Working Nights

A Primer of Sleep Disorders for Shift Workers

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) won’t be published by the American Psychiatric Association APA) for a few years (May 2013).  However, developing the roadmap of psychiatric diagnoses is a huge initiative as feedback is being sought from over 600 global experts.  The DSM provides the standard classification of mental disorders used by mental health and other health professionals for diagnostic and research purposes.  In addition, insurance companies use the DSM diagnoses to determine which psychiatric conditions will be covered by health insurance.

Over the years since the last DSM was published (1994), new research has been published on many psychiatric conditions.  New research leads to new opinions on the identification and treatment of disorders. Sleep disorders, many of which often plague shift workers, have received a significant amount of attention in recent years and as a result, the current draft of the DSM-5 includes information that shift workers and their employers should be aware of.  The recommendations for revisions to the DSM are posted on the APA’s web site for the manual – www.DSM5.org.  Public review and written comments are welcome. Comments will be reviewed and considered by the DSM-5 Work Groups.

 The sleep disorder work group is recommending greater inclusion of sleep disorders. This is being proposed primarily as a way to educate non-expert sleep clinicians (such as psychiatrists and general medical physicians) about sleep disorders that have mental as well as medical/neurological aspects.

Among the changes being recommended the significant ones impacting shift workers include:

1.  Adding obstructive sleep apnea hypopnea syndrome to the DSM-5 – this disorder was previously contained under the sleep disordered breathing category.  Obstructive sleep apnea is associated with snoring, obesity, increased waist girth, and male gender. Central sleep apnea is most strongly associated with advanced age, heart failure, and diabetes.  Cardiac problems associated with obstructive and central apnea are different.  

• Obstructive sleep apnea is associated with ventricular ectopy which is often experienced as a strong or skipped heart beat resulting from abnormal electrical activation originating in the ventricles (heart’s lower chambers) before a normal heartbeat would occur.  Studies have indicated that sleep apnea promotes ventricular ectopy. 
•  Central sleep apnea is more strongly associated with atrial fibrillation. During atrial fibrillation, the heart’s two upper chambers (the atria) quiver instead of beating effectively. Blood isn’t pumped completely out of the chambers, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.

People with coronary artery disease whose blood oxygen is lowered by sleep disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death. CPAP treatment may reduce this risk. Sleep disordered breathing, including apnea, may cause coronary artery disease and hypertension.

2.  Adding primary central sleep apnea to the DSM-5.  See 1. above. Point is to separate obstructive and central sleep apnea as the risk factors and outcomes for each are different. 

3.  Adding restless leg syndrome to the DSM-5.  According to the DSM web site the rationale is that “RLS is a sufficiently common syndrome to merit elevation to an independent category. In national and international studies the prevalence of RLS appears to be between 7-10% of the population, depending upon age and gender.”

4.  Including circadian rhythm, delayed sleep phase, advanced sleep phase, irregular sleep wake rhythm and free-running sleep disorders in the DSM-5 as separate subtypes.  The rationale for this proposed change is based on new data indicating not only the differences in clinical characteristics, but also the underlying pathophysiology and in some cases, genetic basis for the different types of circadian rhythm sleep disorders.

To read more about other primary sleep disorders, follow the links below: 

Primary Sleep Disorders 307.42 Primary Insomnia 307.44 Primary Hypersomnia   347.00 Narcolepsy   327.3x Circadiam Rhythm Sleep Disorder   307.47 Nightmare Disorder  

©2010 Circadian Age, Inc. ‘Working Nights’

It’s Important to Talk with your Doctor about Working Shift Work

If you’ve read much of the material on this blog, you know that working shift work contributes to many challenging, but manageable, health and lifestyle issues.  One way to make sure you manage your own unique circumstances is by talking with your health practitioner about the fact you work shifts and raising any concerns you have about shift work.  A recent study by the University of Illinois at Chicago and the VA Center for Management of Complex Chronic Care found that physicians tend to follow a fairly standard approach to care for most health conditions.  Physicians do not generally take into account  a particular patient’s situation or life context, so the fact that a patient works shift work is not likely to enter the doctor’s radar screen.  But, it’s critical for shift workers to have doctors who understand the unique challenges of working shift work.

