Re­set­ting your body clock

Many shift work­ers ex­pe­ri­ence health dif­fi­cul­ties due to their ir­reg­u­lar hours. Aileen Lee looks at how they can bet­ter man­age eat­ing, sleep­ing and wak­ing pat­terns

Irish Examiner - Feelgood - - Feature -

“Med­i­cal stud­ies have in­di­cated shift work­ers are at a higher risk for cer­tain can­cers

“WORK­ING nine to five, what a way to make a livin” – Dolly Par­ton sang it, and the ma­jor­ity live it, but if we were faced with the choice of shift work (in­clud­ing the grave­yard shift), we’d hap­pily stick to the stan­dard work­ing week.

Ac­cord­ing to the Health and Safety Au­thor­ity of Ire­land, shift work can con­trib­ute to the fol­low­ing: car­dio­vas­cu­lar disor­ders, gas­troin­testi­nal disor­ders, sleep loss/fa­tigue, in­creased ac­ci­dents, and stress.

In Ire­land, ap­prox­i­mately 15% of the work­ing pop­u­la­tion are shift work­ers. The HSA lists the sec­tors most com­monly re­liant on this type of work as: the emer­gency ser­vices, se­cu­rity ser­vices, util­ity ser­vices, pro­duc­tion, leisure and en­ter­tain­ment ac­tiv­i­ties, delivery ser­vices, and 24/7 re­tail ser­vices.

These shift work­ers, who pro­vide key ser­vices and gen­er­ally make our lives a lot eas­ier, are faced with work re­al­i­ties that can un­der­mine their health. Their jobs re­quire them to work against their bod­ies’ nat­u­ral clock, known as cir­ca­dian rhythms, which reg­u­late your body’s temperature, me­tab­o­lism, di­ges­tion, blood pres­sure, se­cre­tion of adrenalin, sleep­ing and wak­ing.

One man who can at­test to the ill-ef­fects of shift work is David Cryan, who re­cently com­pleted Op­er­a­tion Trans­for­ma­tion. Over the eightweek pe­riod of the show, he lost the most weight of the group, an im­pres­sive three stone and 4.5 pounds.

“Shift work is hard on the body. I’m 18 years a Garda. You never get used to it be­cause you go from an early shift to a late shift to a night shift. It def­i­nitely would have helped me put on weight and would have made me tired. I would have found it hard to be more ac­tive and I would have been tied down be­cause of the shift work,” he says.

Med­i­cal stud­ies have wor­ry­ingly in­di­cated that shift work­ers are at a higher risk for cer­tain can­cers. A meta-anal­y­sis of 61 stud­ies con­ducted in Europe, North Amer­ica, Asia and Aus­tralia, which spanned 3.9m fe­male par­tic­i­pants, was pub­lished in Jan­uary this year in Can­cer Epi­demi­ol­ogy, Biomark­ers & Preven­tion. The review found that women in long-term night shift work had an in­creased risk of skin (41%), breast (32%), and gas­troin­testi­nal can­cer (18%) com­pared with women who were not. Re­searchers also found that the risk of breast can­cer in­creased by 3.3% for ev­ery five years of night shift work.

Dis­rup­tion to shift work­ers’ sleep is such that it can re­sult in shift work dis­or­der, where work­ers fail to get a good quan­tity of sleep dur­ing the day, and as a re­sult, can­not re­main awake and alert at night when their work de­mands it.

Motty Vargh­ese, se­nior sleep phys­i­ol­o­gist at St James’s Hospi­tal, Dublin, says: “Shift work dis­or­der is very com­mon, be­cause of the huge work­force do­ing shift work. It is a prob­lem, but more than just ad­dress­ing it, I think we should ad­dress the is­sue of sleep op­ti­mi­sa­tion in peo­ple who are work­ing shifts. What’s im­por­tant for them is to limit or con­trol light ex­po­sure when they fin­ish their shift work”.

He of­fers some help­ful tips on how shift work­ers can man­age this: “One of the things that is ad­vised is to wear dark sun­glasses if it is bright out­side on the way home — but you need to be re­ally care­ful not to fall asleep while you are driv­ing. When you get home, it is im­por­tant that you don’t ex­pose your­self to bright lights, like your LED read­ing light, smart­phones, iPads or lap­tops — any of those things should be cut off two hours be­fore you go to bed”.

Shift work­ers also need to man­age their wak­ing up time. Vargh­ese rec­om­mends ex­po­sure to bright light when you wake up, to help stop mela­tonin pro­duc­tion — the hor­mone that in­duces sleep — and limit tired­ness as the day goes on. In lieu of bright nat­u­ral sun­light, bright light ther­apy glasses or bright light boxes will also work.

Cryan’s sleep has also improved since par­tic­i­pat­ing in Op­er­a­tion Trans­for­ma­tion. He cred­its this with learn­ing to switch off more, much like what Vargh­ese rec­om­mends: “It was Dr Eddie [Mur­phy] who helped me more in that sense, be­cause I was prob­a­bly bring­ing work home with me and think­ing about dif­fer­ent things. What I am learn­ing to do now is switch off the phone and give your­self that hour or two break be­fore bed. Of course, the shift work

help but when you come home, re­lax and turn the phone off, it’s amaz­ing how well the body re­laxes com­pletely”.

