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Thomas DC, Somaiya T, Meira E Cruz M, Kodaganallur Pitchumani P, Ardeshna A, Ravi A, Prabhakar S. The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient. J Am Dent Assoc 2024:S0002-8177(24)00298-8. [PMID: 39007793 DOI: 10.1016/j.adaj.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders. TYPES OF STUDIES REVIEWED The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine. RESULTS The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science. CONCLUSIONS AND PRACTICAL IMPLICATIONS The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.
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Crowther ME, Ferguson SA, Gupta CC, Reynolds AC. The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale. Behav Sleep Med 2024; 22:353-377. [PMID: 37807653 DOI: 10.1080/15402002.2023.2265520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale. METHODS The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire. RESULTS The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. CONCLUSIONS The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.
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Affiliation(s)
- Meagan E Crowther
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Sally A Ferguson
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Charlotte C Gupta
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, South Australia, Australia
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Vallières A, Pappathomas A, Garnier SDB, Mérette C, Carrier J, Paquette T, Bastien CH. Behavioural therapy for shift work disorder improves shift workers' sleep, sleepiness and mental health: A pilot randomised control trial. J Sleep Res 2024:e14162. [PMID: 38443322 DOI: 10.1111/jsr.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Abstract
The present study evaluates the efficacy of behavioural therapy adapted for shift work disorder with a randomised control design in a healthcare population. Forty-three night shift workers (m. age: 34 years; 77% women) experiencing shift work disorder were randomised to either the behavioural therapy for shift work disorder (BT-SWD) or a waiting-list control group offered after the waiting period. Participants completed questionnaires on insomnia, sleepiness and mental health pre- and post-treatment, pre- and post-waiting, and at follow-up, and a sleep diary. As night shift workers alternate between sleeping during the day after their night shifts and transitioning to nighttime sleep on days off, insomnia severity and sleep variables were analysed for daytime and nighttime sleep. The BT-SWD involved sleep restriction therapy, stimulus control and fixed sleep periods in the dark. Statistical analyses were performed under intent-to-treat and per-protocol approaches. Repeated-measures two-way ANCOVA analysis, controlling for age, sex and pre-treatment daytime total sleep time, was performed with Bonferroni corrections, and between-group effect sizes computed. Fourteen participants dropped out after randomisation. Under the intent-to-treat analysis, BT-SWD participants had a significant greater decrease in daytime insomnia severity and an increase in daytime total sleep time at post-treatment than the control group, with large between-group effect sizes (-1.25 and 0.89). These corresponding results were also significant with large effect sizes under the per-protocol analysis. Sleepiness, anxiety and depression levels improved at post-treatment and maintained at follow-up when the BT-SWD treated controls were added to the BT-SWD group. The behavioural therapy for shift work disorder can be used to improve the sleep and mental health of healthcare night workers.
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Affiliation(s)
- Annie Vallières
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Alric Pappathomas
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | | | - Chantal Mérette
- Centre de recherche CERVO, Québec, Québec, Canada
- Département de psychiatrie et de neurosciences, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Julie Carrier
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
- Centre d'étude avancée en médecine du sommeil, CIUSSS-NIM, Montréal, Québec, Canada
| | - Tyna Paquette
- Centre d'étude avancée en médecine du sommeil, CIUSSS-NIM, Montréal, Québec, Canada
| | - Célyne H Bastien
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
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Bessman SC, Harrison EM, Easterling AP, Snider MN, Preilipper SMM, Glickman GL. Hybrid effectiveness-implementation study of two novel spectrally engineered lighting interventions for shiftworkers on a high-security watchfloor. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad051. [PMID: 38084298 PMCID: PMC10710545 DOI: 10.1093/sleepadvances/zpad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/13/2023] [Indexed: 06/26/2024]
Abstract
Shiftwork leads to myriad negative health and safety outcomes. Lighting countermeasures can benefit shiftworkers via physiological effects of light (e.g. alerting, circadian adjustment), and short-wavelength light is the most potent for eliciting those responses; however, limited work indicates it may not be required for alerting. We developed similar-appearing light boxes (correlated color temperature: 3000-3375 K; photopic illuminance: 260-296 lux), enriched (SW+, melanopic EDI: 294 lux) or attenuated (SW-, melanopic EDI: 103 lux) in short-wavelength energy, and implemented them on a high-security watchfloor. Efficacy and feasibility of these two novel lighting interventions were assessed in personnel working 12-hour night shifts (n = 47) in this within-participants, crossover study. For each intervention condition, light boxes were arranged across the front of the watchfloor and illuminated the entire shift; blue-blocking glasses were worn post-shift and before sleep; and sleep masks were used while sleeping. Comparisons between baseline and intervention conditions included alertness, sleep, mood, quality of life (QOL), and implementation measures. On-shift alertness (Karolinska Sleepiness Scale) increased in SW- compared to baseline, while changes in SW+ were more limited. Under SW+, both mood and sleep improved. Psychomotor vigilance task performance did not vary by condition; however, perceived performance and QOL were higher, and reported caffeine consumption and sleep onset latency were lower, under SW-. For both interventions, satisfaction and comfort were high, and fewer symptoms and negative feelings were reported. The addition of spectrally engineered lights to this unique work environment improved sleep, alertness, and mood without compromising visual comfort and satisfaction. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection.
