PLAIN LANGUAGE ABOUT SHIFTWORK

¥ ¥ ¥ ¥ ¥ ¥ ¥ ¥ ¥ ¥ ¥ ¥ ¥

¥ ¥
¥ ¥ ¥ ¥ ¥ ¥
 Plain Language About Shiftwork

Roger R. Rosa1
Michael J. Colligan2

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service, Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health
1
Division of Biomedical and Behavioral Science
2
Education and Information Division
Cincinnati, Ohio

July 1997
 Disclaimer

Mention of company names or products does not constitute endorsement

by the National Institute for Occupational Safety and Health (NIOSH),
Centers for Disease Control and Prevention (CDC).

DHHS (NIOSH) Publication No. 97-145

ii
 Plain Language About Shiftwork
Public Health Summary

What are the hazards?

S
hiftworkers and night workers often are tired and sleepy
because of their work schedule. Being overly tired makes it
difficult to concentrate, which increases the possibility of errors
or accidents. This can be a risk both to the worker and to the public.
The stress of shiftwork also can aggravate health conditions, such as
heart disease or digestive disorders.

How do these hazards occur?

Working at night makes it difficult to get enough sleep. Sleep after
night work usually is shorter and less refreshing or satisfying than
sleep during the normal nighttime hours. Brain and body functions
slow down during the nighttime and early morning hours. The com-
bination of sleep loss and working at the body’s low-point can cause
excessive fatigue and sleepiness. This makes it more difficult to per-
form well, which increases the risk of accidents. Also, shiftwork can
be stressful because of frequent switching from a day to night sched-
ule and because of separation from family and friends. These stresses
can be harmful to health.

iii
 How can these hazards be avoided?
Many workers cannot avoid night or rotating shiftwork. Therefore,
this booklet suggests ways of coping with shiftwork. Organizational
or group approaches include redesigning the work schedule, redis-
tributing the workload, improving the work environment, and institut-
ing programs to improve worker awareness. Individual approaches
include improved sleep strategies, exercise and diet programs, and
relaxation techniques.

How do I get more information?

If you would like extra copies of this booklet, or if you have
questions about the material in this booklet, contact the National
Institute for Occupational Safety and Health (NIOSH) at the number
listed below.

1-800-35-NIOSH
(1-800-356-4674)

iv
 Plain Language About Shiftwork

About this booklet....

This document gives basic facts about shiftwork and talks about
ways to make shiftwork life easier. It is organized into six sections.
If you prefer, go directly to the section of interest to you. The six
sections are:

1. Background information .........................................................1

2. How to examine work schedules...........................................5

3. Health and safety effects of shiftwork .................................13

4. Improving shiftwork through the organization ...................19

5. Coping strategies for the individual ....................................27

6. Recommended reading .........................................................37

v
 Introduction

D emanding work schedules are a fact of life in modern, 24-hour

society. Goods are produced and services are provided at all
hours of the day and night. Because of this, people are required to
work at all hours. These kinds of work schedules can be quite a
strain and can affect a worker’s safety or health. Mistakes from a
fatigued shiftworker also can affect the public’s safety or health.
To prepare this document, we borrowed ideas and information from
many people who have studied shiftwork or done shiftwork them-
selves. Some of our sources are mentioned in the recommended
reading list at the end of this document. We encourage the reader
to check this list to learn more about shiftwork.

vi
 1
1

Background Information

Defining Shiftwork
There are many work schedules that are called shiftwork. Shiftwork
involves working outside the normal daylight hours. That is, outside
the hours of around 7 a.m. to 6 p.m., the time period in which many
people in our society work a 7- to 8-hour shift. Shiftworkers might
work in the evening, in the middle of the night, overtime or extra-
 long workdays. They also might work regular days at one time or
another. Many shiftworkers “rotate” around the clock, which involves
changing work times from day to evening, or day to night. This might
happen at different times of the week or at different times of the
month. Police officers and firefighters, for example, often work rotat-
ing shifts. Other workers might have a “permanent” shift and only
work at night or in the evenings. Waiters and waitresses, for example,
might work only the evening shift. Night watchmen, on the other
hand, might work only the overnight or “graveyard” shift.

Society and Employer Reasons for Shiftwork

There are several reasons for shiftwork. A major reason is that mod-
ern technology has made it possible to do many activities at any time
of the day or night. This “24-hour society” of ours requires that
important services be provided at all times. Critical services include
public safety, such as police and fire protection; military defense;
health care; transportation; and public utilities, such as electrical
power, water and telephone. Other industries must operate 24 hours
per day because the production process is much longer than 8 hours
and must be performed continuously. Many chemical products
require such a process. Also, manufacturing industries often have
expensive machinery that needs to be operated continuously in order
to be profitable.
Because several occupations and industries operate around the clock,
other services have expanded their hours to accommodate evening
and nighttime workers. (They also have expanded access for all the
rest of us who simply enjoy the convenience.) Some obvious exam-
ples are grocery stores, gas stations, and restaurants that are open
24 hours per day, seven days per week. The increase in these
expanded-time services in the past decade or two has opened up the
job market for new shiftworkers. This is ironic. Because there are so
many shiftworkers, society now needs more shiftworkers.

2 • Plain Language About Shiftwork

Numbers of Shiftworkers
Estimates of the number of shiftworkers varies with the definition of
shiftwork. The Bureau of Labor Statistics reports that about five per-
cent of American adults work in the evening. Permanent night work-
ers and workers with irregular schedules make up another four per-
cent. Still another four percent are rotating shiftworkers. All together,
this amounts to about 15.5 million people.
Almost any occupation or industry has some people doing shiftwork.
A quick check of lists provided by the Bureau of Labor Statistics
shows about 2 to 10 percent of almost any occupation
working evening, night, or rotating shifts. These kinds of
schedules happen quite often among police officers and
firefighters. More than half of them work evenings and
nights, and about a quarter of them rotate shifts. Many
transportation and public utility workers — about one-fifth
of them — also work shifts. Long-haul truckers often make
their best time in the evening or at night.
Lately, many materials must be delivered “just in time,” or
just before they are used in manufacturing. For example,
parts for making automobiles are delivered this way. This practice has
forced more truckers to take trips at all hours and at the last minute
to make their deliveries on time.

