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Shift Work - PowerPoint Presentation

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Shift Work - PPT Presentation

By MHDavari MD What is shift work Shift work is defined as work outside of the normal daylight hours from about 7am until 6 pm Midnight Midnight Noon What is Shift Work One speaks of shift work if two or more persons or teams of persons work in sequence at the same work pla ID: 531302

work shift night sleep shift work sleep night workers midnight day amp circadian dis hours evening noon fatigue alertness

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Slide1
Slide2

Shift Work

By

M.H.Davari M.DSlide3

What is shift work?

Shift work is defined as work outside of

the normal daylight hours from about 7am

until 6 pm

Midnight

Midnight

NoonSlide4

What is Shift Work?

One

speaks of shift work if two or more persons , or teams of persons , work in sequence at the same work place.

Often

, each worker s shift repeats, in same pattern , over a number of days.Slide5
Slide6

Production process > 8 hours or continuous

Expensive machinery that must be used continuously to be profitableSlide7

7

How many workers work

shift work in North America?

13 – 16

% of total work force work some shift work

Total

of

shift workers estimated to be

24 -25

million

5-6 % work evening shifts

4-5% work permanent night

shift

4-5 % work rotating shiftsSlide8

Why can shift work be difficult?

That is, they are biologically programmed to

sleep during the day and be awake at night. e.g. owls, bats, raccoons

Some

animals

are what

scientists

call

NOCTURNAL

8

DIURNAL

Humans

are what scientists call

That is, we are biologically

programmed to sleep at night

and be awake during the day.Slide9

How does the body work

Internal Biological Clock

(Circadian rhythm)

External stimulantsSlide10

Circadian

RhythmDifferent body functions vary during the 24 hour dayMetabolism is greatest in the afternoon to evening

Most people most alert

10 PM-8 AM

and most sleepy

2-4

AM

The body has a natural cycle of 25 hours

External factors synchronize us to a 24 hour day

The internal clock is located in the

suprachiasmatic

hypothalmusSlide11

The

Suprachiasmatic

NucleusSlide12

Circadian body rhythms

Hormone and gastric

secretionsBody tempreture

Bronchial reactivity

Blood Pressure

Sexual arousal

Anxiety

Metabolic

Rate

Short term

memory

Work performanceSlide13

Biochemistry and Circadian RhythmsSlide14

External clues “

Zeitgebers

”Light/Dark cycle

Timing of meals

Social interactions

Actual time clockSlide15

In 1879

Thomas Edison invented

the light bulb. Slide16

This forever changed our ability to work

at night, but not our biological programming

to sleep at night. Slide17

The 4 Hazards of

Shiftwork

1.

Increased risk of errors & accidents

in the work and out of the work

2 Insufficient daytime sleep leads

to

increased fatigue & sleepiness

3. Increase in health problems

4. Increase in social and domestic

problemsSlide18

Fatigue

affects alertness in many

shiftworkers 80-90 % of shiftworkers feel sleepy during night shift (?% nap!)

Studies

show

increase

in accident

rate

Tendency for more

severe

/ serious accidents to occur

Alertness and Accidents Slide19

Fatigue Related Accidents

Midnight

MidnightNoon

NumbersSlide20

Meter Reading Errors

Midnight

MidnightNoon

NumbersSlide21

Fully Alert

Midnight

Midnight

Noon

Relative Alertness

Biological Rhythms

DrowsySlide22

Drowsy

15

10

5

12

15

18

21

00

03

06

09

12

Exxon

Valdez

00:15

Full Alertness

 

Time of Day & Major Accidents

Bhopal

01:00

Chernobyl

01:23

Three Mile

Island

04:00

Midnight

Noon

NoonSlide23

Exxon Valdez

Disaster

Cleanup cost: $2 BillionExxon Fined: $5 BillionEnvironmental damage: ?$ Slide24

Health Hazards

Short effects:

sleep disturbancePoor concentration Decrease alertnessDecrease safetyProlonged exposure to chemical and biological substances and other hazardsSlide25

Long effects:

GI problemReproductive effectsCancer

Exacerbation of Sleep disorders Asthma Diabetes mellitus Coronary Artery Disease Slide26

GI Dis.

