the role of self-regulation and shift schedule in countering the slow violence … role of...
TRANSCRIPT
The Role of Self-Regulation and Shift Schedule in Countering the Slow Violence of Shiftwork: Notes from the
Front Line
Ruhi Snyder, RPSGT, CCSH Sleep Disorders Lab
Kingston Health Sciences Centre, Kingston, Canada [email protected]
Structure of the Talk:
• AbriefintroductiontoCircadianRhythms• ImportantHormones• Chronotypes• ShiftWorkTolerance
• ConsequencesofCircadianDisruption• Metabolic• Cognitive
• RoleofSelfRegulationandShiftSchedule–MyCaseStudy• Results• Conclusion• ClosingStatement
What is shift work?
• Atypicalworkschedulesthatextendbeyonda9-5workday,suchas• Earlyworkstarts• Compressedworkweeks• Eveningwork• Nightwork
… observed the harmfulness of shift work, in particular night work: such as bakers who work at night, so when others sleep
they stay awake, while trying to sleep during the day like animals who escape the light: hence in the same town, there
are men living an antithetic life in comparison with others
BernadinoRamazzini.DeMorbisArtificumDiatriba.1713.
“Slow Violence” is the term coined by Rob Nixon to describe the catastrophic effects of
environmental deterioration and its invisible trauma on human beings.
As shift-workers, we commit
the slow violence against ourselves.
Nixon,Rob.SlowViolenceandtheEnvironmentalismofPoor(2011).HarvardUniversityPress.
The Slow Violence of Shift Work
• CircadianRhythmDisorders• MetabolicDisorders• SleepDisorders• MoodDisorders• Cognitivedysfunction• Cancer
Normal circadian rhythm
• Theapproximately24hourbiologicalclock–keepstherhythmandsynchronicityofvariousphysiologicalaspectsincluding:
• Hormones• Bloodsugar• Sleep/wake• Metabolism
• It’ssynchronicityisfundamentaltovariousaspectsofwellbeing.• Itallowsorganismstoadjusttheirphysiologybyanticipatingdailyenvironmentalchanges,ratherthanmerelyrespondingtotheminareactivemanner.
Krygeretal.PriniciplesandPractiseofSleepMedicine5thedition.
The Master Clock
ImagefromGoogleImagesonMasterClock
The Human Circadian Clock
• Hasaninherentrhythmthatislongerthan24hours
• Itrequiresresettingorentraining.
• Themostpowerfulcueorsynchronizerislight(465nm).
Appleman,K.SleepMedicine2013(14)456-461
Regulation of the Central Pacemaker
Int.J.Mol.Sci.2014,15,23448-23500.J.PinealRes.2012;52:1-11
Melatonin - Darkness Hormone
• Oneofthemostwellknowncircadianoutputsignal,othersbeingthecentralnervoussystemandthecorebodytemperature
• Consideredtobegoldstandard• Suppressedbylightduringthedaytime.
• markerforcircadiansystem• Releasedbythepinealgland.• Hasantioxidativepropertiesthatcombatsfreeradicaldamage
J.PinealRes2012(52)1-11;AnnClinBiochem200643:344-353
Long-term effects of Chronodisruption:
Circadianrhythmdisruption• Behavioralchanges,• Sleepdisorders,• Alteredhormoneandmetabolicdysregulation
Leadingto:
Krygeretal.PrincipleandpracticeofSleepMedicine5thed.2011Karatsoreosaetal.ProcNatAcadSciences.2011;108:1657–1662
• Mooddisorders• Cognitiveimpairment• Obesity• Diabetes
• Hypertension• Cardiovasculardisease• Cancer
Chronotypes
• Twotypes:• Eveningtype“theowl”• Morningtype“thelark”
• Chronotypecanvarywithageandgender• Chronotypemodulatesshiftworker:
• Sleepduration• Sleepquality• Socialjetlag(internaldys-synchronization)
• MunichChronoTypeQuestionnaire(MCQTshift)
Judaetal.JBiolRhythms2013;28(2):141-51BiologicalRhythmsRes2010;(6):415-413
Tolerance of shift work (SWT) studies
AIM:determineindividualdifferenceofshiftworktolerancebyevaluationofsleep,sleepiness,fatigue,socialfunctioning,physicalandmentalhealthAcohortof2,059Norwegiannurses(38%responserate)weresentquestionnaires,remindersFindings:• VariablesveryimportanttoSWT:well-beingandphysicalhealth• Shiftworktolerancedefinitionshouldnotonlyincludeinsomnia,fatigue,anxietyanddepression,butalsomentalhealthandsocialfunctioningvariables
.
IntArchOccupEnvironHealth2004;71,121-129BiologicalRhythmsResearch2015:46,No.257-264
Saksvik-lehouillieretal.IndustrialHealth2015;53:69-77
Tolerance of shift work (SWT) studies
AnotherstudyonDutchPoliceofficersFindings:• SWTwasdirectlyrelatedtoqualityofsleep.• Womenweremoreintolerantbecauseofaddedresponsibilitiesoutsideofwork.• Ofteninshiftworkerssleepisshortenedto4.8–5.5hourswhichoftenleadstochronicsleepdeprivation.
