Sunday, 05 June 2011 10:30
By Dr Jerry Simon
When as a boy I would be up watching TV late into the night, my mom would say, “Day mek foo work and night mek foo sleep.”
Whether it was made through scientific discovery or pure common sense, this concept is of uttermost importance for millions of people worldwide who suffer from Shift Work Sleep Disorder (SWSD). Presently, it is one of the fastest growing medico-social problems in Antigua & Barbuda, but is not being significantly addressed by doctors, patients or labour authorities.
What is SWSD?
Each of us has what is called a circadian rhythm. This is an in-built, roughly 24-hour cycle of chemical, physiological, and behavioural processes in our bodies. This rhythm is especially important to our quantity and quality of sleep, and is influenced greatly by daylight.
During the day, the chemical and other changes that take place in our bodies gear us for work and physical activity, and the changes in the night gear us for rest and sleep. Hence the concept of day for work and night for sleep is a fundamental law of nature.
SWSD is a circadian rhythm disorder characterized by insomnia (inability to obtain quality sleep) and excessive sleepiness by people whose work hours are scheduled during typical sleep period. It is often seen in security workers, hotel workers, doctors and nurses, law enforcement officers, sex workers, “party animals” and even people who stay up all night watching TV or surfing the web. Of course, it is not limited to the above mentioned groups.
The symptoms presented by people with SWSD are quite variable because of the numerous patterns of shift work, but there are certain typical symptoms. The patients tend to be excessively sleepy at times and in situations when they typically should be awake. As a result, they very well could fall asleep on the job or at the wheel.
This excessive sleepiness is manifested as a desire to nap, unintended dozing and head nodding, impaired mental function, irritability, reduced performance (sexual and otherwise), and increased levels of accidents. As people who work nights also often work in the day (especially in the present economic climate), it is common for them to suffer from fatigue.
For SWSD sufferers, the inability to obtain quality sleep is another fundamental symptom. This insomnia stems from trying to sleep in the day with the natural daylight, noise, traffic, human, and other distractions and dealing with social obligations (for example, tending to one's children).
But worst of all are the long-term medical and social implications of SWSD.
There are many studies that have linked chronic medical problems to shift work. For example, in 2007 a study by the International Agency for Cancer Research concluded that there is an increased rate of cancer among shift workers. And numerous other studies have established a link between shift work and increased incidences of high blood pressure, heart disease, diabetes, stroke, eating and digestive disorders, menstrual irregularities, anxiety, depression, drug abuse and dependence, other mental illnesses, and death by accident.
Interestingly, in many of these studies the increased medical problems were found in shift workers even if they were not diagnosed with SWSD. Hence, it stands to reason that there is an inherent danger to one's health when the sleep-wake circadian rhythm is broken in a frequent manner.
The social impact of shift work and SWSD cannot be ignored. Whenever parents work at night, there are going to be issues of child supervision and a family's physical security. Also, imagine if children are at home during daytime hours (for example when they are on holidays). It may be a very difficult and tense home atmosphere if a parent needs to sleep and cannot get to.
Also, people who are constantly fatigued tend to get irritable, and may not be as friendly to be around. It can put undue strain on marriage and family life.
I cannot imagine it is ever an easy choice between being physically there to protect and bond with your family and adequately providing for their physical and financial necessities. I do not think it is a dilemma that many ask for. However, many face it due to their economic realities.
To tackle the problem of SWSD, one has to recognise it is a multi-factorial problem and treat it as such. The reality is, there are certain jobs which have to be carried out at night; so ways and means have to be found to protect the health and well-being of workers who perform these tasks.
In situations where shift work has to be done, schedules have to be made in a way so as to prevent individuals being overburdened by working steadily on the night shift. Firm guidelines have to be made to limit the hours and frequency of these shifts. And the labour authorities have to ensure that adequate provision is made to protect shift workers, especially in these difficult economic times.
Employers cannot be so set on productivity that it is achieved at the expense of worker burnout. A balance has to be drawn between productivity and worker health and well-being. Appropriate systems and plans have to be put in place to ensure that children of shift work parents are adequately supervised and cared for.
I sometimes hear complaints from security workers and nurses who have to wait for company transport more than an hour after their shift has ended. Incidentally, I have also heard of doctors (in developed countries) that have died from overwork.
When I was a medical student, I heard of a young British intern who fell dead after working about 96 hours in a week. It means that SWSD is not a respecter of social or educational status. We all need to sleep.
Notice that I have not mentioned anything about medication. This is because there is no medication that can provide an adequate solution to chronic SWSD. In fact, medication tends to compound the problem.
The bottom line is, overdoing the graveyard shift will put you in a permanent place in the graveyard much sooner than you think.
Dr Jerry Simon (NSA Medical Surgical Rehab Centre,
, 268 561 1104)