75% of night workers vs. 20% of day workers

ComplaintsLoss of appetite

Constipation

Dyspepsia

Heart burn

Abdominal pain

Flatulence

Many problems may not show up until years later

Reasons

Poor food quality

More caffeine

More alcohol

More tobacco

Drugs used to keep awakeSlide27

Cardiovascular problems

Increased incidence of

ischemic diseaseMay

be

related to:

disturbance of circadian

blood pressure

and

pulse

rate

Substance abuse

more likely in shift

workers

Elevated triglyceride levels in phase advance workersSlide28

Hypertension

Shift workers were found to have approximately

25% greater chance of developing hypertension than non shift workersSlide29

Cancer

At least three nights per month for 15 or more years may increase the risk of

Colorectal cancer in women 35%Shorter durations also have increased risk

Due to the suppression of melatonin production with nocturnal light exposure. Melatonin has

anti-

neoplastic

properties

Breast Cancer ,

Attributed to inhibition of melatonin production by light exposure during the nightSlide30

Cognitive

AbilityRecent studies have found deterioration in cognitive ability in shift workers vs. non shift workers.

This increases with duration of exposure

The effect seems to diminish 4 years after discontinuationSlide31

Medical evaluation:

History:

CAD

GI

dx

Sleep

dx

Epilepsy

diabetes

Asthma

Difficulty in night visionSlide32

Psychological

Shift workers demonstrate:

More

depression

and

despondency

More likely to use psychotropic

drugs

or require

hospitalization

Will have magnification of

underlying depression or bipolar disorders

Circadian

rhythm

disturbance may be a

cause

for depressionSlide33

Social Impact

Increases

Divorce

Family violence

Social Isolation

Sexual dysfunction

May affect women more than menSlide34

Impaired logical reasoning and decision-making

Impaired vigilance and attention

Slowed mental operationsLoss of situational awarenessSlowed reaction time

Short

cuts

Fatigue Effects on PerformanceSlide35

Major Fatigue Factors

Time of Day

: between midnight and 6 AM

Cumulative Sleep Debt:

Acute Sleep Debt:

More than 17 hours since the last

sleep period

Continuous Hours Awake:

Less than eight hours in last 24 hrs.

More than eight hours accumulation.Slide36

Shift work type:

Fixed pattern

Night

Evening

Rotating pattern

Clockwise (morning- evening- night)

Rapid (less than 4 days)

slow (more than 4 days)

Counter

clockwise

(night-evening- morning)

Rapid

slow Slide37

Oscillating shift work

Split shift workRelief Shift workSlide38

Quickly rotating shift system

:

Minimize sleep deprivation (Fischer et al., 1997)Minimize circadian rhythm disruption

(

Knauth

1993, 1995)

Improve social

contacts

(

Knauth 1993, 1995) Improve alertness and well-being

(Williamson & Sanderson 1986, Phillips et al., 1991)

Clockwise rotation

:

Better tolerated by the

shift workers,Improve

production & well-being

(Czeisler

et al

., 1982

)

Improve sleep quality

(

Folkard

1993

)

Reduce physical, social and psychological problems

(

Landén

1981)Slide39

Shift work

Maladaptation15-20% of workersSigns & symptoms:Sleep dis.Fatigue

Behavioral dis.GI dis.Sedative drugs usageSlide40

Shift work

Maladaptation:Age > 50Morning typeSecond job or heavy house workLong sleep time

Fixed & regular sleep patternHx sleep dis.Hx GI dis.Hx cardiovascular dis.Asthma,DM,EpilepsySlide41

How to keep worker alert?

High illumination

level

Breaks

Naps

Occasional

stirring

music

Stretching or light exercise

Social interaction

Snacks & caffeinated beverages

FDA recommended use

Modafinil

(

Provigil

)

for shift work sleep disorderSlide42

Suitable Shift systems

:Daily work: not be more than 8 hr.Number of night or evening shifts: as small as possible.A full day of free time follow every night shift

Contain consecutive work-free days, preferably including the weekend Clockwise rotationRapid Shorter shift ( < 8hr) : heavy manual workLonger shift (12hr) : light jobSlide43

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