We know that sleep is important. The need for sleep is biologically similar to the need to eat and drink, and it is critical for maintaining life and health and for working safely. Sleeping 7 to 8 hours a night is linked with a wide range of better health and safety outcomes. NIOSH has been actively involved in research to protect workers, workers’ families, employers, and the community from the hazards linked to long work hours and shift work. In honor of National Sleep Awareness Week, we have summarized the sleep and work issue below and, in a companion blog tomorrow, will highlight NIOSH research in this area.
A growing number of American workers are not getting enough sleep. Research shows an increase from 24% in the 1980s to 30% in the 2000s in the percentage of American civilian workers reporting 6 or fewer hours of sleep per day—a level considered by sleep experts to be too short (Luckhaupt, Tak, & Calvert 2009).
Why are more Americans getting less sleep? Work demands are one factor. The timing of a shift can strain a worker’s ability to get enough sleep. Working at night or during irregular hours goes against the human body’s biology, which is hard-wired to sleep during the night and be awake and active during the day. Still, society needs certain workers around the clock to provide vital services in public safety, healthcare, utilities, food services, manufacturing, transportation, and others. The resulting shift work—any shift outside the normal daylight hours of 7 a.m. to 6 p.m.—is linked to poorer sleep, circadian rhythm disturbances, and strains on family and social life. It is not possible to eliminate shift work altogether, so the challenge is to develop strategies to make critical services available while keeping workers healthy and everyone around them safe. In addition to shift work, some data suggest that a growing number of employees are being asked to work long hours on a regular basis. Every extra hour on the job is one less spent attending to the person’s off-the-job responsibilities. When the day is too full to fit everything in, it is often sleep that gets the short shrift.
What are the risks of long work hours and shift work?
Risks for Workers:
- Sleep deprivation
- Lack of adequate time to recover from work
- Decline in mental function and physical ability, including emotional fatigue and a decline in the function of the body’s immune system
- Higher rates of depression, occupational injury, and poor perceived health
- Higher prevalence of insomnia among shift workers with low social support
- Increased risk of illness and injury
- Strain on personal relationships, such as marriage and family life
- Increased risk of long-term health effects, such as heart disease, gastrointestinal disorders, mood disturbances, and cancer
Risks for Employers:
- Reduced productivity
- Increase in errors
- Absenteeism and presenteeism (present at work but not fully functioning because of health problems or personal issues)
- Increased health care and worker compensation costs
- Workforce attrition due to disability, death, or moving to jobs with less demanding schedules
Risks to the Community:
- Potential increase in errors by workers leading to:
- Medical errors
- Vehicle crashes
- Industrial disasters
Research indicates that the effect of long work hours and shift work may be more complex than a simple direct relationship between a certain high number of work hours or shift schedule and risks. The effects appear to be influenced by a variety of factors including characteristics of the worker and the job, worker control, pay, non-work responsibilities, and other characteristics of the work schedule.
Both workers and employers share in the responsibility of reducing risks connected to poor sleep. Therefore, it is important for both workers and managers to make sleep a priority in their personal life and in the assignment of work.
What can employers do to address this issue?
- Regular Rest: Establish at least 10 consecutive hours per day of protected time off-duty in order for workers to obtain 7-8 hours of sleep.
- Rest Breaks: Frequent brief rest breaks (e.g., every 1-2 hours) during demanding work are more effective against fatigue than a few longer breaks. Allow longer breaks for meals.
- Shift Lengths: Five 8-hour shifts or four 10-hour shifts per week are usually tolerable. Depending on the workload, twelve-hour days may be tolerable with more frequent interspersed rest days. Shorter shifts (e.g., 8 hours), during the evening and night, are better tolerated than longer shifts.
- Workload: Examine work demands with respect to shift length. Twelve-hour shifts are more tolerable for “lighter” tasks (e.g., desk work).
- Rest Days: Plan one or two full days of rest to follow five consecutive 8-hour shifts or four 10-hour shifts. Consider two rest days after three consecutive 12-hour shifts.
- Training: Provide training to make sure that workers are aware of the ups and downs of shiftwork and that they know what resources are available to them to help with any difficulties they are having with the work schedule.
- Incident Analysis: Examine near misses and incidents to determine the role, if any, of fatigue as a root cause or contributing cause to the incident.
What can workers do to address this issue?
- Make sure you give yourself enough time to sleep after working your shift.
- Avoid heavy foods and alcohol before sleeping and reduce intake of caffeine and other stimulants several hours beforehand since these can make it difficult to get quality sleep.
- Exercise routinely, as keeping physically fit can help you manage stress, stay healthy, and improve your sleep.
- Choose to sleep someplace dark, comfortable, quiet, and cool so you can fall asleep quickly and stay asleep.
- Seek assistance from an appropriate healthcare provider if you are having difficulties sleeping.
What does the future hold?
NIOSH is working on several projects to reduce the risks associated with long working hours and shiftwork. Our current research includes:
- Studying new methods to better measure work hours
- Surveillance to better understand the extent of the problem
- Studies to estimate risks to workers and employers
- Training interventions
Stay tuned for another blog tomorrow summarizing NIOSH research efforts related to sleep and work.