In terms of Ir­ish re­search, the 2016 safe­food Ire­land re­port, Manag­ing Food on

Shift Work, looked at the three largest em­ploy­ment sec­tors on the is­land of Ire­land re­liant on shift work: ac­com­mo­da­tion and food ser­vices, health and so­cial care, and man­u­fac­tur­ing. It was a ro­bust study, which in­cluded fo­cus groups as well as a tele­phone sur­vey of 1,300 shift work­ers, look­ing at par­tic­i­pants’ work pat­terns, eat­ing be­hav­iours, spe­cific life­style be­hav­iours and work­place en­vi­ron­ments.

Most par­tic­i­pants across the three sec­tors re­ported skip­ping meals on work days. It was noted that 66% were also not get­ting the rec­om­mended seven to nine hours sleep per 24 hours. Other ex­ter­nal fac­tors noted were er­ratic break times and is­sues with fin­ish­ing on time at the end of a shift — these were com­mon fea­tures of both the health and so­cial care and ac­com­mo­da­tion and food sec­tors. Vend­ing ma­chines were re­ported to have the largest im­pact on work­ers’ di­ets.

On those find­ings, Dr Cliodhna Fo­ley-Nolan, di­rec­tor of hu­man health and nu­tri­tion at safe­food, says: “There needs to be ad­e­quate fa­cil­i­ties and time to use them, such as a can­teen or a self-ser­vice kitchen with a mi­crowave and fridge. Vend­ing ma­chines are just not enough for an eight to 12-hour shift. Fa­cil­i­ties and ac­cess to them is one thing, but get­ting a breather is an­other. Short staffing of­ten re­sults in staff sim­ply not hav­ing the time to take a break to eat”.

The HSA’s guid­ance for em­ploy­ers and em­ploy­ees on night and shift work of­fers a com­pre­hen­sive over­view of how to iden­tify the haz­ards as­so­ci­ated with shift work. It high­lights some of the likely risk fac­tors to con­sider and how to avoid or min­imise them, for ex­am­ple, the po­ten­tial for fa­tigue or dif­fi­cul­ties for em­ploy­ees in adapt­ing to shift pat­terns. It in­cludes the rec­om­men­da­tion that where rea­son­ably prac­ti­ca­ble em­ploy­ers should pro­vide the same ac­cess for shift work­ers to meal and wel­fare fa­cil­i­ties, first aid oc­cu­pa­tion, health ser­vices and train­ing and de­vel­op­ment as they do to day­time work­ers.

It also sign­posts the obli­ga­tions that em­ploy­ers would have un­der the law.

Ibec says that it recog­nises the oc­cu­pa­tional health and safety chal­lenges as­so­ci­ated with night and shift work, and rec­om­mends the guid­ance pro­vided by the HSA. In ad­di­tion, it says that its Oc­cu­pa­tional Health and Safety ad­vi­sory team of­fers a be­spoke ser­vice to its mem­ber com­pa­nies to help ad­dress spe­doesn’t

cific queries that may arise.

Cryan cred­its his par­tic­i­pa­tion in Op­er­a­tion Trans­for­ma­tion with help­ing him to turn around some bad habits, es­pe­cially in re­la­tion to meal plan­ning: “Aoife [Hearne] gave me a great plan. The whole idea on Op­er­a­tion Trans­for­ma­tion is that you eat three meals and two snacks ev­ery 24-hour pe­riod, so when you’re work­ing nights, you change the or­der around, which I would never have thought of, so say you’re in the mid­dle of nights, and you’re get­ting up at 3pm, you have a lit­tle snack to get your body go­ing. You have your big din­ner then be­fore you start. You have your lunch at 1am, and then the big thing I would never have done, you have your break­fast at 5.30am be­fore you go home. You’re not starv­ing your body”.

Fail to pre­pare and pre­pare to fail — David would cer­tainly agree with the say­ing, as food prepa­ra­tion has been key to his weight loss.

“The big­gest thing I have learned is plan­ning and prepa­ra­tion, es­pe­cially as I am never guar­an­teed a break when I go to work. If you have the food with you, you will eat it. If you don’t have it with you, at 2am you’re not go­ing to be able to buy food that’s healthy”.

Dr Neil Stan­ley, an in­de­pen­dent sleep ex­pert who has been in­volved in sleep re­search for over 30 years, says that greater ef­forts need to be made to make shift work more work­er­friendly. He also ques­tions the ne­ces­sity of the 24/7 prac­tices we have brought into some ser­vice in­dus­tries: “We have an ex­pec­ta­tion that some peo­ple should be work­ing shifts and those peo­ple should be given ev­ery ben­e­fit and ev­ery ad­van­tage to make their shift as ben­e­fi­cial as pos­si­ble, but I do not be­lieve the abil­ity to go to a su­per­mar­ket at 2am is am­ple ne­ces­sity for hav­ing that per­son work a shift”.

David Cryan: Op­er­a­tion Trans­for­ma­tion has taught him the im­por­tance of switch­ing off the phone and hav­ing a break for an hour or two af­ter night work.

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