The 24/7/365 Economy, Shift Work, and Sleep

Shift work can take a toll on your physical and mental health.

Posted Mar 31, 2018

We have long since entered the 24/7/365 economy and more and more people are feeling the impact of its demands on their time and energy (Wickwire et al, 2017). As the economy has slowly, but steadily, recovered from the Great Recession, people are finding jobs and more are working full time. As I previously discussed, there is evidence that full-time workers are indeed sleeping less than they did 40 years ago. An important component of the modern economy is the use of shift work to meet the needs of companies and governments engaged in providing around-the-clock services and products.

"Yin and Yang" by Klem - This vector image was created with Inkscape by Klem, and then manually edited by Mnmazur.. Licensed under Public Domain via Wikimedia Commons -
Source: "Yin and Yang" by Klem - This vector image was created with Inkscape by Klem, and then manually edited by Mnmazur.. Licensed under Public Domain via Wikimedia Commons -

Shift work can be defined as working outside the usual 8:00 AM to 6:00 PM workday (American Psychiatric Association, 2013). This is especially the case for people who have to work at night on a regular basis and not as a part of occasional overtime. Note that this definition can also apply to workers who need to be on the job early in the morning. It is estimated that about one-fifth of workers around the world are currently working on some form of a non-traditional schedule and shift-work has been associated with problems such as cognitive dysfunction, poor life quality, and even cancer (Wickwire et al, 2017). Recent estimates suggest that somewhere between 16% and 20% of the workforce is engaged in nighttime work (American Psychiatric Association, 2013). Similar rates of shift work have been reported around the world (Wickwire et al, 2017). Of these workers, it is estimated that 5% to 10% experience sleep-related symptoms significant enough to be diagnosed with the circadian rhythm sleep-wake disorder, shift work type (American Psychiatric Association, 2013). The rate of shift work sleep disorder tends to increase with progression into middle-age and with the increasing length of time spent working the night shift. It appears that coping with a change in the circadian rhythm becomes more difficult with advancing age.

There are a number of circadian rhythm sleep-wake disorders that occur because the internal circadian (24 hours) system becomes altered or there is a misalignment between the circadian rhythm and the social demands of the person’s schedule (American Psychiatric Association, 2013). This kind of misalignment can result in problems such as difficulty falling and staying asleep as well as excessive daytime sleepiness. When these problems become significant enough that they interfere with a person’s social or occupational functioning, a diagnosis of circadian rhythm disorder can be made. The circadian rhythm disorders include those such as jet lag, delayed sleep phase disorder, and shift work sleep disorder.

There appear to be a number of factors that increase the risk for the development of a shift work sleep disorder (American Psychiatric Association, 2013).  Some of these include a tendency to function best in the morning (being a “lark”), a need to sleep more than eight hours to feel refreshed (being a long sleeper), and having a strong conflict between work demands and other responsibilities (such as childcare). People who are committed to a lifestyle that allows for working at night with few daytime demands appear to be better able to cope with night shift work and at less risk for shift work sleep disorder. We are all probably know people who report that they prefer working the night shift. Many of them gravitate to occupations such as police work and nursing where they can volunteer for the night shift.

There is a tendency for night shift workers to be obese (American Psychiatric Association, 2013), most likely related to their poor sleep, and this increases the risk of sleep apnea. Many of the technicians and technologists who conduct polysomnographic studies in sleep laboratories, for example, struggle with weight gain over the course of their careers. We often find clinically that is extremely difficult to cope with the demands of night shift work while also suffering from untreated sleep apnea.

The effects of shift work sleep disorder can be significant and include poor work performance and increased risk for accidents including those involving motor vehicles. There may also be increased risk for mental health problems such as depression and substance abuse as well as poor physical health related to cardiovascular disease, diabetes, and cancer. Of particular concern for psychiatric patients is the potential for the triggering of a manic episode in people with bipolar disorder because of missing sufficient sleep.

While it is true that nontraditional and shift work schedules are often economically advantageous to companies and are also necessary for the functioning of the modern economy (as we would not want to, for example, do without the availability of 24-hours a day medical and police services), there are also costs for the companies that require these schedules and the economy as a whole. We are more aware of the negative impact of these schedules on many of the individuals who have to work them, but it is also true that the increased rate of accidents and health care costs create a significant burden for companies and governments as well (Wickwire et al, 2017).

Because of the circadian misalignment that can occur due to shifting work, people working shifts often experience difficulty falling asleep when they are finally able to go to bed. This tends to occur on the mornings after completing the night shift or after completing a series of night shifts. Nurses, some factory workers, police, medical residents, and others are familiar with this experience. It can be very upsetting to arrive home extremely fatigued only to find that is impossible to fall asleep after getting into bed in the morning (Epstein & Mardon, 2007). This occurs because workers are trying to fall asleep at a time when their bodies are actually prepared to be awake by their internal circadian clock.

It can be very challenging, even after falling asleep, to stay asleep during the day (Epstein & Mardon, 2007). This occurs because the circadian clock is alerting the worker’s body to be up as it is a day when humans are typically awake. This can result in workers sleeping in short stretches with difficulty falling back asleep after awakenings. Of course, kids playing next door and a neighbor’s barking dog as well as the bright sunlight coming through the cracks in the shades in the bedroom may also contribute to daytime sleep difficulties. It may then be incredibly challenging to stay awake during the overnight work shift. The cumulative sleep deprivation that occurs with long-term shift work may result in excessive sleepiness during the day when workers are off from work.

I frequently work with patients who are experiencing problems with sleep, with wakefulness, and with inadequate ability to function, due to their work schedules. These problems can be extremely challenging to effectively address because of the demands of their schedules and the need for them to continue working them for financial reasons. In the next blog, I will discuss more the physiological and psychological bases of shift work sleep disorder and will address some of the countermeasures that can be implemented to help cope with these problems.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.

Wickwire, E.M., Geiger-Brown, J., Scharf, S.M., & Drake, C.L. (2017). Shift Work and Shift Work Sleep Disorder: Clinical and Organizational Perspectives. Chest, 151 (5), 1156-1172. DOI: http://dx.doi.org/10.1016/j.chest.2016.12.007

Epstein, L.J. & Mardon, S. (2007). The Harvard Medical School guide to a good night’s sleep. New York: McGraw Hill.