Ian Macdonald

Work shift duration: a review comparing eight hour and 12 hour shift systems.

OBJECTIVES: Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative effects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. METHODS: Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. RESULTS: The research findings are largely equivocal. The bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. CONCLUSIONS: There can be considerable extension of the persons time awake either side of the shift. However, the effects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed.

A process model of shiftwork and health

The authors developed and tested a process model of adaptation to shiftwork, which hypothesizes that various individual and situational variables influence the development of sleep and social and domestic disturbances. Both types of disturbances trigger various types of coping behavior, leading to several proximal outcomes. The end result is the development of chronic health problems in the form of digestive and cardiovascular symptoms. The model was tested with survey data collected from 2 samples of nurses (N = 1,532) in the United Kingdom and was cross-validated against a 3rd sample of industrial workers (N = 370). Results indicate support for the model across the 3 samples, although some sample-specific and subgroup effects were found. Results have direct implications for the development of shiftwork theory and interventions.

Beyond the Three-Process Model of Alertness: Estimating Phase, Time on Shift, and Successive Night Effects

This paper starts by summarizing the development and refinement of the additive three-process model of alertness first published by Folkard and Åkerstedt in 1987. It reviews some of the successes that have been achieved by the model in not only predicting variations in subjective alertness on abnormal sleep-wake schedules but also in accounting for objective measures of sleep latency and duration. Nevertheless, predictions derived from the model concerning alertness on different shifts, and over successive night shifts, are difficult to reconcile with published data on accident risk. In light of this, we have examined two large sets of alertness ratings with a view to further refining the model and identifying additional factors that may influence alertness at any given point in time. Our results indicate that, at least for the range of sleep durations and wake-up times commonly found on rotating shift systems, we may assume the phase of the endogenous circadian component of alertness (process C) to be “set” by the time of waking. Such an assumption considerably enhanced the predictive power of the model and yielded remarkably similar phase estimates to those obtained by maximizing the post-hoc fit of the model. We then examined the manner in which obtained ratings differed from predicted values over a complete 8-day cycle of two, 12-h shift systems. This revealed a pronounced “first night compensation effect” that resulted in shift workers rating themselves as progressively more alert than would be predicted over the course of the first night shift. However, this appeared to be achieved only at the cost of lowered ratings on the second night shift. Finally, we were able to identify a “time on shift” effect whereby, with the exception of the first night shift, alertness ratings decreased over the course of each shift before showing a modest “end effect.” We conclude that the identification of these additional components offers the possibility that in the future we may be able to predict trends in accident risk on abnormal sleep-wake schedules.

The impact of early and late shift changeovers on sleep, health, and well-being in 8- and 12-hour shift systems.

The effects on industrial shift workers of the timing of the changeover from the night to morning shift and of the length of the shift were examined. Two groups changed over at 6 a.m. and worked either 8-hr or 12-hr shift systems; the other 2 groups changed over at 7 a.m., working either 8- or 12-hr systems. Night sleeps between consecutive shifts that started at 6 a.m. were shorter and more disrupted than those starting at 7 a.m. Day sleeps following night shifts that finished at 6 a.m. were longer and less disrupted than those finishing at 7 a.m. Early starts were associated with poorer psychological and physical health. These effects of changeover time are considered in relation to the circadian rhythms in sleep duration and propensity. Although several measures favored 12-hr shifts, physical health indicators appeared to favor 8-hr systems, especially in combination with late changeovers. However, the observed effects of shift length on chronic outcome measures are somewhat inconsistent with previous research findings.

