fatigue risk management system for the canadian aviation industry

Fatigue Risk Management Systemfor the Canadian Aviation Industry

Fatigue ManagementStrategies forEmployees

TP 14573E

April 2007

edu.au

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Project Team

Edu.au Transport CanadaKirsty McCulloch Isabelle Marcil, Transportation Development Centre (TDC)Angela Baker Jacqueline Booth-Bourdeau, Civil AviationSally Ferguson Mark Laurence, Civil AviationAdam Fletcher TDC Communications UnitDrew Dawson

Notices

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Transport 2008

All rights reserved. This document may be reproduced in part or in whole and by any means only in the context of personal or public non-commercial use only. Any other use or any modification of this documentis strictly forbidden under the applicable copyrights law without prior written permission of TransportCanada. Please contact the Civil Aviation Communications Centre at 1-800-305-2059 (EST) for assistance. The information in this publication is to be considered solely as a guide and should not be quoted as or considered to be a legal authority. It may become obsolete in whole or in part at any time without notice.

Transport Canada does not endorse products or manufacturers. Trade or manufacturers’ names appear inthis report only because they are essential to its objectives.

Une traduction de ce document est également disponible en français : «Système de gestion des risques liés à lafatigue pour le milieu aéronautique canadien : Stratégies de gestion de la fatigue pour les employés», TP 14573F.

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Preface

This document is part of the Fatigue Risk Management System (FRMS) Toolbox forCanadian Aviation developed by Transport Canada and fatigue consultants edu.au ofAdeliade, Australia.

The FRMS toolbox includes the following components:

1 FRMS for the Canadian Aviation Industry: An Introduction to Managing Fatigue, TP 14572E: introductory material intended to raise awareness about fatigue

2. FRMS for the Canadian Aviation Industry: Fatigue Management Strategies for Employees,TP 14573E: provides the knowledge and skills required to apply appropriate fatiguemanagement strategies at the individual level

3. FRMS for the Canadian Aviation Industry: Employee Training Assessment, TP 14574E: anoptional module intended to assess employee competence in topics covered in theFatigue Management Strategies for Employees workbook

4. FRMS for the Canadian Aviation Industry: Developing and Implementing a Fatigue RiskManagement System, TP 14575E: explains how to manage the risks associated withfatigue at the organizational level within a safety management system framework

5. FRMS for the Canadian Aviation Industry: Policies and Procedures Development Guidelines,TP 14576E: proposes a policy structure while providing examples and guidelines tohelp organizations through the process of designing fatigue risk management policies and procedures

6. FRMS for the Canadian Aviation Industry: Fatigue Audit Tools, TP 14577E: provides anoverview of tools available to employers to help determine whether scheduling provides employees with adequate opportunities to get sufficient sleep.

7. FRMS for the Canadian Aviation Industry: Trainer's Handbook, TP 14578E: in addition toa training presentation on fatigue, fatigue management systems, and individualfatigue management strategies, the package includes background information fordelivery of the workshop, learning outcomes, and questions frequently asked by participants

These documents are available on the Transport Canada web site at www.tc.gc.ca

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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Why a training program on fatigue risk management? . . . . . . . . . . . . . . . . . . . . . . . . .1What is the purpose of this workbook? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1How to use this workbook? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Will this program be assessed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

1. Working Non-Traditional Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Living in a 24-hour society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Body clock (circadian rhythms) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Individual differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

2. Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7What is fatigue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Symptoms of fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Consequences of fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11How big a risk is fatigue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11High risk times for fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

3. Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13What is sleep? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Recovery sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Age and sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Setting up your bedroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

4. Napping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21The benefits of napping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Sleep inertia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Contents

5. Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Why think about food to manage fatigue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Digestion and hunger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Controlling blood sugar with food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Low-fat protein strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Where to from here? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28Case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

6. Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Can hydration affect alertness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32Contributors to dehydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32Case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

7. Caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35What is caffeine? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Strategic use of caffeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

8. Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39What is alcohol? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Accident risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Metabolizing alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42A standard drink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Alcohol and sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Alcohol and performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

9. Nicotine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45What is nicotine? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46Nicotine withdrawal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

10. Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49Prescription drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50Over-the-counter drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50How drugs work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Sleeping pills and sedatives (benzodiazepines) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

11. Well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55Gastrointestinal problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57Pregnancy and reproductive health in women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

12. Physical Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59Establishing a routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60Benefits of exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

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13. Social/Family Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63Unsocial hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64Coping strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

14. Commuting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67Commuting as a hazard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68What can be done? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68Case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

15. Work Schedule Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71Shiftwork on the rise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72Work schedule design as a countermeasure to fatigue . . . . . . . . . . . . . . . . . . . . . . . . .72Employer and employee responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73Different types of shifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

16. Jet Lag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Jet lag and the body clock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78Effects of jet lag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78Easing the effects of jet lag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

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family or social impacts of such hourscould result in shift patterns that compro-mise any potential benefits. Appropriateand efficient management of the work-force is crucial to meeting the demands ofthe Canadian Aviation Regulations, aswell as ensuring high levels of work siteproductivity.

What is the purpose of this workbook?

This workbook aims to provide theknowledge and skills to help you to adoptappropriate fatigue management strate-gies.

More specifically, you will learn how to:

• monitor potential causes of fatigueand devise action plans to minimizetheir effects in accordance with com-pany procedures;

• identify personal warning signs offatigue and appropriate counter -measures in accordance with work-place procedures to ensure thateffective work capability and alertnessare maintained;

Fatigue Management Strategies for Employees 1

Why a training program onfatigue risk management?

Transport Canada is committed toimproving aviation safety through themanagement of fatigue-related risks. Tothis end, a set of tools was developed tosupport the Canadian aviation industryin implementing Fatigue RiskManagement Systems (FRMS) withinSafety Management Systems.

An important part of an FRMS consists oftraining all employees in the managementof fatigue as a safety hazard. To achievethis goal, the tools developed include var-ious training materials that are designedto meet the business needs of participat-ing organizations and the skills develop-ment needs of their employees in relationto fatigue risk management.

Managing human resources has alwaysbeen a demanding task and now morethan ever industry must acknowledge theunique needs of employees who workoutside the Monday-to-Friday, 9-to-5 schedule. Non-traditional work sched-ule designs have benefits for employersand employees. But decisions made with-out thorough knowledge of the safety and

Introduction

Will this program beassessed?

Depending on the training format chosenby your company, you may have to com-plete an assessment to receive a certificateof completion for this course. Your traineror supervisor will inform you whether anassessment process will be used and itsexact format. An assessment can take var-ious forms, including:

• If your training program includesclassroom delivery for this course, theassessment could include group andcase study exercises (written and oral)to reinforce the course content.

• By completing the exercises in eachchapter of the workbook, you maydemonstrate that you are able toapply this learning to your individualwork situation. This may be endorsedby the assessor or your supervisor.

• You may be asked to complete anassessment exercise to show that youhave retained knowledge andacquired skills from this training. Thisinvolves answering questions on thecontent of this workbook (similar tothe exercises and knowledge checks).

• Skill achievement may also be demon-strated through maintaining a candi-date’s log. This process requires youto record how you have applied theskills learned during the course inyour specific work situation and dailylife.

• make positive lifestyle choices to pro-mote the effective long-term manage-ment of fatigue;

• adopt and apply effective practicesand countermeasures for combattingfatigue; and

• communicate your personal fatiguemanagement strategies to relevantpeople.

How to use this workbook?

This workbook involves a combination oftheory and practical strategies related toboth work and non-work situations. Thisstudy guide will be your reference duringyour training.

Each chapter begins with a list of learningoutcomes. These are provided to organizethe training around clearly defined out-comes that students are expected todemonstrate on completion. The contentof each chapter includes backgroundinformation on the featured topic andrelated practical strategies to minimizethe effects of non-traditional work hoursand fatigue. Topics covered include sleep,nutritional, physical, social, and workdesign strategies to minimize the risk offatigue.

Exercises are provided throughout theworkbook. Students are asked to demon-strate they can apply the knowledgelearned to everyday situations by com-pleting the exercises provided in eachchapter. Knowledge checks are alsoincluded at the end of each chapter toallow students to verify whether theyneed to review some of the content.

Fatigue Risk Management System for the Canadian Aviation Industry2

Learning Outcomes

After reading through this chapter, youshould be able to:

• Explain positive and negative impactsthat non-traditional hours of work canhave on you.

• Identify individual differences thatinfluence the capacity to adapt to non-traditional hours of work.

CHAPTER 1

Working Non-Traditional

Hours


Living in a 24-hour society

We live in a 24-hour society where manydifferent work patterns have developedbeyond the traditional Monday-to-Friday,9-to-5 routine. An increasing proportionof the workforce is engaged in shift workand non-traditional schedules. Between15 and 30% of the workforce of industrial-ized countries is engaged in shift work. InFinland, 25% of the working populationare shift workers, while in Singapore thatfigure is closer to 32%. In Canada, approx-

imately 30% of workers are employed insome form of shift work.

Working shifts work or non-traditionalhours involves more than just a workschedule. It is a way of life with a funda-mental impact on not only work, but sleeppatterns and the management of health,family, and social lives. Research alsoindicates that shift work affects physicaland mental health, as well as work per-formance.

CHAPTER 1

Working Non-Traditional Hours

What are some of the personal difficulties that you or some of your co-workers have experienced as a result of shift work or non-traditionalworking hours?

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themselves trying to sleep and eat at timeswhen their body is not programmedto do so. This is why, in the long run, shiftworkers are more likely to experiencefatigue due to sleep disruption and gastro -intestinal problems.

Performance

Work hours influence a person’s ability toperform in a given situation. Other factorsplay a role as well, such as the type of taskto be performed, motivational effects, indi-vidual differences among workers, andhow well workers adjust to changes in rou-tine. Unlike health effects, deterioration inperformance can occur very soon afterbeginning to work certain hours. The neg-ative effects on performance can be worsein jobs that require sustained attention,extended hours, or high-risk tasks.

Can you think of positive and negative effects of these work hours onhealth, lifestyle, safety, or well-being?

Positive effects Negative effects

Some shifts (such as night shifts) are more likely to be harmful tohealth than others (see Chapter 15 for the different types of shifts andtheir impact on the worker). The effects of a particular shift depend onwhen it falls within a 24-hour period and the disruption it causes toyour body clock.

Body clock (circadian rhythms)

One of the most predictable environmen-tal variations to which the body mustrespond is the cycle of night and day. Thiscycle relates strongly to why we feelsleepy at night and awake during the day.Many body rhythms, such as sleepinessand wakefulness, secretion of digestiveenzymes, hormone production, and bodytemperature operate on a 24-hour cycle.These are called circadian rhythms.

