The risks of shift and extended

work hours
Laurence Hartley

Murdoch University
This talk
First half presents the hazards of
shiftwork

Second half presents the hazards of
extended work hours

What is shift work?
Shift work: the alternation of teams of
workers, usually performing the same tasks,
so work can continue for longer than one work
period

Some or all, work will occur outside of daytime
hours

Work hours can be fixed or rotate (change)
and rotation can be fast or slow

Whats the problem for
shiftworkers?
The rhythms of alertness & sleepiness
The daily circadian rhythms
Rhythms driven by clock in brain
Alertness is max during the day
Sleepiness increases during the night
Maximum sleepiness in pre-dawn
Clock is mainly set by day light
So clock time cannot be easily changed
So workers do not adapt much to
shiftwork

The 4 Hazards of Shiftwork
1. Increased risk of errors & accidents
when working or driving at night

2 Insufficient daytime sleep leads
to increased fatigue & sleepiness

3. Increase in health problems

4. Increase in social and domestic
problems
1. Daytime sleep is
insufficient for night
shiftworkers
Circadian rhythms (daily rhythms) in
body clock keeps body awake and alert
during the day; daytime not suitable for
sleep!

Circadian rhythm of alertness means
night workers are most sleepy at work
and driving home


Other disturbances during the day eg.
noise, light, heat

Body rhythms and external
disturbances combine so that day
sleep is shorter (1-2hrs) and of poorer
quality than night sleep

Early shift start times cut down night
sleep

Insufficient sleep (<7-8hrs) or poor quality sleep
leads to sleepiness & fatigue, and decreased
alertness & performance

A sleep debt of ~ 2 h per night shift
accumulates; 3 night shifts = 1 lost sleep.

2-3 nights needed to recover from debt.

Workers may not realise how sleepy they are at
work (masking) till driving home
Insufficient sleep increases the likelihood
of microsleeps and nodding off
occurring

People are unaware of microsleeps

Loss of awareness and control of
surroundings . an accident can
happen!

2. More errors and
accidents at night
Folkard (2003) Mean relative
risk across 3 shifts
SHIFT
Night (22-06) Af t ernoon (14-22) Morning (06-14)
M
e
a
n

R
R
1. 4
1. 3
1. 2
1. 1
1. 0
. 9
Folkard (2003) Mean relative risk
over 4 successive night shifts
Successive Night Shifts
4 3 2 1
M
e
a
n

R
R
1. 5
1. 4
1. 3
1. 2
1. 1
1. 0
. 9
Folkard (2003) Relative risk of
different blocks of successive
night shifts
No of Successive Nights
7 6 5 4 3 2 1
M
e
a
n

R
R
1. 5
1. 4
1. 3
1. 2
1. 1
1. 0
. 9
Three times risk of a crash with less 6 h sleep

Night workers are more likely to fall asleep at the
wheel, and to have a crash or near-miss than day
workers

Night workers are at 6 times the risk of a car
crash than day workers, especially at dawn
Fatigue and shift work is a major workplace road
safety issue
Long hours awake without sleep can
impair performance to a similar/greater
level than acceptable BAC for driving

17hrs awake leads to performance similar to
BAC 0.05%

20-25hrs awake leads to performance similar
to BAC 0.1%



3. More health problems
on the night shift
Gastrointestinal complaints
- 20-75% night shift workers
- 10-20% day & evening workers

Cardiovascular Disease
- a 40% increased risk for developing
cardiovascular disease for shift
workers

4. Social and Domestic
Problems for the night
shift
Shift workers can have less suitable
time off and less quality time off

Shift workers often curtail their sleep
time to be with family and friends;
this means they can be awake for a
long period of time, and they do not
get enough sleep

Folkard (2003) Relative risk
over hours on duty
Hours on Shift
12 11 10 9 8 7 6 5 4 3 2 1
M
e
a
n

R
R
2. 5
2. 0
1. 5
1. 0
. 5
0. 0
Folkard (2003) Estimated relative
risk on different lengths of shift
Length of Shift (hours)
12 11 10 9 8 7 6 5 4 3 2 1
M
e
a
n

R
R
1. 3
1. 2
1. 1
1. 0
. 9
. 8
. 7
. 6
. 5
. 4
Folkard (2003) Estimated relative
risk on different spans of 8, 12 h
No of Successive Nights
7 6 5 4 3 2 1
M
e
a
n

R
R
1. 8
1. 6
1. 4
1. 2
1. 0
. 8
8-hour
12-hour
Hours of work-relative transport
crash risk. Folkard, (1997)
Hours of work -U.S. F.M.C.S.A.
Shift work hazard control
strategies
Three Essential Shift Work
Hazard Control Measures

1. Adequate, good quality sleep

2. Suitable shift work schedules

3. Appropriate work conditions
1. Adequate, good quality
sleep

Maintain pre-sleep routines similar to night
sleep

Bedroom dark and quiet

Avoid caffeine for 5 hrs before sleep

Avoid alcohol before sleep

Avoid exercise before sleep
Naps can help maintain alertness,
performance, and safety

Naps can supplement insufficient sleep,
but

BEST if taken after 7-8hrs main sleep and
before feeling fatigued:
Nap at home before night shift
Nap early in the night shift
Nap before driving home after night shift
2. Suitable shift work
schedules
No one best shift work system

Employers should consider their
worker population and work tasks,
and decide, in collaboration with
workers, on the most suitable
schedule for their work place

Then evaluate the schedule


Rapid rotations are preferred to slow rotations

No more than 2 consecutive night shifts

Forward (clockwise) rotation of shifts

8hr shift length; 12hrs maximum

5-7 consecutive work days maximum
Fewer if shifts >8hrs or night shifts




recommendations
2 days off minimum after a block of shifts
More if shifts >8hrs or night shifts

11hrs off minimum between
consecutive shifts

Keep schedules regular and predictable, but
allow flexibility

3. Appropriate work
conditions

Regular rest breaks reduce accidents

Incorporate movement, stretching or
light exercise, social interaction

A proper meal break away from work
duties
Employers should tailor work tasks
according to shift time; some tasks are
not suitable for night shift

Work tasks should vary during the shift

Schedule tasks so monotonous, boring,
dangerous, and safety critical tasks are
done early in the night shift

Bright lighting, comfortable temperature,
and good ventilation

Background music may help temporarily

Appropriate facilities for healthy eating

Napping facilities

Summary
Shift work is an OH&S hazard
employers and employees have a
duty of care to control or minimise
the hazards

Mutual responsibility is essential


Employers duty of care to provide an
appropriate work schedule and work
environment, and continuing education
and training for workers about coping
strategies

Employees duty of care to follow the
recommended strategies to manage their
sleep, health, and family life