AASM, Sleep Research Society Issue Guidance on Work Shift Duration for Employers

The Academy of Sleep Medicine (AASM) and Sleep Research Society last week issued guiding principles in designing optimal work shift durations in the workplace.

Associated with a myriad of risks, including burnout, cardiovascular disease, and excessive daytime sleepiness, shift work has been indicated to significantly reduce employee well-being and raise health care costs. Moreover, the performance and safety implications of working while fatigued has been noted to increase risk of occupational accidents and triple the risk of a car crash.

In addressing the plethora of concerns linked with irregular working schedules, Indira Gurubhagavatula, MD, MPH, corresponding author and physician in the division of sleep medicine of the Perelman School of Medicine at the University of Pennsylvania, highlighted that the new guidelines expand upon the traditional one-size-fits-all approach promoted in prior shift duration guidance, which focused primarily on physical fatigue.

"Rather than providing a single, generic recommendation, these new guiding principles involve taking a more holistic view when setting customized shift durations for each individual workplace, considering not just physical fatigue, but mental fatigue, time of day, job requirements, safety risks, lifestyle factors, and health," Gurubhagavatula said in a statement.

In establishing work shift durations, the guidance recommended that employers and stakeholders leverage a science-based approach characterized by 3 strategies:

• A recognition of the factors contributing to fatigue and fatigue-related risks
• An understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks
• An informed approach to selecting workplace-specific strategies for managing work hours

"An overall assessment of the risk factors associated with work shifts in a particular setting is key to making informed decisions about optimal shift durations in that setting," noted senior author Hans Van Dongen, PhD, director of the Sleep and Performance Research Center at Washington State University, in a statement.

In addition to increasing the amount of sleep or raising the level of waking alertness, efforts to reduce the adverse risks of extended work shifts included those targeting operational risk outcomes, such as checklists, quality control checks, warning systems, and team-based work strategies.

As Gurubhagavatula mentioned, the guidelines serve to be tailored to the context, in which caffeine usage is promoted to decrease fatigue/sleepiness, but not in high doses, as it may lead to reduced recuperative potential of sleep. Napping may provide some benefit, but may also create problems with cognition and motor skills immediately after awakening, otherwise known as "sleep inertia."

“Countermeasures are generally useful to help manage the effects of fatigue/sleepiness and related risks, but the availability of countermeasures should not, in itself, be used as a justification for making work shifts longer,” added authors.

“Educating the workforce regarding the importance of adequate sleep and strategies to reduce the short- and long-term risks associated with fatigue/sleepiness is a central component of any countermeasure program.”

Ultimately, authors say that deciding on an optimal work shift duration involves the balancing of risk factors, countermeasures, and the potentially competing goals of employers or their representatives.

To develop appropriate shift durations, a shared decision-making process that clearly identifies the potential risks as well as costs and benefits to all stakeholders was recommended, with employees encouraged to participate as well.

“The assessment of these risks, therefore, includes consideration of their impact on the various stakeholders; indeed, those who may be most impacted may differ from those who reap the greatest benefits of a particular shift duration policy,” concluded authors. “A choice of whether to accept the risks or intervene to reduce the risks is then required.”

Reference

Gurubhagavatula I, Barger LK, Barnes CM, et al. Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society. J Clin Sleep Med. Published online July 15, 2021. doi:10.5664/jcsm.9512