Effects of direction of rotation in continuous and discontinuous 8 hour shift systems

OBJECTIVES Previous research has produced conflicting evidence on the relative merits of advancing and delaying shift systems. The current study assessed the effects of the direction of shift rotation within 8 hour systems, upon a range of measures including sleep, on shift alertness, physical health, and psychological wellbeing. METHODS An abridged version of the standard shiftwork index which included retrospective alertness ratings was completed by four groups of industrial shiftworkers on relatively rapidly rotating 8 hour systems (n=611). Two groups worked continuous systems that were either advancing or delaying; the other two groups worked discontinuous systems that were either advancing or delaying. RESULTS Few effects were found of direction of rotation on chronic measures of health and wellbeing, even when the systems incorporated “quick returns” (a break of only 8 hours when changing from one shift to another). This was despite the use of measures previously shown to be sensitive to the effects of a broad range of features of shift systems. However, advancing continuous systems seemed to be associated with marginally steeper declines in alertness across the shift (F (3,1080)=2.87, p<0.05). They were also associated with shorter sleeps between morning shifts (F (1,404)=4.01, p<0.05), but longer sleeps between afternoons (F (1,424)=4.16, p<0.05). CONCLUSIONS The absence of negative effects of advancing shifts upon the chronic outcome measures accorded with previous evidence that advancing shifts may not be as harmful as early research indicated. However, this interpretation is tempered by the possibility that difficult shift systems self select those workers most able to cope with their deleterious effects. The presence of quick returns in advancing continuous systems seemed to impact upon some of the acute measures such as duration of sleep, although the associated effects on alertness seemed to be marginal.

A COMPARISON OF SOME DIFFERENT METHODS FOR PURIFYING CORE TEMPERATURE DATA FROM HUMANS

Nine healthy females were studied about the time of the spring equinox while living in student accommodations and aware of the passage of solar time. After 7 control days, during which a conventional lifestyle was lived under a 24h “constant routine,” the subjects lived 17 × 27h “days” (9h sleep in the dark and 18h wake using domestic lighting, if required). Throughout the experiment, recordings of wrist activity and rectal (core) temperature were taken. The raw temperature data were assessed for phase and amplitude by cosinor analysis and another method, “crossover times,” which does not assume that the data set is sinusoidal. Two different purification methods were used in attempts to remove the masking effects of sleep and activity from the core temperature record and so to measure more closely the endogenous component of this rhythm; these two methods were “purification by categories” and “purification by intercepts.” The former method assumes that the endogenous component is a sinusoid, and that the masking effects can be estimated by putting activity into a number of bands or categories. The latter method assumes that a temperature that would correspond to complete inactivity can be estimated from measured temperatures by linear regression of these on activity and extrapolation to a temperature at zero activity. Three indices were calculated to assess the extent to which exogenous effects had been removed from the temperature data by these purification methods. These indices were the daily variation of phase about its median value; the ratio of this variation to the daily deviation of phase about midactivity; and the relationship between amplitude and the square of the deviation of phase from midactivity. In all cases, the index would decrease in size as the contribution of the exogenous component to a data set fell. The purification by categories approach was successful in proportion to the number of activity categories that was used, and as few as four categories produced a data set with significantly less masking than raw data. The method purification by intercepts was less successful unless the raw data had been “corrected” to reflect the direct effects of sleep that were independent of activity (a method to achieve this being produced). Use of this purification method with the corrected data then gave results that showed least exogenous influences. Both this method and the purification by categories method with 16 categories of activity gave evidence that the exogenous component no longer made a significant contribution to the purified data set. The results were not significantly influenced by assessing amplitude and phase of the circadian rhythm from crossover times rather than cosinor analysis. The relative merits of the different methods, as well as of other published methods, are compared briefly; it is concluded that several purification methods, of differing degrees of sophistication and ease of application to raw data, are of value in field studies and other circumstances in which constant routines are not possible or are ethically undesirable. It is also concluded that such methods are often somewhat limited insofar as they are based on pragmatic or biological, rather than mathematical, considerations, and so it is desirable to attempt to develop models based equally on mathematics and biology. (Chronobiology International, 17(4), 539–566, 2000)

Distribution of rest days in 12 hour shift systems: impacts on health, wellbeing, and on shift alertness.