These normal biological rhythms do notadjust easily to a pattern imposed by workschedules unless the schedule is day work.On the whole, most people find working atnight more difficult than working duringthe day. This is because these schedules aremore likely to disrupt sleep/wake patternsand other biological rhythms. People find

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Individual differences

The impact of a schedule varies from oneperson to another. Exercising, eating abalanced diet, having good sleepinghabits, and using effective time manage-ment strategies are all behaviours thathelp in better coping with shift work.More information is provided in the fol-lowing chapters on how these factors canreduce the impact of shift work.

Coping with shift work and fatiguebecomes increasingly difficult with age.This is in part because the body’s physio-logical systems become gradually lessable to adapt. However, as we age, ourpast experiences and the strategies wehave developed to manage and cope with

the demands of non-traditional workhours may help to counter some of thephysiological effects of aging.

The ability to cope with shift work alsodepends on an individual characteristicrelated to circadian rhythms. People canbe categorized either as morning orevening types depending on the momentof the day when they perform at theirbest. Morning people will better adapt toearly morning hours but will have moretrouble coping with night work. Eveningtypes cope more easily with evening andnight shifts. They tend to cope better withshift work overall since they generallyhave less rigid sleep habits and find it eas-ier to catch up by sleeping late in themorning.

Knowledge Check

• Name three aspects of your life that can be affected bynon-traditional hours of work.

• Name two types of biological rhythms that are regulatedby the body clock.

• Name three personal characteristics that influence theimpact of non-traditional hours of work on a person.

Learning Outcomes


• Describe what fatigue is.• Name factors that contribute to fatigue.• Identify signs of fatigue.• Name the times of day when fatigue is

at its highest level.

CHAPTER 2

Fatigue


What is fatigue?

Fatigue is an experience of physical ormental weariness that results in reducedalertness. For most people, the majorcause of fatigue is not having obtainedadequate rest or recovery from previousactivities. In simple terms, fatigue largelyresults from inadequate quantity or qual-ity of sleep. This is because both the quan-tity (how much) and the quality (howgood) of sleep are important for recoveryfrom fatigue and maintaining normalalertness and performance. Furthermore,the effects of fatigue can be made worseby exposure to harsh environments andprolonged mental or physical work.

Inadequate sleep (quality or quantity)over a series of nights causes a sleep debt,which results in increased fatigue that cansometimes be worse than a single night ofinadequate sleep. A sleep debt can only berepaid with adequate recovery sleep.

Working outside the Monday-to-Friday,9-to-5 routine can limit the opportunityfor sleep and recovery in each 24-hourperiod. It can reduce the amount of sleepyou get by between one and three hours

per day. This is because these hours ofwork:

• limit the amount of time available forsleep

• disrupt the body clock, which is pro-grammed for activity during the dayand sleep at night

In addition to sleeping less, people whowork non- traditional hours often obtainsleep of a lower quality.

In the current 24 hour, 7 day a week (24/7)society, there are many reasons that work-ers don’t obtain the quality or quantity ofsleep that they require to be adequatelyrested. Some of these reasons are workrelated and some are non-work related.Examples of work-related fatigue factorsare:

• hours of work (especially night work,early morning starts, and high totalnumber of hours)

• task demands or time pressures thatdo not allow for adequate breaks dur-ing shifts

• working conditions that may com-pound fatigue (for example, heatstress and time pressures)

CHAPTER 2

Fatigue


list. If you experience two or more of thesymptoms listed, you may be experienc-ing some level of fatigue or reduced alert-ness. Fatigue is not the only cause of allthe symptoms, but when they occurtogether it likely indicates fatigue-relatedimpairment.

If you exhibit fatigue-related symptomson a regular basis, you should considerseeing an appropriate medical specialist.This is particularly important for individ-uals with a body mass index greater than30 and a neck size greater than 40 cm,since they have a significantly higher riskof sleep apnea.

Symptoms of fatigue

In general, we are poor judges of our ownfatigue levels. It’s difficult to tell when ourfatigue has reached a point where it’s nolonger safe to work or drive. However,there are signs or symptoms that can beused as a gauge.

Fatigue-related symptoms can be dividedinto three categories: physical, mental,and emotional. The diagram on the fol-lowing page outlines some of the majorsymptoms in each category. Dependingon the type of work being conducted,there may be some task-specific indica-tors of fatigue that can be added to this

Examples of non-work-related fatiguefactors include:

• undiagnosed or untreated sleep dis -orders

• individual family or social factors thattake priority over sleep

Identify at least two causes of work-related fatigue that have affectedyou during your working life.

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Symptoms of fatigue

Circle any of the above symptoms that have significantly affected you inthe past. Reflect on these symptoms and indicate how they have affect-ed your work.

• Yawning• Heavy Eyelids• Eye-rubbing• Head drooping• Microsleeps

Ph

ysi

cal

Sym

pto

ms

• Difficulty concentrating on tasks

• Lapses in attention• Difficulty remembering

what you are doing• Failure to communicate

important information• Failure to anticipate

events or actions• Accidentally doing

the wrong thing• Accidentally not doing

the right thing

Men

tal

Sym

pto

ms

• More quiet or withdrawn than normal

• Lacking in energy• Lacking in motivation

to do the task well• Irritable or grumpy

behaviour with colleagues,family, or friends

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0.05% --the legal driving limit in manycountries.

• A person who wakes at 7 a.m. andthen stays awake for 23 hours until 6a.m. the following day will have a per-formance as impaired as someonewith a BAC of 0.10% -- more than thelegal limit of 0.08% in Canada.

Although there are differences betweenbeing fatigued and being drunk, thisresearch provides valuable information.One night of sleep deprivation can leaveyou more impaired than would be accept-able for driving a vehicle.

High risk times for fatigue

There are particular times of the daywhen the risks associated with fatigue areincreased, regardless of the relationshipbetween fatigue and recovery sleep. It isimportant to understand these risks whenmaking decisions about hours of work,hours of overtime, contingency planning,and emergency responses.

Times when fatigue levels increase are:

• midnight to 6 a.m. (and especially 3 a.m. to 5 a.m.). This is the low pointin the body’s circadian rhythm thatgoverns alertness and performance.

• the beginning and end of shift whenhandover occurs. Fatigue levels canaffect communication.

• when breaks have not been taken for anumber of hours. Employees whohave been on duty longer may haveaccumulated fatigue.

Consequences of fatigue

A fatigued individual is often impairedand can’t continue to perform tasks safelyor efficiently. For example, fatigue canaffect your ability to:

• react quickly in emergency situations• communicate clearly with fellow

employees • work productively

Fatigue and falling asleep have been identified as significant contributors to incidents and accidents in a wide cross-section of industry. This relationship hasbeen well supported by evidence fromorganizational and government investiga-tions as well as industrial risk data. Theincidents and accidents that result fromfatigue can be severe and include fatali-ties, but are most often associated withemployee injury or equipment damage.

How big a risk is fatigue?

In recent years, researchers have com-pared effects on performance of alcoholand fatigue. While most people under-stand that alcohol intoxication can be asignificant risk on the roads, the effects offatigue are not generally understood oracknowledged.

Studies have found:

• The performance of a person whowakes at 7 a.m. and stays awake for 17 hours until midnight will be asimpaired as that of someone with ablood-alcohol concentration (BAC) of


• early shift starts (before 6 a.m.). Earlystart times shorten sleep obtained thenight before if you either neglect to goto bed earlier in compensation, or“clock watch” because you are anx-ious about getting up on time.

• when employees are new to the job orworkplace. Learning the new job and

getting to know the environment andpersonnel is stressful. People may findthey do not sleep as well during thefirst week or so of a new job whilethey become accustomed to the newworkplace, role, commute, and hours.

Describe one or more safety hazards you have witnessed in your workenvironment as a result of any of the above situations.

Knowledge Check

• What are two major causes of fatigue?• Name four symptoms of fatigue.• Compare performance in the following situations:

- Being awake for over 17 to 23 hours- Being under the influence of alcohol

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Learning Outcomes


• Describe the general functions ofsleep.

• Explain the consequences of sleepdeprivation.

• Explain ways of establishing a sleep-ing environment that can promoteyour sleep.

CHAPTER 3

Sleep

Sleep cycles and sleep structure

Sleep varies through the night; it is notuniform. The various sleep stages followeach other in a continuous cycle that lastsbetween 90 and 120 minutes. Each cycle iscomposed of five sleep stages. Stage 1 iswhere we fall asleep. During this stage,you may occasionally experience muscletwitches or starts. Stage 2 is a light sleepstage, when you are easily awakened.Stages 3 and 4 are deep sleep stages.These stages are considered to be thosewhere the body regenerates. People aredifficult to waken during these stages.The final stage is known as REM sleep, forrapid eye movement. If you were toobserve a person in this stage of sleep,you would notice their eyes movingunder their eyelids, and possibly somemuscle twitches. This is the stage of sleepwhen we dream. This stage of sleep isimportant in learning and in memoryconsolidation.

Early in the night, we spend more time instages 3 and 4 of each sleep cycle. As thenight progresses, we spend more time inREM sleep. Whenever we are sleepdeprived, our body will try first to catchup on deep sleep (stages 3 and 4) and

What is sleep?

Sleep is defined as a state of partial or fullunconsciousness during which voluntaryfunctions are suspended and the bodyrests and restores itself.

Despite the obvious importance of sleep,its specific function is not fully under-stood. In a broad sense, it is thought thatduring sleep the mind and the body“recover” from the stresses of the day and“prepare” for those to come. Informationabout the function of sleep has mainlycome from studies depriving animals andhumans of sleep.

Prolonged sleep deprivation of animalsover two to three weeks resulted in skinlesions, weight loss, and ultimately death.In humans, prolonged sleep deprivationleads to reduced mental and physical per-formance and symptoms such as handtremors, slurred speech, and increasedsensitivity to pain.

Both the quality and quantity of sleep aredetermined largely by the timing of sleepin the 24-hour day. Human beings areprogrammed to sleep during the nightand to be active during the day.


CHAPTER 3

Sleep


REM. A person who is sleep-deprived willquickly fall asleep, and move rapidlyfrom light sleep (stages 1 and 2) to deepslumber (stages 3 and 4).

Stage 1

Stage 2

Stage 3

Stage 4Stage 3

Stage 2

REM Sleep

90 to 120 min.

The human sleep cycle

Adapted from Shifting to Wellness, Keyano College, 1995.

Can you recall any situations where you have suffered from sleep depri-vation? Please provide details.

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Recovery sleep

Unwanted sleepiness and fatigue can beconsidered an annoyance -- and a dangerunder certain circumstances. It can befatal, for instance, while driving a vehicleor flying an aircraft.

