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Work-family Conflict, Sleep, and the Heart

Posted on by Orfeu M. Buxton, PhD and Henrik Jacobsen, PhD


nursesleepHealth care workers represent an increasingly important and ever growing work force in our society. They are also a group of “high-risk workers” meaning they report a lot of musculoskeletal pain, work-related injuries and sleep deficiencies. In addition to this, many health care workers labor in rotating shifts, with little time in-between shifts, so it is no surprise that many of these workers also report scheduling difficulties between work and family. A large study on nurses from 2006 reported that they are concerned about their lack of time and energy when prioritizing family responsibilities and friends outside the workplace. Perhaps exacerbating this concern are increasing demands from a strained economy, the increasing number of single parents in the US, and the fact that health care workers often report working additional jobs – restricting this time even further.

This specific sort of role incongruence is coined “work to family conflict” in the fields of occupational psychology and occupational medicine, and it is widely recognized as a source of distress for those who report high levels of such incongruence. We wanted to investigate whether work-to-family conflict as a potential stress factor was related to sleep deficiencies as potential outcomes, and if so, how these two were related.  And could other factors explain sleep deficiency to a greater extent than these specific work and non-work role conflicts? Furthermore, could these conflicts and sleep deficiencies affect health care worker physiology, in the form of increased risk of cardiovascular disease? To answer these questions we designed and conducted two studies on a fairly large cohort of health care workers, using two stages of data collection with two samples of participants, one large and one small – both from the same cohort of health care workers.

In the first study, nearly 1600 health care workers, primarily nurses and nursing assistants completed a workplace and health survey in 2009. Then we re- surveyed them two years later, collecting additional biological and survey data from one hundred of the original respondents. The first time we asked them about their role incongruence between work and family, and both times we asked if they experienced any sleep deficiencies, and about their demands and personal control in the workplace.

When we looked at the answers from the health care workers, we found that not only was work to family conflict related to sleep deficiencies in the large sample, it actually predicted a report of insufficient sleep (never or rarely feeling rested upon waking) in the smaller, longitudinal sample. Participants who reported high levels of work to family conflict in 2009 were more likely to report insufficient sleep in 2011. Moreover, it was the only variable to show such predictive value suggesting that future sleep programs for health care workers should include a specific focus on work to family conflict [Jacobsen et al., Workplace Health & Safety, 2014].

Next, we aimed to investigate whether such conflict would be related to the risk of heart disease in health care workers. Employing a new statistical model for investigating modifiable 10-year risk for heart disease, we looked at the small sample, as this particular risk-estimate necessitates the collection of cardiometabolic risk biomarkers from blood samples. Using the self-reported data collected for the previous study, we combined these with biomarkers including glycosylated hemoglobin and cholesterol, body mass index and current smoking habits. This combination of data was done using the new Marino score recently validated independently in the Framingham Offspring cohort (Marino et al., American Journal of Preventive Medicine, 2014). With the baseline collected data from 2009, biomarkers and a newly developed and validated score predicting 10-year cardiometabolic risk, we tested the hypothesis that work to family conflict, job demands and control, physical activity, night work, and sleep deficiencies are related to longitudinal risk for heart disease. Our analysis showed that in female nurses prone to work-related stress and sleep deficiency, maintaining sleep and exercise patterns had a strong impact on the modifiable risk for heart disease [Jacobsen et al., American Journal of Industrial Medicine, 2014]. Should you want to see the results and potential impacts from this study explained in a short video, please click here.

Sleep could well be considered a pillar of health (, as a part of a healthy lifestyle including diet, sleep, and exercise. It is related to well-being, and can be strongly influenced by work-related factors (see related blog). Positive interventions modifying sleep as a component of wellness aligns with the Total Worker Health program (see related blog), and is part of ongoing studies of workplace interventions (see related blog).

We would like to hear from you.

  • Do you find sleep to be a priority at home?
  • Do you find sleep to be a priority at the workplace?
  • What makes a compelling case for making sleep health a priority in your workplace?
  • Do you find it hard to stay physically active outside the workplace?