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Affiliation(s)
- Sara C Bessman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Elizabeth M Harrison
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Alexandra P Easterling
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Michelle N Snider
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Sebastian M M Preilipper
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Gena L Glickman
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, USA
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5
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Kalkanis A, Demolder S, Papadopoulos D, Testelmans D, Buyse B. Recovery from shift work. Front Neurol 2023; 14:1270043. [PMID: 38020633 PMCID: PMC10651732 DOI: 10.3389/fneur.2023.1270043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
One fifth of today's workforce is engaged in shift work and exposed to various mental and physical health risks including shift work disorder. Efficiently recovering from shift work through physical and mental interventions allows us to mitigate negative effects on health, enables a better work-life balance and enhances our overall wellbeing. The aim of this review is to provide a state-of-the-art overview of the available literature. The role of sleep timing and naps, light therapy and psychotherapy, diet and exercise in recovery from shift work is presented here. We further review the impact of shift schedules and social support on post-shift unwinding.
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Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Saartje Demolder
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dries Testelmans
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium
| | - Bertien Buyse
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium
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6
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Aránguiz Bravo C. [Towards a healthier night shift: the need for nutritional, well-being, and organizational strategies]. NUTR HOSP 2023; 40:1112-1113. [PMID: 37705446 DOI: 10.20960/nh.04831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Introduction
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7
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Zhang Y, Murphy J, Lammers-van der Holst HM, Barger LK, Lai YJ, Duffy JF. Interventions to improve the sleep of nurses: A systematic review. Res Nurs Health 2023; 46:462-484. [PMID: 37710916 PMCID: PMC10539041 DOI: 10.1002/nur.22337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
Nurses are at a high risk for short sleep duration and poor sleep quality due to irregular work schedules and high occupational stress. Considering the effect of nurses' sleep on the safety and health of themselves and their patients, it is important to promote healthy sleep for nurses. We sought to synthesize the published experimental and quasi-experimental studies that address interventions to improve sleep in nurses. A systematic search was conducted for studies published in English up until May 15, 2023, using the databases PubMed, CINAHL, Academic Search Ultimate, and PsycINFO. In total, 38 articles were included, covering 22 experimental and 16 quasi-experimental studies with sample sizes ranging from 9 to 207. Studies were assessed using the Cochrane Risk of Bias tool and considered as low to medium quality. Thirty-six of the 38 studies reported positive findings for at least one sleep outcome. Intervention types included aroma therapy, dietary supplements, cognitive behavioral therapy, light therapy, mind-body therapy, sleep education, exercise, napping, shift schedule modification, and multicomponent intervention, all of which showed moderate effectiveness in promoting sleep outcomes of nurses. Comparing and contrasting studies on specific interventions for improving sleep in nurses is sparse and often equivocal. With the variations of research methodology and outcome measures, it is difficult to make a conclusion about each intervention's effectiveness on specific sleep outcomes. Additional high-quality research, including randomized controlled trials, is needed to evaluate strategies for improving sleep in this unique, safety-sensitive occupational group.
