Occasionally, I have described my career in emergency medicine as enduring 30-plus years of sleep depravation.
Actually, it’s longer than that. In college, I worked several summers in a major-chain, meat-packing plant. The worst shift was from 8 p.m. to 4 a.m., unloading 10,000 to 12,000 pounds of bacon bellies from atop a four-story smokehouse, with the temperature rising to 120 degrees-plus.
The last two years of medical school weren’t much different, with some rotations going to midnight every other night. A few of us also worked one night a week and two weekend days (24 hours) per month as lab techs at a suburban hospital. There was no thought of stimulants, not even coffee. The work was stimulating enough. Nor do I recall any concern about night-shift work and its impact on health or mortality back then. However, the health impacts of nighttime work have more recently been studied – with some bothersome conclusions.
For instance, accidents during night work are three times more frequent than during day shifts, and auto accidents occur twice as often compared with those returning home from day work. Studies also have shown increased eye-closure duration is not uncommon en route home from night shifts. One emergency-room colleague fell asleep driving home from a 24-hour shift – no injury, but he quit that ER the next day.
Notable are the Three Mile Island and Chernobyl accidents, the Exxon Valdez grounding and spill and the deaths of thousands from toxic chemicals spilled at Bhopal, India – all of these accidents occurred at night.
Permanent night workers, who make up about 25 percent of night-shift workers, are somewhat less affected than those who work rotating shift systems (e.g., five days to five swings to five nights). In Europe, there is a movement to restrict night shifts to a maximum of eight hours.
The health risks from night-shift work are probably lifestyle related; the science is difficult. Humans’ circadian rhythm (diurnal clock) is fine-tuned and complex. It banks our metabolic fires in the evening and begins to stoke them in the early morning. Until electric lights – the modern bull in the metabolic china shop – there wasn’t much night work.
Austria established night-shift regulations in 1981 in an effort to protect workers employed in arduous work, including excessive heat and noise, between 10 p.m. and 6 a.m. These workers are entitled to extra holidays, special rest periods, extra severance pay, preventive health and safety measures and some pension payments at age 57. An Austrian study concluded “improvement in working conditions especially with regard to heavy work does have a positive impact on life span.”
Having trouble? Try Googling “Shift work sleep disorder, Cleveland Clinic.”
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.