Many strategies have been identified toreduce the likelihood or consequences offatigue. Some are discussed later in thisworkbook, such as the use of caffeine orbeing more aware of what you eat. Moreextreme examples include the use ofamphetamines and other stimulants.However, such strategies are only a tem-porary fix, no matter how effective theyare. At some stage, sleep must beobtained for physical and mental recov-ery to occur.

The exact amount of sleep that each per-son needs every 24 hours to perform opti-mally differs, but in general it’s between 7and 9 hours. The need for sleep does notdiminish as we get older, even thoughsleep may prove more difficult to obtain.Most people go to sleep naturallybetween 10 p.m. and 8 a.m. Older peopletend to go to sleep earlier than youngerpeople. Sleep is most valuable if obtainedin a single block. However split sleep, or anumber of short sleeps, is better than notgetting any at all. A short sleep or nap canprovide a powerful boost to alertness.However, it is important to know thatnapping does not eliminate the need forsleep. There are other considerationsrelating to napping covered in Chapter 4.

Approximately how many hours of sleep do you get (on average) perday?

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traditional hours of work difficult. Recentresearch suggests that an aging bladdercan contribute to sleep disturbancesbecause it causes you to wake up more often to visit the toilet. Along withother age-related changes, this can causemore frequent awakenings across thesleep period. Frequent awakenings canlead to increased sleepiness when you areawake.

Age and sleep

As we get older it becomes physicallymore difficult to stay asleep during asleep period without waking up. This isparticularly true during daytime sleep,but even nighttime sleep may prove to bemore difficult as we get older. Fallingasleep and poor sleep are not the onlyage-related changes that make non-

Have you noticed any significant changes in sleep patterns, either inyourself or in an acquaintance, that appear to be related to age? If so,what are they?

Does the amount of sleep that you normally get vary with the differentshifts that you work? If so, please explain.

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ened out. For example, many peoplehave success using a white noisesource such as a fan, air conditioner, orrelaxing CD on “repeat.” Ear plugs canbe of use if you can sleep with them in.They are especially useful if you aresleeping away from home. Manyworkplaces supply foam ear plugs,and you can buy more solid silicone-based plugs at a drugstore or sportinggoods store.

• Minimize caffeine and alcohol intakein the hours before bedtime. Caffeineacts as a stimulant to keep you moreawake. The stimulating effects of caf-feine can last up to six hours. In addi-tion, both caffeine and alcohol arediuretics, substances that flush waterfrom your body. That is, they makeyou more likely to wake up to go tothe toilet.

• Set up a “thermo-neutral” zone. Thebody sleeps best when the environ-mental temperature is between 18 and24°C. If you are too cold or too hot,your body will wake up to control itstemperature more efficiently. Athermo -neutral zone is best set upusing good placement of the bedroomin the house, good use of insulation,and using an air conditioner or heaterwith a thermostat.

• Don’t panic if you can’t get to sleep.Most people have days when they can’tsleep. Staying in bed, trying your hardest to get to sleep is unlikely tohelp, and may even make sleep moredifficult. If you cannot sleep within 30minutes, get out of bed and do some-thing relaxing instead of staying in bedand being frustrated with yourself.

• Establish a pre-bed routine, includingquiet/relaxing activities. Each bed-

Setting up your bedroom

Obtaining adequate sleep can sometimesbe a challenge, even in the most ideal cir-cumstances. From both a biological andsocial perspective, sleeping during the daycan cause the greatest difficulty. This isrelated to the body’s biological program-ming to be awake during the day, as wellas the fact that it is noisier and brighterduring the day. In addition, you may havemore pressures on your time during theday. While some of these things are hard tochange, you can set up your bedroom tomaximize your chances of getting sleepwhen you have the opportunity.

Things you can do to your bedroominclude:

• Block out as much light as possible.This might involve the use of blackoutcurtains, roller shutters, heavy blinds,or even an inexpensive option such asblack plastic.

• Use your bedroom only for sleep,relaxation, and sex. Remove workdesks, home offices, computers, andeven televisions.

• Control the noise that enters yourbedroom. This can be done usingphysical barriers such as roller shutters, double glazed windows, andinsulation, but it can also be managedby simply placing a sign on the doorwhen you are sleeping. Unless you areon call, you should also turn down thetelephone so that it does not disturbyour sleep.

• Reduce the disruptive noise that entersyour bedroom. In addition to the phys-ical barriers listed above, there areother ways that noise can be damp-



Insomnia

Insomnia generally refers to difficultyfalling asleep or staying asleep. A fre-quent medical complaint, it is the mostcommon type of sleep problem. Rates ofinsomnia are higher in shift workers andpeople who work non-traditional hours.

Insomnia is usually defined as being tran-sient (lasting up to one week), short-term(lasting weeks to months), or chronic(lasting longer than three months).

have a sleep disorder. Signs like mak-ing choking sounds or stoppingbreathing regularly during your sleepare classic symptoms of sleep apnea, abreathing-related sleep disorder thatcan reduce your capacity to stayawake when you are at work, driving,or engaged in other activities.

time, do the same activities in thesame order. For example, shower,clean your teeth, and lock the door. Itdoesn’t matter how many things youdo, so long as they are always thesame and in the same order each time.This trains your body to associatethese activities with falling asleep.

• Consult with your doctor if you sus-pect -- or have been told -- that you

Are there any improvements you could make to the way your bedroomis set up? What are they?

Treatments focus on chronic insomniabecause most people experience transientor short-term insomnias several times ayear.

There are many potential contributors toinsomnia. These include work hours, lifestressors, age, and sleep environment.Treatments may involve changes toschedules, habits, and lifestyle. The use ofdrug treatments is controversial and ismost useful for transient or short-terminsomnia.

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Knowledge Check

• How could Damien improve his sleep?• Who should Damien see regarding his sleeping problem?• On average how many hours of sleep should you ideally get

each night?• How can “white” noise positively affect sleep?• What room temperature range is most suitable for promot-

ing sleep?• Explain the positive effect of a pre-bedtime routine.

Damien is 51, married and has three grownchildren. He has spent 18 years working shiftsas an aircraft maintenance engineer. He drives45 minutes each way to work his 12-hourshifts.

Recently, Damien drove off the road on hisway home from work at 5:45 a.m. Although

it’s normal to be tired after working a night shift, it was the fourth timein the past six months and this time it scared him. He stopped the vehicle, and walked around outside in the cold air before he continuedhome.

Although he has been avoiding talking to his doctor about a possible sleepdisorder, this latest incident was the trigger for Damien to make anappointment. His wife, Tonia, has been telling him for nearly two yearsto do something because his stories about nearly falling asleep at work oron the way home from work scared her. Damien thought he could avoidan accident, but now realizes that he could hurt himself or others if hedoes not get help.

Case study

Learning Outcomes


• Discuss the benefits of napping.• Describe the short-term way that

sleep inertia may compromise thebenefits of a nap.

CHAPTER 4

Napping


The benefits of napping

Short sleeps or naps can deliver most ofthe benefits of longer sleeps over a short-er time frame. These benefits can includeimproved short-term memory, increasedperformance, improved alertness, andimproved reaction time. But the benefitsof naps do not generally last as long as thebenefits gained from longer sleeps.

Naps as short as 10 or 15 minutes candeliver measurable benefits. In general,the longer the nap is, the more beneficialit will be in terms of recovery andimprovements in performance.

Some research suggests that the time ofday you take a nap also affects its recov-ery value. Other research suggests thatthis is not the case and that getting anysleep is much more important than thetime the nap is taken. Take naps in theway that you believe best suits you. Keepin mind that a nap can negatively affectyour chances of sleeping later that day ornight.

CHAPTER 4

Napping

Is napping permitted in your workplace? If yes, under what circum-stances?

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no effective way to eliminate or reducethe effects of sleep inertia. Sleep inertiatends to last longer when you:

• are woken up as opposed to wakingnaturally from sleep

• wake up or are woken up from deepsleep compared to light sleep -- this ismore common following longersleeps than shorter naps

• wake up or are woken up at the lowpoint of the circadian rhythm (gener-ally between midnight and 6 a.m.)

• wake up or are woken up after a napfollowing a period of sleep deprivation

Sleep inertia

While both long sleep periods and nap-ping are highly beneficial for a widerange of reasons, it is important to under-stand that your performance and alert-ness may be impaired for a while afteryou wake up. Most people experience aperiod of confusion when they wake orare awakened from sleep. This state isknown as sleep inertia and generally lastsbetween five and 20 minutes. You shouldminimize activities that would be sensi-tive to sleep inertia (such as driving) for20 minutes after waking up.

Exactly how long sleep inertia lastsdepends on a number of factors. There is

Is napping a strategy that you could benefit from? If so, how could youapply it?

Knowledge Check

• Explain what sleep inertia is.• Name two benefits of napping.

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Learning Outcomes


• Describe the glycemic index.• Distinguish high, intermediate, and

low glycemic index foods.• Explain the impact of these foods on

alertness.• Explain how digestion and hunger are

affected by non-traditional hours ofwork.

CHAPTER 5

Food

nal upsets are very common in peoplewho eat outside of traditional meal times.These upsets can be worsened by drink-ing tea, coffee, or alcohol. Research hasfound that night workers are five timesmore likely to get peptic ulcers than dayworkers.

Many people working outside traditionaldaytime hours also notice that theirhunger patterns change and that they gethungry at unexpected times of the day.

Controlling blood sugar with food

Given that non-traditional hours of workaffect digestion and hunger, it is not sur-prising that it is difficult to keep yourblood sugar stable under such circum-stances. A stable blood sugar level is animportant ally in minimizing the ups anddowns in energy levels that are commonfor shift workers.

The belief that snacks loaded with sugarcause a fast rise and fall in blood sugar hasbeen recently disproved. The way bloodsugar levels react to different foods isknown as the glycemic index (GI) of foods.

Why think about food tomanage fatigue?

As discussed elsewhere in this workbook,the ability to stay awake is largely relatedto whether you have had adequate restand recovery. However, there are otherfactors that may contribute to feelingweary, sluggish, and more tired in gener-al. One of these is low blood sugar. Manypeople underestimate or are unaware ofthe affect of low blood sugar on their abil-ity to stay alert and safe.

Digestion and hunger

As humans, we are programmed to beawake during the day and asleep at night.Many other processes also follow this pat-tern, including digestion. Digestion isprogrammed to be most efficient duringthe day and much less so at night. This isbecause digestive juices (stomach acidsand enzymes) are mainly secreted duringthe day.