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Affiliation(s)
- Yuan Zhang
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | - Jennifer Murphy
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | | | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
| | - Yun-Ju Lai
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | - Jeanne F. Duffy
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
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Reynolds AC, Sweetman A, Crowther ME, Paterson JL, Scott H, Lechat B, Wanstall SE, Brown BW, Lovato N, Adams RJ, Eastwood PR. Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis. Sleep Med Rev 2023; 67:101716. [PMID: 36459948 DOI: 10.1016/j.smrv.2022.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia.
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Meagan E Crowther
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia; Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Jessica L Paterson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Sian E Wanstall
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Brandon Wj Brown
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
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Norful AA, Haghighi F, Shechter A. Assessing sleep health dimensions in frontline registered nurses during the COVID-19 pandemic: implications for psychological health and wellbeing. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 4:zpac046. [PMID: 36733409 PMCID: PMC9885842 DOI: 10.1093/sleepadvances/zpac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 12/05/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic altered work environments of nurses, yielding high rates of stress and burnout. Potential protective factors, including effective sleep, may influence psychological health and wellbeing. Evidence about sleep in nurses may help develop interventions that mitigate burnout and poor psychological outcomes. A cross sectional survey was distributed across three hospitals to nurses in New York City (NYC). During the first wave of the pandemic (March-April 2020), NYC had the highest incidence of laboratory-confirmed COVID-19 cases (915/100 000) and half of all COVID-related deaths nationwide. Multivariable logistic regression was used to determine associations between Pittsburgh Sleep Quality Index (PSQI) global sleep score, PSQI sleep dimensions, and psychological health (burnout, depression, anxiety, and compassion fatigue), unadjusted and then controlling for individual and professional characteristics. More than half of the participants reported burnout (64%), depression, (67%), and anxiety (77%). Eighty percent of participants had PSQI global scores >5 (poor sleep) (mean 9.27, SD 4.14). Respondents reporting good sleep (PSQI ≤ 5) had over five times the odds of no burnout (OR: 5.65, 95% CI: 2.60, 12.27); increased odds of screening negative for depression (OR: 6.91, 95% CI: 3.24, 14.72), anxiety (OR: 10.75, 95% CI: 4.22, 27.42), and compassion fatigue (OR: 7.88, 95% CI: 1.97, 31.51). Poor subjective sleep quality PSQI subcomponent was associated with burnout (OR: 2.21, 95% CI: 1.41, 3.48) but sleep duration subcomponent was not (OR: 0.84, 95% CI: 0.59, 1.19). Daytime dysfunction was significantly associated with all psychological outcomes. Sleep disturbances and medications yielded higher anxiety odds. Overall, sleep quality appears more strongly related to burnout than sleep duration in nurses working during the COVID-19 pandemic. Sleep interventions should target individual sleep dimensions in nurses.
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Affiliation(s)
| | - Fatemeh Haghighi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- U.S. Department of Veterans Affairs, James J Peters VA Medical Center, New York, NY, USA
| | - Ari Shechter
- Columbia University Irving Medical Center, New York, NY, USA
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Cyr M, Artenie DZ, Al Bikaii A, Borsook D, Olson JA. The effect of evening light on circadian-related outcomes: A systematic review. Sleep Med Rev 2022; 64:101660. [PMID: 35753149 DOI: 10.1016/j.smrv.2022.101660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
Bright light exposure at night can help workers adapt to their shift schedules, but there has been relatively little research on evening light. We conducted a systematic review of studies that manipulated light exposure in the evening (broadly defined as 16:00-22:00) before real or simulated night shifts. Across the five eligible studies, evening light produced phase delays in melatonin, body temperature, and sleep propensity; it also improved sleep quality, sleep duration, memory, and work performance. There were mixed effects for mood, no changes in sleepiness, and no negative effects. The confidence in these results ranged from moderate for physiological markers of circadian phase delays to very low for mood. Future studies should compare the relative effectiveness and safety of evening versus night-time light exposure. Overall, the benefits of evening light for shift workers are tentative yet promising.
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Affiliation(s)
- Mariève Cyr
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Despina Z Artenie
- Department of Psychology, Université du Québec à Montréal, QC, Canada
| | | | - David Borsook
- Departments of Psychiatry and Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jay A Olson
- Department of Psychology, Harvard University, Cambridge, MA, USA.
