The Hidden Health Costs of Night Shifts

Your body clock is thrown, you feel sick, tired, irritable and forgetful. Anyone would think you were experiencing the morning after a big night out, but you are actually suffering from the after effects of a night shift.

More than 3 million people in the UK work nights –one in 12 of the working population – yet a growing body of research points to the negative health impacts of night shifts. The list runs from a heightened risk of obesity and diabetes through to a greater likelihood of cardiovascular disease and even breast cancer. We’ve now learned that even when night-workers get plenty of sleep, it’s at the wrong time.

It had always been assumed that our body clock would adapt to the demands of working at night, but as one of Britain’s leading sleep experts, Prof Russell Foster, from Oxford University, says “the really extraordinary finding across a whole range of different studies, is that you don’t adapt”. And that means those working at night for long periods are more likely to get a range of serious diseases from type 2 diabetes to coronary heart disease and cancer.

A massive study in the US has been following 75,000 female nurses who work shifts over the past 22 years. It has shown that one in ten of those who have worked rotating shifts for six years will die early.

There are no specific health and safety laws on shift working in the UK but employers do have a duty of care. And some companies and governments are starting to take the issue more seriously – not least because of the threat of legal action. The Danish government has given compensation to women who developed breast cancer after long periods of night shifts. In Korea, electronics workers on long-term night-working who contracted diseases have also received compensation.

So what can you do to help yourself and your employees?

Sleep and fatigue problems

Tips for employees

  1. avoid caffeine, alcohol and large meals before going to sleep
  2. restrict energy intake on the night shift between midnight and 06.00 and try to eat at the beginning and end of the shift
  3. eat breakfast before your day sleep after a night shift to avoid waking up because of hunger
  4. make sure that family and friends are aware of and considerate of your sleep hours and needs
  5. ensure you have a comfortable, quiet place to sleep during the day
  6. air conditioning, telephone answering machine, foam ear-plugs, eye masks and good blinds/curtains can improve your sleep
  7. make time for quiet relaxation before bed (e.g. reading, breathing exercises, muscle relaxation techniques)
  8. try to establish a sleep schedule to facilitate sleeping during the day
  9. avoid strenuous exercise before sleeping because your body’s metabolism will remain elevated for several hours and this makes sleeping difficult
  10. if you can’t fall asleep after one hour, read a book or listen to quiet music for a while
  11. if you still can’t fall asleep, try again later in the day
  12. try to quit shift work by around age 40, as that’s often when shift workers’ sleep problems get worse.

Tips for employers

  1. evaluate shift schedule design such as length of breaks, and start and finish times
  2. allow adequate time between shifts for sleep, meal preparation
  3. avoid quick returns
  4. schedule the most demanding work early in the shift when workers are most alert
  5. schedule no more than five to seven shifts in a row, and no more than two nights in a row
  6. ensure the workplace is brightly lit
  7. avoid excessive overtime, split shifts and excessive 12-hour shifts
  8. rotate shifts forward (morning – afternoon – night)
  9. provide at least 48 hours between shift changes to allow the body to adjust
  10. take advantage of individual differences
  11. provide a room with facilities for workers to lie down and rest before and after a shift
  12. identify and treat workers who have sleep disorders, and transfer them to day work
  13. evaluate sleep problems during regular health checks, and ensure that these health checks become more frequent from age 40 and in those who have been shift workers for 10 years or more.

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Psychological and physical health

Tips for employees

  1. try to avoid doing 10 consecutive years of shift work
  2. maintain a healthy lifestyle with exercise, regular meal times, and good sleeping habits when not working
  3. stick as closely as possible to a normal day and night pattern of food intake, dividing your daily food into three main meals, each contributing about a third to your overall intake. The higher your energy needs, the more frequent your meals and snacks should be
  4. avoid sugar-rich products like soft drinks, bakery items, sweets, and non-fibre carbohydrate foods like white bread
  5. instead, choose vegetables, salads, fruit, lean meat, poultry, fish, dairy products, grains, vegetable soups, wholegrain bread, boiled nuts, green tea
  6. use relaxation techniques such as deep and slow breathing
  7. plan days off in advance if possible.
  8. try to prioritise tasks and tackle one at a time
  9. afternoon/evening shift workers should have their meal in the middle of the day rather than during their shift
  10. night workers should eat lightly throughout the shift, with a moderate breakfast
  11. relax during meals and allow time for digestion
  12. drink lots of water
  13. reduce foods high in fat and salt and avoid using fast food and vending machines
  14. avoid excessive use of antacids, tranquillisers and sleeping pills.

Tips for employers

  1. move people from shift work after 10 years of exposure
  2. plan shifts as far in advance as possible
  3. keep schedules flexible by allowing workers to trade shifts
  4. schedule time off over weekends
  5. provide workshops and information sessions on stress management
  6. make sure demands on workers are reasonable
  7. maximise worker autonomy
  8. include a mental health component to employee assistance programmes
  9. consider offering facilities for social activities such as recreation and staff social gatherings
  10. provide exercise facilities on site
  11. provide a 24-hour cafeteria where night workers can obtain a hot, nutritious meal and appropriate dining facilities that, for example, allow a meal to be eaten away from the workplace, with colleagues, in as pleasant a surrounding as possible
  12. schedule regular meal breaks
  13. provide day employment for workers who can’t work shifts for medical reasons
  14. provide regular (annual) health checks for shift workers and transfer them to day work if required.

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Social isolation

Tips for employees

  1. use a calendar to schedule events and activities
  2. establish good communication skills
  3. schedule at least one daily meal with the family, to keep communication channels open and promotes a good eating habit
  4. socialise with other shift workers and their families, to minimise the disruption that shift work can have on your social life
  5. keep in touch with partner and children daily
  6. set time aside for just you and your partner
  7. carefully plan family activities, as family ties are a precious commodity
  8. pay close attention to physical fitness, as a regular exercise programme helps the body adjust to the negative effects of shift work and can also help improve the quality and quantity of sleep
  9. practise stress reduction.

Tips for employers

  1. provide an on-site day-care facility
  2. offer 24-hour day-care solutions
  3. offer activities for employees’ children, such as sponsoring sports teams, etc
  4. provide transportation to events
  5. provide workshops on communication and conflict resolution
  6. organise hobby or interest groups within the workplace (for example, art classes, support groups)
  7. sponsor employee sports teams and leagues (for example, company football league).

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