Food eaten at night is digested at a slow-er rate. This can often lead to feelingbloated or constipated and can causeheartburn and indigestion. Gastro intesti -

CHAPTER 5

Food



High GI foods make your blood sugarlevels rise and fall quickly, whereas lowGI foods make your blood sugar level riseand fall slowly. High GI foods are idealwhen you have been doing physical workor exercise and need energy quickly torecover. Low GI foods are ideal to keep analready stable blood sugar level frombecoming too high or low. Low GI foodsare also ideal for raising blood sugarslowly and avoiding the fast drop inblood sugar (and energy) that can occurafter eating high GI foods. Low GI foodsare ideal as regular snacks across a shift tohelp avoid big changes in your energylevels.

Research into GI foods also holds impor-tant implications for people with dia-

betes. In general, medical practitionersrecommend that diabetics avoid high GIfoods to help regulate blood sugar levels.But high GI foods can be useful as a pick-me-up for non-diabetics, particularly afterphysical work or exercise. More oftenthan not, however, low GI foods will bemore useful in your day-to-day life.

Low-fat protein strategies

Research also suggests another eatingstrategy for shift workers: evidence showsthat eating low-fat protein foods can helpyou stay awake. This is due to a processinvolving the amino acid tyrosine andleads to increases in the levels of stimulat-ing chemicals in your body.

White or whole grain bread Cornflakes or Coco Pops

DoughnutsMuffins

Examples of high GI foods

Oranges or orange juiceBaked beansFruit bread

All bran, porridge, muesli

Examples of low GI foods

BananaBasmati rice

Rye or high-fibre breadFull-fat ice cream

Examples of intermediate GI foods

Low-fat dairy productsHard boiled eggs

Examples of low-fat protein foods

Baked or mashed potatoCakes

Breakfast barsPancakes

White or quick brown riceFrench fries

Rice crackersPuffed corn or rice cakes

Noodles or pastaApples or apple juice

GrapesOat bran or grain bread

Low-fat yogurtLentils

ChocolatePeanuts or cashews

Sweet cornSoft drinks

CookiesCranberry juice

SugarPineappleWeetabix

Flavoured milk drinks

Protein shakesLentils

Cooked and canned fishLean chicken, beef, or lamb


What type of GI foods do you normally consume at work or beforework: high, intermediate, or low? Give examples.

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low and intermediate GI foods along withsome good quality protein is most benefi-cial. In addition, it is important to consid-er the level of fibre in your diet (fromfresh fruit and vegetables) as well as thelevels of minerals and salt. The recom-mended daily salt intake is 3.8 grams perday to replace the amount lost dailythrough perspiration and to ensure yourdiet provides sufficient amounts of otheressential nutrients. However, any moresalt than this can result in high bloodpressure, which can lead to stroke, heartdisease, or kidney disease.

Where to from here?

It is likely that at least some of the infor-mation in this chapter is new to you. Youmay have picked up some fresh strate-gies. Try things for a while and see howthey work for you. Keep in mind that youare more likely to notice a differenceusing these strategies if you apply themwhen you are tired.

It is also important to maintain a balanceddiet. In general, the evidence suggeststhat a low-fat diet comprised mainly of


Knowledge Check

• Why might Jeff experience stomach problems after eating aheavy meal on the night shift?

• What changes might Jeff make to his diet to help reduce hisstomach problems?

• Why are low GI foods generally appropriate when workingshifts?

• What effect does a stable blood sugar have on energy levels?

Jeff is a 58-year-old maintenance engineerwho has been working in the aviation industrysince he was 16 years old. His three childrenare grown up and have their own homes andfamilies. Jeff and his girlfriend Lisa have beentogether for seven years.

Lisa prepares Jeff’s meals. When he has a nightshift, afternoon shift or an early morning shift, she packs whatever theywould have eaten had they been together. Jeff cooks his meals in thekitchen at work and often prepares steak and eggs, reheats meatloaf, orroasts pork chops. This is the way things were before Lisa was around,and this is the way they have stayed.

The problem is that in the last few years, Jeff has been getting really badstomach pains whenever he eats a heavy meal on the night shift. Jeff hasonly a few more years until he plans to retire and he doesn’t want tochange the way he does things now. Jeff’s doctor has been saying that thepains are associated with the type of food that he eats on nights, but Jeffthinks he’ll be okay.

Jeff actually has a serious case of peptic ulcer. It’s unfortunate that Jeffdoesn’t listen to his doctor because ulcers can be treated quite easily withdiet changes and short-term daily medication.

Case study

Learning Outcomes


• Explain why being hydrated is impor-tant for alertness.

• Name factors that contribute to dehy-dration.

• Determine whether you are drinkingenough water daily to stay hydrated.

CHAPTER 6

Water


Can hydration affect alertness?

As mentioned earlier in this workbook, itis not just sleep that affects your alertness.Examples have been provided related todigestion and food. Similarly, hydrationhas an affect on your ability to feel alertand be safe.

When your body is low on water, it triesto conserve what you have left. It doesthis by reducing your activity and makingyou relax and slow down. When you arerelaxed, you have a higher chance offalling asleep. Being dehydrated can alsomake you feel lightheaded and causeheadaches.

Most people do not drink enough waterto be fully hydrated. In extreme cases, thiscan result in medical problems, includingkidney problems. In most cases, however,the effects of dehydration are short termand are easily solved by drinking morewater.

Contributors to dehydration

The recommended daily intake of water istwo litres or eight glasses. Drinking lessthan this contributes to dehydration.There are other factors that can causedehydration, even if your daily intake ofwater is adequate. Some of these factorsinclude:

• Performing physically demandingtasks

• Drinking a lot of caffeinated drinks.Caffeine is a diuretic, a substance thatactively flushes water from your body

• Working in hot environments• Drinking alcohol, which is also a

diuretic• Drinking soft drinks, which may not

provide the same degree of hydrationas plain water

• Eating foods that are high in salt,which require additional water to beprocessed through the body

CHAPTER 6

Water


To be as alert and awake as possible, youneed to be aware of your water intake. Forsome people, this may mean doublingtheir fluid intake or more. Surprisingly,many people find that when they drinkmore water they feel more alert but don’tgo to the toilet any more often -- theirurine output is simply higher each time.

Another problem can be the availability ofwater in the workplace. For example,many employees who drive vehicles for aliving do not have access to water unlessthey bring it with them.

What sort of fluids do you drink at work?

Approximately how much water do you drink at work?

Based on what you have just read, do you think you need to make anychanges in your drinking habits? Provide details.

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Knowledge Check

• Why might Terry have to go to the toilet more frequentlywhen he drinks caffeinated drinks?

• What effects do alcohol and caffeine have on water in thebody?

• How does water affect alertness?• On average, what is the minimum amount of water you

should drink every day?

Terry is a 52-year-old pilot who has been fly-ing for 24 years. He flies 100 to 110 hours permonth at all hours of the day.

A while ago, Terry’s friend suggested thatdrinking water might help him feel more alertwhile flying. She also recommended that hethink more about when he drinks coffee andalcohol.

Now Terry only drinks coffee when he is really tired. This way he reduceshis dehydration from caffeine but still gets its stimulating benefits. Terryalso drinks more water now but doesn’t need to go to the toilet any morefrequently. Although he was initially sceptical, these new strategies havehelped Terry feel more alert.

Case study

Learning Outcomes


• Explain the effect of caffeine on bodilyfunctions.

• Understand the effect of caffeine onalertness.

• Discuss the effect of caffeine on sleep.• Name symptoms of caffeine with-

drawal.

CHAPTER 7

Caffeine

What is caffeine?

Caffeine is an addictive drug. You may beaddicted to caffeine if you feel you cannotfunction without it and need to consumeit every day. Caffeine occurs naturally inmany plants including coffee beans, tealeaves, and cocoa nuts. It is also found inan array of food products and beveragessuch as chocolate and cola drinks.

If you drink caffeinated beverages, youare probably aware that caffeine perksyou up. If you are low on sleep and needto remain active, caffeine can make youfeel alert by blocking adenosine reception.Adenosine causes blood vessels to dilateand nerve cell activity to slow down,causing drowsiness. After drinking coffee, you may notice that your handsget cold, your muscles tense up, you feelexcited, and your heart beats faster.

It takes caffeine approximately 20 min-utes to enter your system, and the effectscan last up to six hours. You should avoidhaving your last caffeinated drink tooclose to bedtime. The stimulant effect mayreduce your chance of falling asleep.


Strategic use of caffeine

Most people don’t use caffeine as effec-tively as they could. They tend to drink itwhen they are not really tired, whichmeans the stimulating effect doesn’t havemuch impact. Regular caffeine consump-tion leads to increased tolerance, whichmeans that over time we get less effectfrom the same quantity. When you have ahigh tolerance to caffeine, drinking one ortwo cups when you are really tired maymake little difference to your alertness.

People who are addicted to caffeine oftenexperience withdrawal effects when theystop drinking it. These include a dullheadache that lasts from one to five days,irritability, nervousness, restlessness, andsleepiness. In extreme cases, nausea andvomiting have been reported.

To use caffeine more effectively, start bybeing more strategic about when youdrink it. Here are a number of tips on howto use caffeine to its best advantage:

• Avoid drinking caffeinated drinkswhen you are not tired. The caffeine

CHAPTER 7

Caffeine


• Be aware that caffeine usually getsinto your system within 20 to 30 min-utes and the noticeable effects lastapproximately 4 to 6 hours.

• Be aware of how much caffeine is indifferent foods and drinks (see tablebelow).

• If you do drink caffeinated drinks,increase your water intake to countercaffeine’s diuretic effect. You mayhave noticed that you need to urinatemore frequently when you drink caf-feinated drinks.

Most importantly, be strategic: the lesscaffeine you drink, the more effective itwill be when you need to use it to helpyou stay awake.

will have little effect and will con-tribute to increasing your caffeine tol-erance. Your body will get used tohaving it and, over time, you willneed to drink more to get the sameeffect.

• Avoid drinking caffeinated drinks inthe morning. The early part of the dayis a time when your body is wakingup naturally and, generally speaking,you will feel more awake as the morn-ing progresses. Using caffeine tospeed up the process simply increasesyour tolerance to it. One exceptionmay be if you have to get up reallyearly in the morning.

• Avoid caffeinated products for a fewhours before bedtime. Because caf-feine acts as a stimulant, it can makefalling asleep and staying asleep moredifficult.

Coffee (250 ml)• Instant 65-100 mg• Drip 115-175 mg• Brewed 80-135 mg• Espresso 100 mg

Caffeinated beverages(250 ml)• Coke 50 mg• Jolt 100 mg• Red Bull 80 mg

Level of caffeine in common substances

Tea (250 ml)• Green tea 8-30 mg• Normal 50-70 mg

Most chocolate bars• Approximately 20-40 mg

NoDoz, 1 regular strength tablet• 100 mg


Review your caffeine intake. Are there any changes you could make tothe way you use caffeine on the job?

