Shift work is unavoidable in many professions but working outside the traditional 9-to-5 can come with some health risks. Whether you're a nurse, a factory worker, or part of emergency services, your body may be silently bearing the brunt of irregular work hours. Let's dive into the impact of shift work on health and explore strategies to minimize its toll.
The Impact of Shift Work on the Body
Shift work can significantly affect the body’s circadian rhythm—the natural 24-hour sleep-wake cycle. Here are some of the common health issues associated with shift work:
Increased Risk of Chronic Conditions:
Research has shown that irregular sleep patterns may increase the risk of cardiovascular diseases, type 2 diabetes, and obesity. The disruption to circadian rhythms also affects hormone production, metabolism, and digestion.
Night shift workers are more likely to experience coronary heart disease and atrial fibrillation but fortunately not more stroke or heart failure.
Blood pressure tends to be higher in people who work night shifts. The risk of high blood pressure increases with more frequent night shifts.
Night shift workers are more at risk of developing Type 2 Diabetes, especially with rotating shifts. The more night shifts worked per month, the greater the risk of developing diabetes becomes.
There may be an association between night shift work and osteoporosis. 3 of 4 studies found a relationship, though there was some conflicting research on this topic. Osteoporosis is a whole other thing so we wont go into detail with that condition in this article.
Mental Health Effects:
Sleep deprivation, combined with the physical and emotional demands of work, can increase stress levels, leading to anxiety, depression, and burnout.
One study found night shift work was associated with an increased risk of sleep deprivation, family stressors, and mood changes. Rotating shifts made matters worse for night shift nurses and their complaints were often not taken seriously in the work place.
Another study noted that shift workers were more likely to develop depression and anxiety than non-shift workers. It should be noted, the overall numbers of people with anxiety or depression was fairly small in the study so even though shift workers were more likely to develop these conditions, the difference between the two groups was not too substantial.
The difference between shift workers and non-shift workers in a study specific to nurses was about 2-4% depending on severity for both anxiety and depression. These shifts are subtle but small percentage shifts applied to a large population can have a substantial impact. The study was larger so the impact was highlighted better.
Pregnancy Outcomes
There was a very large study of how pregnancy can be affected by shift work. The quality of the evidence was considered low so our understanding is likely to be refined with information from future studies. The study found that working rotating shifts was associated with an increased risk of preterm delivery, an infant small for gestational age, preeclampsia, and gestational high blood pressure, when compared to those who worked a fixed day shift. Working fixed night shifts was associated with an increased risk of preterm delivery and miscarriage.
Compared with standard hours, working longer hours was associated with an increased odds of miscarriage, preterm delivery, an infant of low birthweight, or an infant small for gestational age. The differences were rather substantial. Analysis showed that women working more than 55.5 hours (vs 40 hours) per week had a 10% increase in the risk of having a preterm delivery.
Strategies for Mitigating the Impact
1. Focus on Reducing the Risk Factors That You Can Control
Shift work is just one risk factor of many for the heart related and metabolic conditions (type 2 diabetes) listed above. If you focus on reducing your other risk factors you have a better chance of avoiding future problems. Controllable risk factors for these conditions overlap a lot so I combined them into one list. Keep in mind, just because something is listed here as controllable doesn't mean it is easy to change. Guidance and support are often needed.
Smoking
High blood pressure
High cholesterol
Lack of exercise
Diabetes and obesity (can be difficult to change for some)
Moderate to heavy alcohol use
Uncontrolled stress
High salt consumption, low potassium consumption
One study that looked at anxiety and depression found that modifiable risk factors played a large roll. When considering smoking status, sedentary time, BMI, and sleep duration together, these mediators explained 31.3% of the association between shift work and depression and 21.2% of the association between shift work and anxiety.
Another study highlighted that anxiety and depression rates in nurses specifically were influenced by fatigue during shift work, psychological stress, feeling refreshed after resting, using sleep medication, physical discomfort during night shifts, busyness during night shifts, food intake during shift work, working > 40 h/week and sleep quality.
