Jessica L. Paterson

Sleep, stress and compensatory behaviors in Australian nurses and midwives

OBJECTIVE To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts). RESULTS Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days; experienced sleep disruption on more than 50% of work days; struggled to remain awake on 27% of work days; and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study). Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.OBJETIVO: Descrever sono, estresse e comportamentos compensatorios em enfermeiras e parteiras. METODOS: O estudo incluiu 41 enfermeiras 21 parteiras em hospitais australianos de 2005 a 2009. A participacao foi voluntaria. Os participantes registraram diariamente as horas de trabalho, sono, stress e niveis de exaustao, cafeina e uso de ajuda para dormir durante um mes (1.736 dias, 1.002 turnos). RESULTADOS: Os participantes relataram de moderados a elevados niveis de stress e de exaustao em 20%-40% dos dias de trabalho; experimentaram disturbios do sono em mais de 50% dos dias de trabalho; relataram esforco para permanecer acordado em 27% dos dias de trabalho; e sofreram sonolencia extrema ou acidente perto de casa em 9% dos dias de trabalho. Idade, duracao do sono percebida e jornadas foram preditores significativos da ingestao de cafeina. Aproximadamente 60% dos participantes relataram utilizar a ajuda para dormir: cerca de 20% relataram uso de medicacao prescrita e 44% das enfermeiras e 9% das parteiras consumiam alcool como auxilio para dormir pelo menos uma vez durante o estudo. Estresse e dias de trabalho foram preditores significativos do uso de sedativos. Em geral, 22% relataram ser indiferente, ou ligeiramente insatisfeito com seu trabalho. CONCLUSOES: Problemas no sono, estresse e exaustao elevados e diminuicao na satisfacao no trabalho sao prevalentes. Sao comuns o uso de alcool e de medicamentos para dormir, e consumo de cafeina para se manter alerta. Enfermeiras e parteiras parecem usar a cafeina para compensar a reducao do sono, especialmente em dias de trabalho, e usar soniferos para compensar o estresse diario.

Sleep and obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a chronic mental illness that can have a debilitating effect on daily functioning. A body of research reveals altered sleep behaviour in OCD sufferers; however, findings are inconsistent and there is no consensus on the nature of this relationship. Understanding sleep disturbance in OCD is of critical importance given the known negative consequences of disturbed sleep for mood and emotional wellbeing. A systematic literature search was conducted of five databases for studies assessing sleep in adults diagnosed with OCD. Fourteen studies met inclusion criteria and qualitative data analysis methods were used to identify common themes. There was some evidence of reduced total sleep time and sleep efficiency in OCD patients. Many of the sleep disturbances noted were characteristic of depression. However, some OCD sufferers displayed delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder (DSPD). Severe OCD symptoms were consistently associated with greater sleep disturbance. While the sleep of OCD patients has not been a major focus to date, the existing literature suggests that addressing sleep disturbance in OCD patients may ensure a holistic approach to treatment, enhance treatment efficacy, mitigate relapse and protect against the onset of co-morbid psychiatric illnesses.

Changes in structural aspects of mood during 39—66 h of sleep loss using matched controls

A number of studies have described mood change during sleep loss in the laboratory, however, an understanding of fluctuations in structural aspects of mood under such conditions is lacking. Sixty-two healthy young adults completed one of three possible conditions: one (n = 20) or two (n = 23) nights of sleep loss or the control condition which consisted of one (n = 9) or two (n = 10) nights of 9 h time in bed. The Mood Scale II was completed every two waking hours and data were analysed in terms of the frequency and intensity of mood reports. Overall, sleep loss conditions were associated with significantly less frequent happiness and activation and more frequent fatigue reports (p < 0.001). Intensity was also significantly reduced for activation and happiness, and increased for depression, anger and fatigue (p < 0.05). Interestingly, there were no significant differences in anger following two nights in the laboratory with or without sleep. Further, two nights in the lab with normal sleep was associated with significant increases in depression intensity (p < 0.05). Findings support the hypothesis of a mood regulatory function of sleep and highlight the relative independence of frequency and intensity and of positive and negative mood dimensions. Findings also suggest that the laboratory environment, in the absence of sleep loss, may have a significant negative impact on mood.

