8/25/2017 The risks of night work

SCIENCE WATCH

The risks of night work

Millions of American workers fight against their circadian clocks
every day, putting them and others in their paths in danger.
Psychologists are looking for solutions.
By Michael Price
Monitor Staff
January 2011, Vol 42, No. 1
Print version: page 38

Nearly 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts,
according to the Bureau of Labor Statistics. That means a signicant sector of the nations work force
is exposed to the hazards of working nights, which include restlessness, sleepiness on the job,
fatigue, decreased attention and disruption of the bodys metabolic process.

Those eects extend beyond the workers themselves, as many of us share the road with night-driving
truckers, count on the precision of emergency-room workers and rely on the protection of police and
national security personnel at all hours.

Now, psychologists are gaining a better understanding of how exactly night and shift work aect
cognitive performance and which interventions and policies could keep shift workers and the public
safer.

"The basic take-home is that fatigue decreases safety," says Bryan Vila, PhD, a sleep expert and
criminal justice researcher at Washington State UniversitySpokane. Learning healthy sleeping
practices is "just as important as occupational training," he says.

Natural rhythms
Poor scheduling, combined with unhealthy attitudes about the need for sleep, can cause major
problems for night workers. Thats because working at night runs counter to the bodys natural
circadian rhythm, says Charmane Eastman, PhD, a physiological psychologist at Rush University in
Chicago. The circadian clock is essentially a timer that lets various glands know when to release
hormones and also controls mood, alertness, body temperature and other aspects of the bodys daily
cycle.
Our bodies and brains evolved to relax and cool down after dark and to spring back into action come
morning. People who work the night shift must combat their bodies natural rest period while trying to

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remain alert and high functioning. It doesnt matter whether they get enough sleep during the
daytime, she says. All the sleep in the world wont make up for circadian misalignment.

Thats especially dangerous for people whose jobs require them to be on high alert and make split-
second, life-or-death decisions during the night, such as medical personnel or police ocers. Its
common for police departments, for example, to require rookies and lower-ranking ocers to bear
the brunt of night shifts. Theyll often work a few days during normal daytime hours, then either work
an extra-long shift that carries on until the morning, or take a day o, rest, then work a full night shift.
But that seesaw scheduling approach is a doubly bad idea, says John Violanti, PhD, an organizational
psychologist who was a New York state trooper for 23 years. Not only are these highly stressful,
performance-draining shifts being foisted upon the least experienced ocers, but the young ocers
arent given time to adjust their sleep schedules for night work. Also, many ocers seek night shifts to
get overtime pay, he says. According to Vilas research, roughly 40 percent of the nations 861,000
police ocers work more than 12 hours a day and a similar proportion suer from a sleep disorder
such as insomnia or excessive sleepiness.
Working against a persons natural sleep cycle causes such sleep disorders, as well as fatigue.
Fatigue, in turn, worsens moods, decreases cognitive abilities and reexes, and makes people more
vulnerable to disease, says Vila. That resulting crankiness and warped perspective can interfere with
ones ability to make sound decisions and manage people eectively, and can increase the
frequency of negative encounters.
Thats not a recipe for good decisions, says Vila, especially when ocers must make decisions about
whether to use deadly force often in ambiguous, fast-paced, high-risk situations. Neither is it safe
for more routine activities, such as driving. "When youre drowsy, local parts of the brain shut down for
milliseconds or seconds at a time, then come back online," he says.
Night work and fatigue may also contribute to the risk of heart disease and cancer, according to
research by Violanti, Vila and colleagues (Policing, Vol. 30, No. 2). Working with 98 Bualo, N.Y., police
ocers, the researchers looked for metabolic syndrome a combination of symptoms that contribute
to poor heart health and diabetes, including large waist circumference, elevated triglyceride levels,
high cholesterol, high blood pressure and high levels of glucose when not eating. They found that the
ocers who most frequently worked the 8 p.m.-to-4 a.m. shift had the highest prevalence of
metabolic syndrome symptoms. Those who commonly worked that shift and also averaged fewer
than six hours of sleep were four times more likely than other ocers to have metabolic syndrome.
Vila and Violanti hope their ndings will spur changes in shift scheduling, both for the publics safety
and the ocers.
Of course, police ocers arent the only night-shift workers suering from circadian misalignment. A
number of studies have found that fatigue due to prolonged work hours or being called into work in
the middle of the night can result in lapses in judgment and impaired motor skills among medical
workers. For instance, a 2008 article in the American Journal of Surgery (Vol. 195, No. 2) reports that,
when performing "surgery" on a virtual patient, well-rested surgeons were signicantly smoother in
their hand motions and made fewer errors than did their sleep-deprived counterparts.
Fatigue is also risky for the physicians themselves, other research has found. A 2005 report
published in the New England Journal of Medicine (Vol. 352, No. 2) found that medical interns whose
shifts lasted longer than 24 hours were more than twice as likely to have a car crash and ve times as
likely to have a driving near-miss after leaving work as interns who worked shorter shifts.
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In fact, any worker who must drive while tired whether its on the job or driving home after a night
shift is at risk. In 2004, the National Institute for Occupational Safety and Health reported that car
crashes are the top cause of occupational fatalities, accounting for 22 percent of work-related deaths
between 1992 and 2001. In 7 percent of those cases, drowsiness or falling asleep while driving was
cited as a primary factor in the crash. But other factors such as driver inattention, speeding and
running o the road can also be inuenced by fatigue, the institute found.
Another report from 2004 found that workers across a variety of occupations who worked 12-hour
night shifts were more likely than their day-shift-working colleagues to experience physical fatigue,
smoke and abuse alcohol.