People Who Work Shifts

If we look only at full-time jobs, men work more night and rotating
shifts, while women work more evening shifts and do more part-time
work. However, full-time shiftworking women are not far behind in
numbers. And more women are entering the workforce full time, so
these numbers are changing quickly. Younger people are more likely
to work shifts than older people. African-Americans do more shift-
work than Caucasian-Americans. Single people work more shifts than

Background Information • 3
 married people. If we look at married couples who each have paying
jobs, about one-quarter to one-third of these couples have at least
one partner who is a shiftworker. If we look at mothers with children
at home, single mothers work shifts more often than married mothers.

Employee Reasons to Do Shiftwork

Some workers actually prefer non-day work, but most do not seek
out shiftwork. Reasons for employees choosing shiftwork include
better pay, more available time during the day for child care, more
daylight hours for recreation, and more time to attend school. Some
workers prefer the night shift because it is quieter and there are fewer
supervisors. Usually, however, workers say they did not choose shift-
work. They do it either because it is required of the job, or no other
job is available.

4 • Plain Language About Shiftwork

 2

How to Examine

2
Work Schedules

S hiftwork experts often are asked what is the best or worst work
schedule.There is no simple answer to this question because there
is no ideal schedule that fits every situation. Both good and bad points
can be found in most work schedules. In this section, we suggest ways
to examine work schedules to identify their advantages and disadvan-
tages.

How to Examine Work Schedules • 5

 Types of Work Schedules
There are hundreds of different shiftwork schedules. However, it is
difficult to accurately count the many shiftwork schedules being used.
No thorough records are kept by the federal government, trade orga-
nizations, or labor unions. Different schedules might be used by the
same occupation, the same industry, or even the same workplace.
The most common shift schedule probably is five days on a single
shift followed by two days off. If this is a rotating shift schedule, the
worker will change to a new shift after the days off. Depending on
the job, it is even possible to work 7, 10, or 14 days in a row. Off-
shore oil rig workers, for example, might work two weeks out on the
rig followed by two weeks off at home.
Since so many different schedules exist, researchers have thought of
ways to measure different features of the schedules. These features
are used to study how work schedules might affect safety, health, or
productivity. The features are listed in Table 1 with explanations
below.

Work Schedule Features

We already have mentioned the time of the shift and whether shifts
are permanent (fixed) or rotating. It also is important to consider:

• How long a shift might be.

• How many shifts are worked before a rest day.
• How many rest days are on weekends.
• Whether there is overtime.
• How much rest is taken between shifts.
• How much rest is taken during the shift.
• Whether the work schedule is regular and predictable.

6 • Plain Language About Shiftwork

As we will explain, all of these features can affect the amount of
stress and fatigue a person feels because of the work schedule. If
people experience too much stress and fatigue, then they might not
do their jobs safely and efficiently. Or they might develop health
problems. Here are some particulars about the different shift features.
Time of Shift: Twenty-four hour operations usually are divided into
two or three shifts. Start- and end-times depend on the length of the
shift. Day shift (also called morning or first shift) starts around
5 to 8 a.m. and ends around 2 to 6 p.m. Evening shift (also called
afternoon or second shift) starts around 2 to 6 p.m. and ends
around 10 p.m. to 2 a.m. Night shift (also called third,
“graveyard,” or “mid” shift) starts around 10 p.m. to
2 a.m. and ends around 5 to 8 a.m.
Why is the time of shift important? Because people
who work in the late night or early morning hours
often feel sleepy and fatigued during their shift. This
happens because their body rhythm (also called a
circadian rhythm) tells them to be asleep at those
times. Night workers also must sleep during the day,
when their circadian rhythm tells them to be awake.
Because of this, day sleep is short and feels “light” or
unsatisfying. Often, night workers don’t get enough sleep during
the day to combat nighttime fatigue and sleepiness. Also, day
workers sometimes must wake up very early to go to work. This
might cause them to cut off their sleep, which makes them feel tired
during the day.
Shift times also determine when a worker can see family and friends.
Many social events take place in the evening, which means they
might be missed by evening or night workers. Parents who work the
evening shift might not see their children during the week because
they are at work when the kids return from school. If this happens
too often, it can be stressful.

How to Examine Work Schedules • 7

 Permanent versus Rotating Schedules: We might think that perma-
nent night workers adapt or get used to their work times. Usually, the
longer somebody does something, the easier it becomes. With experi-
ence, many night workers figure out tricks or personal methods to
fight off some of the nighttime fatigue. However, research tells us that
most permanent night workers never really get used to the schedule.
That is, there are many nights when they still feel tired and sleepy.
Fatigue occurs because most night workers go back to a day schedule
on their days off. This is not surprising because family and friends are
active during the day. Also, many errands and chores (like getting the
car fixed) must be done during the day. Because most night workers
often return to a day schedule, they never completely allow their
sleep and body rhythms to adapt to being awake at night. They also
sleep less during the day, so they don’t recover from fatigue. This
fatigue can carry over from day to day. Over several days, fatigue can
accumulate to unsafe levels.
People working rotating schedules face a similar situation. Because
the shift times are always changing, they can never completely adapt
to a set work schedule. Rotating schedules are often used because
they are considered fairer to all workers. Everybody in the workforce
takes their turn at both the popular and unpopular shifts. Rotating
shiftworkers are always trying to get used to changing work times.
This is not easy, which is why rotating shiftworkers have more com-
plaints than other workers about physical health and psychological
stress. Research has shown that rotating shifts have special features
that might affect a person’s ability to get used to the schedule. These
features are explained below.
Speed and Direction of Rotation: Adapting to rotating shifts can be
affected by the speed of rotation and the direction of rotation. Speed
of rotation means the number of consecutive day, evening, or night
shifts before a shift change occurs. Direction of rotation means the
order of shift change: A forward rotation is in the clockwise direction,

