What's That Rash? - How bad is shift work for your health?

0:00ABC Listen. Podcasts, radio, news, music and more. Written from us. Written into us. These are the pages to which Australia returns. The ABC Radio National Top 100 Australian Books Countdown. Voting closes October 1st. You don't have long. abc.net.au slash top 100 books. Vote now.

0:36Norman, I am guessing that both as a journalist and a doctor you have done your fair share of shift work over the years. I have but it was a long time ago when I was a pediatric registrar in Sydney and I didn't take to it very well. It was one infamous night where I think it might have been Christmas night. I was on night duty and I had banging on the door of my apartment. Basically one of my colleagues thought I died because I hadn't turned up for work. And I was sound asleep because of shift work and my alarm hadn't gone off.

1:11I think every shift worker has at least one story of them or a colleague just not showing up because the alarm let you down. Or you're paranoid about it, that's right. And so you don't sleep very well anyway. So I have done a bit of shift work. Can relate to the not sleeping because I'm preparing for my alarm to go off. Anyway, shift working is what we are talking about today here on What's That Rash? The show where we answer the health questions that everyone is asking. Well, I mean, I could have written some...

1:42Some questions into us on shift work, having done a fair bit of it myself over the years, but I didn't have to because Brooke and Allison have both emailed in. Brooke says, I have been listening to your podcasts about jet lag and sleep as a shift worker in the emergency department, currently having just completed a run of night shifts. Brooke asks, what is your best advice for managing night shifts? Sleep.

2:06eating, when to exercise, have caffeine, et cetera, particularly around transitioning into them and then also back to daylight hours afterwards. And Alison says, do you have any tips for shift workers? What is the best way to navigate getting reasonable sleep before a night shift and recovering afterwards? Shift work seems to be associated with a number of adverse health outcomes. Is there anything to be done to minimize the risks?

2:33Well, Norman, you have shared your nap secrets before. You have shared your jet lag secrets before. I'm wondering if you have any other regular sleep pattern tips. We've talked about your insomnia before. We know a lot about your sleep. That's right. What are your shift work tips then? Look, I didn't do enough of it to really make a sensible comment. And then listen, those days, you either rotated between day work and night work and you didn't So often shift workers will do eight hours a morning shift, an afternoon shift, and a night shift. In medicine, it's usually day or night. And a lot of this has got to do with, are you doing it all the time? Are you changing shifts? How does your employer change shifts? Do they do it sensibly, according to the science, or is it random? So there are a lot of things involved in shift work.

3:24But there's not a lot of good to be said about it. And we need shift workers. We need people who are working through the night. We need our airlines to be doing this. We need our police to be doing our ambulance services. We need people to do shift work, but it's not necessarily good for you. It's actually quite a large proportion of the population that's involved in shift work as well. So in industrialised countries, it's estimated 15 to 20 percent of workers are shift workers, which is up to a fifth of the population. And it does strike me that as soon as you have some people working shifts, you need other people working shifts. So as soon as you've got people awake and driving around at night, they want to be fed. And so you have 24 hour.

4:07fast food restaurants and you need people on the roads as ambulance officers and police officers because there are people driving and potentially getting into car crashes and that sort of thing at that time. So shift work begets more shift work. Look at its core. We are animals who are entrained in the day, night cycle and that controls a lot of different mechanisms in our body. So almost every tissue in the body has a body clock.

4:33And those body clocks tend to be entrained in the day-night clock that stems from our pineal gland in our brain, particularly the hormone melatonin. So the day-night cycle can affect our whole body. And you are really fighting against it when you do shift work because you are not getting those normal triggers. So you've got to be careful how you manage that.

4:54Yeah you're asking your body to be awake and functioning at a time when every other cue is telling it to be asleep so like you said melatonin it's triggered by the light around us but then there's other things that go into our body clock as well what times of day we're active so the exercise piece and then also the food piece like when we're eating and then the pattern across our days so we sort of get into a rhythm as well so with shift work especially when it's changing all of those things are kind of changing along with it, which makes sense that you get out of sorts. That's exactly right. So there are a lot of what statisticians would call confounders. So when you are on night shift and you're trying to get sleep during the day, your sleep's not as great. You're trying to hide yourself from light and get into the dark during the day, which is a good idea because you want to try and change your body clock accordingly.

