Saturday, April 14, 2012

Police Shift Work And Healthy Sleep

10 Steps to Staying Sleep Healthy During Rotating Shift Work

It’s good news for Police Departments forced to use rotating shift schedules that major progress has been made in understanding and treating Circadian Rhythm Sleep Disorders (CRSD’s).  It’s now time to put this understanding and the resultant treatment recommendations into practice.  The benefits of which should likely include a reduction in nighttime department vehicle accidents and an increase in nighttime officer alertness.

CRSD’s are currently broken into 6 categories; Delayed Sleep Phase Type (DSPT), Advanced Sleep Phase Type (ASPT), Irregular Sleep-Wake Phase Type (ISWPT), Free Running Type (FRT), Jet Lag Type (JLT), and Shift Work Type (SWT).   The basic feature of a CRSD is a persistent or recurrent pattern of sleep disturbance due primarily to alterations in human circadian rhythms brought on by changes in light and darkness that accompany shift work changes.  At a basic level Circadian Rhythm is the body’s internal clock related to alertness, sleep, hunger, body temperature, and general activity level.  The main driver of circadian rhythm is light and for most of us that means awake and alert during day light hours with decreased alertness and sleep during nighttime hours.

Here at our Police Department officers rotate shifts every 49 days in a clockwise fashion.  Shift 1 starts at 0600 hours, shift 2 starts at 1400 hours and shift 3 starts at 2200 hours.  Every effort is made to provide for at least some family and spouse time as well as time for conducting personal business during the normal 9 to 5 business hours most of society operates under.  Even with the officer benefits of such a schedule, special attention needs to be paid to every officer getting a restful and uninterrupted period of sleep. 

When all goes well the outcome is 3 shifts of equally alert and physically prepared officers ready to provide for the health and safety of the community.  When all is not well, alertness decreases, vehicle and other equipment accidents are more likely and the potential for serious injury, disability or death looms larger.

A diagnosis of shift work disorder (SWD) is made upon a persistent and recurrent pattern of sleep disruption which results in the mismatch between the individual’s internal sleep-wake cycle and the external demands of their work.  Individuals with this disorder may complain of insomnia at certain times of the day and excessive sleepiness at others with a resultant impairment in social or occupational functioning or a verbal report of marked subjective distress.  When the disorder persists for a significant amount of time additional physical health issues can arise including cardiac and psychological problems.  In fact it is not uncommon to talk with retired officers who are still trying to sort out sleep issues long after leaving the force.

Normal sleep for humans is around 8 hours per session (night) and it is theorized that one third of our lives is spent sleeping or trying to.  Physiologically, sleep originates in the suprachiasmatic nucleus (SCN) in the hypothalamus which is the main control center of the circadian rhythms of sleep and temperature.  Light resets the SCN via a small branch of the optic nerve known as the retinohypothalamic path which travels directly from the retina to the SCN.  The SCN regulates waking and sleeping by controlling activity levels in other areas of the brain. The SCN regulates the pineal gland, an endocrine gland located posterior to the thalamus.  The pineal gland secretes melatonin, a hormone that increases sleepiness.  Melatonin secretion usually begins 2 to 3 hours before bedtime.  Melatonin feeds back to reset the body’s circadian rhythm through its effects on receptors in the SCN.

Although there is a constant mismatch between light, darkness and work responsibilities for shift work individuals, much can be done to set and re-set circadian rhythms that provides for a normalized pattern of sleep regardless of the actual hour of the day it begins or ends.  Because the needs of police departments in providing for public safety will not change, shift work is always likely to be part of the equation, especially in smaller departments.  Therefore the following are recommendations based upon current sleep research and the practice parameters and treatment guidelines of the American Academy of Sleep Medicine.

1.        Aim for one, uninterrupted 8 hour segment of sleep in every 24 hour period.*
2.       Ensure the sleeping environment is as dark as possible and free from noise or other sleep interrupting stimulation.
3.       A prescribed sleep-wake schedule (an 8 hour time block for sleep and awakening) should be devised and adhered to, even on off days.   It may be your weekend but keep the same sleep schedule, even though it might mean staying up from 2200 hours until 0700 hours.   For those on clockwise rotating shifts, pick a time block that gets you up two hours before your shift so the rotation is easier when it happens.
4.       Melatonin, an over the counter supplement found in most pharmacies, in amounts from 3 mg’s to 5 mg’s has been shown to be effective in producing sleep.  It often produces the best benefits when taken 2 to 3 hours before desired sleep onset.  Effective dosage often varies between individuals so starting at the lower dose and working up is likely to be most advantageous.
5.       A 20 to 60 minute nap prior to the start of night shifts has been shown to be of benefit for those who wake up 8 or more hours before their shift.
6.       Replacing a meal break with a 20 minute nap during a night shift has been shown to be beneficial.
7.       Increasing the available light inside the station or work area during night shifts has shown good effectiveness.  Available light should exceed a minimum of 1000 Lux and adding extra lighting for the midnight shift is a very good idea.
8.       Caffeine is often beneficial to maintaining alertness on shift.  If you’ve already come close to exceeding your normal 24 hour intake, cut back some and save it for the difficult 0300 hour time period.  Eliminate caffeine several hours before desired sleep onset. **
9.       Although easily gotten and willingly prescribed, sedative hypnotic sleep agents are not recommended to bring about sleep.  The possibility of addiction and undesired interference with normal sleep cycles makes this a bad idea.  Sleeping pills are still the number one culprit in producing and maintaining long term sleep disorders.
10.   Practice good sleep hygiene and stimulus control.  Beds are for sleep and physical intimacy.  No TV watching from bed, eating in bed or internet surfing.  If you do not fall asleep within 20 minutes or so, get up and do something until you feel you can fall back to sleep.  Repeat as often as necessary until you’ve taught yourself good sleep habits.

* Older officers may need less sleep or notice nightly awakenings for bladder issues.  Try and get back to sleep after using the washroom and be willing to settle for 2 long periods of sleep interrupted by one bathroom break.

** A prescribed medication called Modafinil (Provigil) is used to treat excessive sleepiness caused by shift work sleep disorder (and narcolepsy).  I do not recommend the use of this prescribed agent to maintain alertness by police officers.  It is relatively new to the market and more needs to be learned before it can be said to be 100% safe for professions which require a high state of alertness with few side effects.

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