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Safer Healthier Workers

Sleep, Pain, and Hospital Workers

Categories: Healthcare, NIOSH-funded Research, Sleep, Total Worker Health, Women, Work Schedules

We know that decreased sleep duration and extended shifts in healthcare workers are linked to workplace injuries.  The effects of decreased sleep on pain in the workplace are less clear.  New research from the Harvard Center for Work, Health and Wellbeing  –one of four NIOSH Centers of Excellence funded to explore and research the concepts of Total Worker Health™- examines the question: Does lack of sleep increase pain and limit function among hospital care workers?    

The study, published in the American Journal of Occupational and Environmental Medicine, finds that sleep deficiency (including short sleep duration, insomnia symptoms, sleep insufficiency, or all three) is significantly associated with pain, functional limitations of daily living tasks due to that pain, and difficulty performing work tasks due to that pain, among hospital care workers. These effects may impact productivity or the ability to perform demanding health care work such as patient handling.  This study is in agreement with a growing body of research linking poor sleep with pain. For example, laboratory studies have shown that restricting sleep duration can increase reports of new pain, consistent with the higher pain reports associated with insomnia. Other studies have shown that sleep-deprived persons respond differently to a standard pain stimulus.

These findings are particularly noteworthy given the high risk of musculoskeletal disorders, pain and injury prevalent among healthcare workers. The annual incidence of back injury and pain in the nursing workforce ranges between 30% and 75%.  Nursing aides suffer more days away from work for back pain than any other occupation.

Prior work in sleep typically focused on the presence or absence of a specific sleep disorder. An innovative aspect of this analysis in this study is the use of the sleep deficiency construct. The sleep deficiency construct suggests that sleep may become “deficient” for a variety of or even a constellation of reasons.  Sleep deficiency may be caused by work factors.  Alternatively, bodily pain, work interference from this pain, and functional limitations of daily living tasks may increase the likelihood of sleep deficiency.

The study recommends that comprehensive workplace interventions include a sleep deficiency component in assessments of modifiable outcomes. The study also suggests that multilevel interventions may be an effective way of supporting changes among individual workers in the work environment. For example, policies that provide increased flexibility on shift length and timing may contribute to a supportive work environment that acknowledges the pivotal role of sleep in worker health outcomes. Educational programs that inform workers of the important associations between sleep, musculoskeletal disorders, and pain may help motivate workers to adopt better sleep practices and behaviors. Research shows solid support that good sleep practices and behaviors improve sleep.

Healthy sleep is known to be related to alertness and performance, to be involved in memory and learning and can influence chronic disease risk, and even mortality. These new data show that sleep affects employees at both work and home.

We would like to hear from readers.

  • Does work impact your sleep? Either amount or quality of your sleep?
  • Does your sleep affect how things go at work?
  • Do you find you have more pain when you sleep poorly?

 

Orfeu M. Buxton, PhD;  Glorian Sorensen, PhD, MPH

Dr. Buxton is Assistant Professor, Division of Sleep Medicine, Harvard Medical School and Associate Neuroscientist, Department of Medicine, Brigham and Women’s Hospital

Dr. Sorenson is the Director of the Harvard Center for Work, Health and Wellbeing and  Professor of Society, Human Development and Health at the Harvard School of Public Health

 

For more information on sleep see the  Harvard Medical School’s Division of Sleep Medicine webpage  and the CDC’s Sleep and Sleep Disorders webpage for data on sleep insufficiency of U.S. adults.

For information on sleep and work see the NIOSH topic page: Work Schedules: Shift Work and Long Work Hours and two recent posts on the NIOSH Science Blog: Sleep and Work and NIOSH Research on Work Schedules and Work-related Sleep Loss.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. August 10, 2012 at 1:53 pm ET  -   Carla Bentley RN COHN-S

    Evaluation of sleep habits should be part of everyone’s medical history questionnaire. My personal experience with this (not pain, thankfully; but overall quality of life and job performance affected by quality of sleep) is that many workers, and their employers, would benefit from diagnosing & treating their sleep disorders sooner rather than later.
    I suspect sleeping pills are way over used. Sleeping pills are commonly reported as a prescription used by health care employees. The prescription drug history from health insurance claims for any health care employer would be revealing.