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Brown BWJ, Crowther ME, Appleton SL, Melaku YA, Adams RJ, Reynolds AC. Shift work disorder and the prevalence of help seeking behaviors for sleep concerns in Australia: A descriptive study. Chronobiol Int 2022; 39:714-724. [PMID: 35253569 DOI: 10.1080/07420528.2022.2032125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this study was to examine the help seeking behaviours of Australian workers who meet criteria for SWD. Of the 448 (46% of sample, n = 964 total) Australian workers reporting non-standard work hours, 10.5% (n = 41) met the criteria for probable shift work disorder (pSWD). Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD. Of the small proportion of workers with pSWD who sought help, general practitioners were the most common healthcare professionals for sleep problems. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of 'accept it and keep going' as a sleepiness management strategy, highlighting a potential barrier to help seeking behaviour in workers with pSWD. These findings provide novel insight into the help seeking behaviours of those with pSWD. There is a need for further research to understand why individuals at risk for SWD are not actively seeking help, and to develop health promotion and intervention strategies to improve help seeking when needed.
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Affiliation(s)
- Brandon W J Brown
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | | | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
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12
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The Development, Implementation, and Feasibility of a Circadian, Light, and Sleep Skills Program for Shipboard Military Personnel (CLASS-SM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053093. [PMID: 35270786 PMCID: PMC8910671 DOI: 10.3390/ijerph19053093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7−9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.
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13
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Circadian Rhythm Sleep-Wake Disorders. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Fischer D, Hilditch CJ. Light in ecological settings: Entrainment, circadian disruption, and interventions. PROGRESS IN BRAIN RESEARCH 2022; 273:303-330. [DOI: 10.1016/bs.pbr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Abstract
Circadian rhythms, present in most phyla across life, are biological oscillations occurring on a daily cycle. Since the discovery of their molecular foundations in model organisms, many inputs that modify this tightly controlled system in humans have been identified. Polygenic variations and environmental factors influence each person's circadian rhythm, contributing to the trait known as chronotype, which manifests as the degree of morning or evening preference in an individual. Despite normal variation in chronotype, much of society operates on a "one size fits all" schedule that can be difficult to adjust to, especially for certain individuals whose endogenous circadian phase is extremely advanced or delayed. This is a public health concern, as phase misalignment in humans is associated with a number of adverse health outcomes. Additionally, modern technology (such as electric lights and computer, tablet, and phone screens that emit blue light) and lifestyles (such as shift or irregular work schedules) are disrupting circadian consistency in an increasing number of people. Though medical and lifestyle interventions can alleviate some of these issues, growing research on endogenous circadian variability and sensitivity suggests that broader social changes may be necessary to minimize the impact of circadian misalignment on health.
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Affiliation(s)
| | | | - Ying-Hui Fu
- Department of Neurology
- Institute for Human Genetics
- Weill Institute for Neurosciences, and
- Kavli Institute for Fundamental Neuroscience, UCSF, San Francisco, California, USA
| | - Louis J. Ptáček
- Department of Neurology
- Institute for Human Genetics
- Weill Institute for Neurosciences, and
- Kavli Institute for Fundamental Neuroscience, UCSF, San Francisco, California, USA
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Crowther ME, Ferguson SA, Vincent GE, Reynolds AC. Non-Pharmacological Interventions to Improve Chronic Disease Risk Factors and Sleep in Shift Workers: A Systematic Review and Meta-Analysis. Clocks Sleep 2021; 3:132-178. [PMID: 33525534 PMCID: PMC7930959 DOI: 10.3390/clockssleep3010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Shift work is associated with adverse chronic health outcomes. Addressing chronic disease risk factors including biomedical risk factors, behavioural risk factors, as well as sleep and perceived health status, affords an opportunity to improve health outcomes in shift workers. The present study aimed to conduct a systematic review, qualitative synthesis, and meta-analysis of non-pharmacological interventions targeting chronic disease risk factors, including sleep, in shift workers. A total of 8465 records were retrieved; 65 publications were eligible for inclusion in qualitative analysis. Random-effects meta-analysis were conducted for eight eligible health outcomes, including a total of thirty-nine studies. Interventions resulted in increased objective sleep duration (Hedges' g = 0.73; CI: 0.36, 1.10, k = 16), improved objective sleep efficiency (Hedges' g = 0.48; CI: 0.20, 0.76, k = 10) and a small increase in both subjective sleep duration (Hedges' g = 0.11; CI: -0.04, 0.27, k = 19) and sleep quality (Hedges' g = 0.11; CI: -0.11, 0.33, k = 21). Interventions also improved perceived health status (Hedges' g = 0.20; CI: -0.05, 0.46, k = 8), decreased systolic (Hedges' g = 0.26; CI: -0.54, 0.02, k = 7) and diastolic (Hedges' g = 0.06; CI: -0.23, 0.36, k = 7) blood pressure, and reduced body mass index (Hedges' g = -0.04; CI: -0.37, 0.29, k = 9). The current study suggests interventions may improve chronic disease risk factors and sleep in shift workers; however, this could only be objectively assessed for a limited number of risk factor endpoints. Future interventions could explore the impact of non-pharmacological interventions on a broader range of chronic disease risk factors to better characterise targets for improved health outcomes in shift workers.