Knowledge Check

• Why does caffeine loses its ability to improve your alertnessif you drink caffeinated drinks regularly?

• Name three tips you can apply to get the maximum benefitfrom caffeine as a stimulant.

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Learning Outcomes


• Discuss the effects alcohol has onalertness.

• Discuss the effects alcohol has onsleep.

• Explain how alcohol consumptionaffects performance.

CHAPTER 8

Alcohol

What is alcohol?

Alcohol is known to significantly impairperformance at moderate and high levelsof intoxication. Alcohol intoxicationgreatly affects the way you respond andinteract with your environment andincreases your risk of having an accident.

In many industrialized countries, work-places require a zero blood alcohol con-centration (BAC) for their employees. TheCanadian Aviation Regulations demandthat air crews not drink alcoholic bever-ages within eight hours of flying. In mostworking environments, employers cannottell employees how much alcohol they areallowed to consume away from work. Inorder to be well rested and fit for work,you need to understand how alcoholworks and how it influences sleep andalertness.

Alcohol is the second most widely con-sumed drug after caffeine. Alcohol is legalin most countries and is so common thatit is easy to forget that it is a drug and thatit can be dangerous if not used sensibly.

Alcohol is a central nervous systemdepressant. In small doses, it can make


you feel more relaxed and less inhibited.In larger doses, it makes you drunk andimpaired.

Alcohol reduces:

• environmental awareness• responses to sensory stimulation• mental functioning• physical activity.

In high doses, alcohol can produce:

• increased drowsiness• lethargy• amnesia• hypnosis • anaesthesia

Alcohol intoxication is one of the majorcauses of road accidents. Most countrieshave laws restricting people with a BACabove a certain level from driving, work-ing, or operating dangerous equipment.In Canada, a BAC of 0.08% or highermeans that driving is prohibited. Manyactivities in the aviation field have a zeroalcohol tolerance.

CHAPTER 8

Alcohol


At a BAC of 0.10 to 0.14%, there is a six- toseven-fold increase in the risk of a motorvehicle accident.

At a BAC of 0.15% and higher, there is a25-fold increase in the risk of a motorvehicle accident.

Accident risk

The table below details the effects of vari-ous blood alcohol levels. Alcohol progres-sively impairs your ability to perform anddramatically increases the risk of acci-dents.

At a BAC of 0.05 to 0.08%, there is a four-fold increase in the risk of a motor vehicleaccident.

Blood alcohol levels and the relative effect

Blood Alcohol Stages EffectsConcentration

Up to 0.05% Feeling of well being TalkativeRelaxed

Above 0.05% to 0.08% Risk state Judgment affectedMood affectedIntense high or low moods

Above 0.08% to 0.15% Dangerous state Slow speechUnstable balanceBlurred visionVomitingSleepiness

0.20% to 0.40% Drunken stupor Heavy sedationNo bladder controlComa

0.45% to 0.60% Shock/Death ShockDeath


Metabolizing alcohol

On average, a person can metabolize 7 to10 grams of alcohol per hour. This isabout the same as clearing two-thirds ofthe alcohol in a standard drink from thebody through the liver, sweat, breath, andurine.

If you consume more alcohol in an hourthan you are able to metabolize, yourblood alcohol concentration will increase.

A standard drink

Alcohol concentration is usuallyexpressed as alcohol “proof.” Proofmeans twice the percentage of alcohol. So,if a drink is referred to as 80 proof thismeans it contains 40% alcohol.

A standard drink contains approximately13.5 grams of alcohol. See the table belowfor examples of standard drink equiva-lents.

According to the Canadian HealthNetwork, guidelines for low-risk drinkingare:

• Drink no more than two standarddrinks on any day (see table below).

• Men should limit their weekly total ofstandard drinks to 14 or fewer.

• Women should limit their weeklytotal of standard drinks to nine orfewer.

• Drink slowly to avoid getting drunk.For example, wait an hour betweendrinks. Also, consume food and non-alcoholic beverages while drinkingalcohol.

Alcohol and sleep

In small amounts (two standard drinks),alcohol taken close to bedtime can helpsome people relax and get to sleep easier.However, this is not a recommended sleepstrategy, as alcohol can affect the quality ofyour sleep. In larger amounts (four ormore standard drinks), alcohol will helpyou fall asleep or pass out quickly, but notonly will it reduce the quality of yoursleep, it will also lead to a more restlessand light slumber toward the end of thesleep period. This may cause you to wakeup feeling less refreshed.

Standard drink equivalents

341 ml (12 oz)142 ml (5 oz)85 ml (3 oz)

43 ml (1.5 oz)

5% alcohol12% alcohol18% alcohol40% alcohol

Regular-strength beerWine

Fortified wineSpirits


The costs associated with alcohol abuse inthe workplace include:

• Increased number of accidents caus-ing injury

• Increased absenteeism or lateness• Reduced productivity• Frequent stoppages• Lower quality work• Equipment damage

Alcohol and performance

Drinking alcohol can lead to increasedsleepiness and reduced alertness, evenafter the alcohol is no longer detectable.This effect is commonly known as a hang-over. Alcohol intoxication significantlyimpairs performance, as previously men-tioned.

Knowledge Check

• Describe three ways sleep can be affected when you havemore than four standard drinks before going to bed.

• Name four effects alcohol has on the body.

Learning Outcomes


• Discuss the effects of nicotine on alert-ness.

• Discuss the effects of nicotine onsleep.

• Name symptoms of nicotine with-drawal.

CHAPTER 9

Nicotine

What is nicotine?

Nicotine is a stimulant found in the leavesof the tobacco plant. Tobacco has beensmoked or chewed for centuries. Nicotinestimulates respiration and heart rate anddepresses appetite by activating nicotine-sensitive nerve receptors. In small doses,it wakes you up and gives you a high byexciting the central nervous system. It ishighly addictive and the dangers tohealth have been well documented.Smoking cigarettes increases the chancesof heart and lung disease and most smok-ers are less fit than non-smokers.

Cigarettes contain 1 to 20 mg of nicotine(depending on the brand and strength).The effect of nicotine mostly dissipatesafter 60 minutes. Nicotine readily diffusesthrough skin (patches), lungs (smoke),and mucous membranes such as thegums and the lining of the nose. The mostcommon and quickest way for nicotine toenter the body is through the lungs.Nicotine moves to the small blood vessels,then to the brain, and finally to the rest ofthe body. Once it has reached the brain, itis responsible for the “good” feelingssmokers experience. People usually keepsmoking to maintain a constant level of

nicotine in their bodies. The number ofcigarettes it takes to do this varies fromperson to person because different peoplemetabolize nicotine at different rates.People also have varying degrees of toler-ance to and dependence on nicotine.

Nicotine withdrawal

Nicotine withdrawal can occur at night,making it difficult to fall asleep and stayasleep. Nicotine withdrawal may alsocontribute to nightmares and problemswaking up in the morning. This is espe-cially true for heavy smokers.

If you smoke, avoiding nicotine in theevening and at bedtime may helpimprove your sleep. If you stop smoking,you are likely to start sleeping better after10 days without a cigarette. In heavysmokers, withdrawal symptoms can kickin 20-30 minutes after the last cigarette.Physical and mental withdrawal symp-toms may include:

• headaches• muscular aches• sore gums and tongue• impaired concentration• low blood pressure


CHAPTER 9

Nicotine


can last up to 10 days. Sleep improvesdramatically after withdrawal symptomshave passed.

• lowered heart rate• feelings of stress or anxiety• depression and irritability

Physiological symptoms of withdrawalpeak three to four days after quitting but

Knowledge Check

• Why might heavy smokers wake during the night?• Name two negative health effects caused by smoking.

Learning Outcomes


• Name problems associated withsleeping pills.

• Explain the difference between pre-scription and over-the-counter drugs.

CHAPTER 10

Drugs

• angiotensin (such as Losartan,Valsartan or Candesartan for bloodpressure)

• antihistamines (Benadryl, Claritin, orReactine for allergies)

• barbiturates (Amytal, Seconal, andTuinal for sleep and anxiety)

• benzodiazepines (diazepam, alprazo-lam, and triazolam for sleep and anxi-ety)

• monoamine oxidase inhibitors (Nardiland Parnate for depression)

• phenothiazines (Mellaril andThorazine for mental disorders)

Always check the warning labels on thepackaging of your medication and askyour doctor or pharmacist if you areunsure.

Over-the-counter drugs

Some over-the-counter drugs used forpain relief or colds and flu may increasedrowsiness and fatigue-related symp-toms. If you are unsure about the drugyou are taking, talk to your pharmacist ortell your supervisor so they are aware ofyour situation.


Prescription drugs

Some prescription drugs can affect yourability to drive or operate heavy machin-ery. They may also interact with existingfatigue levels and other drugs (includingalcohol), further affecting your perform-ance.

If you take prescription medication:

• ask your doctor about possible inter-actions with other drugs

• ask your doctor about the drug’seffects on performance, such as yourability to drive and operate machinery

• tell your supervisor what you are tak-ing so they are aware of your situation(depending on the policies and regu-lations in your workplace)

• remember anaesthetics are prescrip-tion drugs that can show a positiveresult on a screening test -- informyour supervisor if you’ve had ananaesthetic recently

Drugs that come with a warning not todrive or operate heavy machineryinclude:

CHAPTER 10

Drugs


son; they can also vary for the same per-son depending on time of day, mood,tiredness, and the amount of food eaten.A person might get drunk on just a fewbeers one night but be hardly affected bythe same amount on another night. Age,gender, and size of a person also influencethe overall impact of drugs and the rate ofrecovery.

Sleeping pills and sedatives(benzodiazepines)

Definition

Benzodiazepines are a group of syntheticdrugs prescribed by a medical practition-er mostly for the treatment of insomniaand anxiety. There are more than 30 dif-ferent types available. They are takenorally or, more rarely, by injection. Someof the more common forms include:

• Valium• Serapax• Rohypnol• Librium• Mogadon• Temazepam

Drug effects

Some benzodiazepines last as little as fourto six hours, while others last as long astwo to three days.

They are known to:

• relieve anxiety and reduce muscle ten-sion, producing a feeling of calmnessand relaxation

Some employees who work irregularschedules and have difficulty sleepingpurchase over-the-counter sleeping pills.Examples of this type of medicationinclude Nytol, Sominex, and Sleep-eze.Various antihistamines that cause drowsi-ness are sometimes used to help the onsetof sleep. While these drugs can be effec-tive for getting to sleep, they can alsocause increased sleepiness the followingday. Use of these drugs is better avoidedwhere possible, and limited to no morethan two nights in a row.