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  2. August 13, 2012 at 5:44 am ET  -   Diana Sabrain

    I concur with Carla, sleeping pills are way over used.
    There are natural supplements for sleep like ZMA, 5-HTP, melatonin, valerian root etc.
    And also a lot of us are not getting enough sunlight. Which can be supplemented with Vit D3 if you fon’d get enough

    Diana Sabrain

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  3. August 31, 2012 at 12:03 pm ET  -   William Buchta

    Since you ask for personal experience, I am willing to share that if I have 2 or more consecutive shortened sleep cycles, I will predictably be crabby and less tolerant of stress, particularly at work. A good night of sleep will take care of it. As noted above, soporifics should not automatically take preference over tried and true steps toward good sleep hygiene, which simply takes discipline.
    Professionally, having focused my occupational medicine career on treatment of healthcare workers for the past 20 years, I can definitely agree that most workers with pain issues also have sleep issues — not always sure which came first but it tends to become cyclical such that it really does not matter which is causative. My policy has been to address the sleep issues aggressively, assuming the pain will not resolve as quickly otherwise. This would be a good area for research. Rules on shift assignment, particularly overtime, is a reasonable administrative control measure to reduce work injuries and/or their impact on performance.

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  4. September 13, 2012 at 3:35 am ET  -   SELLES F. MD,PICORELLI S. MD

    Epidemiological studies have shown sleep disturbances in patients experiencing acute or chronic pain. But research on sleep disturbance for these specific types of pain, have been few and almost none has included the use of polysomnographic studies polisomnografia.Los have found disruptions and sleep fragmentation in a high prevalence and low in primary alterations sueño.El the problem is not just the pain itself, but the sleep disorder, affects the quality of life, both physically and psychologically and that it weakens the body. Turn makes it more vulnerable to feel and suffer pain, which becomes a vicious cycle, especially for those workers who have aches hospital routine.

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  5. September 23, 2012 at 9:00 pm ET  -   Depok

    Skillfully, obtaining targeted my occupational medication profession on remedy associated with health care staff to the beyond two decades, I can definitely concur that most staff having ache difficulties also have rest difficulties — not absolutely guaranteed that arrived very first but it tends to turn into cyclical such that it really does not issue which is causative. My own insurance plan continues to be to address the particular rest difficulties in a hostile manner, presuming the particular ache will not take care of because quickly in any other case. This specific will be a excellent location regarding exploration. Policies on adjust job, specifically overtime, is usually a fair management management calculate to cut back function accidental injuries and/or their influence on functionality.

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  6. October 30, 2012 at 6:44 am ET  -   raja

    I agree involved in memory and learning and can influence chronic disease risk, and even mortality.

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  7. November 3, 2012 at 10:08 pm ET  -   BD Dale

    As many times as I have been in hospitals, it never occurred to me that Health Care workers get injured. Wow..

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  8. November 25, 2012 at 11:22 am ET  -   Antonio

    I really aprecciate to read your blog. We here from Brazil have learned a lot from your posts. Antonio B Duarte Jr.

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  9. March 25, 2014 at 11:51 am ET  -   Joe Alexander

    Another component albeit small but important would be the sleep environment provided these workers. Quiet, dark, with no sensory distractions and a comfortable, medium firm memory foam mattress or organic latex mattress, and a nice selection of pillows to accommodate different size people.

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  10. April 15, 2014 at 11:24 am ET  -   Sunset

