Sleep disorders during work hours
Introduction
Sleep disorder due to rotation of shift also called secondary sleep disorder to turn turnover work, it is expressed clinically by insomnia or excessive daytime sleepiness accompanied by a reduction in total sleep time (1 to 4 hours) and the efficiency of the efficiency ofdream, poor quality of the same as well as a decrease in the state of alert and work performance associated with a work schedule that overcomes the usual time of sleeping.
The shifts that initiate in the morning (between 04:00 – 07:00 am) are associated with difficulty complaints of sleep and waking up, while permanent night shifts may be associated with difficulty to maintain sleep;However, those shifts that involve working during the day, night or turn rotation are expressed with excessive drowsiness accompanied by cognitive impairment and the need to take naps.
Developing
There are several types of shift schedules between them: evening shifts, at night, morning, turns rotation, divided, night guards and prolonged working days;Until hours of work at night the tolerance to them depends on the ability to adapt each individual, the shift, the hours of work, the periodicity of the same and the comorbidities that accompany the individual.
The rotation on duty at work is a reality and produces negative consequences for worker’s health. These effects are the result of two fundamental mechanisms: the lag of biological rhythms and sleep deprivation. Health -associated comorbidities occur with greater intensity in rotary and nocturnal shifts, evidence of this is the increase in the prevalence of gastric ulcers, increased cardiovascular risk, development of metabolic disorders, reproductive problems and increased labor accidents.
Sleep needs varies according to age, gender and special health conditions. Insufficient dream is the cause of working age individuals suffer negative consequences in their cognitive, mood and physical performance4 abilities4. Excessive drowsiness (SE) is a frequent complaint in much of diurnal schedule and workers of rotary and nocturnal shifts sleep less, which is why they present greater drowsiness than daytime workers.
People who work in night shifts sleep an average of 4 to 6 hours a day, if they also suffer from sleep disorder due to turn the average of the sleeping hours is reduced to less than 5 hours;These patients under optimal controlled environmental conditions achieve a daytime sleep less than 6 hours. Even having a longer time to sleep 6.It is estimated that between the 50’s and the 90’s the average sleep was reduced from 8-9 to 7 hours,.
For 2015 the proportion of adults that slept regularly less than 6 hours reached 30%9. Current evidence indicates that sleep deprivation is associated with greater morbidity and manneity, diabetes, work accidents and cognitive impairment. The most direct consequences of work in the rotation turn are: drowsiness, fatigue, cognitive and sleeping alteration which leads to serious implications in the areas of work performance and probability of occupational accidents
. Involuntary sleep episodes are more frequent during night shifts (especially between 3-6 am) with the highest risk of vehicular, aviation or industrial accidents. A 3 times greater risk of occupational accidents and house in rotary shift workers compared to the people who work during the day has been reported.
If the worker is revealed intermittently and also has a respiratory disorder during sleep such as Obstructive Sleep Apnea Syndrome (SAOS) that fragments his sleep, and causes cardiorespiratory alterations as well as daytime drowsiness, he can end in cardiac heart attacks or cerebrovascular events .According to previous research, in experimental studies with animals it has been identified that sleep deprivation has repercussions on the alterations of glucose metabolism, increased appetite and decreased energy expenditure.
This leads to insulin-resistance / diabetes mellitus and obesity. Some epidemiological studies have demonstrated an increase consisting of the body mass index (BMI) in recent decades, which has been parallel to the reduction in the amount of average sleep hours. An analysis in adult population in primary care shows that obese and overweight patients sleep less than those with normal BMI, a longitudinal studies analysis target showed the positive association between shorter duration of sleep and increased weight.
Workers with rotation on duty have symptoms of excessive drowsiness (SE) in labor environments, this symptom is a problem that annually costs millions of dollars;causes decrease in work performance and increases the risk of home, work, transport and industry accidents. Subjects with work shift rotation may present daytime sleepiness during their work activities.
Previous investigations document that 52% of occupational accidents were related to drowsiness and that between 75 and 90% of workers at night had drowsiness at work causing the most frequent accidents (falls and accidents in motor vehicles).The SE in workers with labor turn, contributes errors in production procedures;For example, the probability that nursing personnel make a work error increases 3 times, after working more than 13 hours;But the risk begins to increase after 9 hours of continuous work.
The most frequent work errors in the nursing staff that have been reported in investigations are:
- Administration of wrong patient medication.
- Erroneous application.
- Incorrect dose.
- Erroneous schedule.
- Omission of administering the medication.
In the nuclear plants Three Mile Island (Pennsylvania), Oak Harbor (Ohio) and Sacramento (California) human errors were presented between 1:00 and 4:00 am, which caused a high risk of explosion of the reactors;Officially Chernobyl accident was a consequence of a series of errors that began at dawn.
The possible causal relationship of factors such as darkness, monotony, vehicular flow, alcohol use, suicide, speeding and time management time with night vehicle accidents (AVN) on road;However, sleep deprivation and two factors present in these accidents are.
Automobile accidents are one of the main causes of death among adolescents and young adults, it has been estimated that between 3 and 30 % of them are due to the wheel. Vehicle accidents have two frequency peaks within 24 hours that coincide with the two points of greatest drowsiness due to the Sleep-Vigilia circadian rhythm. Drivers who handle large distances have important sleep debts and consequently decreased sleeping latency.
This provides an increase in the risk of accidents with electro-physiological somnolence signs.It has been reported that most workers consider that the characteristics of their night work activity not only alter sleep, but also create difficulties in their family life, restrict social life, reduce recreational activities and affect their health.Sleep alterations are one of the main problems of this type of workers.