5:45You're probably not eating as healthy a diet as you would in a normal cycle of day and night. If you're eating a meal during the night in a hospital, let me tell you the food is crap. And I'm sure it is for ambulance people as well and others who are out and about. So the the food sources that seem to be that are available are often not that healthy. You're not necessarily getting your regular exercise. And we'll talk a little bit about exercise and shift work because exercise is good for shift workers, but you might not be getting that. You may be more sedentary. You might be putting on weight. So is it a direct effect of shift work or is it the secondary effects of shift work? And that makes the analysis of the evidence of shift work harder to do.

6:28because it may not be shift work itself. It may be the things that go around it. What was your go-to night shift meal back in the day? Oh, God, now you make me feel ill thinking about it. There used to be a fridge with pre-prepared meals in it from the hospital kitchen. And you would go into that fridge and take a meal out and then heat it up. And those meals were pretty bad anyway. And three in the morning, they were even worse.

6:53See, that sounds better than my options were Vendo or whoever was like fundraising for their kids. sporting team, and they'd have those boxes of chocolates, and it's pretty irresistible at one o'clock in the morning when you're just trying to keep your eyes open. So let's let us talk about some of the purported health harms of shift work. There's sort of a couple of big hitters here. Cancer, the one that no one ever wants to hear bandied about with their way of life, cardiovascular disease, gastrointestinal disorders, mental health and metabolic disorders. Let's go through them.

7:28There is evidence, and it's an association rather than cause and effect, that, for example, in women who are shift workers of an increased risk of breast cancer, and it's far from clear how strong that link is, but it has been shown more than once. That could be hormonal effects. It could be direct effects. It could be because of the impaired circadian rhythm of tissues.

7:53and maybe the immune system gets caught up in that, and the immune system has the surveillance system, which knocks off malignant cells. Maybe that doesn't work as well. So there is a documented relationship between shift work and cancer, which is debatable as to whether or not it's caused an effect. With heart disease, there is some suggestion that heart disease can increase in shift workers.

8:19which could be for the reasons that we've just said. It also could be that you are stressed by shift work. You feel out of control of your life and the shift work is if you're like taking control away from yourself. This loss of look is control that we've spoken about before on Watch That Rash.

8:35And that definitely increases the risk of coronary heart disease, maybe increases your risk of high blood pressure. And certainly if you take up unhealthy lifestyles like smoking or you find it hard to give up smoking because you're working shift work because of the stress, that also would increase heart disease. So you get the message here, it may not be the shift work itself, but it may be the mushroom cloud of stuff that goes around it. Yeah, that lifestyle kind of knock on effects. What about gastrointestinal disorders? Is this just because you're eating different things at different times of day and night?

9:04possibly, but there's certainly, again, research which shows more than once that tummy discomfort, constipation, diarrhea, tummy upsets, essentially, where you lose your usual routine. So you lose motions, constipation, mixed irritable bowel syndrome, worse. Again, it could be the diet that you eat, but again, it could be that the displacement of your body rhythm affects your gut microbiome. We don't know, but there is an association.

9:34Well again confused with sleep and sleep is very very quality high quality sleep is incredibly important for mental health and so inconsistent hours not getting to sleep properly during the day You go home to your apartment and if you're sharing your apartment with others getting them to stay quiet so that you can get some sleep So there's a lot of sleep disruption that can occur and that can certainly affect your mental health and well-being And also social isolation. So if you're asleep and everyone else is awake and doing things, you're missing out on that connection that you'd otherwise have. That's right. And it's one reason, among many, that people say you shouldn't be on a permanent night shift. You should be...

10:12rotating and of course how you rotate is important. We'll get to that after we've just finished talking about some of these other side effects. Yeah so the final of the big five kind of health risks that are talked about around shift work is metabolic disorder. So this is things like obesity and diabetes. Yes and again shouldn't be a surprise. Various hormones in the body also have a circadian rhythm, a night day rhythm.

10:36which is partly entrained by the pineal gland and melatonin. And therefore, again, your cortisol levels, your appetite hormones and other essential hormones for metabolic health are disrupted. And the evidences that people who are on night shifts have a higher BMI than day shift workers. And there is measurable changes to food intake and also unhealthy lifestyles, which can exacerbate the metabolic ill health.

11:05It's so hard shift work is non-negotiable for a lot of people like I suspect most people doing shift work It's not necessarily their first choice for how their work life would look but it's just the way it is We've obviously identified that there's like a high risk here, but hopefully your kind of health future isn't set in stone by this Let's talk a little bit about how you can offset some of these risks Because some of it is within your control and some of it maybe is in your employer's control, and maybe there are some employers listening here too. So random changes in your shifts are really bad because they just mess up your circadian rhythm. So like doing a morning shift one day and a night shift the following day? Yeah, or jumping from night shift to afternoon shift, for example. So going backwards. What seems to be the healthiest way to change shifts is to do it in a normal day cycle. So you would start, it doesn't matter where you start, but it would be morning shift, afternoon shift.