Beyond working time: Factors affecting sleep behaviour in rail safety workers

There are many factors that may affect the sleep behaviour and subsequent fatigue risk of shift workers. In the Australian rail industry the emphasis is primarily on the impact of working time on sleep. The extent to which factors other than working time might affect the sleep behaviour of employees in the large and diverse Australian rail industry is largely unknown. The present study used sleep, work and fatigue diaries completed for two weeks, in conjunction with actigraphy, to understand the contribution of demographic and health factors to sleep behaviour in 40 rail safety workers. Both shift type and having dependents were significant predictors of sleep duration (P<.05). Sleep duration was greatest prior to night shifts, followed by afternoon shifts and morning shifts. Participants with dependents got significantly less sleep than participants without dependents. Both timing of sleep and smoking were significant predictors of sleep quality (P<.05). Day sleeps were associated with lower subjective sleep quality than night sleeps and smokers reported poorer sleep quality than non-smokers. These findings indicate that factors other than working time have the potential to influence both the sleep duration and subjective sleep quality of rail safety workers.

The shift work and health research agenda: Considering changes in gut microbiota as a pathway linking shift work, sleep loss and circadian misalignment, and metabolic disease

Prevalence and impact of metabolic disease is rising. In particular, overweight and obesity are at epidemic levels and are a leading health concern in the Western world. Shift work increases the risk of overweight and obesity, along with a number of additional metabolic diseases, including metabolic syndrome and type 2 diabetes (T2D). How shift work contributes to metabolic disease has not been fully elucidated. Short sleep duration is associated with metabolic disease and shift workers typically have shorter sleep durations. Short sleep durations have been shown to elicit a physiological stress response, and both physiological and psychological stress disrupt the healthy functioning of the intestinal gut microbiota. Recent findings have shown altered intestinal microbial communities and dysbiosis of the gut microbiota in circadian disrupted mice and jet lagged humans. We hypothesize that sleep and circadian disruption in humans alters the gut microbiota, contributing to an inflammatory state and metabolic disease associated with shift work. A research agenda for exploring the relationship between insufficient sleep, circadian misalignment and the gut microbiota is provided.

Managing fatigue: It really is about sleep

Biomathematical models of fatigue can assist organisations to estimate the fatigue consequences of a roster before operations commence. These estimates do not account for the diversity of sleep behaviours exhibited by employees. The purpose of this study was to develop sleep transfer functions describing the likely distributions of sleep around fatigue level estimates produced by a commercial biomathematical model of fatigue. Participants included 347 (18 females, 329 males) train drivers working commercial railway operations in Australia. They provided detailed information about their sleep behaviours using sleep diaries and wrist activity monitors. On average, drivers slept for 7.7 (±1.7)h in the 24h before work and 15.1 (±2.5)h in the 48h before work. The amount of sleep obtained by drivers before shifts differed only marginally across morning, afternoon and night shifts. Shifts were also classified into one of seven ranked categories using estimated fatigue level scores. Higher fatigue score categories were associated with significant reductions in the amount of sleep obtained before shifts, but there was substantial within-category variation. The study findings demonstrate that biomathematical models of fatigue have utility for designing round-the-clock rosters that provide sufficient sleep opportunities for the average employee. Robust variability in the amount of sleep obtained by drivers indicate that models are relatively poor tools for ensuring that all employees obtain sufficient sleep. These findings demonstrate the importance of developing approaches for managing the sleep behaviour of individual employees.

