Today, in most industrialized countries, both the manufacturing and service sectors have come to rely on shift work or extended hours of working to increase production, provide continuous service or to optimize the return on investment. A considerable or higher percentage of the working population works outside normal work hours and work at least one night shifts per month (Amelsvoort, Jansen, Suaen, Brandt & Kant, 2004).

Do you work for long hours? How are you coping?

Shift work is generally defined as the working hours outside of normal work hours and extended period of work more than 8 hours a day (Monk & Folkard, 1992). The establishment of a norm for the length 0f the working day has historically been a major source of conflict between employers and employees. However, today an accepted general norm is eight hours a day or forty-hour a week shift.

Shift work: a serious concern?

“Shift work, although allowing continuous operation may negatively impact upon the worker and organization” (Stirton & Khela, 1997). Extended continuous shift work and night shift work has been associated with considerable negative impacts on physical and mental health and well-being of the worker. Also, the social and family life has been found to be affected by the shift work (Maertz Jr., & Boyar, 2011). So, the extending hours of work or shift work may lead to a decrease in work output both in terms of volume and quality. According to Verron, (1940); Monk & Folkard, (1985) and Knauh, (1993), as cited in Monk et al., (1992), this drop-in work efficiency and work volume directly affect the organization or employer and the drop in quality directly affect the general population or consumers.

Although the popularity of shift work and other alternative work schedules are growing all around the world, the concern is increasing over the negative impacts created in the lives of the workers and their families. Daily cyclic changes in physiological variables or biological rhythms termed “Circadian rhythms” are interactive and require a high degree of phase relationship to produce subjective feelings of well-being (LaDou, 1982). Any disturbances in these daily biological rhythms either due to extended periods of work or shift work schedules can lead to serious health effects as well as psycho-social imbalances.

The Biological Clock 

Most studies on the consequences of shift works, particularly night shift work primarily concerns with the disturbance of the employee’s circadian rhythm. The body functions that increase by the day and decrease by night include body temperature, heart rate, blood pressure, mental abilities, adrenaline production and physical capacity (Pulat, 1992).

The three important circadian rhythms are the sleep-wake cycle, temperature, and digestion (Stirton et al., 1997). The long extended shifts can affect all these physiological rhythms. Particularly, the shifts which include night work causing serious health problems like gastrointestinal disorders, migraine, aggravation of diabetes, epilepsy, sleep disorders, etc. The adaptation and tolerability to these physiological changes highly dependent upon the individual. “Work and sleep times are predictable, and there is the ability for the worker to make a commitment to a nocturnal way of life, and workers can arrange their life around a nocturnal working schedule” (Monk, 1996, p. 22).

Day sleep vs night sleep…

However, The quality of sleep may be affected regardless of individual ability, regular practice, and adaptations. Day sleep is not as effective as night sleep; there are a number of interruptions for quality sleep in day time such as light, noise by children, household works, TV, music or traffic, family issues, social norms, and biological or physiological factors. This lack of quality sleep results in the long extended hours of sleep during weekends or no shift days which are necessary for full recovery (Lille,1967, as cited in Grandjean, 1988).

But when the employer again goes back to the work, the circadian rhythm is again disturbed and will be difficult to gain nocturnal orientation leading to adverse effects on work performance and health. So, some individuals may adapt to the changes in biological rhythm but most individuals find it difficult to adapt and will experience detrimental health effects over the long term from shift works especially night shifts.

 

Shift work and health

Sleep disturbance and altered eating patterns are the two primary risk factors of shift work (LaDou, 1982).

Sleep disturbance

Both the quantity and quality of sleep is disturbed when sleep time is shifted from night to day time. Daytime is not conducive to sleep either in terms of circadian rhythm or environmental conditions (Drake, Roehrs, Richardson, Walsh & Roth, 2004). Many studies have suggested that night shift and early morning shift workers sleep comparatively fewer hours (4-5 hours a day) than the daytime workers. This impairment in both quantity and quality of sleep develops the symptoms of insomnia or excessive sleepiness, digestive disorders like ulcers and reduced mental alertness and concentrations.