Some of the special issues shift workers can face include:

1.  Sleep disturbances from work schedules distrupting sleep schedules.

2. Lower levels of Vitamin D resulting from lack of exposure to sunlight.

3. Overweight due to lack of nutritional food when working nights.

4. Higher rates of divorce due to lifestyle challenges of working shifts.

5. Increased risk for depression arising from lower levels of seratonin.

Read other posts throughout this blog for more areas of risk when working shifts. 

Next time you go to your health practitioner, bring a list of your concerns and be vocal about them with your provider.  Make sure your doctor or nurse practitioner knows you work shift work.  The University of Illinois at Chicago and the VA Center for Management of Complex Chronic Care study found that doctors were more likely to respond to biomedical facts – e.g. test results - than to contextual red flags - such as I work  shift work and I’m concerned about my increased risk for cardiac problems even though I don’t have any family members with heart health issues.  Both biomedical facts and contextual red flags are equally important to planning appropriate care, according to the study researchers.  By planning care with your provider you can prevent shift work challenges from impacting your health and lifestyle.

©2010 Circadian Age, Inc. ‘Working Nights’

Desperate for Sleep? Scientists say – Try Tart Cherry Juice

Researchers from University of Pennsylvania, University of Rochester and VA Center of Canandaigua report that adults who drank eight ounces of tart cherry juice in the morning and at night reported significant reductions in the severity of insomnia.   

The researchers suspect tart cherries’ benefits could be due to their relatively high content of melatonin, which helps moderate the body’s sleep-wake cycle.  Melatonin, produced naturally by the human body, plays a role in inducing sleepiness at night and wakefulness during the day (shift workers often produce less melatonin – read more).  Russel J. Reiter, Ph.D, a biomedical scientist at the University of Texas Health Science Center and one of the world’s leading authorities on melatonin, quoted in E Science News says, “When consumed regularly, tart cherries may help regulate the body’s natural sleep cycle and increase sleep efficiency, including decreasing the time it takes to fall asleep,” says Reiter. “And, because cherries are so rich in other antioxidants, such as anthocyanins, you get other important health benefits.”

We’ve previously written on the benefits of eating and drinking red, and this is another example of how red toned food and drinks can improve shift workers’ health. 

Looking for tart cherry juice?  Try R.W. Knudson, Old Orchard, or Cheribundi (this was the brand used in the study).

Extra Sleep Improves Performance, Alertness and Mood

According to a new study being presented tomorrow at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC, getting extra sleep over an extended period of time improves athletic performance, alertness and mood.  In this small study, football player participants extended their sleep for seven to eight weeks during the season, obtaining as much sleep as possible and aiming for a minimum of ten hours of sleep each night.  By substantially increasing their length of sleep, the players decreased daytime sleepiness and fatigue and felt increased vigor towards the end of their season.  For more details click here.  This study supports other research indicating that sleep improves the performance, alertness and mood of shift workers.

Employee Health and Shift Work Lifestyle Training Leads to a Happier and Healthier Workforce….and to Increased Company Profits!

Is employee morale low at your company? Employee morale is higher when companies provide shift work lifestyle training.  Nearly 60% of employees at companies providing shift work lifestyle training rank their morale as good or excellent compared 35% without shift work training.[i] 

Some shift workers are at a greater risk for cardiovascular disease.  Want to save upwards of $6,500 for each of these at-risk employees per year?  And, protect your employees from this number one killer!

Workers in shift work operations generate, on average, more health care costs than other workers.  How about reducing overall company health care costs by 17% to 37% by targeting this population and helping them improve their health?[ii] Other cost savings may also be possible, including safety incident and workers’ compensation costs. Worker productivity may increase, possibly even up by 39%.[iii]

In extended 24-hour operations, a well-designed shift schedule or roster is unlikely to provide adequate protection from worker fatigue.  An integrated risk management system incorporates data analysis and training towards an effort of reducing fatigue and reducing a company’s costs, risks, and liabilities.[iv]

Among the shift worker population, 71% of men and 53% of women are overweight, 54% of workers have smoked or currently smoke, only 27.5% workers report having good nutritional practices, and 77% report not exercising regularly.  Add to this the sleep deprivation statistics, 27% of shift workers report making mistakes of inattention several times per month, and it’s clear that both shift workers and their employers would benefit from worker health and lifestyle training.[v]  In addition, a fatigue management program would help target the reasons shift workers aren’t always as attentive and productive as day-time workers and help companies and employees develop some initiatives to reduce employee fatigue levels. 

