Sleep Song #3: “Shiftwork” by Kenny Chesney and George Strait

One thing I’ve always loved about country music is the recurring theme of hard work. Like sweet tea, personal freedom, trucks and cutoff jeans, getting your hands dirty and proudly carrying out your duties for yourself and your family are major topics in country songs old and new. And boy, can I relate.

 

I can also relate well to the topic of this little nugget from Kenny Chesney (with a little help from “The King,” the great George Strait). Growing up I worked late washing hundreds of thousands of dishes at a restaurant, and as a medical postgraduate trainee I was expected to work not only night call but also “night float,” in which we worked all night for weeks on end.

According to the Bureau of Labor Statistics, roughly 15 million Americans work permanently at night or regularly rotate in and out of night shifts. That’s a lot of people. People work the night shift for all sorts of reasons: it often pays better, for example, or they may simply prefer the quieter work environment, or their professions or particular stations in life may leave them no choice. Regardless, many or most of these millions of people suffer from sleep problems directly or indirectly related to the timing of their work.

A primary sleep-related problem for shift workers is fatigue. The feeling of tiredness or drowsiness can be pervasive, and when experienced during work can lead to a host of negative consequences, ranging from substantially reduced productivity to major industrial accidents. Working at night can often lead to falling asleep on the job, reduced attention and concentration, and missed time from work.

Why are such problems so prevalent in night shift workers? The answer usually lies in the difference between their weekly activities and the way we are designed to sleep. Days off from work are precious to night shift workers like they are for everybody else. The problem is, on days off, most night shift workers want to be awake during the day, because that’s when family, home, social, and leisure activities take place for everybody else around them. As a result, they end up flipping their sleep schedules around abruptly, such that now they are staying awake during the day instead of sleeping during the day on their non-workdays.

Unfortunately, your brain isn’t quite that flexible. Your body clock “wants” regularity in its sleeping patterns–which the basis for the concept of “jet lag,” for example–and completely changing your bedtime schedules around by reverting suddenly back to a night-time sleep schedule on non-workdays often or even inevitably leads to sleepiness and reduced quantity and quality of sleep.

No matter how many years you’ve put in work at night, your body clock does not biologically adapt or accommodate for your work shifts if you regularly revert back to a night-time sleep schedule when you’re not working. Instead, you adapt subjectively, accepting a certain degree of fatigue as a regular component of your life, and/or inserting a nap here and there to make up for the reduced sleep, or breaking your sleep times up into 2 or 3 separate parts in a day.

There will be more to say about shift work in future posts, because it’s not only a potential medical problem, but also a major public policy issue. Bottom line: fatigue due to irregular sleep schedules stemming from night shift work is potentially dangerous, decreasing safety at work and putting people at risk.

On that grim note, enjoy Kenny’s song! The lyrics don’t delve directly into sleep issues associated with working the night shift, but the fatigue so many shift workers feel can certainly cause “’round-the-clock pain” and make you feel like a big ol’ pile of . . . shift work.

Have a great weekend, No Shoes Nation, shift worker or not!

Shiftwork
(written by Troy Jones)

Shift work, hard work, tired body
Blue collar shirt and a baseball cap
Union made

He’s hot, sweat drops, ’round the clock
Door never locks
And the noise never stops
Not all day
Work seven to three
Three to eleven
Eleven to seven

Shift work, tough work for the busy convenience store clerk
Two feet that hurt, going insane
She’s mad at some lad
Drove off and didn’t pay for his gas and he won’t be the last
‘Round-the-clock pain
Work seven to three
Three to eleven
Eleven to seven

I’m talkin’ about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Well I work shift work,
Ten years man, I hated that work
Then I made a break with the money I saved
It took me to the beach
To have a beer by the edge of the sea
And this ’round-the-clock place
I drank my money away
We partied
Seven to three
Three to eleven
Eleven to seven

I’m talkin’ about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Talking about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Seven to three
Three to eleven
Eleven to seven

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Turn the Clock Forward Tonight!