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Affiliation(s)
- Meagan E Crowther
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Sally A Ferguson
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Grace E Vincent
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health (AISH): A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
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17
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Garde AH, Begtrup L, Bjorvatn B, Bonde JP, Hansen J, Hansen ÅM, Härmä M, Jensen MA, Kecklund G, Kolstad HA, Larsen AD, Lie JA, Moreno CR, Nabe-Nielsen K, Sallinen M. How to schedule night shift work in order to reduce health and safety risks. Scand J Work Environ Health 2020; 46:557-569. [PMID: 32895725 PMCID: PMC7737811 DOI: 10.5271/sjweh.3920] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives This discussion paper aims to provide scientifically based recommendations on night shift schedules, including consecutive shifts, shift intervals and duration of shifts, which may reduce health and safety risks. Short-term physiological effects in terms of circadian disruption, inadequate sleep duration and quality, and fatigue were considered as possible links between night shift work and selected health and safety risks, namely, cancer, cardio-metabolic disease, injuries, and pregnancy-related outcomes. Method In early 2020, 15 experienced shift work researchers participated in a workshop where they identified relevant scientific literature within their main research area. Results Knowledge gaps and possible recommendations were discussed based on the current evidence. The consensus was that schedules which reduce circadian disruption may reduce cancer risk, particularly for breast cancer, and schedules that optimize sleep and reduce fatigue may reduce the occurrence of injuries. This is generally achieved with fewer consecutive night shifts, sufficient shift intervals, and shorter night shift duration. Conclusions Based on the limited, existing literature, we recommend that in order to reduce the risk of injuries and possibly breast cancer, night shift schedules have: (i) ≤3 consecutive night shifts; (ii) shift intervals of ≥11 hours; and (iii) ≤9 hours shift duration. In special cases - eg, oil rigs and other isolated workplaces with better possibilities to adapt to daytime sleep - additional or other recommendations may apply. Finally, to reduce risk of miscarriage, pregnant women should not work more than one night shift in a week.
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Affiliation(s)
- Anne Helene Garde
- The National Research Centre for the Working Environment, Lerso Parkallé 105, DK-2100 Copenhagen, Denmark.
