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NIGHT SHIFTS READY FOR WAKE-UP CALL
THE HIGH COST OF 24/7

SLEEP RESEARCHERS ARE FINDING POORLY SCHEDULED EXTENDED HOURS ARE
BAD FOR BUSINESS AS WELL AS HEALTH, VIRGINIA GALT WRITES:
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In his cramped examining room, Toronto doctor Jeffrey Lipsitz treats the casualties of the sleepless economy: Casino workers, bankers, information technology professionals, retail employees, airline pilots, physicians and nurses.

In Saint John, psychiatrist Rachel Morehouse's patient roster includes manufacturing employees, truckers, fishermen and call-centre employees -- "...we have a lot of call centres here in Saint John."

Working 24/7 is exacting a toll. Sleep researchers have long talked about the health costs associated with shift work; now they are uncovering hidden economic costs in operations where shift work has been poorly scheduled.

Consulting firm, Circadian Technologies Inc. of Lexington, Mass. recently estimated that "the unintended and largely unrecognized costs associated with irregular schedules, night shifts and extended  hours are eroding the profits of American businesses by $206-Billion (US) annually, approximately $8,600 per extended-hours employee." Productivity is 5 per cent lower between the hours of midnight and 7:00 am than during the day, Circadian reported.

Absenteeism among companies with extended hours of operation is more than twice the US national average, and average turnover is more than three times higher among extended-hours workers.

There are no comparable Canadian statistics.

However, a report commissioned by the Canadian Institutes of Health Research last year also raised alarms about the issue of shift work and fatigue: "The profound economic and social costs associated with work-related fatigue and sleep loss demand continued efforts to identify solution to these problems," the report said.

Dr. Morehouse, and internationally recognized specialist in sleep disorders, said Canadian employers are not beating a path to the door of her sleep lab for advice on how to minimize the negative impact of shift work on their employees. "They just don't really have a proactive stance in this regard,. I think we just have sort of a 'suck it up' attitude." However, she added, there are "a few progressive employers" who have established nap rooms, stocked the company fridges with nutritious food and designed schedules that provide enough time off so that employees can catch up on their sleep. "This is to be applauded."

The Canadian arm of Intuit Inc., Edmonton-based Inuit Canada Ltd., has three nap rooms with comfortable beds and alarm clocks so employees don't drift into a deep sleep that is hard to wake up from.

"They say between 20 minutes and half an hour is ideal," Steve Quesnelle, vice-president of human resources, said in an interview. The company also has a fitness centre that is open 24 hours a day and fridges filled with boxed lunches that late-toiling employees can help themselves to "on the honour system" when the cafeteria is closed, Mr. Quesnelle said.

The company offers flexible start and finish times, plus the option of compressed workweeks, where employees work longer hours for fewer days of the week. Mr. Quesnelle said these benefits were introduced in consul- tation with employees because Intuit Canada -- a leading developer of tax return software -- wants to be able to retain its best employees and support them through tax season.

The Royal Bank of Canada staffs the overnight shifts at its Moncton, NB call centre with employees who have volunteered for those hours. And even the, "we give them a  three-month time frame to adjust," team leader Martin Steen said. Those who can't handle the hours have the option of transferring back to a more conventional schedule, he said. "Obviously, if you are coming from a day shift to an overnight shift, something has to give. You can't live both lives," Mr. Steen said.

Some people adapt better than others, said Dr. Morehouse, whose own employees work overnight in the sleep laboratory. "Its the ultimate tease, watching other people sleep," she said. Dr. Morehouse tries to practice what she preaches. She tries to minimize the ill effects of overnight work by keeping areas outside of the sleep rooms well lit so the technicians are not fighting to stay awake in the dark. There is a kitchen area where they can prepare decent food, "not junk" And recovery time is built into the schedule. "They work three 12-hour days in a row, but then they have four days off before we expect to see them again.."