Each of the examples above show the overwhelming benefits to a company and its employees when an employee health and shift work lifestyle training program tailored to the company’s needs is implemented……..It’s all in the details, so read on for more information about targeting a program for your operation….. Read this article…

What’s Green and Beige and Eaten All Over?

Pistachios! 

Researchers report that up to 95% of people do not get enough potassium.  Failing to meet the standard recommended daily intake levels can lead muscular cramps, twitching, and weakness, poor reflexes, fatigue, kidney failure, lung failure, and cardiac arrest. Also, too little potassium can result in insomnia, cognitive processing delays, and depression.  Getting enough potassium is important for shift workers who are already susceptible to sleep disorders, such as insomnia and restless leg syndrome, as well as fatigue.  When working shift work, it’s important to pay attention to eating nutritiously, which isn’t always easy to do.  Planning meals ahead is often the only way to guarantee a balanced diet when working nights, in particular.

Read this article…

Next Time Don’t Complain, Tell a Joke Instead!

Almost all serial killers are men. That’s ’cause women like to kill one man slowly over many, many years.  (Robert Duchaine)

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Men who consistently leave the toilet seat up secretly want women to get up to go the bathroom in the middle of the night and fall in.  (Rita Rudner)

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I found out why cats drink out of the toilet. My mother told me it’s because it’s cold in there. And I’m like: How did my mother know THAT?  (Wendy Liebman) 

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Laughing puts us in a positive mood.  The physiological reaction to humor results in lower stress hormone levels, increased immune activity, and lower cholesterol and blood pressure.  Repetitive laughing has similar effects on the body as moderate exercise, according to a study from Loma Linda University’s Schools of Allied Health and Medicine.

Read this article…

New Study Makes it Clear; We Need More than Six Hours of Sleep

Shift workers are known to get less sleep than people working regular days.  It’s been studied, written, and talked about for years.  Some people brag about how little sleep they can survive on.  Others complain about their lack of sleep and how tired they feel all the time.  A new study is going to make all of us take a much closer look at our sleeping habits.  It will show us why we need to do all we can to get in the recommended 6 – 8 hours per 24 hour period (we actually recommend 7 – 8).

Researcher from the University of Warwick and the Federico II University Medical School in Naples, Italy, have concluded that people who sleep for less than six hours each night were 12% more likely to die prematurely than those who get the recommended 6-8 hours.  This research offers indisputable evidence of the need for adequate sleep. The researchers also found that long sleepers, those who sleep 9 hours or more regularly, are likely to have other underlying health conditions.

The study included more than 1.3 million participants, followed up for up to 25 years, with more than 100,000 deaths recorded.  The study was published in the May 3^rd issue of the journal, Sleep.

For information about working shift work and sleep click on the links below.  Each one will give you or your employees, if you’re a manager, ideas about how to get more sleep while working shift work.

Insomnia and Shift Work

Men and Sleep

Women and Sleep

Restorative Sleep Improves Memory and Creativity

©2010 Circadian Age, Inc. ‘Working Nights’

Seeking a Real Quick Route to Better Health? Eat More Red!

Shift workers are at greater risk for cardiovascular disease and diabetes as they themselves report getting less exercise and being prone to eating more unhealthy foods, especially when working nights.  As a result, they are often overweight, contributing to heart disease and diabetes.   But, small steps can make a big difference.  The results from three new studies, all promoting the benefits of eating red foods [and drinks], have been released in the past few weeks.  Read this article…

How Do You React to Stress?

Work can be hugely stressful. In fact, twenty-five percent of Americans say that their job is their greatest contributor to the angst in their lives.  And, clearly there are other stresses too.  Pressure, anxiety, and tension can result in headaches, sleep disturbances, difficulty concentrating, short tempers, upset stomachs, low morale, and general life dissatisfaction.  Shift workers can experience extra stress as a result of working variable hours, getting less sleep, having little access to family members and friends, leading to increased isolation and lack of support.