If pregnant and working a shift work job, it should be noted that working fixed night shifts carried fewer risks than rotating shifts did. Fixed shifts still had some risk but fewer. And hours per week makes a difference. Pregnancy is not the best time to take on extra shifts if that is at all avoidable.
2. Prioritize Sleep Hygiene
Quality sleep is crucial for shift workers. Establish a bedtime routine, create a sleep-conducive environment, and limit exposure to screens and light before sleep. Consider using blackout curtains to simulate nighttime during the day. Apply blue light filters to screens if using before you intend to sleep.
3. Optimize Nutrition
Shift workers often struggle to maintain a healthy diet due to irregular mealtimes. Plan and prepare nutritious meals in advance to avoid relying on fast food or unhealthy snacks during shifts.
To reduce your risk or cardiovascular disease and diabetes, try to consume a lot of vegetables and fruits. High fiber foods are great for keeping your cholesterol levels low. Whole grains and lean proteins sources like beans, are also helpful.
4. Stay Active
People who work night shifts tend to get less exercise than those who work regular shifts. Regular exercise is not only beneficial for physical health but also helps combat the negative effects of shift work. Incorporate exercise into your routine, whether it's before or after a shift. Physical activity can improve sleep quality, boost mood, and enhance overall well-being. Exercise is likely not ideal right before you intend to go to sleep as it can boost your cortisol and keep you awake. Regular exercise is known to improve sleep quality but it takes a few months of consistent exercise to see the benefit.
5. Seek Social Support
Shift work can be isolating, as it often conflicts with social events and family time. Connect with other shift workers for a sense of camaraderie and understanding. Communicate your challenges with loved ones to gain support and foster a healthy work-life balance.
In a study of nurses working shift work, there was an association between those who lacked social supports and those who developed a shift work sleep disorder. This was a much stronger association in women workers compared to men. The study suggested that ...
"social support by supervisors and colleagues helps workers to appreciate their own value and competencies and enables them to cope with upcoming demands and difficult situations."
Good sleepers tend to have more social supports than poor sleepers. More social supports are associated with fewer sleep complaints and higher perceived sleep quality. Social support from a supervisor at work is a protective factor against the persistence of insomnia even one year later in employees.
6. Manage Stress
The demanding nature of shift work can take a toll on mental health. Practice stress-reducing techniques such as mindfulness, meditation, or deep breathing exercises. Find healthy outlets to unwind and recharge away from work-related stressors.
A number of studies found job strain led to shift work sleep disorders, though one study refuted those findings so the association is not solid and more research is needed to determine who is correct.
7. Get Paid (or Pay Your Shift Workers Well)
Shift work impacts your health and thus, these positions should pay well to justify the personal cost. Shift workers are more likely to experience burnout. Burnout is not a result of just overwork, it is a the result of an imbalance between the level of work performed and the level of reward gained from that work. Rewards can involve more than just financial compensation but money is one of the more impactful rewards. People who get paid well burnout less when subjected to overwork. For more on burnout, visit this article.
Women workers are more susceptible to the effects of job stress than their male counterparts and are more likely to suffer adverse health effects of shift work because of this. One study said this was due to lower wages and slower career progression which results in less reward in the workplace, which we know leads to quicker burnout.
"...less frequent promotions and consequently lack of career progress have been proved to be major sources of job stress for women and they have been associated with impaired health status and dissatisfaction at work."
Employers can reduce the adverse effects of shift work by granting promotions equitably, paying women workers fairly and removing glass ceilings.
Embracing a Healthier Approach
By acknowledging the hidden health risks of shift work and implementing proactive strategies, you can lead a healthier and more fulfilling life and honestly, you deserve too. Remember, self-care is not selfish but essential for thriving in a demanding work environment. Prioritize your well-being, listen to your body, and seek professional help if needed to navigate the unique challenges of shift work with resilience and strength. Shift workers give so much of themselves, you deserve to live in a healthy state well past your working years.
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