 

A week from tomorrow is “Selection Sunday,” the day in which the National College Athletic Association (NCAA) announces the participating teams in the annual national college basketball tournament, and the ways in which those teams will match up and “seed.”  Much less exciting, however, is what will happen tomorrow, which is that this year’s Daylight Saving Time (DST) will begin.  In most parts of the United States, clocks will be moved forward in time by one hour, starting from 2 a.m. overnight.  Some portions of the U.S. remain on “standard” time all year ’round:  Hawaii, some parts of Arizona, and U.S. territories of Guam, the American Virgin Islands, American Samoa, and Puerto Rico.  The idea is that advancing clocks forward a bit will provide us with more light in the evening and less light in the morning.

What this means is that the vast majority of Americans will feel tonight like we’ve “lost” an hour of time this weekend.  This one-hour shift does not truly represent a loss, of course, because we “gained” an hour in November 2012 (and will gain it again in November of this year).  But it can feel that way.  DST can be potentially disruptive to computers, various forms of equipment, medical devices, and other electronics, but it can also disrupt some people’s sleep, though usually mildly.

Adults are typically able to handle up to one hour’s worth of “shift change” in sleep scheduling per day (a critical concept in the understanding of jet leg, for example).  Everybody’s different, though, and everybody has different thresholds for feeling effects of changes in bed schedules and work schedules.  Making the change Saturday night into Sunday morning further allows for maximal societal flexibility in absorbing this time change in time for the beginning of most people’s typical work or school weeks.

For those who are particularly sensitive to effects of sleep schedule shift changes, my suggestion would be go to bed just a little bit earlier tonight (Saturday) than usual, say 15-30 minutes.  Then tomorrow night (Sunday), go to bed slightly earlier than you did tonight.  This exercise is not very taxing, and should allow you to absorb easily the time change internally in time for work or school come Monday morning.

Many basketball teams are playing their end-of-regular-season games today, so there will undoubtedly be some “bubble” teams (and their fans) that won’t be sleeping all that well tonight if they lose, independent of DST.  Most people, however, will sleep well and will find the shift change pretty easy to handle, though many (like myself) will grumble a little about the subjective sensation of the time “loss.”

Enjoy the weekend nonetheless, everybody!

Sleepy Teen? Read On

You have a teenager in the house. He’s 15. Great kid, popular, happy, fun to be around. Problem is, recently, with several months of school under his belt, he is sleepy too, all the time, falling asleep in front of you at the dinner table.

 

Excessive daytime sleepiness is increasingly prevalent in our society. Certainly social and academic pressures represent a potential cause. I’m constantly astounded with what so many parents now expect of their children: all the activities, sports, school projects, social outings . . . it is all just so different compared to when I was young:  everything is more, crazier, faster, more wired (or wireless), more complicated. My wife and I get caught up in that as well, I’m afraid, and though we do our best to maintain a reasonable balance to our children’s lives, their after-school hours remain dominated by what feels like an endless cascade of commitments: tae kwon do, basketball, skiing, adventure guides, student council, math olympiad, latin root class, on and on. For the most part our boys enjoy these activities and participate with relish, but I really do wonder how they’re going to find the time for additional activities or expanding interests as they get closer to high school, not to mention that all-important, precious time that should be spent with family.  Back in the day, we kids had time and space to relax, even laze from time to time. Time is just such a precious commodity now for us all.

Our planet’s population continues to grow, and subsequently so do the challenges for our children, who now must compete with a huge army of peers for a limited number of scholarships, college placements, internships, jobs, and resources. It thus seems natural–crucial, even–to push your kids to do more, accomplish more, dig deeper, become exposed to more things to give them a leg up in an increasingly competitive world. However, there’s still only 24 hours in a day. So what time is often easiest to sacrifice? You guessed . . . the time usually allocated for sleep.

Adults typically need 7.5-8 hours of sleep per night to feel fully rested during the day. Teens often need more sleep than adults, such as 9 hours per night. Teenagers need proper amounts of sleep like adults do, obviously, and in fact in many ways they need their sleep even more than adults do, considering they are still growing and developing. The effects of chronic sleep deprivation for a teenager can completely wreck one’s quality of life: daytime sleepiness, tendencies to fall asleep in class, lethargy, headaches, poor academic performance, depression, social withdrawal.