Stress can be reduced though, and here are some ideas to help. Read this article…

Insomniacs with Nighttime Awakenings Have a Huge Impact on Health Care Costs and Workforce Management

Did you know that 30-40% of adults report some symptoms of insomnia within any given year?  But that’s nothing…..according to the National Sleep Foundation, over 60% of people who work shifts report that they suffer from insomnia.  And, 30% of shift workers claim that they’re excessively tired all the time.  People who work shifts are twice as likely to fall asleep at the wheel as those working during the day-time.  Read this article…

Restorative Sleep Improves Memory and Creativity

Johah Lehrer has written  a terrific summary pointing to what we gain and what we lose when we don’t get enough sleep.  Watching his wife sleep comfortably and soundly, while he lies awake with insomnia, Lehrer reviews the literature, touching on how the brain replays our own experiences over and over again, sketching them deeply into the neural networks of our brains.  This cements our long term memories.  Lehrer also points out that REM sleep helps make us more creative and lets us integrate new information into our problem solving. 

To read the entire article, click here.  

Jonah Lehrer is a contributing editor at Wired Magazine. He’s the author of “How We Decide” and “Proust Was A Neuroscientist” and blogs at The Frontal Cortex.

Feeling Grouchy and Touchy? Read This!

We learn from a very young age that when we don’t get enough sleep, we get cranky.  Since shift workers only get 5-6 hours of sleep on average, many feel grouchy, irritable, and touchy a lot of the time.  Bad-tempers can be difficult to hold inside, and when fury is released onto spouses, partners, kids, work associates, and managers, it can become toxic.  What’s the result?  Blowing your top can cause you to be fired and it can result in divorce.  Being argumentative and disagreeable doesn’t usually get a positive response.  Lack of sleep starts a progression down a slippery slope often ending with frustration and rage.  Remember those terrible-two’s temper tantrums?  Now we’re talking adult sized anger! 

Melinda Beck, Editor of the Wall Street Journal Health Journal interviewed psychologist Pauline Wallin, author of “Taming Your Inner Brat.”  In the interview, Dr. Wallin provides a few concrete ideas about how to manage anger.  She suggests that when you feel angry, you should slow down and talk sense to yourself.  Don’t react quickly to what’s going on around you, take time and think about it.  One good suggestion by Dr. Wallin is to imagine that you wake up in the morning with $1 worth of energy for the day.  Then, as the day progresses and issues come up, if you feel yourself getting frustrated and angry, think about whether you want to give 80 cents of your energy to that situation or just 5 cents.  Most likely you’ll decide not to waste your energy on negative, small issues.

To listen to the interview, Demand for Anger -Management Grows. But Does It Work – WSJ.com.

2010 Sleep in America Poll Released!

The National Sleep Foundation (NSF) has just released the 1st poll to examine sleep among four ethnic groups in the United States: Asians, Blacks/African Americans, Hispanics and Whites-the 2010 Sleep in America Poll. Although significant differences in the sleep habits and attitudes of each group are revealed, there are also a number of interesting similarities. The poll found that more than three fourths of respondents from each ethnic group agree that poor sleep is associated with health problems. It also showed that each group reports similar experiences missing work or family functions because of fatigue. This is of extreme significance to shift workers who routinely average less sleep than day workers.

The NSF is committed to understanding people’s sleep needs and giving them the tools necessary to get the optimum amount of rest. Read more about the poll and its findings at the NSF’s website…

New Study Supports Claims that Oatmeal is Good for Shift Workers!

Numerous studies have indicated that sleep is essential for normal immune system functioning and to maintain the bodies’ ability to fight off disease and sickness. Most shift workers exist in sleep deprived states as a result of only getting 5-6 hours of sleep per 24-hour period.  So, as a result, it’s likely that shift workers’ immune systems are compromised, contributing to more cases of the common cold and flu, but also to chronic health issues many shift workers face – for example, diabetes and heart disease.

At Working Nights, we’re always looking for new solutions to improve shift worker health and wellbeing.  Here’s a new idea…..

Read this article…