This site is intended for healthcare professionals

Surviving and Thriving on shifts: the challenges of shift working



MPS are also offering those who renew from F1 into F2 and new F2 members a £20 Amazon gift voucher. Read more here >>

Related content

Similar communities

View all

Similar events and on demand videos


Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Are you a shift worker? Now? Um A shift worker, I'll just put, basically as I'm working when I would be sleeping or I would be resting. So we'll put a quick poll up there and see what you think of yourselves. Are you shift workers already? So a simple yes or no. And we'll see what comes excellent stuff and we'll see it. 0 100% said yes. OK. So you're clearly highly motivated to show up today. Um When I do these talks for, for, you know, health professionals of all ages and all types, not everyone thinks they answer shift workers. So you guys are clearly motivated to kind of learn lots today. Now, traditionally, a shift worker would be one of these guys, you probably think of them as being employed. So you're employed to wait and work when you'd be sleeping. But there's also a group of unemployed shift workers or her selfemployed, which are parents. Um And I wonder how many of your parents already or carers, people who are caring for someone outside of their career and those are the hard caring shift workers that we usually think of, but there are others as well that you might need to consider and maybe later on on in your career, that might be worth considering. And that's people whose body clock is out of sync. And there's a group of hidden shift workers. So we know, for example, if you struggle with insomnia, that means your brain is working. For example, when you're lying in bed at night, your brain is worrying and at least 10% about 40% of healthcare workers are actually brains are busy at night when they're trying to sleep or maybe if you work indoors. So my son asked me, what do you do? Dad? And I say I help people through a screen, which is not what I trained necessarily to do at medical school. But now I'm a shift worker because I'm out of sync with the sun or um if you need stimulants. So caffeine to get you up in the morning or you use anything to try and get you to sleep at night, then your brain and body are out of sync and similarly adolescents, which are people between the age of uh 12 and 28. Their, their, their body clocks naturally synchronized to be like. So their body clock actually shifts to be more alike than LA like. Um And that has a consequence for kind of turning up at medical school or turning up at conferences and trying to learn, you know, at the crack of dawn or similarly if you're older. So I wonder all of you said you're shift workers. But I wonder if you might continue to be shift workers though, you're not necessarily employed as such. And there's a great book, if you want to learn more about that called the Circadian Code by Sain Panda, who does a deep dive into the importance of our circadian rhythms. And he actually alongside lots of other um professors have recognized a term called scarred, which is sleep and circadian rhythm disorder where if we're out of sync with our body clocks, there can be significant consequences. We're gonna dive a little bit deeper into the science there. And um I'd like to start this part by just pausing and seeing if there were any particular needs or questions that came up. Kat, were there any questions that came up or? Yeah. No, nothing at the moment. Um But do feel free to post anything that, that you want to ask? Yeah. Yeah. He fantastic. OK. Dokey. Well, I'll, I'll, I'll um I'll press on then and if anything comes up, I'll pause and listen. And so um qui a quick thing, Gko meter. Um uh I'm gonna get quite geeky but if it's not geeky enough, put more geeky in the Q and A s and if it's too geeky, just put less geigy in the Q and A s and I'll try and reduce it down and I'll let Cath say so I've got my geometer as a little prompt here. But keeping it really simply because I actually teach this to kids as well as um medics. Our sign of our c biology is based on four clocks. So just like me, if I invite you to get your left hand up, give it a little shake for the kinesthetic learners and then put your left hand on your belly because underneath your belly, every one of those cells has got their own body clock. So every cell in this body, your, your body has its own clock. And it's a DNA mediated clock, but not like this. Here, it's actually a 24 hour clock or slightly longer, 24 hours and around 20 minutes. So it's slightly out of sync. So it needs to be synchronized and entrained and it's much more effective to have it running slightly longer and bring it in time than, and get it precisely on 24 hours. And that's because it needs to adapt to our shifting seasons and our shifting needs in life. So it's got to be able to adapt to our brain clocks. So maybe pop your left hand on your head and give it a shake. There we go. Here, we got our brain clock and inside that we've got a couple of san timers. So first of all, we've got something called an Ultradian rhythm where every 90 minutes, our attention suddenly needs to relax and our brains need to reboot. And as a result, we have peaks and troughs during the day of our, our cognitive performance. And that's why it's really important to take breaks. And the other thing is we build up a chemical in our brain called adenine. Now, Adena zine is a byproduct of a and so the more um brain active we are and the longer we're awake, the more this Adena builds up and in certain parts of our brain, we detect it and then become sleepy. And