Circadian Technologies founder and physician Martin Moore-Ede, a former professor at Harvard Medical School, said in a recent interview that he first became interested in sleep medicine in 1971 during his internship at Toronto East General Hospital. Physicians are among the worst at maintaining healthy work schedules, he said.

He recalled working 36-hour stretches non-stop during his surgical internship, "walking around like a zombie, nodding off in the O.R., writing prescriptions that didn't make sense the next day."

His consulting firm advises employers on how to manage the risks associated with round-the-clock operations. "Clearly, companies choose to operate extended hours to maximize productivity and return on assets. In a 40- hour work week, only 23.8 per cent of the maximum potential of a company's current assets are utilized." Circadian said in its recent study. "But, often, extended-hours operations instigate excess and unbalanced overtime levels, high absence and turnover rates, increased recruiting costs and excessive health and accident costs."

Most senior managers, Circadian said, are nine-to-five managers, with little appreciation for the unique challenges facing employees working in extended-hours operations. "There is limited availability of corporate resources, such as human resources representatives, medical and exercise facilities, cafeterias and corporate- sponsored child-care facilities for extended-hours employees."

In Canada, 30 per cent of employees are shift workers. And, wile people in long-established shift-work profes- sions -- policing, nursing and mining -- have learned, by trial and error, to develop healthier work schedules and better eating and sleeping habits, the new white-collar shift workers tend to have "poorer (health) hygiene," said Marlene Reimer, acting dean at the University of Calgary's faculty of nursing. Health problems arise when shift workers drink too much caffeine to stay awake and too much alcohol to get to sleep, and eat too much fast food because it is more convenient than preparing more nutritious brown-bag meals at  home.

Ms. Reimer was part of the group of health-care professionals that prepared the report for the Canadian Institutes for Health Research calling for more applied research on the economic impact of disorders associated with shift work, extended hours and fatigue.

"A large proportion of the work force is exposed to the risks associated with lost sleep and disrupted circadian rhythms. These risks have proved to be very large. Many studies have demonstrated that shift workers have increased risks for cardiovascular and gastrointestinal disease and a few have demonstrated increased breast cancer risks,"  the report said. Researchers are divided about how much this results from the fact that shift workers tend to smoke more and have poorer dietary habits than the nine-to-five population.

"More clear cut is the evidence that those working at night, whether driving or flying commercial vehicles, operating machinery, working in health care or protection services or acting as flight traffic controllers are at increased risk of falling asleep on the job. They are also at increased risk of accidents when travelling to and from work, depending on the timing of their shift changes," the report said.

Dr. Lipsitz, founder and medical director of the Sleep Disorders Centre of Metropolitan Toronto, said humans are biologically programmed to be 'diurnal creatures' -- active by day and resting at night. Daytime sleep is often lighter and less refreshing, and many night-shifters find themselves sleeping two to four hours less during the day than they would if they were working days and sleeping nights. Shift workers should install blackout curtains in their bedrooms, although garbage bags will do in a pinch; turn off the telephone ringer; and send a clear do-not-disturb message to friends and family to ensure better quality sleep, Dr. Lipsitz said. Most can adapt, but not without considerable effort by both employees and employers.

"We live in a 24-hour society," Dr. Lipsitz said. And as much as some might debate whether it is essential for people to sell groceries or operate casinos throughout the night the fact of the matter is that people are scheduled to provide these services. "People might say how critical is that? But, that's not much help to the casino employee who is so tired she can't count the chips at 4:00 in the morning.

Shift-work fatigue is gaining prominence as a bargaining issue as increasing numbers of employees are required to work non-standard hours.

Brian McArthur, national bargaining coordinator for the United Food and Commercial Workers, said unions negotiate shift premiums both to reward employees and to discourage unnecessary scheduling. They attempt to negotiate longer rest breaks for night shift workers and explore support for compressed workweeks, which involve longer shifts but more consecutive days off. "We try to make it more palatable," he said, adding that, with persistently high unemployment, employees don't always have much choice over their hours.