8 • Plain Language About Shiftwork

from day to evening to night shift. A backward rotation is in the
counterclockwise direction, from day to night to evening shift.
Different rotation speeds also affect a worker’s ability to get used to
change of shift times. We have already talked about the same situa-
tion under permanent versus rotating shifts. Longer rotations (for
example, three to four weeks of working the same hours) are sup-
posed to allow workers more time to get used to night shifts.
However, workers usually return to a day schedule on their days off.
A fast rotation (every two days, for example)
allows no time to get used to night work. Some
researchers prefer the fast rotation, because the
worker quickly gets through the tough shifts
and then has a couple of days off. Very fast
rotations are used in Europe more than in
America.
Direction of rotation can affect the ability of cir-
cadian (daily body) rhythms to adapt to the
change in work times. Sleep, for example, is a
circadian rhythm because each person sleeps
for part of every day. Some researchers suggest
that a forward, or clockwise, rotation is better
for helping a worker adjust to new sleep times. This suggestion was
made because it is easier to go to bed later and wake up later than
earlier. Our body rhythms make us feel more awake and alert in the
early evening. This makes it harder to fall asleep earlier. Backward
rotations work against the body rhythm by forcing the worker to go
to sleep earlier and earlier.
Although we don’t have hard and fast numbers, it seems that back-
ward rotation schedules are used frequently in the United States. It is
not completely clear why. It is partly because of custom (We always
did it this way) and partly because workers like the “long change.” In
the long change, workers pick up an extra day off when going to

How to Examine Work Schedules • 9

 evening shifts after night shifts. This happens because evening shift
starts late in the day, which leaves most of that day free for non-work
activities.
Work-Rest Ratios (or How Much Work Before a Rest): The more a
person works, the less time he or she will have for rest. People who
work an 8-hour shift will have 16 hours left in a day to do everything
else, and also to get some rest. People who work a 12-hour shift have
only 12 hours to do everything else and to rest. In a situation like
this, the extra work hours mean more tiredness and less time for rest.
This is a two-edged sword. For example, many times a worker’s
home responsibilities, such as taking care of children, cannot change
from day to day. So, if workers do overtime or a 12-hour shift, they
still must take care of home duties. Since these duties take the same
amount of time every day, workers may sacrifice rest and sleep after
a long workday. This example shows us how important the length of
shift can be in terms of stress and fatigue.
When looking at work versus rest, we also must consider how many
breaks are taken during the shift and the length of breaks. Depending
on the type of work and length of the day, several short breaks might
be better than a few long breaks. Short breaks might be better partic-
ularly for jobs requiring heavy physical labor.
How tired a worker is also depends partly on how many days in a
row he or she works. Fatigue builds up over several workdays, as
well as over a single workday. This happens especially when a per-
son gets less sleep between workdays than on rest days. As we men-
tioned earlier, a worker might not get enough sleep between long
workdays because of home responsibilities. So, if a person works
several days in a row, for example, six or seven, a good deal of sleep
might be lost. Then the worker feels quite tired during the last one or
two shifts.

10 • Plain Language About Shiftwork

Table 1: Work Schedule Features
Feature Particulars Example

Time of Shift Day, evening or night

Shift Rotation

Permanent Fixed shift times

(no rotation)

Rotating Changing shift times

Speed Number of workdays Rapid: 2 days per shift
before shift change Slow: 21 days per shift

Direction Clockwise (forward) Clockwise: day to evening

or counterclockwise to night
(backward) change Counter: day to night to
evening

Work-Rest Ratios (or How Much Work Before a Rest)

Weekly Number of workdays 5 workdays/2 restdays

to number of restdays 7 workdays/3 restdays

Overtime workdays

Daily Work hours to rest hours 8 h work/16 h rest

12 h work/12 h rest
Rest breaks within a day Lunch, coffee break

Overtime work hours

How Regular or Predictable?

Can affect any other Emergency or “on-call”
part of the schedule Unplanned overtime
Demand-based scheduling
or working off a “call board”

How to Examine Work Schedules • 11

 How Regular or Predictable? Most jobs have a very regular, set
schedule. A worker usually knows the schedule ahead of time. Even
if the shift times change, a worker will know several days before-
hand. This makes it easy to schedule other non-work activities, such
as making sure somebody is at home when the children get there.
Other jobs are not so regular or predictable. For example, health care
workers might respond to emergencies that keep them on the job
much longer than expected. Or, they might be on call for such emer-
gencies. At a factory, a breakdown or a last-minute call for a product
might keep workers at the plant working overtime. Railroad workers
sometimes work off a “call board.” This means they can be assigned
to a train at the last minute to move a “just-in-time” order of goods.
If workers cannot predict their schedules, it is difficult to get ade-
quate rest. Maybe they just get to sleep when they are called back to
work, or maybe they have just worked a long shift when an emer-
gency happens. So, they stay at work a few more hours. Maybe they
are on call and never get deep, satisfying sleep because they are
always listening for the phone. Some people call this “sleeping with
one eye open.”

12 • Plain Language About Shiftwork

 3

Health and Safety Effects

of Shiftwork

W e have mentioned several positive points about shiftwork.

Because of shiftworkers, our society is kept moving 24 hours
a day. To the worker, shiftwork might mean extra pay or more free
hours during the daytime. We also mentioned that shiftwork sched-
ules are demanding and likely to produce stress and fatigue. Here we

Health and Safety Effects of Shiftwork • 13

 summarize ways that shiftwork might affect safety, health, or ability to
do the job. Some of these things happen very soon after starting shift-
work. We talk about these under Immediate Effects. Health changes
take a longer time to appear. We talk about health under Long-Term
Health Effects.

Immediate Effects
Sleep
Soon after starting shiftwork, people notice changes in their sleep.
Night workers usually get the least amount of sleep. Evening shift-
workers get the most sleep, and day shiftworkers get a medium
amount of sleep. Night workers are forced to sleep during the day,
when their circadian rhythm makes them feel more awake. Day sleep
is usually shorter than night sleep—sometimes two or three hours
shorter. Day sleep also is lighter than night sleep. Day sleepers often
say they don’t sleep as deeply as they do at night. Because their sleep
is lighter, they are easily awakened by sounds. This makes sleeping
difficult. Since there is more activity during the day, there are more
sounds to wake up the sleeping shiftworker. Both permanent night
workers and rotating shiftworkers sleep worse when working nights.
However, rotating shiftworkers sleep the least of all.
Sleep loss makes it much easier to fall asleep at inappropriate times.
This affects a worker’s ability to perform safely and efficiently.
Sleepiness can affect performance both on and off the job. Driving to
and from work is a major concern. Sleepiness affects our ability to
concentrate or pay attention, and driving requires us to pay attention
at all times. So, if a person is sleepy, it is easier to have an accident.
Several jobs, such as operating dangerous machinery, also require us
to pay attention at all times. So sleepiness can be risky in many differ-
ent occupations. This risk is not simply a matter of falling completely
asleep. After sleep loss, it is possible to have very brief periods of
sleep that last only a few seconds. Most people may not even realize

14 • Plain Language About Shiftwork

 these short sleeps are happening. During those few seconds of sleep,
they are not paying attention at all. If something dangerous happens
at those times, the worker or somebody else could get seriously hurt.