OBJECTIVES: To investigate of the effects of distribution of rest days in 12 hour shift systems. Although several studies have examined the effects of compressing work schedules by comparing 8 and 12 hour shift systems, there is little published research examining the various forms of 12 hour shift system. METHODS: An abridged version of the standard shiftwork index which included retrospective alertness ratings was completed by a large sample of industrial shiftworkers. The respondents worked 12 hour shift systems that either did or did not incorporate breaks of > 24 hours between the blocks of day and night shifts. For the purposes of the analysis, each of these two groups were further subdivided into those who started their morning shift at 0600 and those who started at 0700. RESULTS: Systems which incorporated rest days between the day and night shifts were associated with slightly higher levels of on shift alertness, slightly lower levels of chronic fatigue, along with longer sleep durations when working night shifts and between rest days. Early changeovers were associated with shorter night sleeps between successive day shifts, but longer and less disturbed day sleeps between night shifts. These effects of changeover time were broadly in agreement with previous research findings. CONCLUSIONS: The distribution of rest days in 12 hour shift systems had only limited effects on the outcome measures, although the few modest differences that were found favoured systems which incorporated rest days between the day and night shifts. It is conceded that the design of the study may have obscured some subtle differences between the shift systems. Nevertheless, it is concluded that the impact of distribution of rest days seems to be minor relative to previously found effects of other features of shift systems--for example, shift duration.

Industrial shift systems

This technical report describes the identification of shift systems worked by industrial shiftworkers in England, Scotland and Wales. A diverse range of shift systems were reported to be in operation across 27 industrial sectors. Companies employed up to 14 different shift systems at a particular site. The numbers of shiftworkers on a given shift schedule ranged from 1 to 2977. Most systems employed fewer than 100 people. The majority of rotas were regular, rotating systems. The most common shift durations were 8 or 12 h. Compared to earlier surveys of shiftwork prevalence in certain industries there appeared to be a substantial increase over the past 3 decades in the proportion of the workforce who work shifts. Information about the average numbers of hours worked per week on major system types is given. In addition, data for the range of shifts per cycle, the distribution of shifts and distributions of their start and end times are presented.

A preliminary investigation into individual differences in the circadian variation of meal tolerance : Effects on mood and hunger

A forced desynchrony methodology was used to assess postprandial blood glucose in 9 female volunteers during a 3-h period following a mixed meal presented at four times of day (08:00, 14:00, 20:00, 02:00). The influence of time of day on the postmeal glucose responses was evaluated by calculating the area under the curve, largest increase, time taken to reach peak, and fasting level. Circadian variations in meal tolerance were found for the area under the curve and largest increase, responses were greater (indicating poorer meal tolerance) in the evening than the morning. Fasting blood glucose exhibited diurnal variation although in the opposite direction to meal tolerance; levels were higher in the morning than the evening. Time taken to reach peak levels was not modulated by circadian rhythmicity. Estimates of the timing of poorest meal tolerance and the magnitude of this intolerance were computed for each subject. Individual differences in the magnitude of meal intolerance were found to influence hunger and self-reported calmness. Subjects with good tolerance had rhythms in both calmness and hunger, which were not found in those with poor tolerance. Subjects with good tolerance also tended to rate themselves as feeling more calm. These mood and hunger effects may result from differences in insulin resistance, which is hypothesized to underlie the circadian variations in meal tolerance.

Time of day effects in, and the relationship between, sleep quality and movement

The study aimed to measure the effects of a 27‐h ‘day’ sleep‐wake regime on actigraphic and subjective sleep variables, and to examine the relationships between these variables. Nine subjects spent 30 days and nights in the laboratory. After sleeping 8 h for each of 8 nights, the subjects had an imposed 27‐h ‘day’, for 18 ‘days’, remaining in bed for 9 h on each sleep period. Sleep periods therefore started 3 h later each day, although subjects’ circadian rhythms stayed entrained to 24 h, because subjects were not isolated from the natural light‐dark cycle. Time asleep, subjective sleep efficiency and subjective sleep quality, but not movement during sleep, were found to be significantly affected by time of going to bed. There were significant decreases in movement during recovery sleeps following each of two episodes of 26 h sleep deprivation. Over the study there were significant within‐subject correlations between subjective sleep quality and subjective sleep efficiency (rav=0.65), movement during sleep and subjective sleep efficiency (rav=−0.48), and movement during sleep and subjective sleep quality (rav=–0.26). We conclude that sleep movement, despite its low within‐and between‐subjects variability, is nevertheless a statistically reliable, but weak, indicator of subjective sleep efficiency and quality.