The sleep problem rate varies between 5%, in workers with a day shift, up to 90% in which they have a night shift to integrate a diagnosis, the following criteria must be met: the main complaint is due to insomnia or drowsinessExcessive accompanied by a total sleep time reduction, associated with a work schedule that overlaps at the usual time of sleeping. The presence of symptoms is associated with work schedules, and which have been present for 3 months.
Sleeping and Actigraphy Monitoring (provided it is possible and preferably with measurement of light exposure) for at least 14 days (work and free days) shows a disturbed pattern of the sleep -vigilia cycle. Sleep disturbance is not explained by another sleep disorder, medical, neurological, mental, poor sleep hygiene or drug use or drugs.
The use of polysomnography is not indicated, however the findings imply, decreased total sleep time, increased latency, difficulty maintaining sleep and fragmentation of this.The multiple latencies test will show excessive drowsiness. Differential diagnosis should include obstructive sleep apnea, narcolepsy, insufficient sleep syndrome, inappropriate sleep habits and chronic insomnia.
Sleep disorder due to work schedule is an increasingly recognized disorder as an important condition for the worker and his family, the prevalence grows as more companies invested the working day 24 hours, the patient’s complaint is dysfunctiongastrointestinal, cardiovascular diseases, depression and drowsiness. The treatment requires the collaboration of the worker and the company,
It is important to raise awareness about the risk factors and health problems that will bring in the future. Design healthy sleep promotion strategies, and health education campaigns related to good rest, will promote a better quality of life from a repairing dream in the worker. The indicators that are proposed to the worker for a better management of their sleep quality are: the scheduled naps before working hours.
Lly the consumption of caffeine at the end of the work schedule, improve sleep habits, exercise regularly before entering work, periods of exposure to light / darkness, control of the sleep environment, adequate diet, not making use ofstimulants or sedatives, make a sleepy diary;mitigate noise and light levels in the room.
It is important to make differential diagnoses or identify comoring sleep disorders during clinical consultation or on the work site. Psychosocial risk factors at work-identification, analysis and prevention were published in the Official Gazette of the Federation. The objective of the NOM is to establish the elements to identify, analyze and prevent psychosocial risk factors, as well as to promote a favorable organizational environment in work centers.
The favorable organizational environment: it is one in which the sense of belonging of workers to the company is promoted;the training for the proper performance of the tasks entrusted;the accurate definition of responsibilities for work center workers;proactive participation and communication between workers;The proper distribution of workloads, with regular working days in accordance with the Federal Labor Law, and the evaluation and recognition of performance.
Psychosocial risk factors: Those that can cause anxiety disorders, non-organic of the sleep-vigilia and serious stress cycle and adaptation, derived from the nature of the functions of the workplace, the type of work day and exposure tosevere traumatic events or acts of labor violence to the worker, for the work carried out.And this is how in the area of psychosocial risk factors, dangerous and insecure conditions in the work environment are understood;
Workloads when they exceed the worker’s ability;the lack of control over work (possibility of influencing the organization and development of work when the process allows);The working days higher than those provided for in the Federal Labor Law, turnover of shifts that include night shift and night shift without periods of recovery and rest, interferes the work-family relationship,
negative leadership and negative relationships at work. The measures to prevent psychosocial risk factors, promote the favorable organizational environment, as well as to address opposite practices to the favorable organizational environment and acts of work violence, apply to all work centers regardless of their size.For prevention of psychosocial risk factors and work violence, as well as the promotion of the favorable organizational environment, work centers must: establish actions for the prevention of psychosocial risk factors that promote: social support, dissemination of theInformation and training.
The working days and turnover of shifts that exceed the provisions of the Federal Labor Law. They represent a requirement of work time that is done to the worker in terms of the duration and schedule of the day, it becomes a psychosocial risk factor when working with extensive days, with frequent rotation of shifts or night shifts, without breaks and breaksClearly established newspapers and no worker prevention and protection measures to detect their health, early.
conclusion
Currently, labor demands are increasing, companies to be competitive and be ableSpecialist in sleep disorders must work together with workers and labor authorities to propose regulations aimed at reducing work accidents and increasing sleep quality in workers from health promotion in companies. In order to improve employment safety conditions for employees with sleep disorder for work hours such as workers, health personnel, drivers, since this would have benefits for the safety and health of the worker.
References
1. – American Academy of Sleep Medicine, Eds. International Classification of Sleep Disorders, 3rd ed.: Diagnostic and Coding Manual. Westchester, Illinois: American Academy of Sleep Medicine, 2014. Pp. 215-219.
two.- Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni or. National Sleep Foundation´s Sleep Time Duration Recommendations: Methodology and Resumary. Sleep. Health, 2015 1: 40-43.
3. – Aldabal L, Bahammam as. Metabolic, Endocrine, and Immune Concequences of Sleep Deprivation. Open Breathe Med J;2011: 5, pp 31-43.
4. -Leibowitz S, Lopes M-C, Andersen ml et al. (2006) Sleep Deprivation and Sleepines Caused By Sleep Loss. Sleep Med Clin 2006;1: 31-45.
5. – BALKIN TJ, RUPP T, Picchioni D et al. Sleep Loss and Sleepiness: Current Issues 2008.
6.- Blasco E, Llor E, Sánchez O, García I, Sáenz N, García M and Ruíz H. Relationship between drowsiness and work shifts in a local police sample, 2002.
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