Circadian Rhythm, Performance, and Safety

The circadian rhythm is a major body rhythm with regular ups and
downs in the 24-hour day. Many systems in the body are very active
at certain times of day, and not active at all at other times of day.
Usually the most activity happens in late afternoon or early evening.
For example, the body’s ability to produce energy from food (metab-
olism) is highest in the afternoon to evening. The least activity usually
happens in the middle of the night when most people are asleep.
This is one reason people feel most active and alert around
4 to 6 o’clock in the afternoon, and sleepiest at 4 to 6 o’clock in the
morning.
There also are personal differences in circadian rhythms. Some peo-
ple are morning types or “larks.” Morning people feel most active and
alert early in the day. They usually go to bed early in the evening.
Other people are evening types or “owls.” Evening people feel most
active in late afternoon or evening, and like to stay up late into the
night. Fishermen who are out on the water before dawn usually are
morning types. Musicians who perform in the evening usually are
evening types. Most people, however, are somewhere in-between the
strict morning and evening types.
The internal circadian rhythm affects how alert people feel. This
affects their ability to perform. People perform best when alertness
and internal body activity is high, and worst when alertness and
activity are low. In the normal day-work, night-sleep situation, people
work when the circadian rhythm is high and sleep when it is low. On
average, this schedule is best for performance, which means it also is
best for safety. When workers perform poorly, they are more likely to
make errors that could lead to accidents or injuries.

Health and Safety Effects of Shiftwork • 15

 When working the night shift, a person is at work when his or her
circadian rhythm is low and asleep when it is high. Such a schedule
means that a person is trying to stay alert when the circadian rhythm
is low. On average, this is not the best time of day for performance.
This low-point affects physical activity and the ability to concentrate.
If a worker also has lost sleep, fatigue could combine with the circa-
dian low-point to double the effect on one’s ability to perform. Poor
performance could affect both productivity and safety. Studies of
errors and accidents at different times of day show an increased risk
at night when the circadian rhythm is low and sleep has been lost.

Interference with Social and Family Life

Most social and family events happen during the evening or on
weekends. Because shiftworkers are on the job in the evening or on
weekends, or because they sleep during the day, they often miss out
on social or family activities. When shiftworkers are asked about
problems with their work schedule, they usually say that the number
one problem is missing family and friends. Most shiftworkers agree
that sleep also is a problem, but sometimes they would rather lose a
little sleep just to see other people, especially their spouse or children.
The amount of time shiftworkers spend with family and friends
depends on their schedule. It also depends on their social and leisure
activities and how flexible these activities are. Shiftwork interferes
little with activities that are not on a strict time schedule. Gardening,
woodworking, or fixing cars are these kinds of activities. Shiftwork
does interfere with activities that are strictly scheduled, such as clubs
or team sports. Shiftworkers often miss these activities because of
work. Child care or visits to the children’s school also can be a prob-
lem because of the work schedule.
A shiftwork schedule affects not only the worker but also the rest of
the family. For example, children at play must be quiet during the
day because the shiftworker is asleep.

16 • Plain Language About Shiftwork

Long-Term Health Effects
In the long run, it is possible for a demanding work schedule to
affect a person’s health. However, studying health problems in work-
ers is difficult. If possible, workers will change jobs if they think the
work is making them ill. A shiftworker might change to a day job for
that reason. This is called the “healthy worker” or the “survivor”
effect. Workers who stay on the job are those who can “take it.”
Because sick workers leave the job, it is much harder to show a rela-
tionship between job factors and poor health. Therefore, researchers
have only fairly healthy shiftworkers to study.
With that in mind, it is not clear whether or not one’s
work schedule is the actual cause of health prob-
lems. But, workers who quit doing shiftwork often
point to health problems as a major reason for quit-
ting. Plus, a stressful schedule can combine with
other factors to hurt a person’s health. If a person
has other major stresses in life, such as a bad mar-
riage or a loved one with a chronic illness, a
demanding work schedule certainly won’t help the
situation. If a worker has poor health habits, such as
using too much alcohol or tobacco, it will be more
difficult to resist the stress of the work schedule. A
demanding schedule also might aggravate an existing
health problem.
Digestive Problems: Some research has suggested that shiftworkers
have more upset stomachs, constipation, and stomach ulcers than day
workers. Other research has not backed up this suggestion. But, there
is always the problem of having only healthy workers to study.
Digestive problems could be more common in shiftworkers because
digestion follows a circadian rhythm. Usually people eat at regular
times during the day. They also eliminate waste at regular times dur-
ing the day. Shiftwork can interfere with regular eating and digestive

Health and Safety Effects of Shiftwork • 17

 patterns by changing work and sleep times frequently. So, it is not
surprising that this could lead to nausea and other stomach problems.
However, digestive problems also could be caused by lack of nutri-
tious food. For example, sometimes on night shift only junk food
from vending machines is available.
Heart Disease: Heart problems also have been noted more often
among shiftworkers than day workers. For example, Swedish
researchers studied paper mill workers in a small town for several
years. This study is especially meaningful, because the paper mill was
the only employer in town. This made it difficult for the employees to
stop working shifts. Most of them had done shiftwork for most of
their lives. Researchers found that the longer people worked shifts,
the more likely they were to develop heart disease. However, the
way in which the work schedule affects the heart is not at all clear.
Work schedule stress might cause heart disease, but it is more likely a
combination of stress, diet, smoking and drinking habits, other life
stresses, and family history of heart disease.
It is difficult to say exactly how the work schedule fits in with all the
other factors producing heart disease. Earlier we talked about several
different work schedule features that could cause stress and fatigue.
Right now we can only guess about which combination of those fea-
tures has the most impact on a person’s health. Constantly shifting
from a day to a night schedule may be one of the stressful factors.
But long work hours, high workloads, and irregular schedules also
can play a role.