Possible solutions
Of course, many workers cant give up the night shift entirely. So the question is, how can night shift
workers adapt to their schedules?
There are two ways, says Rush Universitys Eastman. One is through symptomatic relief by using such
stimulants as coee and caeine pills to stay awake during the night, then taking sedatives to sleep in
the morning. The other way is to shift the bodys circadian clock so that it better tolerates working at
night and sleeping during the day.
Eastman and her team are exploring the latter approach. "The circadian clock is very stubborn and
hard to push around," she says.
Previous research has established that you can delay the circadian clock by about one or two hours
per day. To determine that, researchers measure the bodys circadian rhythm by monitoring "dim-light
melatonin onset," or the time at which the pineal gland begins to secrete melatonin, which is triggered
by the circadian clock. Normally, it kicks in a couple hours before people are ready to sleep. "Its an
output thats a way of seeing what the circadian clock is doing," Eastman says. "Its a very good
marker of the phase of the time of the clock."
By exposing experimental subjects to intermittent bright light during their night shifts and having them
wear sunglasses on their way home and sleeping in very dark bedrooms, Eastman and her team have
found that within about a week, they can shift someones circadian rhythm to align perfectly with
working a night shift and sleeping during the day.
But thats unrealistic for most people, she says. "The problem is that adapting completely
physiologically would leave you a nocturnal person, unable to sleep until very late on days o and
being out of phase with regular day-working people."
So Eastman and her team have developed a compromise system in which people who work
permanent night shifts say, 11 p.m. to 7 a.m. adapt their circadian rhythms just enough to function
well at night, but still be lively during their days o. It works like this: On his or her day o, the worker
goes to sleep as late as possible (in Eastmans experiment, participants went to bed at 3 a.m. and
woke up at noon). On a workday, he or she would be exposed to intermittent bright light, wear
sunglasses on the way home from the night shift, then go to sleep as early as possible. "So the
dierence between sleep on their night shift days and their days o would likely be less than what
most shift workers have now," Eastman says.

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Last year, she tested the cognitive skills of workers who tried this compromise approach and
compared those who fully adapted to a night-shift schedule to those who only partially adapted. Both
groups performed about the same, and both scored almost as well as they did when they rst took
the tests when on a normal daytime schedule (Sleep, Vol. 32, No. 11). "You dont have to be fully
adapted to the night shift to get the benets of shifting your circadian clock," Eastman says.
However, Eastman points out she doesnt yet have a solution for workers who have a combination of
night and day shifts because its impossible to keep shifting their circadian rhythms to keep up with an
ever-changing work schedule. She says it falls on employers to assign shift work in blocks, giving
workers enough time to adapt.
"You cant phase shift the circadian clock with a rapidly rotating shift schedule because the clock cant
move that fast," she says. "The only thing you can do is symptomatic relief, meaning youll have very
sleepy people working at night, which is dangerous."

For more information on improving the health of workers, go to APAs Psychologically Healthy
Workplace Program site (http://www.phwa.org) .

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