
        calendars, email
      • Acknowledge
        cooperation &
        support
Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                 Strategies for the
                   Organization



Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                 Shiftwork Friendly
                     Workplace
                                     Good lighting
                                                             Good ventilation/
               Parking security                            temperature control


              Nap areas
              * after night shift                            Exercise facilities


        Access to health care &                      Accessibility to healthy foods/
              counseling                                       food prep

                   Social opportunities         On site day care esp
                      shiftworkers               for shiftworkers

Occupational Health Clinics for                        Centres de santé des travailleurs
Ontario Workers Inc                                    (ses) de l’Ontario Inc.
      Shift schedule design

     • Is there a “best” shift schedule?
          – No optimum shift design decided on
          – Worker satisfaction and sense of control
            may be very important overall.
          – The best shift system is the one which is
              best for the organization, production and
              the workforce. By design, therefore, there
              cannot be one system which is best for all.


Occupational Health Clinics for           Centres de santé des travailleurs
Ontario Workers Inc                       (ses) de l’Ontario Inc.
  Comparison of work schedule
  designs
                                      Advantages              Disadvantages

      Compressed work              More time between         fatigue & 
      week                          shift schedules           performance
                                   More opportunities       extend workers
                                    for family & social       exposures
                                    activities               child care
      Permanent afternoon          Time to adjust           Permanent night
      or night shifts                                         workers have
                                                              greater sleep
                                                              deficit
      Rotating or variable         Allows greater           Continuous
      shifts                        opportunity for           adjustment
                                    social & family
                                    interaction
Occupational Health Clinics for                           Centres de santé des travailleurs
Ontario Workers Inc                                       (ses) de l’Ontario Inc.
      Key principles in shiftwork
      schedule design
   • Involve shiftworkers where possible in
     developing and choosing shift schedules
   • Avoid permanent (fixed or non-rotating) night
     shift
   • Keep consecutive night shifts to a minimum
   • Avoid quick shift changes
   • Plan some free weekends
   • Avoid lots of days of work followed by 4-7 day
     mini-vacation
                                      minimum (or
   • Keep long shifts & overtime to aCentres de santé des travailleurs
     eliminate)
Occupational Health Clinics for
Ontario Workers Inc                  (ses) de l’Ontario Inc.
Key principles in shiftwork
schedule design cont’d
     • Consider different lengths for shifts
          – Examine start--end times
     • Keep the schedule regular & predictable
     • Examine rest breaks
     • Shifts rotating forward (days, afternoon,
       night) cause fewer problems than going
       the other direction
     • Reduce or eliminate overtime

Occupational Health Clinics for        Centres de santé des travailleurs
Ontario Workers Inc                    (ses) de l’Ontario Inc.
Work design considerations….
      • Organize workloads so that the toughest and
        most dangerous tasks are completed early in
        shift
      • Avoid scheduling demanding or dangerous
        tasks at the beginning of early morning shift
      • Adjust workload during shift to prevent
        boredom
      • Break schedules that allow exercise & social
        interactions

      • Reduce chemical, physical, biological hazards -
        exposure limits are designed for 8 hour day &
        must be adjusted for extended work shifts
Occupational Health Clinics for       Centres de santé des travailleurs
Ontario Workers Inc                   (ses) de l’Ontario Inc.
     Beyond scheduling ….
      • Establish a “no working alone” policy
      • Avoid isolating workers - regularly
        communicate with people who work in
        isolation
      • Available health information - education
        regarding coping with shiftwork for
        worker & their family

Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                  What can you do?

   • Take back control
   • Delegate
   • Negotiate

   • Let go of the things that don’t matter



Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                               Resources (Internet)
      Occupational Health Clinics for Ontario Workers Handout on Shiftwork:
      http://www.ohcow.on.ca/resources/handbooks/shiftwork/shiftwork.pdf

      Plain Language on Shiftwork: Booklet with information on shiftwork impact and coping with working shiftwork.
            Printable at http://www.cdc.gov/niosh/pdfs/97-145.pdf

      Educational information on workplace hazards and prevention:
          http://www.ohcow.on.ca/english/handbook_mf.htm

      National Sleep Foundation: www.sleepfoundation.org

      A site for people who work at night: general information and communication forum for night shift workers.
      http://www.workingnights.com

      Government of Saskatchewan: Information on managing the impact of shift work.
          http://www.labour.gov.sk.ca/safe

      Canadian Center for Occupational Health and Safety: Work schedules information:
          http://www.ccohs.ca/oshanswers/work_schedules/

      Shiftwork information:
      http://www.ccohs.ca/oshanswers/work_schedules/shiftwrk.html
      http://www.ccohs.ca/headlines/text2.html

      Heart and Stroke Foundation of Canada: Information on diet, exercise and general healthy living.
      http://www.na.heartandstroke.ca/index.html

      Society for Neuroscience: lay language articles called “Brain Briefings”. Article on circadian rhythms
      http://www.sfn.org/index.cfm?pagename=brainBriefings_biologicalClocks
Occupational Health Clinics for                                                   Centres de santé des travailleurs
Ontario Workers Inc                                                               (ses) de l’Ontario Inc.
                      Any questions ???

       Contact Information

       mtew@ohcow.on.ca

       smacdonald@ohcow.on.ca




Occupational Health Clinics for   Centres de santé des travailleurs
Ontario Workers Inc               (ses) de l’Ontario Inc.
                   6 Questions to ask
                  (re sleep problems)
      • Do you snore loudly?
      • Have you or others noticed gasping for
        breath during sleep?
      • Do you feel sleepy or doze off during work,
        reading, driving or daily activities?
      • Do you have difficulty sleeping 3 or more
        nights a week?
      • Do you feel unpleasant tingling, creeping or
        restlessness in legs while trying to sleep?
      • Do you have interruptions to your sleep.(Pain,
          heartburn,noise, family members, temperature)

Occupational Health Clinics for                           Centres de santé des travailleurs
Ontario Workers Inc                                       (ses) de l’Ontario Inc.

				
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