18 • Plain Language About Shiftwork

 4

Improving Shiftwork
Through the Organization

Work Schedule Design 4

There are few laws or regulations governing work hours or work
scheduling in the United States. The federal government has placed a
10-hour limit on the length of time a long-haul trucker can drive each
day. There also are federal regulations governing flight time and rest
time for commercial airline pilots. Various state laws establish rules
for overtime pay and child labor. Other than these regulations, the
law does little to guide design of a work schedule to reduce stress or

Improving Shiftwork through the Organization • 19

 fatigue. Nevertheless, research has suggested that work schedules can
be improved. Older, poorly designed work schedules might even be
dangerous because new technologies can change both the physical
and mental demands placed on a worker. A well-designed work
schedule can improve health and safety, worker satisfaction, and pro-
ductivity. Therefore, a good work schedule is an advantage for both
the organization and the worker.
Changing a schedule is not easily done and must be handled carefully.
Designing a work schedule has a large and immediate impact on all
workers. All people on the job must abide by the work
hours, or they will lose their jobs. Also, working hours affect
how people arrange the rest of their lives. So any time a
work schedule is changed, many aspects of job life and
home life must be considered. It is recommended that any
work schedule change should first be temporary and evaluat-
ed carefully. The benefits of the change must outweigh the
possible negative aspects. If it really is a change for the bet-
ter, then it can be established on a permanent basis. Because
such a change is complex, it is a good idea to consult ergonomics, or
human factors, specialists for help in work schedule design and
evaluation.
Shown below are some possibilities that the organization could con-
sider to improve a shiftwork schedule. Given the limited amount of
knowledge and research at this time, these should be considered as
suggestions and not as strict guidelines or regulations. Remember, all
aspects of job and home life must be considered when changing a
work schedule. Some suggestions may be useful in a particular work
situation, and some may not.
Consider alternatives to permanent (fixed or non-rotating)
night shift: Most workers never really get used to night shift because
they go back to a daytime schedule on their days off. Also, some
workers on fixed night shifts lose contact with management and the

20 • Plain Language About Shiftwork

 Improving Shiftwork Schedules
• Avoid permanent (fixed or non-rotating) night shift.
• Keep consecutive night shifts to a minimum.
• Avoid quick shift changes.
• Plan some free weekends.
• Avoid several days of work followed by four- to seven-day
“mini-vacations.”
• Keep long work shifts and overtime to a minimum.
• Consider different lengths for shifts.
• Examine start-end times.
• Keep the schedule regular and predictable.
• Examine rest breaks.

rest of the workers in the organization. They may end up feeling too
isolated or somehow “different” from the rest of the workers. This
could make communication difficult. If possible, consider a rotating
night shift schedule, but take measures to ease the burdens often
experienced in the typical weekly shift rotation. Some suggestions for
making rotation less taxing are given below. We realize, however,
that permanent night shift sometimes is the only choice, such as in a
nighttime security guard job.
Keep consecutive night shifts to a minimum: Some researchers
suggest that only 2 to 4 nights in a row should be worked before a
couple of days off. This keeps circadian rhythms from being overly
disturbed and limits sleep loss.
Avoid quick shift changes: A break of only seven to ten hours
should be avoided before rotating to a new shift, such as going from

Improving Shiftwork through the Organization • 21

 morning to night shift on the same day of the week. With so quick a
change, it is difficult to get much rest before going back to work. On
return to work after a quick change, most people are very tired and
sleepy. At the end of a night shift, at least 24 hours are recommended
before rotating to another shift. Some researchers even suggest that
48 hours should be the minimum between shifts.
Plan some free weekends: If a seven-days-per-week schedule is
required, allow one or two full weekends off each month. Loss of
contact with friends and family is a major problem for shiftworkers.
Weekends are the best time to meet family and friends who are on a
day schedule.
Avoid several days of work followed by four- to seven-day
“mini-vacations”: Working several days in a row followed by several
days off can be very fatiguing. For example, some schedules require
10 to 14 days of work followed by five to seven days off. Frequent
“mini-vacations” are well liked by some workers, especially younger
ones. However, older workers find it difficult to recover during the
mini-vacations before they return to another long spell of work. Poor
recovery from fatigue can produce accidents and damage health. A
long work spell should be used only when there is no other choice,
such as when long travel distances are required to do the work
(e.g., mining or oil exploration).
Keep long work shifts and overtime to a minimum: Extra work
hours add to fatigue. They also allow less rest time per day. If 12-
hour shifts are used, two or three 12-hour shifts in a row should be
the maximum. Two in a row is probably best for night shift. One or
two days off should follow these night shifts.
Consider different lengths for shifts: Try adjusting shift length
to the workload. Heavy physical or mental work or monotonous bor-
ing work is especially difficult at night. Maybe night shifts could be
shorter. If possible, move heavy work to shorter shifts and lighter
work to longer shifts.

22 • Plain Language About Shiftwork

 Examine start-end times: Flexible start-end times, or “flextime,” can
be useful for those with child care needs or a long commute time.
Consider moving shift start-end times away from rush hour. Morning
shifts should not start too early (5 to 6 a.m.) because night sleep
often is cut short before an early shift.
Keep the schedule regular and predictable: Workers should know
their schedule well ahead of time, so they can plan their rest, child
care, and contact with family and friends. Studies of train accidents
showed that very irregular schedules contributed to the accidents by
producing sleep loss and fatigue.
Examine rest breaks: Sometimes the standard lunch and coffee
break are not enough to recover from fatigue. For example, card
dealers in gambling casinos get a 10 to 15 minute break every hour
because their jobs require so much concentration. If their concentra-
tion is low, it is easier for a player to cheat at cards, and the casino
will lose money. In jobs requiring repetitive physical work, brief rest
breaks each hour seem to be best for recovery from muscle fatigue.