There are also over-the-counter drugsavailable to increase alertness. Theseinclude caffeine-based tablets or capsules(such as No-doz and Vivarin) and pseu-doephedrine, which is a decongestant(such as Sudafed). While both can beeffective in increasing alertness anddecreasing fatigue-related symptoms,they also have side effects. Caffeine is adiuretic, which can dehydrate the body. Iftaken within four hours of going to bed, itcan make it harder to fall sleep.Pseudoephedrine can cause increasedanxiety levels, heart palpitations, andtrouble sleeping. These symptoms havethe potential to affect safety and workperformance. It is recommended that useof stimulants be limited.

How drugs work

Drugs are taken into the body through themouth (ingestion), blood (injection), ornose (inhalation). After they enter thebloodstream, they act on the brain. Drugsare eliminated from the body through theliver and kidneys into the urine. Drugeffects vary not only from person to per-

• cause sedation, drowsiness, blurredvision, and affected speech

In high doses, benzodiazepines producesymptoms similar to alcohol. In overdosesituations they can cause unconscious-ness, coma, and death. This is more likelyto occur if benzodiazepines are combinedwith alcohol or other depressant drugs.

Health effects

Due to the tolerance and dependencyeffects of benzodiazepines, people aregenerally advised to take them for onlyshort periods. Long-term usage can pro-duce symptoms of:

• lethargy• irritability• lack of motivation• nausea• headaches• disturbed sleep• increased appetite• depression• loss of muscle and speech coordina-

tion

You can develop dependency on benzo -diazepines after more than one week ofuse. This means that you:

• require higher doses to achieve thesame effect

• will suffer physical withdrawal if youstop taking the drug -- some peopletake up to a week before they begin toexperience any withdrawal effect.

Once you stop taking benzodiazepines,withdrawal symptoms are common andmay last up to a few weeks.


These symptoms include:

• headaches• nervousness• poor appetite• disturbed sleep• sweating• anxiety• vomiting• muscle spasms• depression• flu-like symptoms

Performance effects

In general these drugs adversely effect:

• fine motor skills• cognitive functioning• alertness• learning behaviour

They should not be taken when drivingor operating machinery or in any othersafety critical situation. They impair yourability to judge whether you are physical-ly or mentally affected. Benzodiazepineuse has been associated with hangover-type symptoms on waking. Users oftenreport grogginess and drowsiness afterusing benzodiazepines. These effectscould have implications for work safety.Chronic use can lead to impairment thatpersists long after you stop taking thedrug. However, most users showimprovements once they are no longertaking the drug.


confusion first thing in the morning.Some of the benzodiazepines, such asRohypnol, cause memory loss during thetime they are active.

Clearance times

In general, the time the body takes to clearthe drugs varies between one and sevendays depending on the drug and dosage.As you age, clearance times for long act-ing benzodiazepines (like Valium) cangreatly increase from a few days to amonth. For people who abuse benzodi-azepines, it may take up to six weeks fortheir systems to clear.

Interactive effects

Combined with alcohol or other depres-sants in large doses, benzodiazepinesexaggerate central nervous systemdepression, which can lead to respiratorysuppression and death.

Indicators of benzodiazepine use

A person who takes benzodiazepines mayshow symptoms similar to those underthe influence of alcohol. When used as asleeping aid, benzodiazepines may pro-duce hangover effects. That is, you mayappear sluggish and show some mental

Knowledge Check

• Name three problems associated with sleeping pills.• How does age affect the body’s response to drugs?• What is the difference between a prescription drug

and a non-prescription drug?

Learning Outcomes


• List the body systems affected by non-traditional hours of work.

• Discuss the effects of non-traditionalhours of work on reproductive health.

• Explain why shift workers have high-er incidence of gastrointestinal prob-lems than day workers.

CHAPTER 11

Well-being

Many studies have found health-relatedproblems associated with non-traditionalhours of work. In general, shift workersreport a higher number of health com-plaints than day workers. Shift workers,especially those on rotating shifts, have ahigher incidence of sick leave, a higherrate of visits to workplace clinics, andpoorer scores on a variety of health scales.

Some of the most common complaintsassociated with non-traditional hours ofwork are sleeping problems, fatigue, andirritability. Physical systems affectedinclude gastrointestinal, cardiovascular,and reproductive systems. Apart from spe-cific disorders, the adverse effects of suchhours on workers’ health also influencetheir general sense of well-being. Workersregularly report increased levels of stress,increased use of alcohol and other drugs,and a general feeling of weariness. Thismay be made worse by mental stress relat-ed to being less satisfied in the domesticand social areas of their lives.

Gastrointestinal problems

Research has shown that shift workers arefour to five times more likely to develop a


gastrointestinal disorder, such as pepticulcers, indigestion, heartburn, flatulence,and constipation. As discussed in thechapter on food, the digestive system isless likely to tolerate some foods at nightwhen it slows down.

In the short term, irregularities in foodintake resulting from non-traditional orchanging work patterns may lead todigestive problems and gastrointestinalcomplaints. While the more severe dis -orders generally develop over time, youcan reduce your chances of being affectedby them by changing your habits now.

Strategies to reduce long-term gastro -intestinal problems include eating at nor-mal meal times as much as possible. Asdiscussed in the food chapter, you shouldthink about your diet, what you eat anddrink and when, and how it makes youfeel.

It is important to be aware of early warn-ing signs of gastrointestinal disorders,particularly peptic ulcers, which are oneof the most serious. They can be treatedfairly easily, however. If you think youmay have a digestive disorder, consultyour doctor.

CHAPTER 11

Well-being


frequently of irregular menstrual cyclesand more severe menstrual pain. Studieshave determined a range of factors thatwomen who work non-traditional hoursshould be aware of, including:

• an association between rotating shiftwork and how long it takes to becomepregnant

• a relationship between an increasedrisk of spontaneous abortion andsome forms of shift work

• a link between pre-term birth andnight work

• an association between rotating shiftschedules and lower fetal growth andbirth weight

For some of these effects, the differencesobserved between shift workers and non-shift workers are statistically small. Thebody of evidence on reproductive healthis also relatively small compared to otherareas of research, such as effects of shiftwork on sleep. Nevertheless, it is wise toconsider work hours as a potential factorin reproductive health.

Cardiovascular disease

Shift workers have a higher risk than dayworkers of developing cardiovascular dis-eases such as high blood pressure andheart attack. There is also a strong linkbetween cardiovascular disease andgenetics. If any of your biological familymembers have been diagnosed with car-diovascular disease in the past, youshould pay more attention to your ownlifestyle and factors such as exercise, diet,and smoking.

Practically speaking:

• It is important to know whether yourfamily history includes cardiovasculardisease.

• Regular check-ups of blood pressureand cholesterol can help detect prob-lems early.

• Be aware that smoking is a majoradditional risk factor for cardiovascu-lar disease.

• Always try to maintain a healthy bal-anced diet, low in animal (and othersaturated) fat.

• Get regular exercise.

Pregnancy and reproductivehealth in women

There are specific female health problemsassociated with shift work. Studies haveshown that women who work shifts, andnight shifts in particular, complain more


General health complaints tend to be higher among shift workers thanday workers. Have you experienced any of the following?

• Sleeping problems � Yes � No• Irritability � Yes � No• Fatigue � Yes � No• Frequent colds and flu � Yes � No• Headaches � Yes � No• Gastrointestinal disorders � Yes � No

(stomach and digestive upsets)• Cardiovascular disease � Yes � No• Pregnancy or reproductive health issues � Yes � No

Knowledge Check

• Name four types of health complaints often reported byshift workers.

• What is the most serious gastrointestinal disorder reportedby shift workers?

• Name three factors that may contribute to cardiovascular disease.

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Learning Outcomes


• Name the effects of physical exerciseon sleep.

• Discuss the effects of physical exerciseon general health.

• Name the benefits of physical exer-cise.

CHAPTER 12

Physical Exercise


• increase your stamina • you get more enjoyment from your

leisure time.

Exercise can also improve sleep. Researchshows that exercise taken approximately30 to 180 minutes prior to bed canincrease the amount of deep (restorative)sleep that you obtain. One study foundthat late night exercise before bed evenincreased the feeling of a good sleep thenext morning and reduced the amount ofdaytime sleepiness.

Potential benefits of exercise may include:

• improved sleep• increased energy levels• reduced muscle tension• reduced stress• improved muscle tone and strength• increased aerobic fitness (heart and

lungs)• reduced body fat• improved bone density• increased stamina• improved circulation with better

digestion and body functioning.

Establishing a routine

Many people who work non-traditionalhours find it difficult to establish regularexercise routines. On average, female shiftworkers are 5 to 10 kg heavier than theirnon-shift working colleagues, while maleshift workers are 10 to 12 kg heavier.

Regular, moderate exercise such as walk-ing three to four times a week for 30 to 40minutes can have benefits for health,regardless of age or working hours. Mostpeople feel better for exercising. Exercisehelps to relieve stress, boost your health,strengthen your immune function, andimprove your muscle tone and strength.Before you begin an exercise program,talk it over with your doctor, especially ifyou are over 30 years of age.

Benefits of exercise

Being fit helps:

• reduce the risk of cardiovascular dis-ease, which has a higher incidence inthe shift working population

• make you feel good

CHAPTER 12

Physical Exercise


Walking Running Tennis Dancing Cycling Golf Swimming

Endurance ***** **** *** **** ***** ** *****Flexibility *** *** *** ***** ** *** ***Strength * * * *** **** * **

*****Excellent **** Very good *** Good ** Poor * Very poor(Source: Sydney Hospital, OH&S Unit, 1996)

Benefits associated with different types of exercise

What improvements could you make to your current level of physicalfitness? Describe the first step you would take to achieve this.

What sort of benefits would you expect from increased fitness?

Knowledge Check

• Explain why you should engage in some form of physicalexercise.

• Name three benefits of physical exercise.• What should you do before you engage in any exercise

program, particularly if you are over 30 years of age?•· What effect can physical exercise have on sleep?

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Learning Outcomes


• Explain the impacts that working non-traditional hours may have on familyand social life.

• Identify strategies that may help tobalance work and family/social life.

• Name the benefits of balancing work,family, and social time.

CHAPTER 13

Social/Family Life

Unsocial hours

A healthy social and domestic life is animportant foundation for good physicaland mental well-being. Much of theresearch into shift work and non- traditional work hours shows that work-ing “unsocial” hours creates unique fami-ly and social stresses. Generally, socialtime is arranged around the standardwork week (9 a.m. to 5 p.m., Monday toFriday), and evenings and weekends arehighly valued for social interaction andparticipation. Shift workers have beenconsidered relatively “poor” in socialtime compared to those working tradi-tional hours.