12:01night shift, so splitting the day into three, 24-hour periods. Oh, it's like the jet lag story, sort of moving forward all the time. Moving forward all the time. The way jet lag hits you is different if you're moving east or if you're moving west. So if you're moving sort of like delaying your shift a couple of hours each day is easier for you than moving back a couple of hours each day. Is that what you're saying? Yes. And then with those rotating schedules, if you know if they're predictable and you know exactly what they are and you can plan, then you can change your time of bed, for example, so that you slowly move towards when you would actually fall asleep when you're on night shift. You might want to introduce stronger artificial light before your night shift. There are ways of doing this. We'll have some links to that sort of advice in our show notes. So you can sit in the same way as those jet lag apps, change your day night cycle.

12:57and your time of going to bed to reduce jet lag when you arrive at your destination, you can do that for shift work as well. So there's not this abrupt change to your circadian rhythm. So there are things that you can do. Exercise is thought to be good for people who are on shift work. Mostly it's thought not so much that it affects your circadian rhythm.

13:20but it makes you more alert when you're awake. Oh, so it's not that it's tiring you out. It's actually that it's waking you up. Increasing your alertness and a nap before your night shift. I mean, I'm a big napper as you know. Well, you've got a whole song about it. Yeah. It can increase your alertness at work, which would be a good thing if you're an airline pilot or a doctor or a nurse.

13:42Then the risk that we haven't talked about, so we're talking about heart disease and so on and there's all this confusion about whether it's cause and effect with actual shift work or the secondary effects. The direct effect of shift work can be driving home and the risks of a car accident because you're overtired. Yeah, so you're safe when you're at work. You've worked for a shift that has been deemed to be safe for the work that you're doing, say if you're a pilot, but then you've got to get home and get in your car and drive home and that's when you could be at your most tired.

14:10And if you are feeling tired, you'll find a quiet spot and have a 10 minute snooze and to get you back home. So that's a bit of napping. So how worried are we that having a little nap in the day is going to throw out the rest of your sleep? Not worried at all. And I got less worried. I started using one of those jet lag apps when I travel. And they definitely encourage napping. It doesn't really disrupt your proper sleep.

14:34but keeps you awake when they want you to be awake so that you're adjusting your body clock. So naps do help. We have actually done a whole episode of What's That Rush on napping. It was a couple of years ago now, so maybe we'll chuck the link to that in the show notes. If you want to hear about Norman's tried and true nap time.

14:52He has quite a few of them. It's quite rigid. Let's talk about food Norman. This is the thing that, well, you talked about the disgusting 3am hospital reheat meals. I've talked about the fundraising chocolates that fueled my night shifts back in the day. It's really hard to eat well when A, good quality food isn't available to you and B, all of your defences are down because it is the middle of the night and you're exhausted. So most of the recommendations are that you should have, still have three meals a day. You've just got to time them.

15:20which makes it hard because you might sleep through to the afternoon and it's not that long before your night shift. But BMI does go up in people who are on regular night shifts. So it's not that you're under eating, but you might be eating the wrong things, getting different cravings. But one of the things that you can do for your metabolic health is actually take a made lunch. In other words, your lunch is going to be in the middle of the night. Some people call it dinner. So you know what you're eating rather than being scrambling around for something that might be open or in the hospital.

15:49or airline fridge. That's fair enough. I will say from my own experience, the fact that my body requires food at regular intervals catches me by surprise almost every day. And having prepped your food does make a big difference in terms of the quality of what you eat. The other part of our Brooks question was about caffeine. How do we optimize our caffeine intake for performance without killing our ability to go to sleep when we need to be asleep? Well, caffeine doesn't do you any harm. I mean, let's just qualify what we're about to say here is, you gotta do the things we're talking about, which is, you know, trying to get into darkness, have a good sleep, you know, regularize your routine as much as possible. But caffeine, when you're awake in small doses frequently is going to increase your alertness. And if it's in small doses and you stop it two or three hours before you're due to go to sleep,

16:45then it shouldn't have a big effect. So it's about low dose frequently, so a cup of tea, maybe one shot of coffee or what have you. But there isn't a lot of evidence that caffeine when you're supposed to be awake, particularly the first few hours of being awake. So for example, if your night shift starts at nine o'clock at night and you're taking caffeine through to midnight one o'clock in the morning on a regular basis and stop, that's not going to affect you going to sleep.