IntArchOccupEnvironHealth2004;71,121-129BiologicalRhythmsResearch2015:46,No.257-264
Saksvik-lehouillieretal.IndustrialHealth2015;53:69-77
Metabolic consequences of sleep loss
Sleepdeprivationisassociatedwith:• Neuroendocrineregulationofappetite-decreasedLEPTINlevelandincreasedGHRELIN
• Increasedenergyintakethroughhigh-caloriefood,snacks• Insulinresistanceleadingtodiabetes• Activationofgenesthatpromoteobesity
Sleepdebthassimilarimpactasagingonriskofchronicdisorders
Spiegeletal.JApplPhysiol2005;99(5):2008-2019.VanCauteretal.SleepMed.2008Sept;9(1):S23–S28.
Copinschietal.FrontHormRes2014;42:59-72.
Chronic effect of shift work (SW) on cognition
Prospectivelongitudinalstudy• Cohortof3,232employees/retiredemployees:1,484shiftworkers• Clinicalexamsandquestionnairesatbaseline,5years,10years• Measuredtestsofspeedandmemory
Findings• Shiftworkassociatedwithchronicallyimpairedcognition• StrongerforexposuretoSW>10y• AfterstoppingSW,recoveryofcognitivefunctiontookatleast5years
Marquieetal.OccupEnvironMed2015;72:258-265.
Verylittleresearchintohealthofshiftworkersthatcombinesinterventionsbaseduponlifestylefactors.
Asshiftworkers,• wedealwithmultiplevariables
• wehaveverylittlecontrolofourenvironmentandit’simpactonourphysiology
Case Study
Snyder,Ruhi(2015).
Foundation of Case Study
• TimingandTypeofExercise
• TimingandTypeofDiet
• ShiftSchedules
• Intermittentfasting
• Meditation
• BlueBlockingSunglasses
Methods
• Asleeptechnologistworking12-hournightskeptadetailedlogofshiftschedule,sickdays,burnoutdays,exerciseandfoodintakeduringnightshiftsanddaysoffworkandcreatedaselfregulationprogramthatevolvedoveraperiodofthreeyears.
• Aself-regulationprogramwasimplementedafterthefirstyearandinvolvedmodifying:
• thetimingandtypeofexercise,• timingandcompositionofdiet• Intermittentfastingandmeditation• shiftschedulesduringthenexttwoyearsand• Addedblueblockingglassesafterfinishingnightshiftasashieldfromthemorninglight.
Exercise Related Benefits
• Exerciseimproves:• Sleep• Mood• Stresslevel• executivefunction• Cognition• Neuroplasticity• regulatesmetabolism• Increasesmusclemass
VanReethetal.AmPhysiolSoc1994;E964-74Spark:TheRevolutionaryNewScienceofExerciseandCognition2008
JournalofScienceandMedicineinSport2014;(17)51-55
Benefits of Nocturnal Exercise
• Onlyahandfulofstudieshavebeenconductedoneffectsofnocturnalexercise• NocturnalExercise(HighIntensityIntervalTraining)phasedelaysCircadianRhythmsofMelatonin
• Regularexercisecancreatesubstantialphasedelays• Acceleratesre-entrainmentofthehumansleep-wakecycle
EuropeanJofAppliedPhysio(2007)99:331-341
J.PinealRes.(2012)52:1-11JournalOfCircadianRhythms201614(1):2,1-8
Sample Journal Entry- 2012 2weeksoffworkApproximatelysleptfor11-12hours.Inbedby1:30amWokeupfirstaround10:30amandwentbacktobedat11:00amandthenwokeupagainat1:00pm.Hadabagelcreamcheeseforbreakfastandasingleshotlattewithacupofmilk.Mildheadacheandtook1Advil(200mg).Hadpastawithcheese,peasandcornat6:30followedbyathirdlatte.Arrivedatworkafterbeingofffor12days.
Mood:fairlygood.Attitude:goodExercise:at11:30Stretching:2minutesStairs:1:54Rest:0.1Pushupsandabs:1:29@20eachStairs:2:22Pushupsandabs:.30Stretching:7minutesHadadifficulttimeduringthesecondsetofstairclimbing-pacerelativelyslowgoingdownandatthelowestafterclimbing50stairs.Continuedtorunupatarelativelylowpaceforthenext50stairs.
Levelofenergy:highFocus:highAttitude:positiveConcentration:goodAnalyzed1studyandconducted3diagnosticstudies.Moreenergyandwanttodomorephysicalactivity-recordedat2:18am.anothersetofpullupsat12:30amMeal@1:00amcontainingbeefandabeansoup.Teaat2:00am.Energylevelat4:00-moderate,yawningpresent.Physicallyalert.Mentally-mildlyfoggy.