Drake et al. (2004), results suggest that the prevalence of insomnia is 32% and 26% in the night and rotating shift workers respectively. This is the primary cause of the increase in work-related accidents, sick absenteeism, depression, workplace disputes as well as family and social disputes. These effects not only the workers but also impairs the work and performance and hence affecting the employer and organization. So the shift workers should be questioned regularly about their health state, particularly the sleep hours and should be transformed to another shift if having severe problems with the current shift.

 Disturbance of eating patterns

Shift works can markedly disturb eating patterns and eating habits. This results in loss of appetite, unhealthy diet, nutritional deficiency disorders, and gastrointestinal disorders. These disturbances are primarily caused due to the change in normal eating times, difficult to have hot, nutritious meals, limited time to prepare and eat food during extended periods of works and particularly during rotating shift and night shift works (LaDou, 1982). In many cases, although the calorie intake is adequate, the loss of appetite and eating disorders are associated with the dislike of eating outside the home and the inability to have food with family or friends. All these factors lead to indigestion, constipation and stomach ulcers.

Psycho-social aspects

Shift work may result in a disturbance in the social relationships of the worker with family, friends, and society. Psychosocial problems sometimes may be difficult than physiological problems. Shift workers frequently complain about their family disputes because of lack of adequate and quality time to the family members especially when there are smaller age group children (Maertz et al., 2011). As other family members live in different sleep/work schedule, it is difficult to have quality time together.

The shift workers may be isolated and depressed due to the lack of enough social interactions. They are unable to build relationships with family and friends, and affiliations such as clubs, societies, and church. For example, even if the night shift workers wanted to participate in the social activities, they would often have to do it at the cost of their nocturnal orientation which would lead to difficulty and problems with the circadian readjustment.

In many cases, split in the family and isolation from the society is common. When the individual could not manage the time between his family and social responsibilities and shift work schedule causes a higher degree of psychological and social stress. These psychosocial stressors significantly disturb in the work and performance and also can cause serious health disorders due to the use of excess medications and drugs, and psychological stress. Psychosocial stress has also been found related to the incidence of an increase in cardiovascular disorders and musculoskeletal abnormalities in the shift workers.

 

Health consequences

Continuous extended periods of work, regular rotating, and early morning or night shifts may severely impair both physical and mental health. One of the common and immediate effects of the extended shift works is muscle fatigue (both peripheral or central nervous system-oriented). With the extended shift work requiring a similar position for the long periods can lead to musculoskeletal problems such as joint diseases, back pain, and muscle cramps.

There is a short, easily remembered slogan regarding shift work and health: ‘Shift work is probably bad for the heart, almost certainly bad for the head and definitely bad for the gut’ (Monk et al., 1992, p=32). Shift work and continuous work situation can simply enhance the various risk factors of heart diseases such as smoking and drinking, lack of exercise, high lipid diets, psycho-social, and work stress. So, diseases like hypertension, coronary heart diseases, heart attack are increasing in the shift workers.

Shift work can increase in neurotic symptoms and psychiatric illness leading to a decrease in well-being and subjective health (Meers, Massen &Verhargen, 1978). Due to sleep disturbance, disturbance in circadian rhythm and continuous psycho-social, family and work stress, shift workers are always prone to suffer from headaches, migraine, and other neurological disorders like depression, aggression, dementia, etc. As discussed above, due to the disturbed eating patterns and unhealthy diet, almost every shift workers will complain of gut trouble at some stage or other.

Performance and safety consequences

Our psycho-physiological readiness for work is at a maximum in the morning and in the second half of the afternoon, whereas it is poor immediately after the midday break and declines even more at night (Bjerner, Holm & Swensson, 1955, as cited in Grandjean, 1988). Work performance and efficiency are largely dependent on the type of shift work schedule and the duration of each shift (Costa, 1996). Similarly, safety issues are significantly compromised when one has to attend a task in the middle of the night and continues until morning with insufficient sleep and physical & mental work stress.

Muscular fatigue, as well as mental fatigue, can greatly reduce the work performance and increase the possibility of accidents and injuries during the work. Similarly, reduced mental alertness can highly influence work performance and work safety. For example mistakes due to mental tiredness in some of the sensitive duties like in defense services, quality control can lead to a major accident and unlikely results. Road traffic accidents are growing due to the negative impact of shift work on the quality of sleep or inadequate sleep hours.