Workload Distribution
In some jobs, it might be possible to schedule heavy or demanding
work at times when workers are most alert or at peak performance.
We mentioned that the afternoon and early evening hours are times
of peak performance. If possible, avoid doing the heaviest or most
dangerous work in the middle of the night or early morning hours.
This is the time when circadian rhythms are low, and sleepiness is
high. Especially avoid heavy or dangerous work if the worker is at
the end of a 12-hour shift in the early morning hours. Extra fatigue
from long work hours can combine with early morning sleepiness to
increase accident risk.

Improving Shiftwork through the Organization • 23

 Work Environment
Poor working conditions add to the strain of shiftwork. Adequate
lighting, clean air, proper heat and air conditioning, and reduced
noise will avoid adding to the shiftworker’s burden. Shiftworkers also
may be particularly sensitive to toxic substances because circadian
rhythm changes make the body more sensitive to toxic exposure at
certain times of day. Workers also should have access to hot and
nutritious meals during evening and night shifts. If a cafeteria is not
available, a microwave will allow workers to warm meals brought
from home or bought from vending machines.

Electronic Monitoring
Modern computer technology makes it possible to check a worker’s
performance every minute of the day. Some people have suggested
that a monitoring or test system could be used to check a worker for
dangerous levels of fatigue. There are performance tests on the mar-
ket that claim to test fatigue or determine whether the worker is using
drugs. However, many of them have not been tested scientifically, so
we cannot recommend them at this time.
Some computer systems actually measure worker output or produc-
tivity. For example, a computer might measure the number of times a
worker taps a keyboard or how many phone calls are completed in
an hour. If a worker slows down too much, it could be a sign of
fatigue. It may be possible to use this system as a fatigue test. But this
is tricky business. The feeling of being watched constantly can be
very stressful to workers. (Big brother is watching you.) It can make
workers feel they have no control over their jobs. We suggest that
computer monitoring be used only when the workers themselves
choose it for safety purposes.

24 • Plain Language About Shiftwork

Access to Health Care and Counselling
Often, going to one’s health clinic or to personal or marriage coun-
selling is not possible in the evening or at night. Expanded access to
these services will help improve shiftworkers’ physical and mental
health and boost morale. If services are not available within the orga-
nization, a directory of community health and counselling facilities
with expanded hours could be provided.

Training/Awareness Programs
Meetings to make all workers aware of the ups and downs of shift-
work can be useful, especially for new shiftworkers. It is important to
invite family members to these meetings, so they can know what to
expect from the shiftworker. Use the meetings to share information
on all issues mentioned in this document and in the recommended
reading. Talking about personal experiences also is very valuable in
these types of meetings. If people are having trouble adapting to
shiftwork, it is important they know they are not alone. They might
learn some tricks from other workers that could make their job life
easier. The family will learn just how tough the work schedule can
be. It will help to know when to go easy on the worker because of
the schedule.

Social Programs
A little extra effort at organizing get-togethers, hobby clubs, or sports
and game activities can lessen the feeling of isolation. There is no
special reason for these activities to take place only in the day or
evening. For example, nighttime or early morning bowling leagues
are available in some places.

Improving Shiftwork through the Organization • 25

 5

Coping Strategies
for the Individual

Getting Enough Good Sleep

Take responsibility for getting enough sleep to feel rested and
restored. For some people this happens without doing anything

Coping Strategies for the Individual • 27

 special. However, most shiftworkers need to become more aware of
what to do to get satisfying sleep and when to do it.
When to Sleep after Night Shift: This depends on the individual.
Try different times and see what works best for you. As you experi-
ment with different sleep times, keep a written record of when you
go to sleep, when you wake up, and how rested you feel. This will
help you identify which sleep schedule works best for you.
Some workers like to sleep in one longer period, but many workers
need two shorter sleep periods to get enough sleep after the night
shift. It is a good idea to go to bed as early as possible after the night
shift in order to maximize sleep. A second sleep also could be taken
in the afternoon to get ready for night shift. Try taking advantage of
the natural tendency to be sleepy in mid-afternoon. You might get
your most satisfying sleep at that time.
Does Rest Equal Sleep? Just resting without sleep is not enough.
The brain has to have sleep, or you will be sleepy later in the day
or during night shift. However, rest without sleep still is valuable for
body and muscle recovery. Schedule at least seven hours in bed,
even if you don’t sleep the whole time.
What is the Minimum Amount of Sleep? The vast majority of
workers need at least six hours of sleep but most need more than
this. Most people do not feel refreshed and at their best with just six
hours. Staying with your own preferred amount of sleep is best in the
long run. You might find that you need less as you become more
experienced with shiftwork.
Switching Back to Days: When switching back to days after the
night shift, it is best to get most of your sleep the following night.
Sleep just a couple of hours shortly after night shift to shake off
sleepiness. Then stay awake all day and go to sleep at your regular
bedtime at night.

28 • Plain Language About Shiftwork

 Napping: Shiftworkers frequently nap, especially when working
night shift. Added to your regular sleep, a short afternoon or evening
nap will help fight sleepiness during the night. However, napping is
not long enough to replace regular sleep. If you nap, allow enough
time for drowsiness to wear off before starting work. If you have time
to nap at work during your break, don’t make the nap too short.
A nap of 15 minutes or less might actually make you more sleepy.
Twenty to 30 minutes should be the minimum for a nap during a
work break. Again, allow enough time for drowsiness to wear off
before doing hazardous work. And don’t use work-break naps to
replace your sleep at home. Naps work best when they are extra
sleep time. They don’t work as well when you are trying to make
up for lost sleep.

Protect Sleep
Block Out Noise: Switch off the phone and disconnect the doorbell.
Use ear plugs. Ask the family to use headphones for the stereo or TV.
Set strict times for noisy activity, such as vacuuming, clothes washing,
or children playing. Don’t allow these activities during your sleep
times. Locate your bedroom in the quietest place. If possible, get
away from outside noise and also away from the kitchen or bath-
room. Soundproof the bedroom with insulation and heavy curtains.
Put signs out to say you are sleeping. Tell friends and neighbors
when not to call.
Keep a Regular Sleep Routine: Make the bedroom as dark as possi-
ble. Always sleep in the bedroom. Follow your regular bedtime rou-
tine every time you go to sleep. For example, wash up and brush
your teeth so you feel comfortable. This can serve as a signal to your
body that it is time to sleep. Don’t use the bed for anything except
what it is intended for. For example, don’t read, eat, watch TV, write
bills, or argue with your spouse in bed. Make sure you have a com-
fortable bed that won’t disturb your sleep.