If the hours you work are constantlychanging or unpredictable, the opportu-nities for social interaction are reduced. Itmay also be difficult for shift workers orthose working non-traditional hours tosee themselves as part of the community.Shift workers are less likely to be mem-bers of clubs, attend meetings, join politi-cal organizations, and undertake groupactivities such as sports.

Balancing family and work can be asource of conflict, regardless of whether

you work traditional or non-traditionalhours. Such conflict may make it hard foryou to meet your family’s needs or expec-tations. Conflicts can worsen as thedemands of work or family increase.

The conflicts associated with shift work ornon-traditional working hours can holdespecially true for women, as they gener-ally assume responsibility for managingthe house and parenting. However, manymen are taking on equal responsibilitiesand experience similar pressures. In suchsituations, it is not uncommon for peopleto place family and social responsibilitiesbefore their personal needs. This oftencauses significant stress for the worker.

When people are not able to meet familyand social obligations, they often feel asense of isolation. This, in turn, can leadto depression, which can significantlyaffect the health and well-being of theworker.

As such feelings of isolation increase, peo-ple may begin to sacrifice sleep time forsocial or family time. This is a potentialsafety hazard for employees and employ-ers. If you find yourself in this situation beaware of your elevated fatigue levels, and


CHAPTER 13

Social/Family Life


Some working arrangements have poten-tial advantages for families and activitiesoutside of the workplace. One example isthe 12-hour shift system. Assuming over-time is not worked, 12-hour shifts gener-ally involve long uninterrupted blocks oftime away from the workplace. Theseblocks of free time are often highly valuedby employees because they provide theopportunity for a more flexible lifestyle.This may include being able to spendmore quality time with family, time torelax and engage in social activities, ortime to perform household chores. But italso has a considerable downside. Onworking days, employees have little timefor anything other than work and sleep,which may contribute to difficulties withchild care and involvement in daily fami-ly life.

the associated risk of either a work- ornon-work related accident.

The potential conflicts in trying to balancenon-traditional hours of work with socialand family life are clear. However, whereyou can effectively balance the two, work-ing non-traditional hours can prove bene-ficial. Some of the benefits include:

• Increased income. Many jobs thatrequire non-traditional work hourshave higher salaries to compensate forthe social and family sacrifices.

• Free time during the day. This can beparticularly useful for paying bills,running errands, and having access topublic services that are only availableduring the traditional 9-to-5 work day.

• Free child care. Many parents choose towork non-traditional hours, so thatone parent can always be home tolook after young children.

Provide some examples of changes in family and social life that arebrought on by non-traditional hours of work.

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Coping strategies

There are a number of strategies thatworkers can use to balance work, social,and family time, and thus avoid feelingsof isolation. One of the main strategies istalking about your work schedule withyour partner and children. This can beeffective in planning ahead to spend timetogether as a family. Your family will alsobe more aware of when you are likely tobe sleeping after work. As a result, theycan arrange to be out of the house whenyou are sleeping, or be more considerateof the need for quiet. This in turn can pro-vide you with undisrupted sleep, allow-ing more energy for social and familyinteraction during non-work and non-sleep time.

Another strategy is to actively organizefamily and social events. Make a point ofspending time with those close to you,including your family, friends, and col-leagues. This may be organized on a rou-tine basis around your work schedule toensure regular contact.

Joining a recreational organization canalso be a useful strategy to minimize feel-ings of isolation. This can be particularlyeffective for meeting friends who work asimilar schedule to yours. It provides anopportunity to socialize and relax whenmost other people are working.

Knowledge Check

• Why are some working arrangements referred to as being“unsocial”?

• Describe two strategies that can help in balancing workand family.

Learning Outcomes


• Discuss why commuting can be a haz-ard for workers.

• Name strategies that may help reducethe risks associated with commuting.

CHAPTER 14

Commuting


Commuting as a hazard

So far, we have focused on fatigue as aworkplace hazard. Driving to and fromwork when fatigued should also be con-sidered a hazard. This is increasing inimportance as commute times continue togrow significantly longer.

You will always be at risk of falling asleepbehind the wheel if you are driving whiletired or sleep deprived. There are certainhigh-risk times when you are more at riskof having a fatigue-related accident.These include:

• Long drives without a break• Driving home after a long shift• Driving between midnight and 6 a.m.

(biological low point)• Driving in heavy traffic• Long stretches of road with low traffic

In many cities, it is not uncommon forpeople to commute an hour or even twohours to and from work. This situationarises mostly where jobs are scarce, prop-erty prices have driven people furtherout, or where traffic density is high.

While it is difficult to eliminate all therisks associated with commuting, it ispossible to take some measures toimprove road safety. While the followingsuggestions may not be relevant to every-one, you should be able to come up witha road safety strategy that suits you.

What can be done?

• Take public transport if it is available.This option is not only safer but is lessexpensive than running your ownvehicle. For many people, the down-side is losing the convenience of hav-ing your own car, and taking longer toget to and from work. Others arguethat the extra travelling time can bewell spent reading, relaxing, or justwatching the world go by.

• Move closer to work. On first consid-eration, this may not be a realisticoption but some who have done itreport considerable benefits. Thisoption is most attractive if you arerenting or would be happy to sell yourhome to move closer to work. In somecases, such a move might be inexpen-sive and could save you five to tenhours a week of commuting.

CHAPTER 14

Commuting

Why is commuting a fatigue risk?

Are there any changes you could make to the way you commute thatwould reduce fatigue-related risks?


If a call is that important, find a safeplace to pull over until the call is fin-ished.

• Take a nap. As detailed in the sleepand napping chapter, naps can be apowerful and efficient strategy forgaining temporary improvements inalertness and performance. Naps arerarely convenient unless they are pre-planned, but you should get off theroad if you observe any warning signsof fatigue. Keep your nap short, say 10to 15 minutes, and be sure to giveyourself at least 10 to 15 minutes toshake off your sleep inertia before youdrive off. This wake-up time can gen-erally be shortened if the nap is dur-ing the day.

• Have some caffeine. As covered in thecaffeine chapter, caffeine can providea boost to alertness, making commut-ing safer. Caffeine can reduce yourability to get to sleep once you gethome, but it is more important tomake it there safely.

• If you live close enough to work, con-sider riding, running, or walking towork. This is a particularly good strat-egy if you’ve been trying to get someregular exercise into your week.Another advantage is that, apart fromthe cost of shoes or a bike, it’s free!

• Car pool. This may be a viable optionif you live close to people who workwith you. Car pooling allows costs tobe shared and gives the driver com -pany during the ride, reducing themonotony of the drive.

• Don’t be in a hurry. Many accidentsoccur when people rush, so plan fordelays and don’t get stressed out.Taking risks is unnecessary. Enjoy theconversation, music, or scenery dur-ing your journey.

• Never use a cell phone while driving.Recent research clearly shows thatdividing your attention between driv-ing and talking on a cell phone is dan-gerous. This is true even of cellphones with a hands-free attachment.

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Marie was 38 years of age, married with onechild at home. She was a pilot for almost 12years, working in an emergency rescue opera-tion. She had been called in to fly a hospitaltransfer for a critical patient. While the trans-fer was expected, the exact timing wasunknown. Marie had experience with hospitaltransfers at all times of the day and night, so

she was not worried about the timing.

She had been awake all day and had just gone to bed when the hospitalrang at 11 p.m., asking her to pick up the patient. She arrived at the hos-pital after midnight and delivered the patient to the next hospital after2:00 a.m. By the time she returned and completed her paperwork, it waspast 5:00 a.m. Marie was tired but told her work colleagues that shewanted to drive home because she slept better in her own bed. She nevermade it.

There was no evidence of corrective action being taken by Marie before shehit the stationary semi-trailer. This suggests that Marie was either asleepor otherwise unable to react before impact. The investigation of the acci-dent concluded that she had fallen asleep at the wheel on her way home.

Knowledge Check

• Propose three strategies Marie could have used to get homesafely that morning.

• Name two reasons why many workers spend more time intheir cars travelling to and from work?

Case study

Learning Outcomes


• Discuss respective responsibilities ofemployee and employer in the contextof a fatigue risk management system.

• List considerations when designingworking time arrangements.

• Explain the pros and cons of differenttypes of shifts.

CHAPTER 15

Work Schedule Design

Work schedule design as acountermeasure to fatigue

The best-known countermeasure tofatigue is sleep. Sleep opportunity isdetermined to a great extent by the hoursyou are not at work. Therefore, fatiguereduction strategies must include workschedule design. It is important toremember that there is no perfect workingtime arrangement that suits everyone allthe time.

When designing working time arrange-ments, the following should be considered:

• length of shifts• number of consecutive shifts• direction of rotation in alternating

shifts (forward or backward)• type of shifts to be worked (nights,

afternoons and mornings, days)• staffing levels, experience, expertise,

and opportunities for job rotation• breaks between and within work

periods• types of tasks being undertaken,

(repetitive, boring, exciting, stimulat-ing)

• consulting with all stakeholders aboutdeveloping new work schedules --


Shiftwork on the rise

It is estimated that fatigue is responsiblefor at least as many crashes on the road asalcohol. Despite this, fatigue has onlyrecently begun to receive attention fromregulatory bodies. As the workforceincreasingly moves towards shift workand alternative working arrangements,the potential for fatigue-related risksincreases. This problem is further com-pounded by the growing use of high-powered machinery where the margin forerror is small and the potential for seriousinjury is high.

Globalization and competition are forcingorganizations to adopt new flexible work-ing time arrangements that include 24-hour operations.

There is little doubt that flexible workingtime arrangements have productivitybenefits. Flexible, non-standard workinghours are also attractive to employeeswhose home responsibilities and personalcommitments prevent them from work-ing traditional schedules.

CHAPTER 15

Work Schedule Design

Employee responsibilities

• Arriving at work in a fit state to workthe expected shift length.

• Reporting all incidents and accidents.• Maintaining communication with

work colleagues, management, andrelevant unions.

• Being aware of fatigue and how tocounter it in the workplace; for exam-ple, by getting adequate rest or sleepprior to work times.

Different types of shifts

There are a number of different types ofnon-traditional shifts that are worked inindustry. Extended shifts are but one alter-native to the regular 9-to-5 workday.Workers can also find themselves assignedto shifts starting early morning, in theafternoon, or at night. Work teams can beassigned to these shifts according to slowor fast rotations. There are no hard-and-fast rules about which shift schedule isbest. However, as discussed below, someare more attractive than others in terms ofthe physiological, psychological, andsocial impact they have upon workers.

