Business of Well-being

Lowering Stress and Anxiety for Shift Workers (and for others too!)

Stress and anxiety are normal parts of life. Sometimes we all need a little anxiety to keep us going - to make the best presentation, ace the test or get the job offer. But over time, the effects of too much tension can be mentally and physically taxing. Extended periods of stress can cause destructive changes in the body, such as depression or a suppressed immune system, potentially leading to heart disease, stroke or cancer. Stress and anxiety can be felt physically: an increased heart rate and high blood pressure, sweating, dry mouth, tight muscles, twitching, abdominal pain and headaches.

Emotional responses to stress may include feeling restless, being unable to concentrate and negative self-talk. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Some of the specific anxiety disorders are panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social phobia (or social anxiety disorder), other specific phobias (like agoraphobia - a fear of being in places where help might not be available, usually involving a fear of crowds or of being outside alone) and generalized anxiety disorder.

A recent study by researchers in the department of psychiatry at the University of Pennsylvania School of Medicine found that the genes playing a role in adolescent insomnia are the same as those involved in depression and anxiety. The study found that significant genetic effects are shared between insomnia, depression and anxiety, overlapping genetic mechanisms link the disorders. Similar findings exist as a result of adult studies. For example, an analysis of data obtained from over 25,000 people in Norway found that chronic insomnia was a risk factor for developing anxiety but not for developing depression, although often anxiety and depression were found to be present with insomnia.

These studies suggest that individuals experiencing anxiety and depression should be screened for insomnia. On the other hand, some studies report that insomnia may actually be a marker for risks of developing anxiety disorders. So, chronic insomniacs should probably be screened for anxiety disorders. Shift workers experience unique challenges that can lead to increased tension. Without proper planning, work/life/family balance can get completely out of sync as a result of working rotating shifts or long hours. As a result of the struggle to adapt to ever changing work schedules, shift workers often don't get enough sleep.

While most sleep experts suggest seven to eight hours of sleep is needed to feel well-rested, most people don't get this much and shift workers get even less. The National Institute of Health has reported that people who work at night, have frequent major shifts in their work hours or who have inactive lifestyles, are at a greater risk of developing insomnia. Shift workers report that they don't exercise frequently. People who work rotating shifts have significantly lower levels of serotonin, a hormone and neurotransmitter in the central nervous system that plays a critical role in the regulation of sleep, according to a published in the journal Sleep in 2007.

The study indicated that serotonin levels differed greatly between day workers and rotating shift workers, with levels of serotonin significantly lower in rotating shift workers. In addition to sleep problems, low levels of serotonin are associated with other conditions such as anger, depression and anxiety. When faced with the anxiety that sometimes accompanies working shift work, many people turn to tobacco, drugs (both pharmaceutical and illegal ones) and alcohol as coping mechanisms. While these substances may bring some calm in the short term, they tend to heighten stress and anxiety over the long term.

Caffeine may reduce sleepiness and increase alertness temporarily but it can also cause interrupted sleep. Alcohol may shorten the time it takes to fall asleep but it can disrupt sleep later in the night, increasing sleepiness. Medications may be prescribed for patients, like short-term use of sleeping pills to treat chronic insomnia. The long-term use of sleep medication is only recommended for the treatment of specific sleep disorders.Encourage shift workers trying to cope with working shifts to consider:

  • The power of positive procrastination - giving themselves permission to abandon a task, at least for the moment. Maybe it's mowing the lawn - it can wait until tomorrow or even a few days - or opening the mail: go ahead and leave it in the mailbox.
  • Paying attention to their breathing: listening to their own sigh of relief when a crisis is over or to how easily they sigh when happy.
  • Try and stay in the moment. Being self-aware will help them to relax, prioritize what needs to be done right then and take steps to see the big picture versus the small, frustrating details everyone faces every day.
  • Take time to plan their days, weeks and months. Planning in advance will alleviate some of the pressure that naturally arises each day when they try and fit in all they want and need to do nad help them make the most of the time they have by being efficient.
  • Rely on others. Carpool.  Let others walk the dog. Teach children to find rides or coordinate trips/activities with others.
  • Use a planner or calendar to plot activities out ahead of time and communicate work schedules, necessary appointments, recovery days and specially scheduled arrangements.
  • Make sure they prioritize their activities so they complete what they need to and have time for the things they want to do. Don't spend all their time on things that are "have to's" - save time for the unique activities they look forward to.
  • Quit smoking. Smokers tend to report high rates of insomnia; they have a hard time falling asleep and a hard time maintaining sleep. Last year a new study linked smoking with sleep disturbances. The study found that cigarette smokers are four times as likely as nonsmokers to report feeling not rested after a night's sleep.
  • Shift workers need to pay special attention to how their work shift impacts eating habits; they should eat healthy, routine meals and watch snacking, especially when working the night shift.
  • Shift work often decreases opportunities for physical activity and participation in organized sports. For those shift workers  who are able to exercise, exercise often occurs at unusual and varying times of day. Nevertheless, support workers as they try and keep up with their exercise routine.
  • Despite all the recent focus on sleep, a 2005 National Sleep Foundation survey found that only one-third of patients with insomnia were asked about the quality of their sleep by their health care practitioners. Studies show that insomniacs are just as unlikely to raise the issue with their doctors. If workers are concerned that they might have a sleep disorder of any kind, they should discuss it with their health provider.

This material is provided for personal, non-commercial, educational and informational purposes only and does not constitute a recommendation or endorsement. Research abstract presented June 8, 2009 at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies Neckelmann D; Mykletun A; Dahl AA. Chronic insomnia as a risk factor for developing anxiety and depression. SLEEP 2007; 30(7):873-880.

About the Author

Betsy Connolly, the author is the President of Circadian Age, Inc., the publisher of the Working Nights Calendar. For 25 years the Calendar has been used by 24/7 workers to improve work-life balance. Employers purchasing the Calendar for their employees see fewer accidents and errors, reduced health costs and absenteeism rates, and increased productivity. The calendar is:

  • A simple, cost-effective tool to help shift work employees and their families better manage their unique lifestyle.
  • An educational and motivational publication, including health and safety tips relevant to the challenges shift workers face.
  • Fun - it includes colorful scheduling stickers to easily track shift schedules and important appointments/dates.

In 2009, Circadian is offering 3.5"x 7" pocket calendars in addition to its 12"x 21" wall calendars and their 12"x 18" custom calendars (specialized to client specifications). They also offer a Creative Arts Calendar Contest which employers can use to further engage employees and their families in the importance of health and safety. Circadian also provides employee and management shift work training, posters and newsletters.

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