Coping Strategies for the Individual • 29

 Avoid Heavy Foods and Alcohol Before Sleep: Heavy, greasy
foods are anti-sleep because of stomach upsets. If you must eat, a
light snack won’t disturb your sleep. Alcohol might make you feel
sleepy, but it will wake you up too quickly after falling asleep. Don’t
drink alcohol in the hour or two before sleep.

Exercise
In general, keeping physically fit helps resist
stress and illness. Regular exercise also keeps a
person from becoming tired too quickly. A big
question for the shiftworker is when to exercise.
The timing of exercise is important, so that it
does not make a person too tired to work.
Exercise also should not interfere with sleep. If a
worker does physical labor, too much exercise
before work might make work too tiring. Twenty
minutes of aerobic exercise before work (for
example, a brisk walk, bike ride, jog, or swim) is
enough to help any worker wake up and get
going and also keep the heart in shape. Try to
avoid exercise in the three hours before sleep.
Exercise tends to activate the body or wake it up.
This might make it difficult to fall asleep.
The timing of exercise also might help a person
rotate from one shift to another. Since brisk exercising activates the
body to produce energy, it also might help the body rhythm shift to
the new work time. Try exercise before going on shift. Early morning
exercise is good for day shift, afternoon exercise is good for evening
shift, and early evening exercise is good for night shift. Don’t overdo
it or you will be too exhausted to work.

30 • Plain Language About Shiftwork

Relaxation Techniques
Being able to wind down and take it easy is just as important as
being able to wake up and get going. Give yourself time to relax and
get rid of work-time stresses. This will make home life and sleep easi-
er. Find out what is best for you personally to help you relax best. It
could be just sitting down and closing your eyes for a while. Or it
could be meditating, praying, reading, taking a bath, or watching TV.
The following simple exercise may help you start your quiet relax-
ation time. Try lying down on the carpet or bed, or sitting in an easy
chair. One by one, slowly tense each muscle group in your body,
then slowly let them relax. Do this for your arms, legs, stomach,
neck, and face muscles. Breath deeply during this exercise and go
slowly. Try to feel all the muscle tension draining away from your
body. This is a simple way to let go of all the stresses of the day and
to slow down.

Diet
TV and the newspapers have highlighted diets recommending certain
foods to help people wake up and other foods to help them relax.
Right now we cannot recommend either diet for the shiftworker.
There have not been enough scientific tests to decide whether either
diet really helps a person wake up or relax. In some cases the two
diets recommend the same kinds of foods to do opposite things: one
diet recommends eating protein to wake up, while the other diet
recommends eating protein to relax or become sleepy. This conflict
makes it even more difficult to decide whether either diet really
works. There simply are not enough studies of people using these
diets to be able to recommend them.
We can recommend sticking to a diet that, along with exercise, helps
a person stay physically fit. This means avoiding fatty and sugary
foods, which make a person gain too much weight. Heavy or fatty

Coping Strategies for the Individual • 31

 meals should be avoided especially in the middle of the night
because they are the most difficult to digest at that time. Eating lighter
meals in the middle of the night helps reduce stomach upsets.

Bright Light
Recent research tells us that bright light can affect our circadian
rhythm. As we mentioned already, the circadian rhythm normally
makes us feel most active and alert in the late afternoon, and most
tired and sleepy in the middle of the night. Lately, we have learned
that the high-point and the low-point of the circadian rhythm can be
changed by exposure to bright
light. By bright light we mean
as much sunlight as on a bright
summer day. Bright light affects
melatonin, which is a chemical
naturally produced by the
brain. More melatonin makes
us feel sleepier. Melatonin
usually is produced during the early part of nighttime sleep. Bright
light in the evening will reduce melatonin, or make it appear later in
the night.
In laboratory research, people exposed to a few hours of bright light
in the morning felt alert earlier in the day. They also felt sleepier ear-
lier in the night. People exposed to bright light late in the afternoon
felt most alert in late evening. Their low-point in alertness during the
night also was delayed.
Some researchers have suggested that exposure to bright light could
control the alertness of shiftworkers. The well-timed exposure of a
worker to bright light could quickly increase alertness at night. After
exposure to more bright light, they then could quickly switch back to
being alert during the day. Right now, we see this as a promising idea

32 • Plain Language About Shiftwork

 that needs more work to be practical. Unlike use of drugs, it appears
that there are no bad side effects from controlling bright light expo-
sure. Still, workers have to be careful about using bright light, so that
they will be alert at the right time. For bright light to work, a worker
also must stay in low light or in darkness during some times of day.
In other words, if you get too much bright light at the wrong time,
this might change the circadian rhythm in the wrong direction. If this
happens, you won’t be alert at the times you really need to be.
To sum up, we think it is possible to use bright light to change peak
alertness to different times of the day. But right now, it takes an
expert to work out the right light-dark schedule to fit a particular
work schedule. If workers are exposed to bright light and low light at
the wrong times, they might end up moving their circadian rhythm in
the wrong direction. Using this strategy requires a lot of careful effort
from the worker. This might make it too impractical for some shift-
workers.

Caffeine, Alcohol, and Other Drugs

Just like many people in our society, some shiftworkers drink
caffeinated beverages as a pick-me-up before or during work. They
also might drink alcoholic beverages to relax or to be social. Other
types of drugs, such as amphetamines and sleeping pills, also have
been used to help people wake up or relax and go to sleep. Here we
discuss these substances and whether we can recommend them at
this time.
Caffeine: Caffeine is a mild stimulant that helps a person feel more
alert and perhaps perform better. Caffeine is the most widely used
drug in the world. It is a natural ingredient in coffee and tea (iced tea
too!), and it is added to many soft drinks (for example, most colas,
some root beers, Dr. Pepper, and Mountain Dew). Caffeinated bever-
ages are a common part of our everyday diet and are easily available.