Extended shifts

Extended shifts involve either starting ashift earlier or finishing later than the stan-dard 9-to-5 work day. There are many rea-sons an organization may choose to useextended shifts. In some cases, extendedshifts allow for longer hours of produc-tion, without the need for night work.Extended shifts are also popular amongemployees because of the extra moneythey can earn working longer hours.


participation by all is likely to fosterfeelings of ownership of the outcome

• testing changes to the work scheduleto determine impacts on the health,safety, and productivity of employeesand the company.

Employer and employeeresponsibilities

Managing fatigue and associated risks arethe dual responsibility of employers andemployees. As will be seen in the next twosections, various types of shifts have vari-ous effects on workers and their lives, andentail some fatigue-related risks. Bothemployers and employees must be awareof the risks involved with various types ofshifts. Examples of the respective respon-sibilities of employers and employeeswith regard to fatigue are listed below.

Employer responsibilities

• Appropriate and safe work scheduledesign that allows for adequate recov-ery periods during the shift andbetween shifts.

• Ensuring safe work practices, such asscheduling sensible levels of overtime.

• Appropriate and safe shift duration.• Assessment, control, and monitoring

of fatigue related hazards. • Development of policies, procedures,

and practices to manage risk relatedto fatigue. For example, where nap-ping is allowed, there should be clearinstructions on how to deal with sleepinertia.

• Providing information on workplacehazards, such as fatigue.


Alternatively, the standard 37.5 hourwork week can be compressed into threeor four days, allowing bigger blocks oftime off between shift sequences.

Working the occasional extended shift isunlikely to significantly affect fatigue-related risk. This is especially so if theshift does not affect sleep opportunity(i.e., starting before sunrise, or finishingafter “normal” bedtimes). Over longerperiods, shifts longer than 10 or 12 hoursshould be avoided. Even if these shifts donot specifically affect your sleep periods,they will reduce the amount of social timeavailable. Research has shown thatemployees often sacrifice sleep inexchange for a healthy social life if theydo not have sufficient time for both, pro-ducing higher fatigue levels. If longershifts are required, make sure you haveadequate recovery time after your shifthas ended.

Night shifts

Humans are diurnal, which means we arenaturally active during the day and sleepat night. Because of this, it is particularlydifficult to completely adjust to nightshifts. Night work requires you to beawake when your natural tendency is tobe asleep, which disrupts body rhythmsand affects the quality and quantity ofsleep. Night workers generally get lesssleep, and the sleep they do get is of poor-er quality than that of day workers.

Unlike most other animals, we are influ-enced and motivated by what we chooseto do and how we choose to do it.

Motivation plays a role in how you man-age your work hours. Money has general-ly been used to compensate employeeswho work at non-traditional times. Thosewho work at night, in the evening, and onweekends are traditionally paid at a high-er rate than those who work days,Monday to Friday.

Morning shifts and afternoon shifts

Although they may be less problematicthan night shifts, morning and afternoonshifts are not without problems. Morningshifts that start before 7 a.m. force work-ers to cut sleep periods short, which cancause higher levels of fatigue at work.This has been supported by studies thatshow a higher frequency of accidents atthe start of early morning shifts. As withthe night shift, the risk of a fatigue-relatedincident if sleep is cut short over multipledays becomes a significant safety risk.

From a sleep perspective, afternoon shiftsare ideal. Workers get home around 11 or12 p.m., after which very few peoplewould struggle to get 7 to 9 hours sleep.While for many people sleep is easiestafter an afternoon shift it is not ideal froma social perspective. The evening mealwith family or friends is valued by mostas the most important period of socialtime. This is particularly the case forworkers with young children at home. Asdiscussed above, when individuals aredeprived of social time by extended shifts,they will often sacrifice sleep to catch upon lost social time on other days. Again,this can cause a vicious cycle with fatigue-related risk.


a rotating shift schedule can reducefatigue-related risk by giving employeesfewer night shifts in a row.

Research has found that rapid rotation ofshifts (i.e., changing every few days) ispreferable to a slow rotation. Similarly,rotating shifts forward (i.e., morning, after-noon, night) is preferable to rotating back-ward (i.e., night, afternoon, morning).

Shift rotation

Where night work is required, rotatingshifts are often employed to share thenight shifts among employees, ratherthan restricting them to one group ofemployees. Employees working nightstypically get less sleep, which can accu-mulate to cause high fatigue levels partic-ularly over multiple days in a row. Using

Have you noticed any differences between your sleep patterns whenyou’re on night shift and when you’re on other shifts?

Do you have any suggestions about how current working hour arrange-ments could be improved? If yes, what are they?E

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Knowledge Check

• Name three factors you should consider when designingwork schedules.

• Name two employee responsibilities and two employerresponsibilities with respect to managing fatigue-relatedrisks.

• Name one negative aspect for each of the following shifts:morning, afternoon, and night.

Learning Outcomes


• Describe why long-distance travelcauses jet lag.

• Explain why travelling east can pro-duce more jet lag than travelling west.

• Provide practical strategies to ease theeffects of jet lag.

CHAPTER 16

Jet Lag

Jet lag is a condition caused when wetravel across time zones, and our normalcircadian rhythms are disrupted. It isexperienced in the form of physical andpsychological discomfort. The symptomsmay include excessive sleepiness, feelingdepressed, reduced efficiency, and pre-mature awakening. Some people alsoexperience this for the first day or two fol-lowing the change to daylight savingtime, when bed and wakeup time is shift-ed by an hour. Since daylight saving timeonly displaces our body clocks by anhour, the effects are likely to be minimal.Likewise, crossing only one or two timezones is not likely to produce substantialeffects of jet lag.

The determining factor in the impact andexperience of jet lag is how many timezones are crossed. Since time zoneschange only when travelling in east orwest directions, north-south flights pro-duce far less jet lag. For example, flyingfrom Vancouver to Montreal (three hoursdifference) will produce substantial jetlag. However, a traveller on a north-southflight of the same duration --Vancouver toLos Angeles, for example -- will not beaffected by jet lag, only fatigue resultingfrom travelling.


Jet lag and the body clock

The body clock has already been dis-cussed in Chapter 1 in terms of the effectsof shift work and trying to sleep duringthe day. While circadian irregularities arefundamentally the same for internationaltravel, there are two main differencesbetween shift work and jet lag:

• the time zone change associated withjet lag is preceded by the fatiguingactivity of travel

• the day/night environment surround-ing sleep will have changed (i.e.,become earlier or later), which confus-es the body clock

• although the new “night” sleep actu-ally occurs during the local nighttimewhen it is dark, it may still be daytimeat home and thus not a normal sleeptime

Effects of jet lag

It is easier to move our sleep and wakingtime forward rather than backward, mak-ing the day longer rather than shorter.Eastbound travel shortens the day or

CHAPTER 16

Jet Lag


night, so travelling west produces less jetlag.

You are more likely to be effected by jetlag by flying east because:

• depending on the distance travelled,you lose several hours of sleep time

• your body clock will only partiallyreset when changing time zones. Thebody clock takes an average of oneday to adjust for each time zonecrossed. A difference of four hoursbetween home and local time maytake you up to four days to adjust.

The impact and experience of jet lagvaries dramatically between individuals.How you are affected depends on manyfactors, including:

• direction of travel (travelling west iseasier)

• physical fitness (better fitnessimproves circadian adjustment)

• age (the effects of jet lag increase withage)

One of the most common symptoms of jetlag is sleep disruption. This is likely toinclude:

• difficulty getting to sleep at regularbedtime

• waking up during the night and notbeing able to get back to sleep

• fighting sleep during the day

This level of sleep disruption is likely tolead to insufficient sleep quality andquantity, and subsequent fatigue.

In 1994, a survey was conducted of inter-national flight attendants in NewZealand. Almost all flight attendants sur-veyed said that despite being accustomedto international travel, they regularly suf-fered from jet lag. One of the particularsymptoms reported by the flight atten-dants following a long flight was a sensa-tion of confusion or “fuzziness.” Forexample, some flight crew membersreported checking to make sure theirhotel rooms were locked two or threetimes.

Easing the effects of jet lag

The most obvious technique for minimiz-ing the effects of jet lag is maximizing sleepquality and quantity. Methods varybetween individuals. Three useful tips arerecommended:

• set up your sleeping environment tominimize light and noise disturbance,and set the temperature to between 18and 24°C

• drink lots of water• keep physically fit

Resetting the body clock is more easilyaccomplished gradually than all at once.Depending on the direction you havetravelled, and how long you plan on stay-ing at the destination, one option is tostart adjusting sleep and eating timesbefore you leave. Even shifting your bedand meal times by an hour or two canjumpstart the change in your body clockin the right direction.

Ensure you are well rested before theflight. Many travellers are tempted to stay


• avoid overeating (especially saltyfoods)

• avoid motion sickness drugs whenpossible (they are depressants).

Regular exercise also has a large impacton the severity of jet lag. People who areunfit tend to experience longer periods ofjet lag.

Regardless of your actual fitness, beingforced to remain immobile is one of themost taxing aspects of long flights. Movearound and exercise wherever possible,throughout the flight or during stopovers.Don’t worry what other people think. Ifyou look like you’re enjoying yourself,they may get up and join in.

up late, and get very little sleep before aflight so they will be able to sleep betterupon arrival at their location. In reality,people who are already in sleep debtbefore a flight will experience moresymptoms than those who are well rested. Other than sleep, one of the easiest andmost practical techniques to ease theeffects of jet lag is to drink plenty of water.Dehydration and the dry air aboard air-craft can cause headaches and nasal irrita-tion, which exacerbate the symptomsassociated with jet lag. Drink lots of waterbefore, during, and after the flight. Sometips to remember are:

• take a large bottle of water with youon the flight --water is better than cof-fee, tea, soft drinks, and fruit juices

• avoid coffee and alcohol, which arediuretics and cause dehydration


Have you ever experienced jet lag? Describe your experience.

What techniques do you use to cope with jet lag?

Based on what you have just read about jet lag, are there any changesyou should think about making? If so, what?

Knowledge Check

• Explain what causes jet lag.• Identify two factors that can affect the experience of jet lag.• Explain two ways to ease the negative effects of jet lag.

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• Canadian Health Network website: www.canadian-health-network.ca

• Coren, S. (1996). Sleep Thieves. New York: Free Press.

• Dement, W. C. & Vaughan, C. (1999). The Promise of Sleep. New York: Delacorte Press.

• Hauri, P., & Linde, S. (1996). No More Sleepless Nights. New York: John Wiley & Sons.

• Lavie, P. (1996). The Enchanted World of Sleep. New Haven, CT: Yale University Press.

• Monk, T.H., & Folkard, S. (1992). Making Shiftwork Tolerable. London: Taylor & Francis.

• National Sleep Foundation website: www.sleepfoundation.org

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