"It's a vicious labour market, people are so desperate," he said.

In British Columbia, group home employees are fighting a move by their employers to return to the 24-hour shifts their union got rid of in the last round of bargaining three years ago. Hospital Employees Union negotiator Marilynn Rust, who works in a Victoria home for mentally challenged adults, said the 24-hour shifts were brutal. "Families were breaking up, mothers were losing track of their kids,"

The group home workers were only paid for 10 of the 24 hours, she said, because the shift was considered "a sleep shift." But, Ms. Rust said, you can't sleep when you are the sole person responsible for three or four mentally challenged adults. There are sometimes behavioral issues -- "someone can suddenly go off and start chucking things at 2 in the morning" -- and the non-ambulatory clients have to be changed and turned.

The rotating 8-hour shifts the union negotiated in the last round of bargaining provided a balance between work and family life, and left employees rested enough to take good care of their clients, Ms. Rust said.

Toronto employment lawyer Stewart Saxe said 12-hour shifts are gaining popularity in the manufacturing sector because they offer employees more down time. However, he advises employers to start consultations with their employees a year in advance to build support to the idea and to accommodate, whenever possible, those employees who absolutely cannot work night shifts for health or family reason. And, after employees have worked three or four 12-hour shifts, they should not be called back on overtime, said Mr. Saxe, a partner with Baker & McKenzie.

At the RBC call centre in Moncton, manager Michelle Duke makes a point of meeting her night-shift workers on their schedules, not hers. It is not always easy for  her to stay wake. Ms. Duke said, but "there are 34 Tim Hortons in Moncton, so there is no shortage of caffeine." The bank also makes sure the night-shifters are included major social events; the call centre in Winnipeg recently covered for the Moncton crew so they could attend their annual gala.

"I was particularly proud of our overnight team," Mr. Steen said. The night-shifters were the only left on the dance floor when everyone was fading. They had stamina, he said, "Even in heels."

"All that training paid off."

In Toronto, the police association has hired its own "wellness guy," personal trainer Chris Yap Young, to counsel its members on fitness, nutrition and coping with shift work. During a recent clinic a downtown police division, a steady stream of police officers dropped in for an assessment and advice. Mr. Yap Young tells them to protect their sleep time and stay away from junk food. "Even all night gas stations sell fresh fruit now, not that I'm necessarily advocating that that people eat at gas stations," Mr. Yap Young said.

Police Association executive Andrew Clarke, director of uniform field services, said no on ever gets totally used to shift work, but police officers take better care of themselves than they did in the past. "Contrary to popular belief, we don't eat doughnuts."

Association president Rick McIntosh said U.S. studies have shown that police officers live 10 years less, on average, than people in other occupations. "And it's not because we get shot and killed, it's because of stress and shift work."

But that is changing, he said, "Years ago, when I was starting out, we weren't concerned about nutrition. We lived on a diet of wings and beer." The association's wellness initiative has been incredibly popular, Mr. Clarke said.

On a recent midnight tour through a Toronto neighbourhood -- quite apart from the nocturnal activities of drug dealers, prostitutes and party-goers -- Mr. Clarke caught up with two young officers, Mike Irving and Leslie Gilbert, at the start of their shifts.

As they idled in a Tim Hortons parking lot, one ear to the police radio, alert for a call to action, Mr. Clarke treated them to tea -- each took it with one milk, one sugar. "You guys want a muffin or something?" he asked.

"No, too fattening," Mr. Irving said. "I put on 20 pounds in a year and then I lost 10 to 12 pounds after I stopped eating this crap."

Ms. Gilbert said, "She always eats light at night" and limits her caffeine intake. The "wellness guy" has made a difference, she said.

"Water is the big thing that pretty much everyone is doing now, even the old guys, everyone is packing water."

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From: The Globe & Mail - Sat. December 13, 2003 pp B-1

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