—Claire Caruso, PhD, RN, and Roger R. Rosa, PhD
Dr. Caruso is a research health scientist in the NIOSH Division of Applied Research and Technology.
Dr. Rosa is the NIOSH Deputy Associate Director for Science.
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Public Comments
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March 8, 2012 at 11:32 am ET - Marc Uffner
Most everything said is true and correct, infact most accidents, fatalities, stressing situations all stem from lack of sleep. But there is one question for years that has an answer. What about those who’s can’t sleep? I’m a recovering addict for more than 25 years, and I do not sleep if I take 25 mg. Of Ambien. I had the pleasure of knowing (name (name removed), who passed in 1998 after I was 10 years clean. I was the only client ever to be brought back to (name removed), after being thrown out, relapse the night I got home for a 6 month finally, and I bottomed out and decided to get clean. One thing she said when I could not sleep was simple, if your laying down and your hearts at rest for 8 hours than it is just like sleep. The other, when I die I will get all the rest and sleep I will ever need.
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AUTHOR COMMENT March 13, 2012 at 11:30 am ET - Blog Coordinator
References to products or services do not constitute an endorsement by NIOSH or the U.S. government.
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AUTHOR COMMENT March 19, 2012 at 3:43 pm ET - Claire Caruso
You may want to contact the American Academy of Sleep Medicine (AASM) http://www.sleepcenters.org/
for help finding a certified sleep lab and sleep disorders specialist.
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March 8, 2012 at 3:46 pm ET - kim
I work at a center that offers treatment to workaholics and the symptoms people suffer from this illnes are almost the same I found at this blog. I agree on that it is very advisable to get some help if you can’t controll your working vice by yourself the consequences include relationships troubles, divorce, accidents and low esteem appart from the health issues described here.
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March 13, 2012 at 3:52 pm ET - Dan Alexander
another optioin that may have an immediate effect has been used in the Australian mining industry. the incident statistics for a mine begin at a person’s front door to when he/she returns home. that way the employer is concerned about the effects of fatique on the travel part of a workers’ day not just the at work time.
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May 17, 2012 at 7:42 pm ET - dav321
There are more than 100 different sleeping and waking disorders. They can be grouped into four main categories:
* Problems falling and staying asleep (insomnia)
* Problems staying awake (excessive daytime sleepiness)
* Problems sticking to a regular sleep schedule (sleep rhythm problem)
* Unusual behaviors during sleep (sleep-disruptive behaviors)
medical education is essential.
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May 18, 2012 at 6:49 am ET - Marta Márquez- Pigeon products
Everyone knows the importance of resting, not only to sleep, but to use those hours for resting.
I know this issue close; I have an aunt who has been working for over 5 years on the night shift. She tought it was a good idea because she could sleep in the morning and care for her soon in the afternoon. It was impossible. All the problems you have named are fulfilled in it: she is always tired, irritable nature, is often sick, trouble sleeping … It´s a big problem.
Greetings
Marta
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May 22, 2012 at 9:33 am ET - abhishek
sleeping for 7-8 hours is very important to maintain a healthy mind and body. Working in shift patterns disturbs the natural cycle of human body and is a deterrent to productivity.
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May 22, 2012 at 4:32 pm ET - Mathew Adams
I feel that working during the night shift can be really difficult for anyone who isn’t committed. I was working at UPS as a truck loader and the shifts begins at 3am. And I guess you could say I wasn’t committed as much as I should have. I tried going to bed early but it never worked, I always ended up going to bed at 8pm sometimes 9pm, which is way too late. I ended up leaving this job after only a month.
Working during the night shift is a complete lifestyle change, some people can deal with it while others can’t. Here are some tips I found for going to bed yearly if you work the night shift, source – [http://snoozebubbles.com/sleep-disorders]
* Make the light for the room you sleep in is adjustable (you need to make it completely dark before you go to sleep)
* There has to be no noise, and this can be a little difficult if you live with somebody.
* You need to plan ahead a prepare for getting up when you have to. You need minimum 8 hours sleep.
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June 9, 2012 at 12:55 pm ET - xe nâng hàng
i like your blog. Because, it very important to maintain a healthy mind and body
thank you
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June 14, 2012 at 11:19 am ET - Neila Richard
Sometimes I am not getting enough sleep when in a busy days because of my jobs…consuming some vitamins and fresh fruits can be as other solution
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June 21, 2012 at 3:17 am ET - Treisha Marle
Most of what was said in this post is agreeable. A common reason why people get sick and accidents is because of our lack of sleep. It’s hard enough that we get drained and burnt out with work but even more when we can’t rest enough. Although it is understandable that our work also can’t be blamed for it but can’t we draw the line at some point? Are we just to say yes to everything and not voice out our opinions?
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June 27, 2012 at 2:14 am ET - House of Light
Sleep enough not just good for health but good to productivity.
