Understanding the Importance of Sleep

Sleep disorder are on the rise and the affects millions of people in America. People need sleep to function effectively at work to balance emotional responses. Unfortunately, despite expanding knowledge of the negative effects of sleep lost on our physical and mental well-being, the health care profession has not kept pace with the growing incidence of chronic sleep deprivation. This research review will investigate the effects of sleep deprivation in healthcare worker. Several studies have been completed which examine the effects of working long hours with poor sleep characteristic. What are the impacts of working twelve hour night shifts of healthcare workers versus twelve hour day shift? Sleep lost can lead to attention problems, impaired cognitive risk and errors that put the patients at risk and the challenges of finding a healthy balance between work and personal life.

Sleep, is a natural process when our body is at rest and is increasingly difficult to achieve for more than a third of the U.S population. Despite the advancement in research and study about sleep, there remains a considerable need for increased awareness and education concerning this growing public health problem. In the United States, an estimated 50 to 70 million adults experience chronic sleep loss stated by the Center for disease control and prevention. In addition people need to sleep to function effectively at work and to balance emotional responses. What are the effects of sleep deprivation in healthcare workers? Health care workers are not immune to the ill effects of sleep deprivation. Lack of sleep has been associated with the increased resentment towards patients in the medical system and an increased of incidence of errors at work (Chuah & Chee, 2008). This review will focus on the research conducted on the self-reported health and sleep complaints among nursing personnel working twelve hour night and day shifts.
According to National Sleep Foundation recommends daily sleep requirements’ for adult is 7 to 9 hours of sleep. The effects of loss of sleep is cumulative and losing 1 to 2 hours of sleep per night can result in a ‘sleep dept” that only adequate sleep can reduce (Church, 2012). More and more adults are experiencing chronic sleep lost that could lead to increase in risk of obesity, diabetes, depression, cardiovascular disease and other more. Experts has categorized sleep into 2 main stages: rapid eye movement (REM) and non-rapid eye movement (NREM) (Roth , 2009). He also mentioned that a complete, healthy sleep is composed of four to six cycle of REM and NREM sleep per night, with 90 minutes of sleep cycle. He explained that interference with natural sleep architecture can compound the negative effects of sleep disorders by damaging the homeostatic feedback system over time. According to Church (2012) “The brain’s need to sleep and all of its components may be demonstrated by the fact that even when severely impaired, the brain manages sleep stages” ,with that said sleep is a carefully regulated, natural process used by the body to perform various functions essential to life and well-being (p.588).
As mentioned previously, sleep loss may lead to attention problems, impaired cognitive decision- making, irritability, and increased risk of errors. In a survey of National highway traffic safety administration on hospital nurses, night nurses and “rotators” (day and night shifts) were more likely to report nodding off both at work and behind the wheel compared to nurses who worked day shifts. The same survey also reported many nurses having driving mishap on the way home from work. Night shifts workers usually manage 1.5 fewer hours sleep per 24 hours; because the midnight to 8 AM shifts requires that workers contradicts natural circadian rhythms, these workers bear the greatest risk of sleep disruptions. According to National institute of general medical sciences, Circadian rhythms are physical, mental and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in an organism’s environment. The survey of nurses concluded that 95% of night nurses working 12-hours shifts reported having had an automobile accidents or near-miss accident while driving home from work, and they also reported injuries because of sleepiness ("National institute of," 2013).
A similar study was performed through the University of San Paulo Brazil and chaired by Borges and Fischer was able to study group of night work nurses maintaining adequate alertness throughout the 12 hours night shift is a concern for the hospital managers, healthcare workers and patients. According to Borges & Fischer (2003) the study found that shiftwork constitutes an important stress to nursing personnel compromising, in particular, sleep quality and quantity. They also felt it is important to continue to evaluate the effects of shifts schedule on this population of workers in order to lessen the impact caused by the shiftwork. The objective of the study is assessing the group of night nurses and the two levels are (a) the duration and perceived quality of sleep taken during the day and night of the night shifts, 36 hours off time, and rest days and (b) level of self-perceived alertness throughout the 12 hours of night work (Silva Borges & Fisher, 2003) .
They study the characteristic of the population which is the night shift workers. The participants were solicited by written invitation distributed to employees who had worked for a minimum of 1year the medical facility. They asked the participants to answer the survey: the Work Ability Index and the Sleep Disturbance Questionnaire. The procedure was all the nurses worked 12 hours fixed night shifts, followed by 36 hours off time. The nurses worked 15 nights or 180 hours in total per month. All the nurses wore a wrist activity monitor, actigraph (Ambulatory Monitoring, Inc. New York) which will analyze the sleep duration and quality sleep episode no matter their clock time during the 15 day study period. The analysis of the sleep episodes and wake-time alertness using the actigraph was analyzed by a specific software program. The data collection was divided to six different categories they are:
1. Sleep naps during night work: nocturnal sleep episodes occurring during the work between 19:00 and 06.59 hours.
2. Sleep after the night shift: daytime sleep episodes occurring after the night shifts between 07:00 and 18:59 hours.
3. Sleep during the first night after the night shift: nighttime sleep episodes occurring between 19:00 and 06:59 hours
4. Sleep before night work: daytime sleep episodes beginning between 07:00 until 18:59 hours on work days and during off days.
5. Daytime sleep during the rest day: sleep episodes between 07:00 and 18:59 hours during the rest day.
6. Nocturnal sleep during the rest day: sleep episodes between 19:00 and 06:59 hours during the rest of the day. The rest of the day is an extra off day after 36 hours off-period following designated night shift work. (Silva Borges & Fisher, 2003)
According to the study #1, it was not possible to analyze the sleep quality of the naps taken during night work, since they were detected by the wrist actigraphy because the workers were afraid to register their naps in the daily log since it is against regulation to sleep on the job. They also performed a statistical analysis using the Statistica Program. It measure the central tendency were calculated. Sleep duration in minutes and quality were evaluated according to the above data.
The results of the study base on to the six categories defined in the methods section. The nurses experienced a significant decrease of sleep duration after their 12 hour night shift. The duration of daytime sleep was shorter that nighttime sleep after the end of the night shifts due to several factors such as variation of social family duties (taking care of children/ elderly family member or attending to home chores) (Silva Borges & Fisher, 2003). The researcher did not find any difference in sleep strategy use by the participants. The study showed that the level of alertness decreased significantly as the night progressed. According to the Silva Borges & Fisher, (2003) “There is a benefit in napping to attenuate or avert tiredness and sleepiness seems to be ignored by hospital manages, who prohibits sleep during night work as well as the workers, who did not take naps before reporting to night shifts”(p. 358). Although most nurses sleep/napped during night shift, the self-perception of their alertness decreased with the passage of time during the night work. The study concluded that continuous decrease of alertness during the 12 hour night shifts may cause problems for nurses and compromised their ability to provide quality care for the patients (Silva Borges & Fisher, 2003). The researchers recommendation is proper work schedule must be in place when scheduling nurses at least no more than three consecutive night shifts and restoring the policy for napping during work schedule.