    I have been a regesterd nurse for more than 24 years in the US. My work is at nights due to child care responsibilities, the only available shift, and academic needs for career mobility. Now after all these years I am forced to seek urgent help. I happen to be studying self-care practices for nurses and only through the research that I realized all the problems nurses who work nights encounter. I am so astonished, shocked and still have trouble processing why Nurse leaders (the same people who may or may not have been real nurses at the fore front) are making the nursing workforce unhealthy and toxic through subtle bullying behaviors.
    Just recently, I am under two new leaders. Among all the things the two can do the improve the delivery of safe and quality patient care they have chosen to disprupt the break time of the night employees. There has not been any issues with the way nurses carefully thought out break times.
    This is happening on a busy cardiac monitoring unit, should be a progressive care unit, but happens to be called a Step Down unit. The patients are critically ill and are considered “time bombs”. Nurses are constantly busy caring for these patients and keeping them alive, often times, they are competing demands for the one nurse, she is looking for equipment because the one he/she has is not working, failed, question on accuracy of results or simply unavailable. The emergency room at this facility is open 24 hours, 7 days a week, 365 days a year. Thus, admissions are a normal way of life, anywhere between 6-10 admissions/transfers per night. On this unit, when the patients do not fit the rigorous criteria of the ICU, then they end up on Step Down. There are few days or nights with some down-time; many nights these nurses don’t take their breaks due to heavy workload.
    Nurses took breaks by combining a 30 mins dinner break (which they never have time to take) and a one hour unpaid break and combined them; thus, they get a restful break to return back to deliver quality and safe care. Nurses were not allowed to use anything from the hospital, no linens, no stretcher; but, the employer never provided a designated place to allow for uninterrupted break time. Nurse brought their own resources, blanket (it is very cold at nights). The nurses’ lounge was available and is small, staff go in to eat when it is convenient, which may interruption the concept of “quiet time for re-energizing” while someone maybe on break.The two new bosses ruled that the preceding was acceptable.
    Staff utilized a Resident conference room on the unit which was not utilized during the night time. This was taken away, anyone found in that room on break will be fired.
    These two have obviously planned and visited the unit twice, 12 midnight and 3AM. They found no issue, except the staff were combinging their breaks.
    Just after that, the leader/s ruled, breaks cannot be combined, the only designated place to take breaks is the lounge (there is one filthy chair with a broken leg for more than 2 months and one leader is aware).
    I have been spurred with anger and frustration to search for evidence. There is a dearth of evidence on the importance of sleep to ensure safe care, quality care and ensuring productivity and safety of nurses.
    However, with the amount of evidence on this problem, NIOSH, CDC, ANA’s involvement, it is time for an agency where issues like this can be reported, someone/somewhere where laws/rules holding employers responsible and accountable for providing a safe place with appropriate resources to ensure restful break time especially for night nurses. ACGME has ruled that employers of Residents must be provided a place and must take breaks otherwise employers are sighted. Why can’t someone use all the evidence/research to implement this standard for nurses?
    Not everyone can work night shift. At the same time, night workers are essential for certain types of work. Thus, they need to be protected, be safe, be cared for and valued. It is imperative that something be done to mandate employers to make appropriate accommodations for night workers. If employers cannot comply, then they must be imposed with penalties.
    All these studies and grants focusing on the effect of sleep on night workers needs to be transitioned to setting standards, implementing those standard to protect night workers.

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  11. August 12, 2014 at 11:24 am ET  -   Charlotte Westover

    Thank you.

    This is exactly what I was looking for in detail!
    I work two jobs and my sleep has been lacking a bit.

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  12. October 14, 2014 at 7:55 pm ET  -   Gary

    One of the problems with any type of shift work, including nursing, where you are unable to get consistent hours, the body has a difficult time adjusting its circadian clock to the different hours the person is trying to put their body through. Not having a nightly routine coupled with not restoring the body properly can be very taxing on the body which is what contributes to the pain. The body needs the same amount of sleep every night no matter what schedule you are working just to prevent partial sleep deprivation and accumulated sleep debt. Using a sleep calculator like the one from [name removed] can help you get the right amount of sleep by working with what ever schedule you are working.

    The body needs a consistent amount of sleep but you can get that by sleeping splitting it up if you don’t have a seven hour block available. You can sleep 90 minutes in the afternoon and then five hours at night or two three and a half blocks. The keys is enough time in the REM stages of the sleep cycle to restore the body.

    This coupled with a few good sleep habits such as a routine you go every time you go to bed can help reduce the impact your body feels, like pain, from working such a demanding job.

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  13. September 29, 2015 at 3:25 pm ET  -   Mara

    I am a 47 year old new nurse. I am working 12 hour shifts in a hospital that often are closer to 14 or more because of charting/ learning curve. I work three days a week. I am physically a mess. My feet hurt despite expensive week fitting shoes and shoe rotation. I am sore and dehydrated. I don’t sleep well because of the pain I have from working a 12 hour+ shift. So the next day I am even more tired and in more pain. I love this job but I really don’t see myself working 12 hour shifts for more than a year or two. Why are there no other options but to work 12 hours? It can’t be safe. I see experienced nurses complaining of being mentally foggy at the end of a shift.

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  14. February 1, 2016 at 9:03 am ET  -   sleeping disorders

    Lack of sleep can affect all our activities so i make sure that I get enough sleep or at least take a nap whenever there’s a good chance.

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