Case study – exercise and shift schedule Year ExerciseOnNights ExerciseonDaysoff ShiftSchedule
2011-2012 Variabletiming-Running,yoga,cardio11:30pm-4:00am
Variabletiming-Running,yoga,cardioNoon-7:30pm
4nights/wk3nights/wkIntermittentdayshift
2012-2013 Variabletiming–highintensitytraining12–2:30am
Controlled–martialarts7-9pm2x/wk12-1:301x/wk
4nights/wk3nights/wkIntermittentdayshift
2013-2014 Controlledtiming-highintensitytraining,yogaandmeditation2:00-2:45am
Highlycontrolled12-1:302x/wk–martialartsAfternoon–runningPostexercise-meditation
3nights/wkto3nights/wkandadayshift(fixeddays)
2014-2015 Controlledtiming-highintensitytraining,yogaandmeditation2:00-2:45am
Controlledandflexible12-1:301x/wk–martialartsAfternoon2x/wk–running,hiking,andrecoveryperiods.Postexercise–yogaandmeditation
2nights/weekor2nightsaweekwithaflexibledayshiftFixedschedule
Year DietonNights DietonDaysOff
2011-2012 VariableandunrestrictedAllfoodgroups,somesweets,caffeineanytime,occasionalalcohol
VariableAllfoodgroups,somesweets,caffeineanytime,occasionalalcohol
2012-2013 Eveningmeal6pm-Halfaportionofmealcontainingleanprotein,carbs,two-threevegetablesandasaladSnacks11pm-12ampmfruitsmoothieswithproteinpowder,nutsandvarious1hourpriortoworkout:fruits/vegetablesPostworkoutmealtheotherhalfoftheeveningmeal
BLS-bigmeal7-9:30pmafterworkoutifapplicableSnacks–fruits,nuts,smoothies
2013-2014 Stricttimingofintakeofmealsandcoffee,noprocessedfoodorsugarMeal1hourpriortoshiftMeal1-1/2hourpostworkoutduringtheshiftPreworkout-fruit,wholegraincrackersandnutsNocaffeineafter1pmNofoodintakeafter4am.
Wholegrainsonly;eliminatedalcoholandprocessedsugarS-6:30-8pmStarted12hourfasting
2014-2015 Continuesame Continuesame;occasionalalcohol
Case study – diet type and timing
Results
• AfterimplementationoftheSelfRegulationProgramandchangestoshiftschedule,thefollowingqualitativeandquantitativeobservationsweremade:
• Mental-improvementofmood,tolerance,patience,self-efficacy,senseofempowerment
• Physical-improvementinstrength,endurance,sleepqualityandenergylevel;lesspronetoinjuryandfatigue
• Sick–significantreductioninsickdaysandtimeoffforburnout(eg.preSRP:8sickdays/year;SRP:0sickdayspastyear)
• Productivity–improvementinfocus;increasedworkoutput;improvedinteractionswithpatientandimprovementinwork-lifeintegration.
Shift Schedule
Ruhi Snyder ©2018
Ruhi Snyder ©2018
Shift Schedule
Ruhi Snyder ©2018
Shift Schedule
Ruhi Snyder ©2018
Evolution of Self-Regulation and Impact on Work
Conclusion
• Theauthor’sself-regulationprograminvolvinglifestylefactorshadnumerouspersonalandemployeebenefits
• Regularconsecutivenightshiftsfollowedbyatleast4daysoffandaflexibledayshiftonatwoweekcycle,reinforcedwithselfregulationasperdailytimedexerciseandmeals,anda12hourfast,meditation,wearingblueblockingsunglasses…ledto,bettermentalandphysicalhealth,reducedsickdays,andincreasedproductivityandimprovedworklifeintegration.
Closing statement
Thecasestudyiscomplexasitisembeddedinreal-lifewithmultiplevariablesthatshiftedconstantly.It,therefore,requiredamulti-layered,constantly-evolvingapproach.Itrequiredaprocessofselfawarenessofmyownrhythms,awillingnesstochangeandaltercoursewhenneeded,anopendialoguewithmyorganizationandacompletecollaborationandunderstandingfrommyfamily.Italsorequiredanunderstandingofpersonaleconomy(goingfromfulltimewithbenefitstopermanentparttimewithnobenefits).Asa24-hoursociety,shiftworkisarealityformany(Bluecollarorwhitecollar)andasareit’simplicationsonone’swell-beingandoncommunityandthesociety.Weneedamorecollaborativeandreallifeapproachtoshiftworkforthereisnoonemodelfitsallsolution,forhumanbeingsaredynamicandconstantlychangingsystemswithvariablesthatarechangingfrommomenttomoment.
RuhiSnyder2018
Acknowledgements:
KimSnyder,LucasSnyder,SaruGill-Bajwa,ArzoiBajwa,Dr.HelenDriver,ShelaghFreedman,Dr.KarenSchultz,LaurieAnderson,CynthiaDawson,TabathaKnight,KatherineQuarterman,KrisMarks,Dr.MichaelFitzpatrick,GillianBlekkenhorst,JenniferSnyder,Dr.NicolleDomnik,Dr.MalaJoneja,Dr.ManojDias-Abbey,TallackMartialArts,BenRobinson