Poor Sleep Quality in Australian Adults With Comorbid Psychological Distress and Physical Illness

A population-based questionnaire study of 1,818 Australian adults investigated associations of sleep quality with psychological distress and comorbid physical health disorders. The Kessler Psychological Distress Scale and the Behavioral Risk Factor Surveillance System assessed psychological distress and physical health. The Pittsburgh Sleep Quality Index assessed sleep quality. Participants with physical illness or psychological distress had increased odds for reporting poor sleep quality, compared to those with no illness (odds ratios [ORs] = 2.22, for both; 95% confidence intervals [CIs] = 1.53–3.23 and 3.54–10.36, respectively), but those with comorbid illness had markedly higher odds for poor sleep quality (OR = 11.99, 95% CI = 7.90–18.20). Adults with comorbid psychological distress and physical health disorders are at substantially increased risk of poor sleep quality.

Actigraph Estimates of the Sleep of Australian Midwives: The Impact of Shift Work

Midwives often work night and rotating shift schedules, which can lead to sleep disturbances, increased fatigue, and greater likelihood of accidents or errors. This study investigated the sleep of midwives (n = 17) in an Australian metropolitan hospital. Midwives completed work and sleep logbooks and wore wrist actigraphs for 28 days. Midwives worked combinations of morning, afternoon, and/or night shifts on constant (n = 6) or rotating schedules (n = 11). They obtained less than recommended amounts of sleep, getting only 6–7 hr per 24-hr period. Morning shifts were associated with the lowest sleep durations, lowest subjective sleep quality, and highest postsleep fatigue ratings. Despite the significantly higher amount of wake after sleep onset (51 min), the sleep before afternoon shifts had significantly lower postsleep fatigue ratings and was rated as significantly higher quality than sleep before other shifts or days off. Those who were married or living with a partner reported significantly more sleep and lower postsleep fatigue than those who were separated or divorced (p < .05). Seventy-one percent of midwives took naps, primarily before night shifts, with nearly 40% of nightshifts preceded by a nap. Average nap durations were nearly 1.5 hr. Midwives reported feeling moderately to very physically or mentally exhausted on 22–50% of all shifts and days off. Exhaustion was most common on night shift. This study suggests that midwives may be suffering from chronic sleep loss and as a consequence may be at risk of impairments in functioning that accompany fatigue.

Fatigue and mental health in Australian rural and regional ambulance personnel.

Australian ambulance personnel experience stress, fatigue and exposure to traumatic events. These risks have been extensively researched in metropolitan paramedics. However, there has been limited research in rural and regional personnel. Rural and regional ambulance personnel make up a significant proportion of the Australian ambulance workforce and may be exposed to unique stressors. The aim of the current study was to investigate levels of fatigue, stress, and emotional trauma in rural and regional ambulance personnel.

On-call work: To sleep or not to sleep? It depends

ABSTRACT On-call working time arrangements are increasingly common, involve work only in the event of an unpredictable incident and exist primarily outside of standard hours. Like other non-standard working time arrangements, on-call work disrupts sleep and can therefore have negative effects on health, safety and performance. Unlike other non-standard working time arrangements, on-call work often allows sleep opportunities between calls. Any sleep obtained during on-call periods will be beneficial for waking performance. However, there is evidence that sleep while on call may be of substantially reduced restorative value because of the expectation of receiving the call and apprehension about missing the call. In turn, waking from sleep to respond to a call may be associated with temporary increases in performance impairment. This is dependent on characteristics of both the preceding sleep, the tasks required upon waking and the availability and utility of any countermeasures to support the transition from sleep to wake. In this paper, we critically evaluate the evidence both for and against sleeping during on-call periods and conclude that some sleep, even if it is of reduced quality and broken by repeated calls, is a good strategy. We also note, however, that organisations utilising on-call working time arrangements need to systematically manage the likelihood that on-call sleep can be associated with temporary performance impairments upon waking. Given that the majority of work in this area has been laboratory-based, there is a significant need for field-based investigations of the magnitude of sleep inertia, in addition to the utility of sleep inertia countermeasures. Field studies should include working with subject matter experts to identify the real-world impacts of changes in performance associated with sleeping, or not sleeping, whilst on call.