There’s another important cause of daytime sleepiness in teenagers, and it’s related to their sleep schedules. Here’s a scenario many of you will know well: Sunday night your teen has terrible difficulties falling asleep, and then finds it bloody impossible to awaken early the following morning for school. There is sleepiness all day long Monday at school, and for one or two additional nights there are residual difficulties falling asleep early, compounding the sleep deprivation. You pull your hair out as you cajole and shove your teen out of bed to get to school on time. Finally Friday night comes ’round, but your teen stays up until 1 a.m., and sleeps in like the dead until noon. This happens again Saturday into Sunday, and the cycle repeats itself, with another sleepless Sunday evening. Sound familiar?

Leaving the biochemistry out of it for now, here’s the reason why this occurs. We as humans are generally creatures of habit when it comes to sleep. Our internal body clocks are designed for us to do and feel things at certain times to coincide roughly with the 24-hour period. Our circadian rhythms dictate and regulate the timing of various inner biological processes, such as when we become sleepy or when we feel awake and alert.  When it comes to sleep, many of us have a natural tendency to become drowsy just slightly longer than every 24 hours (which can help explain why many prefer to go to bed later at night as opposed to earlier).  We are usually able to stay on the 24-hour clock because of the environmental cues (like daylight) and social cues (such as work) that “entrain” us to running our sleep every 24 hours. However, adolescents are particularly susceptible to this tendency for a delay in their bedtimes, leaving them prone to feeling awake at night and making it very difficult for them to get out of bed early for school. Things then are made worse when they allow themselves to go to bed very late on weekends and sleep in on weekends, because when Sunday night rolls around it becomes very difficult to fall asleep early. This is called delayed sleep phase syndrome.

 

So, parents, though this routine of trying to get your kid to bed at night and then fighting with them to wake up in the morning gets old quickly and can drive you bats**t crazy, in many ways what you’re seeing is the manifestation of normal adolescent brain biology, essentially a clash between teen physiology and our fast and furious society’s modern expectations.  I mean, if teens didn’t have to awaken at 6 a.m. to get ready for school, but instead could awaken whenever they please, this wouldn’t be nearly as big of a deal, right?  In this real world of ours’, though, it’s still a problem that needs to be addressed:  countless report cards, interpersonal relationships, and family dynamics have been affected negatively by delayed sleep phase syndrome particularly in recent decades.  And if there is pre-existing sleep deprivation due to all the other stuff your teen does after school, this only compounds the problem, worsening daytime sleepiness and all of the sequelae from it.

There are a couple of recommendations that can help.  One is something your kid is guaranteed not to like:  wake up around the same time every morning, including on weekends.  This is generally much easier for adults than it is for teens, but if you don’t sleep in by 3-5 hours on weekends any longer, you will naturally become drowsier sooner at night (including Sundays), making it easier to achieve more sleep and awaken in time for school; you’re essentially then forcing your body clock into regularity, which can then improve the insomnia and total sleep time at night.  The key, however, is persistence, which sometimes can be lacking in some kids.  When I am counseling my teenage patients with delayed sleep phase, I basically become their coach, working to help them understand that they can do it, that they will do it, for the sanity of everyone around them, including themselves.  The other helpful management tool is bright light therapy, such as with a light box (2000-2500 lux) early in the morning, and the avoidance of bright light in the late afternoon to evening.  Certain medications may be useful in severe cases, like melatonin or modafinil, but these are teenagers we’re talking about, and my clinical practice has generally been to try to do things as naturally as possible in this setting.

Take-home message today:  help your teen get proper amounts of sleep by examining his or her bedtime schedules and discussing openly what could be modified to make everybody happier in the house.  As with everything else within the realm of parenting, love, communication, and the constant quest to understand are cornerstones in helping your adolescent achieve good sleep.

There will be more to say regarding circadian rhythm disorders in future posts.  It’s time for dinner now, though, so ’til next time . . . sleep well!