Based on the studies sleep deprivation can severely reduce the quality of one’s life and can affect his or her family life that could be detrimental to ones being. A study by Wells & Vaughn, (2012) investigate and report the effects of poor sleep on the health of individuals and as society as whole. This includes major disasters related to insufficient sleep.

Performance and productivity (fatigue, irritability, difficulty concentrating, change of mood, visual hallucination and paranoid thoughts).
Stress and sleep (high demands of job and low job control)
Drowsy driving ( lack of attention, focusing ability)
Substance use and abuse ( drugs that affects sleep patterns)
Mortality and morbidity (cause by chronic disease such as obesity, heart disease, stroke depression and diabetes).

Most frequent complain of night shift workers are those concerning their social and family life and are the most common cause of maladaptation to nocturnal jobs (Costa, 1997). From my experience this is absolutely valid. My husband has been working 12h shifts for over 16 years since our first child was born. We decided that working different shifts will accommodate the care for our children’s and save money from daycare. Weighing our option of making less money and working less may improve the quality of our marriage. Every situation has pros and cons and taking the night shifts did put a toll in our marriage but a good balance between work/play and supportive family member made this difficult process easier. According to Church, E. (2012) “the need to eat well, exercise, rest, and not skimp on sleep to prevent burnouts” (p. 600).

The article recommended the following healthy balance between work and personal life includes:

Spending more times with supportive friends and family.
Engaging in religious or spiritual activities.
Focusing on success, not problems.
Having adequate administrative support and understanding.
Being in a workplace that emphasizes balance between work and personal lives.
Maintaining good nutrition and exercise. (Church, E. 2012)
The importance of keeping the public inform is an ongoing process that researcher’s main goal. Advancement in imaging helps expert understand sleep and its genesis that effects sleep disorders. Healthcare workers and administrative personnel need to take all this information into consideration because the effects of poor sleep are associated with the safety of the patients, healthcare staff and the general public. A hospital needs to be open 24 hours and balancing between work and family will accomplish a better mental and physical well–being for the healthcare workers.

REFERENCE

Chuah , L., & Chee, M. (2008). Functioning nueroimaging of sleep deprived healty volunteers and persons with sleep disorder. Ann Acad Med Singapore, 37(8), 689-694.
Church, E. (2012). Imaging sleep and sleep disorders. Radiologic Technology, 83(6), 585-602.
Costa, G. (1997). The problem: Shiftwork. Chronobiology International, 14(2), 89-98
National highway traffic safety administration.(2012, January) Drowsy driving and automobile crashes. Report and recommendation. Retrieved from www.nhlbi.nih.gov/health/prof/sleep/drsy_drv.pdf
National institute of general medical sciences. (2012, January). Retrieved from http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm
Silva Borges, F., & Fischer, F. (2003). Twelve-Hour Night Shifts of Healthcare Workers: A Risk to the Patients?. Chronobiology International: The Journal Of Biological & Medical Rhythm Research, 20(2), 351.
Unknown, (2009). Center for disease control and prevention: unhealthy sleep-related behaviors-12 states. MMWR Morb Mortal Wkly Rep, 60(8), 233-238.
Wells, M. E., & Vaughn, B. V. (2012). Poor sleep challenging the health of a nation. Neurodiagnostic Journal, 52(3), 233-249.