So, extended periods of shift work can cause more physical fatigue whereas since the night shift significantly disturbs the circadian rhythm, it causes more mental, physiological and psychosocial problems. To minimize all these ill-effects of shift work to both the employee and employer, different studies have suggested various coping strategies.

Coping strategies for the worker

From the above discussion, we have found that shift works created multifaceted problems and thus requires multifaceted solutions. There is no single and quick-fix solution to minimize or prevent the negative impacts of shift works (Monk et al, 1992). Any strategies to cope with shift work should include the strategies to improve sleep, the circadian system, the social and domestic situation.

Sleep strategies

The most important strategy to improve sleep is to try to get enough of it (Verhaegen, Maasen & Meers, 1982). The shift workers should manage to get enough time to sleep during the working days rather than to sleep for extended periods only in the off days which disturbs the circadian rhythm. Another important component of coping behavior is to maintain the regularity of sleep patterns. Sleep clinicians have developed the patterns, behaviors, and preparations of quality sleep as ‘sleep hygiene’. This includes set of rules such as teeth cleaning, warm water bath and nightwear rituals, use of bed only for sleeping and lovemaking and regularity of sleeping habits (Hauri, 1983, as cited in Monk et al., 1992).

Circadian strategies

The shift workers should maintain their time of sleep and wakefulness according to the nature of their work shift. The regularity of sleeping, eating and other activities’ patterns is the most important component of improving and maintaining circadian rhythm.

Social and domestic strategies

Shift work affects everyone in the family. So, solutions and strategies must come from the whole family to help each other. There is a need for self-discipline, communication, support and sacrifice among the family members to help maintain the circadian rhythm and to ensure enough rest for the shift worker. The family members should not make a loud noise when a shift worker is sleeping. Use earphones or headphones while listening to music and watch television in low volume. All the family members may need to adjust and sometimes sacrifice their scheduled programs to find enough time with family together.

Strategies for the employers 

To maintain the well-being of the workers, the employer or the organization must consider some factors. These factors can enhance the workers’ performance and safety and hence improve overall organization development.

Shift work schedule

The shift workers should get enough time for full rest before they start the next shift. Adequate rest helps to avoid both physical and mental tiredness and hence injuries. According to the set of recommendations for shift work schedule provided by Knauth (1993), the night shift should be reduced as much as possible; extended period of work should be implemented according to the nature and suitability for extended working hours; avoidance of early starts as it results in the reduction of quantity of sleep, increases fatigue; quick changeovers should be avoided; and forward rotational shift with single night shift followed by a day off. So, the shift work needs to schedule in such a way that there is the minimization of loss of sleep and fatigue and maximization of quality time for family, friends, and socialization.

Bright lights at the workplace

Organizations should install bright lights in the workstation to keep shift workers awake and active, particularly during night shifts. According to a study by Czeisler and colleagues (1990), as cited in Monk et al., (1992), illumination of workstation up to the daylight level(7000-12000 Lux) has shown significant improvement in the alertness and performance of the night shift workers.

Clinical support

Shift workers are prone to different illness and fatigue because they are not aware of the coping strategies. They do not know about prevention and time management strategies. So, the company should have shift work clinics. This clinic should include physicians, chronobiologists, sleep clinicians, occupational and physical therapists and family therapists who can help the workers coping poorly (Monk et al., 1992).

Canteen and recreational sources

The shift workers, particularly those who work for more than 10 hours, either do not take their food in time or eat more of frozen and packed foods as they don’t get enough time for cooking. This markedly affects their digestive system and nutritional requirements. So, the organization should provide the well managed hygienic canteen to support the balanced diet for the workers. Similarly, the shift workers should be provided with the various recreational sources during the break time to keep them active and alert throughout the shift.

Conclusion

In conclusion, the shift work has severe negative impacts in physical, mental, physiological health and psycho-social aspects of the workers. Particularly, the night shift can significantly disturb the circadian rhythm leading to various health disorders. These effects can lead to detrimental effects on the work and performance and the work safety of the workers. To reduce or prevent the negative impacts of these consequences of shift work, both the employee and employer should approach the multifaceted coping strategies.

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