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18
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Bjorvatn B, Pallesen S, Waage S, Thun E, Blytt KM. The effects of bright light treatment on subjective and objective sleepiness during three consecutive night shifts among hospital nurses - a counter-balanced placebo-controlled crossover study. Scand J Work Environ Health 2020; 47:145-153. [PMID: 33080034 PMCID: PMC8114564 DOI: 10.5271/sjweh.3930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives The objective was to investigate effects of timed bright light treatment on subjective and objective measures of sleepiness during three consecutive night shifts among hospital nurses. Methods Thirty-five nurses were exposed to bright light (10,000 lux) and red dim light (100 lux) during three consecutive night shifts in a counter-balanced crossover trial lasting nine days, which included three days before and three days after the three night shifts. Light exposure for 30 minutes was scheduled between 02:00-03:00 hours on night 1, and thereafter delayed by one hour per night in order to delay the circadian rhythm. Subjective sleepiness was measured daily (heavy eyelids, reduced performance) and every second hour while awake (Karolinska Sleepiness Scale, KSS). Objective sleepiness (Psychomotor Vigilance Task, PVT) was measured at 05:00 hours during each night shift. Beyond nocturnal light exposure on the night shifts, no behavioral restrictions or recommendations were given at or off work. Results Bright light treatment significantly reduced heavy eyelids during night shifts. However, results on KSS and PVT were unaffected by bright light. There were no differences in subjective sleepiness during the three days following the night shifts. Conclusions This bright light treatment protocol did not convincingly reduce sleepiness among nurses during three consecutive night shifts. Nor did bright light impede the readaptation back to a day-oriented rhythm following the night shift period. Too few consecutive night shifts, inappropriate timing of light, and possible use of other countermeasures are among the explanations for the limited effects of bright light in the present study.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway.
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19
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Münch M, Wirz-Justice A, Brown SA, Kantermann T, Martiny K, Stefani O, Vetter C, Wright KP, Wulff K, Skene DJ. The Role of Daylight for Humans: Gaps in Current Knowledge. Clocks Sleep 2020; 2:61-85. [PMID: 33089192 PMCID: PMC7445840 DOI: 10.3390/clockssleep2010008] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
Daylight stems solely from direct, scattered and reflected sunlight, and undergoes dynamic changes in irradiance and spectral power composition due to latitude, time of day, time of year and the nature of the physical environment (reflections, buildings and vegetation). Humans and their ancestors evolved under these natural day/night cycles over millions of years. Electric light, a relatively recent invention, interacts and competes with the natural light-dark cycle to impact human biology. What are the consequences of living in industrialised urban areas with much less daylight and more use of electric light, throughout the day (and at night), on general health and quality of life? In this workshop report, we have classified key gaps of knowledge in daylight research into three main groups: (I) uncertainty as to daylight quantity and quality needed for "optimal" physiological and psychological functioning, (II) lack of consensus on practical measurement and assessment methods and tools for monitoring real (day) light exposure across multiple time scales, and (III) insufficient integration and exchange of daylight knowledge bases from different disciplines. Crucial short and long-term objectives to fill these gaps are proposed.
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Affiliation(s)
- Mirjam Münch
- Sleep/Wake Research Centre, Massey University Wellington, Wellington 6021, New Zealand
| | - Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (A.W.-J.); (O.S.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, 4002 Basel, Switzerland
| | - Steven A. Brown
- Chronobiology and Sleep Research Group, Institute of Pharmacology and Toxicology, University of Zürich, 8057 Zürich, Switzerland;
| | - Thomas Kantermann
- Faculty for Health and Social Affairs, University of Applied Sciences for Economics and Management (FOM), 45141 Essen, Germany;
- SynOpus, 44789 Bochum, Germany
| | - Klaus Martiny
- Psychiatric Center Copenhagen, University of Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Oliver Stefani
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (A.W.-J.); (O.S.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, 4002 Basel, Switzerland
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (C.V.); (K.P.W.J.)
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (C.V.); (K.P.W.J.)
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Katharina Wulff
- Departments of Radiation Sciences and Molecular Biology, Umeå University, 901 87 Umeå, Sweden;
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, 901 87 Umeå, Sweden
| | - Debra J. Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
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20
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Feldstudie zu verschiedenen Lichtsituationen mit steuerbarem Blauanteil bei industrieller Spätschicht. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-00229-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Wong IS, Dawson D, VAN Dongen HPA. International consensus statements on non-standard working time arrangements and occupational health and safety. INDUSTRIAL HEALTH 2019; 57:135-138. [PMID: 30930407 PMCID: PMC6449635 DOI: 10.2486/indhealth.57_202] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Imelda S Wong
- US Department of Human and Health Services, Centers for Disease Control and Prevention, National Institute for Occupational Health and Safety, USA
| | - Drew Dawson
- The Appleton Institute, CQUniversity, Australia
| | - Hans P A VAN Dongen
- Sleep and Performance Research Center and Elson S. Floyd College of Medicine, Washington State University, USA
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