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June 29, 2012 at 2:48 pm ET - Ademar
I am a labor inspector in Brazil and I find that sleeping is really a security issue. I have read that the hours of work of truck drivers are inspected by the DOT in the US, and not OSHA. I would like to know your opinion about that since the hours of work to which drivers are submitted to are closely related to work pressures and the way the remuneration is done (by productivity), factors that are work related. Sorry for my English. I hope I made myself understood.
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July 7, 2012 at 2:53 pm ET - Victoria Altan
Eating the right foods before you go to sleep can really help you get a better night’s rest. With better rest comes more energy during the work day.
Fish, bananas, a few more are all great to eat.
Those helped me and my husband with our sleep productivity!
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AUTHOR COMMENT July 9, 2012 at 6:00 pm ET - Claire Caruso and Roger Rosa
The NIH document “Your Guide to Healthy Sleep” http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf has several tips to improve sleep including suggestions about food and sleep. These are:
”Avoid caffeine and nicotine. Coffee, colas, certain teas, and chocolate contain the stimulant caffeine, and its effects can take as long as 8 hours to wear off fully. Therefore, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night.
Avoid alcoholic drinks before bed. Having a “nightcap” or alcoholic beverage before sleep may help you relax, but heavy use robs you of deep sleep and REM sleep, keeping you in the lighter stages of sleep. Heavy alcohol ingestion also may contribute to impairment in breathing at night. You also tend to wake up in the middle of the night when the effects of the alcohol have worn off.
Avoid large meals and beverages late at night. A light snack is okay, but a large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause frequent awakenings to urinate.”
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July 28, 2012 at 10:02 pm ET - Peter Bosworth
I find the material on risks to workers from long hours and shift work confusing. Do you mean rotating shift work? Shift work itself just means someone works a generally set eight hour period. What study/studies indicate an increased risk of cancer to workers as mentioned in the last point? Workers who don’t get enought sleep? Workers on rotating shifts? I am particularly concerned about third shift workers who I assume generally don’t get the same length and quality of sleep compared to those workers on the more prevalent first shift. Can someone direct me to studies which focus on the health impact faced by third shift workers?
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August 2, 2012 at 2:00 pm ET - SELLÉS-PICORELLI
As discussed in the article, the shift workers are more at risk of suffering from disorders of digestion and appetite, and increased use of sedatives or stimulants to stay awake., Which could affect performance, increase likelihood of errors and accidents at work, to improve all the negative consequences that this type of workers, there are research studies that claim that limiting work shifts to 12 hours maximum, ensuring that they can rest for two full nights of sleep night until the next turn, could help these people in their daily lives, diminishing the many social, work and family that will cause your shift.
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August 8, 2012 at 11:49 am ET - Bill
I worked M – F, 3 – 11 charge of a small ICU unit for 10 plus years and after being off for a surgical procedure when I came back to work my manager gave me an either or proposition by taking away my position and giving me a schedule of 3 – 11′s and 7p -7a shifts. I tried to explain to the staffing secretary that in a 15 day stretch I only actualy had 1 day off (response: “Get use to it – thats your schedule”) and that my manager indicated: “if I wanted to work my full time hours I will have to adapt”. Primarily they have fouced me into 12 hour shifts 7p -7a and dropping down in hours in order to be able to “try to adapt”. Not having a history of migrains and now developing them is primarily an adapting situation that “I” will have to get use to and when I get home my significant other comes out to the car at times to wake me so I can come inside and go to sleep. My manager is pushing for the 12 hour shifts for “continuity” and cutting down on over time but in the process those who do work the night shift (7p -7a) are getting repromanded for increased sick time hours. I could go on but that is just the beginging… I am going to bring this issue to Human Resoures but fear that I am going to be suffering repercussions for my actions in doing so.
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August 16, 2012 at 6:25 am ET - Travler
Healthy sleep is important for maintaining overall good condition of the body, so it is a very important topic. Thank you!
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September 10, 2012 at 2:44 am ET - Dave G
After working a rotating 12 hour shift for several years I find your body will never adjust. My shift starts with 4 12 hours days shift then 48 hours off, 3 12 hour night shifts then 72 hours off, 3 12 hour day shifts then 48 hours off, and 4 12 hour night shifts. Then we get 6 off days. I can adjust my body clock after the 3rd night shift but then have to start over from scratch. We have talked to our employer about changing to just working 7 nights, having off 7, working 7 days, and so on. This would cut the switching back and forth in half. For me anyway the switching is harder then the working!
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November 24, 2012 at 7:05 pm ET - John Repique, RN
Below is a link to an advocacy video (YouTube) on the complex issues of nurse fatigue, long work hours, and shift work depicted in an animation featuring fictional characters “Super Girl and Sleepy Nurse Sue.”
Created by: John Repique, RN, doctor of nursing practice student, Duke University School of Nursing.
[http://www.youtube.com/watch?v=RMXAuBarCFE&feature=plcp]
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December 8, 2012 at 7:22 am ET - rts
See NYT article: Bus Driver Found Not Guilty of Manslaughter in I-95 Crash “A bus driver accused of being so tired that he caused one of the deadliest crashes in New York City’s history was found not guilty of manslaughter and negligent homicide on Friday, underscoring the difficulty of prosecuting drowsy driving…”
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