Coping Strategies for the Individual • 33

 Because of this, caffeine is used more than any other drug to main-
tain alertness and performance, or to help fight off sleepiness.
Research backs up our everyday experience. There are many studies
that show caffeine does help maintain alertness and performance.
Research also tells us that caffeine is a fairly safe drug if used in small
doses. By a small dose, we mean one to three cups of coffee or tea,
or one to three soft drinks per day.
In small doses, caffeine is the only drug we can recommend as an aid
for the shiftworker. If you drink caffeinated beverages, do so before
the shift or early in the shift. Try to avoid caffeine late in the shift,
especially late in the night shift. Too much caffeine, or caffeine late in
the shift, makes it difficult to fall asleep after the shift. If you do get
to sleep, caffeine makes sleep lighter and less satisfying. So don’t
drink too much and don’t drink late in the shift.
If you now are drinking a lot of caffeine (say five to six cups of cof-
fee every day), we recommend that you cut down. Cutting down may
make relaxation easier and might improve sleep. Reduce caffeine use
gradually over several days. Cut down only by one-half cup or one
cup every couple of days. Cutting down too fast could produce
headaches, nervousness, and bad moods or irritable feelings.
Amphetamines, Diet Pills, “Uppers”: These types of drugs are very
strong stimulants that increase alertness and can eliminate sleep all
together. Unfortunately, they are too strong and cannot be recom-
mended. Most of these drugs are either illegal or can be obtained
only by prescription. It is too easy to become addicted to these drugs.
A worker might end up using them every day just to get going. Also,
over the long run a person has to take more and more of these drugs
just to make them continue to work. This increases the possibility of
becoming addicted. Frequent use produces extreme nervousness and
mood changes, and performance actually becomes worse.

34 • Plain Language About Shiftwork

Alcohol: One or two alcoholic drinks per day, taken with food, is
OK for relaxation and to be social. By one drink, we mean eight to
twelve ounces of beer, four to six ounces of wine, or one ounce of
hard liquor. However, we recommend avoiding alcohol during work
time, even during meal breaks. Also, we do not recommend using
alcohol to help sleep. Alcohol can make a person sleepy, so falling
asleep is easy. But, alcohol actually disturbs sleep. After drinking
alcohol, a person wakes up more frequently and sleeps more lightly.
Alcohol can also reduce sleep so a person doesn’t sleep as long as
they want or need to. Avoid alcohol for one to two hours before
sleep, especially if you have to go to work after sleeping.
Sleeping Pills: These drugs can be divided into prescription and
nonprescription (over-the-counter) types. Nonprescription sleeping
pills usually contain the same drug used in allergy and sinus medi-
cines. Nonprescription drugs sometimes make a person drowsy and
help them fall asleep. However, most are fairly long acting, which
means that the user can still feel drowsy after waking up. If used
often (e.g, more than once or twice per week), nonprescription pills
usually stop working and fail to make a person drowsy.
Prescription sleeping pills work pretty well to help a person fall
asleep and stay asleep, even during the daytime. However, we cannot
recommend regular use (e.g., more than once or twice per week)
because there is no research on shiftworkers and long-term use of
sleeping pills. It probably is not a good idea for shiftworkers to use
sleeping pills every time they want to sleep during the day. For some
people, it is too easy to become dependent on sleeping pills. They
might end up using them every time they have to sleep. When this
happens, they become nervous or irritable if they run out of pills.
Also, some long-acting sleeping pills produce too much drowsiness
after waking from sleep. This is less of a problem with the newer,
short-acting sleeping pills. However, before considering prescription
drugs, we recommend trying the other techniques for improving

Coping Strategies for the Individual • 35

 sleep. If all else fails and there still are problems with sleep, the
worker should discuss taking prescription sleeping pills with his or
her doctor.
Melatonin: As we mentioned already, melatonin is produced
naturally by the brain at certain times of the day. The timing of the
brain’s melatonin production can be controlled by bright light.
Melatonin also can be taken as a drug. Taken this way, melatonin
makes a person feel sleepy. So it might help improve daytime sleep
for the shiftworker.
Melatonin often is sold in health food stores and can be bought
without a prescription. However, we cannot recommend melatonin
for regular use by the shiftworker until more research is conducted.
We need to find out how much melatonin should be taken. We need
to learn the best time to take melatonin for a particular work shift.
We also need to know if taking too much can damage your health.
If taken too often, melatonin could create unknown problems. Also,
the different brands of melatonin sold in stores might have different
strengths or potency. So, we don’t know whether taking one amount
of one brand works as well as taking the same amount of another
brand. Right now, we will have to take a wait-and-see attitude about
melatonin until more research is done.

36 • Plain Language About Shiftwork

 6

Recommended Reading
Authors: Corlett, E.N., Quiennec, Y., and Paoli, P.
Title: Adapting Shiftwork Arrangements
Publisher: European Foundation for the Improvement of Living and
Working Conditions, Dublin, Ireland
Year Published: 1988

Authors: Folkard, S. and Monk, T.H. (editors)

Title: Hours of Work: Temporal Factors in Work-Scheduling
Publisher: John Wiley and Sons, New York
Year Published: 1985

Author: Lamberg, L.
Title: Bodyrhythms: Chronobiology and Peak Performance
Publisher: William Morrow and Company, New York
Year Published: 1994

Author: Monk, T.H.

Title: How to Make Shift Work Safe and Productive
Publisher: American Society of Safety Engineers, Des Plaines, Illinois
Year Published: 1988

Authors: Monk, T.H. and Folkard, S.

Title: Making Shiftwork Tolerable
6

Publisher: Taylor and Francis, London

Year Published: 1992

Recommended Reading • 37
 Author: Scott, A.J. (editor)
Title: Shiftwork: Occupational Medicine State of the Art
Reviews. Volume 5, Number 2.
Publisher: Hanley and Belfus, Inc., Philadelphia
Year Published 1991

Author: U.S. Congress, Office of Technology Assessment

Title: Biological Rhythms: Implications for the Worker
(OTA-BA-463)
Publisher: U.S. Government Printing Office, Washington, D.C.
Year Published: 1991

Author: Wedderburn, A.
Title Guidelines for Shiftworkers
Publisher: European Foundation for the Improvement of Living and
Working Conditions, Dublin, Ireland
Year Published: 1991

38 • Plain Language About Shiftwork

Background Information • 39
 Delivering on the NationÕs promise:
Safety and health at work for all people
Through research and prevention

DHHS (NIOSH) Publication No. 97-145