For the vast number of workers who engage in shift work, catching up on missed sleep can be a difficult task. Nearly 20% of workers globally and around 27% of the American workforce conduct their schedules around shift work, which occurs outside of the standard 8-hour workday.1 Sleep disturbances linked to shift work can lead to major mental health issues, as well as workplace challenges, including safety concerns and poor on-the-job performance.
To better understand the impact of shift work on mental health, Emerson Wickwire, PhD, associate professor of psychiatry and medicine, University of Maryland School of Medicine, and director of the insomnia program, University of Maryland Midtown Medical Center in Baltimore, and colleagues conducted a review of literature from 2016 to mid-2019 (N=23 articles total). In particular, Dr Wickwire and colleagues noted that shift work can disrupt sleep by “creating a desynchronization between homeostatic pressure and the circadian rhythm.” As a result, shift workers struggle with loss of sleep and insomnia, as well as complications with wake time concentration and social and leisure activities.
Psychiatry Advisor spoke with Dr Wickwire to learn more about the ways that shift work can disrupt sleep and, in turn, workers’ mental health.
“Shift workers are faced with an unfair choice: get the sleep and rest I need or spend time with family and friends,” Dr Wickwire noted. Resilience in the face of challenging work and sleep schedules can rely on a concept known as chronotype. Dr Wickwire told Psychiatry Advisor: “Each of us has an innate circadian tendency, called a chronotype, which refers to the body’s natural internal rhythm. Chronotype is driven [in part] by genetics, and [in party] by modifiable factors such as environment and behavior. Relative to morning types, evening types have an easier time adjusting to shift work.”
The medical consequences of shift work can be particularly serious: people who work shifts are at higher risk for stroke, obesity, cardiovascular disease, and cancer. Psychiatric disorders, including depression and anxiety, are also highly prevalent in populations that engage in shift work, with many individuals relying on alcohol or other addictive substances to cope with sleep trouble and stress. “Insufficient and disturbed sleep can precede, exacerbate, or prolong virtually every mental health condition, and also worsen quality of life,” Dr Wickwire indicated.
The study authors note that medical trainees and nurses experience loss of sleep. For people working in the medical professions, maintaining healthy sleep habits can often be incompatible with the demands of their job. Notably, nearly half of shift workers are not satisfied with their wellbeing and 58.2% of shift workers are displeased with their sleep, with 28.3% being unhappy with their physical and mental health. “There is no question that shift work increases burnout, and workers become less able to tolerate shift work over time,” Dr Wickwire concluded. Thus, for medical systems, targeting employee scheduling and encouraging healthy sleep may be a critical way to counter the rising trend of burnout among healthcare workers.
Disclosure: Dr Wickwire reported financial support from the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Brown JP, Martin D, Nagaria Z, Verceles AC, Jobe SL, Wickwire EM. Mental health consequences of shift work: an updated review. Curr Psychiatry Rep. 2020;22:7.