Positive Results from Lifestyle Education and Training
The impact and value of lifestyle education for shiftworkers and extended hours employees has long been a subject for discussion. Recently, a joint study by Circadian Technologies and a major surface mining company found very positive results with a group of operators who were provided training on “Managing A Shiftwork Lifestyle” at a Colorado mine site. The positive impact was not limited to just areas of sleep improvement, but also included improvements in overall health indicators.
“The Managing a Shiftwork Lifestyle” (MSL) program is designed to assist extended hours employees and their families in coping with the special issues associated with working long or irregular shifts”, says Sam Sirois a Senior Consultant at Circadian. The training “workshops” were four hours long, they were conducted by a Circadian trainer, and they included spouses or partners. The content included information on how to get better sleep, tips for using naps effectively, special timing of the content of food, especially on the night shift, maintaining fatigue and alertness, round-the-clock safety, and methods for balancing work and home life.
The Study
The study began with the collection of sleep/wake data from heavy equipment operators at the mine. These operators volunteered to fill out sleep/wake/activity for an entire 28 day shift cycle. The operators also completed a diagnostic survey on their sleep habits, diet, family/home life, fatigue, alertness, health and safety. After the initial data collection, the operators attended the “MSL” training course presented by an expert trainer from Circadian Technologies. They were also provided with several monthly support publications to reinforce the training. Approximately two months after the training session, the operators completed an additional month of daily sleep/wake logs, as well as a post-training survey.
Key Findings
One of the most compelling results from the sleep/wake logs was the increase in sleep quantity and quality. Prior to the training, the operators were averaging 4.8 hours of daytime sleep when working night shifts. This increased to 5.8 hours following the training – a 21% improvement after just one training session! Overall, following the training, 67% reported getting more than 5 hours of sleep when working nights compared to only 45% prior to the training. This demonstrates a conscious effort on the part of the operators to get more sleep. More evidence of behavioral change can be seen in the fact that, prior to training, 82% had stayed awake for more than 18 hours at some point in the previous work week, while after the training only 67% had done so. More than half (54%) indicated making changes to their sleeping environment, to make it easier for them to get to sleep and stay asleep, especially when working th night shift and having to sleep during the daytime.
The employee surveys included a set of questions that are known as the Epworth Sleepiness Scale, a scientifically validated index that shows overall levels of sleepiness/fatigue for an individual or group. The Epworth Sleepiness score dropped from 9.2 to 8.9 following the training. This lower score further supports that better quality and quantity of sleep achieved through the various methods were gleaned from the MSL served to improve overall alertness. Although the score is still higher than the general population score of 5.9, it fell more closely in line with the average shiftwork operation score of 8.5.
Although there was no schedule change associated with the training, there were some noticeable differences between the pre- and post-implementation groups with regard to rating their current schedule. For example, before the training, 41% found it very or often difficult to fulfill domestic responsibilities, while after the training only 23% found this very or often difficult. This can be attributed to the generally better overall feeling of health, alertness, morale and performance which leads to a different perception of both work and home life. Another example of this was the response to having adequate time for entertainment and recreational activities; 46% found this very or often difficult prior to the training, compared to 23% after the training. It was also noteworthy that in the post-implementation survey, 77% felt that their overall health would improve with a different schedule as compared to only 59% in the pre-implementation survey. This was attributable to a better understanding of how their own personal circadian rhythms are impacted by the shift schedule, and to the self determination that a different schedule would be easier for them to work.
Included in the survey was another standard research index that measures gastrointestinal distress. The improvement in the gastrointestinal index scores was quite dramatic dropping from 17.9 to 13.6. Although the shiftworker average is 12.8, the downward trend for these operators from pre- to post-implementation was very positive. This finding also correlated well with results from the survey which indicated that a high percentage of the operators were not only more aware of good nutrition, but were also incorporating healthy eating habits into their shiftworking lifestyle.
Excessive use of caffeine, as defined by drinking more than four 12 oz. servings in a 24-hour period, decreased from 24% to 16% when not working. Even more impressive was the decrease while working night shifts, which fell from 32% to only 8% drinking 4 or more servings in the post-implementation. Because caffeine has a half life of 7-hours, this reduction in nighttime consumption significantly enhanced daytime sleep.
A battery of questions that screen for obstructive sleep apnea, a common sleep disorder among shiftworkers characterized by cessation of breathing while asleep, was included in the survey. Sleep apnea risk reduction overall realizes time to achieve substantial weight loss and to improve physical fitness (unless CPAP breathing equipment or surgery is required). However, since apnea is closely linked to overall health (e.g. exercise, weight, diet, etc.), it was pleasantly surprising that a slight decrease in apnea risk was noted in the survey results – again attesting to the motivation for personal behavioral change stimulated by the training.
Conclusions
The overall positive impact was readily apparent in the analysis of the data. Both the employee survey and the sleep/wake/work log analysis showed marked improvements from pre-training to post-training. These results support the continuing drive to provide training and education support publications for extended hours employees on how to better manage the special issues and challenges they face.
Although training alone is not the entire solution for achieving a comprehensive fatigue management program, the results of this study indicate that it is certainly a key cornerstone for a strong plan. Combined with scheduling improvements, policy and procedure modifications, and strategic informational programs and publications, lifestyle training can yield tremendous return on investment for shiftworkers and extended hours employees.