so if you find yourself becoming a bit of a nodding doc at about 3 p.m. you'll know why it's because your adenosine has built up and you haven't given yourself a natural break to boost it. But the thing we use to bypass adenosine, the old method would be to be a four year old and just lie down. But modern-day drugs like caffeine and dark chocolate and coca-cola, the caffeine in them block your adenosine receptor. So it's like putting your hand over the engine warning light that's beeping away and just saying, oh, I'm just gonna ignore that and that's how caffeine works. The problem is it comes at a price. It does disrupt our brain architecture, particularly when we're going into the rem the emotional processing stages of sleep. So that's brain clocks and the brain and the body need to be synchronized. So we're sleepy and tired in bed. So body's tired, brain is sleepy at bedtime and similarly awake in the day. So they need to synchronize with our sun clock. So for millennia, our so would have been the factors that entrained those two clocks. And we'd naturally wake up and go outside and pee outside of our cave and we get a little dose of light, which has a certain blue wave length in it because of the dire direction that the earth is rotating when the sun rises. So blue light in the morning helps us set our body clocks in the morning. And then we'd naturally be in the be in and out during the day. And so we have a yellowy light with the sun above our heads during the day. And then we have a red low light in the sky at night. Again, those shifts in the wavelengths really important in entra our body clocks and then dark, we wouldn't have had artificial lights at night. And so maybe a bit of moonlight or firelight. And so as a result, the darkness would Trigg Melatonin which is the starting gun for sleep. And so if you had those entrained, then your brain and your body clock would be synchronized a bit like an orchestra that has a conductor. So think of an orchestra without a conductor, it's very messy. They can't synchronize. Um Now the conductor can shift your body clock. And so being quite advanced beings, we can change our body clock according to our situation. So if there's a tiger in the village, we will delay our sleep, we'll become hyper aroused. The thing is we release two chemicals, a Rhein and noradrenaline that wake us up at night and trigger those parts of our brain. They're called the on switch, Erin and noradrenaline. Interestingly, our, our brain can't really differentiate between a tiger and being excited at work or having a project to do. And so that's why insomnia is so prevalent for us, particularly since COVID, because our levels of excitement in consideration of existential challenges have increased. And so if you're awaking at night, it might suggest that you're producing a bit too much of those chemicals at the wrong time. So a lot of info went in there synchronizing our body, our brains, our sun and our situation. So here's my question to you and it's, it's rhetorical and I just want you to ask yourself ru in sync. And I have to be honest, I'm not always in sync. Sometimes I'm out late. Um Maybe I'm checking blood results late at night because I'm a bit worried about someone or, or sometimes I'm out dancing with my wife, which I love doing. In which case, you know what, I'll challenge my body clock. But I use the methods. I'm gonna teach you to get me back in sync again. So why is this so important? Why is it so important? And this is because if we're out of sync, our cells can't work together and that makes us bad, mad, stupid, sick and sad. Er, and this is kind of quoting the British Medical Journal 2016, 335355. And, and also multiple other articles on sleep deprivation. This is really well known and this is the scary slide. But the reason I prime you for this is I'm gonna tell you how you can manage these issues, but unfortunately it affects our body. First of all, you name the organ system and if they're out of sync, your risk of disease increases. And this is quoting the World Health Organization as it shift, working as a probable carcinogen, it also really increase your risks of strokes, your dementia risk, your cardiac disease risk, your inflam inflammatory risk or infertility risk, you name it. It also makes us mad. So our valence changes. So when we look at things, we interpret them as bad rather than good. If we're out of sync, it doesn't matter how much sleep we've got, we, we interpret it and as a result, we're more likely to have arguments and incidents. We also impair our performance. So our braves a brains actually behave like we drunk our impairment in our cognition and performance. And remember I crashed my car and this is even though we're potentially thinking we're awake, our brain has micro sleeps. And so that's really scary. And that's part of the reason why the European working time directive was introduced. Um The other thing is that the drugs don't work. So drugs that are normally tested on folks actually in exclude shift workers because they tune negatively, bias their results. And so that's really uh a bit sobering when you consider that. But this is the really sobering thing is that it doesn't necessarily associate with a long and healthy happy life. So I'm gonna give you some good news, but I just wanted to share the scary stuff first, it has massive impacts for your body, for your brain, for your environment and for your situation. And if you wanna look at some of the hard facts, there's a great book by uh called Lifetime by a, a professor Ruff Russell Fossa, who's an expert in circadian biology, who's also come up with some excellent solutions to it.