17:13when you get off your shift, but if you take it throughout your shift, then it will make a difference. Okay, so we're talking about caffeine. That's the awakey part of the day. What about other drugs? Sleeping pills are not a good idea. You want to try and do this naturally. Why? Why not? Because they don't give you a normal night's sleep.

17:30and you certainly can't rely on them to change your sleep pattern in a reliable way. Most GPs are reluctant to prescribe sleeping pills, and if they do, it's really for a very short space of time. So it could be that after you come off your shift, particularly over an extended period, you're really finding disrupted sleep. Maybe your GP would think it's a good idea to try a sleeping pill. We've got to try and do this naturally so you get the best sleep possible.

17:52Some people try melatonin. Melatonin isn't a sleeping pill. It adjusts your body clock and some people swear by it for sleeping, but it really is a means to adjust your body clock. And again, I would be taking the advice of your GP on that one rather than the advice of a podcast like ours, no matter how reliable and majestic we are. Majestic indeed.

18:16It is interesting, I don't know if you ever found this, I know anecdotally from talking to fellow friends who had night shift, you sort of come home at whatever time, you're zonked, but the idea of falling straight into bed and going to sleep is almost impossible. You sort of need a bit of time to wind down, which sometimes feels counter-intuitive when it's three or four in the morning.

18:35Yes. And the key then is, or if you get home and it's bright light, is actually to shield yourself from the bright light that time in the morning, so wearing sunglasses. Stay away from bright light when you are trying to chill out and wind down.

18:49rather than getting out into the sun because getting out into the sun is not going to be conducive to getting off to sleep very quickly. You mentioned exercise before Norman, the fact that it's important, it's important for alertness and that sort of thing. Do we know at all when to time your exercise, whether that makes a difference across your day? The evidence here is a bit confusing and a bit mixed. Exercise is generally good. Some people say that in fact for sleep consolidation, you do your exercise immediately coming off your shift.

19:17Which would contradict what I said a moment ago, which is you want to be dark, but maybe you do it with sunnies. Sunnies. So that seems to be good for you or just before your shift, which improves alertness. It is very hard, especially if your exercise is walking or running outside. There are certain times of the day that just doesn't feel.

19:36safe or sensible. I really do feel for people who are trying to fit this in around changing shift schedule. Yeah. And the message here is one size doesn't fit all. You've got to find the things that work best for you. So, I mean, we've talked about a lot here, Norman. Do we have a bottom line for Brooke and Allison? I mean, you'll find out for yourself what works for you, but you've really got to eat healthily. You've got to get exercise. Your regular exercise should be maintained, albeit at a different time of day. You've got to socialize.

20:05you know, make up your packed lunches for the evening so you know you're eating healthy food. You can, and we'll have a link to some of this on our website, is you can shift. If you know if your shifts are predictable, you can shift your time of sleep and time of exposure to light to help you make that transition. And if your employer is being random about the change in shifts, you've really got to talk to them about changing that to a much more predictable change for your health and well-being. And indeed, Your safety at work, which is their duty of care. Maybe easier said than done, but look, we're just trying to bring you the evidence-based advice here. Brooke Allison, thank you both so much for your questions. I hope this has been useful. I hope that you managed to get some restful sleep, whatever shift you're currently on. If you've got a question you want to ask us, our email address is that rash at abc.net.au. So what's in the mailbag? So Kate says...

21:00A huge thank you for the show. Kate says, in our house, we say ding after every time we mentioned health advice shared on what's that rash. For each yummy tomato salad with balsamic dressing, there are multiple dings. I hope it doesn't get in the way of conversation. Well, it does for us. So we managed to get through it. So Kate says, without your common sense and expert advice, I'd be down endless influencer rabbit holes, paranoid, exhausted, and likely broke from falling under the spell of their offer of programs or potions.

21:29Think of the snake-eye scene in the jungle book with what's at rash. I can carry on calmly with a healthy and wholesome life knowing I'm doing the best I can, guided by information from a trusted source. That peace of mind is priceless in these crazy times. I love the humour you share as well. Oh, that's nice, Kate. Thank you very much indeed. Thank you so much, Kate. If you would like to send us an equally glowing recommendation.

21:56Or next week for balance, because the ABC loves balance, will send us your worst thoughts. Your harshest criticism. That's right. Just hit us. Hit us. We'll put it on here. Norman can take it. I absolutely can't. Either way, the email address is that rash at abc.net.au. Tell all your friends. See you next week. See you then.