Please let us know your thoughts in the comments section below.


Orfeu M. Buxton, PhD and Henrik Jacobsen, PhD


Dr. Buxton is Associate Professor, Department of Biobehavioral Health, Pennsylvania State University; Adjunct Associate Professor, Department of Social and Behavioral Sciences, Harvard School of Public Health; Lecturer on Medicine, Division of Sleep Medicine, Harvard Medical School; and Associate Neuroscientist, Department of Medicine, Brigham and Women’s Hospital.

Dr. Jacobsen, PhD, is a researcher at the National Advisory Unit for Complex Symptom Disorders, St Olavs Hospital, and a clinical psychologist at the Center for Pain Management and Research, Oslo, Norway.


This research is funded by NIOSH through the Harvard School of Public Health Center for Work, Health, and Well-being, a Center of Excellence supported by the NIOSH/CDC Total Worker Health program. Grant number U19OH008861 (Glorian Sorensen, PI).  For more information:



Jacobsen HB, Reme SE, Sembajwe G, Hopcia K, Stoddard AM, Kenwood C, Stiles TC, Sorensen G, Buxton OM. Work-family conflict, psychological distress, and sleep

deficiency among patient care workers. Workplace Health Saf. 2014 Jul;62(7):282-91. doi: 10.3928/21650799-20140617-04. PubMed PMID: 25000547.


Marino M, Li Y, Pencina MJ, D’Agostino RB Sr, Berkman LF, Buxton OM. Quantifying cardiometabolic risk using modifiable non-self-reported risk factors.

Am J Prev Med. 2014 Aug;47(2):131-40. doi: 10.1016/j.amepre.2014.03.006. Epub 2014 Jun 17. PubMed PMID: 24951039; PubMed Central PMCID: PMC4107093.


Jacobsen HB, Reme SE, Sembajwe G, Hopcia K, Stiles TC, Sorensen G, Porter JH, Marino M, Buxton OM. Work stress, sleep deficiency, and predicted 10-year

cardiometabolic risk in a female patient care worker population. Am J Ind Med. 2014 Aug;57(8):940-9. doi: 10.1002/ajim.22340. Epub 2014 May 8. PubMed PMID:

24809311; PubMed Central PMCID: PMC4111954.

Posted on by Orfeu M. Buxton, PhD and Henrik Jacobsen, PhD

5 comments on “Work-family Conflict, Sleep, and the Heart”

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 ».

    I worked as a personal care attendant some time ago, and experienced the effects of long, irregularly scheduled and overnight shifts. I didn’t have a family of my own at the time, but it still posed “home to family conflicts” and was definitely hard on my sleep schedule. I can only imagine trying to do the same job now that I have a partner and a little one at home.

    Any good healthcare employer should be concerned about the host of health issues sleep loss can cause among its workforce ( But if good conscience isn’t enough, one thing that makes an incredibly compelling case for healthcare employers to make sleep health a priority (and this isn’t new) is the potential risk to patients being cared for by sleep-deprived workers. Most of us can remember times when lack of sleep affected our judgement, physical abilities, mental stability, etc. Just imagine experiencing that on a daily basis and being given the responsibility of medically caring for another human life. I definitely remember times when, for my patient’s safety, I really shouldn’t have been at work due to lack of sleep.

    Very resourceful blog post!! I really enjoyed reading. Keeping our health fit and active for longer period is the main priority. I believe through studying such post people actually can learn lot of such aspect. I’m looking forward to share such post details with others to contribute people health improvement goal. Thanks.

    Certainly the lack of sleep affects family relationships.
    But may I say with humility, that a person who does regular exercise, and therefore does not represent functional bodily health, exponentially increases the risk referred to present family issues.
    I speak from personal and professional experience, since my wife is a nurse and professor of Physical Education, and I dump some of these combined knowledge in my blog.

    I am Spanish speaking and I would like my comment in Spanish.
    Sin duda la falta de sueño afecta las relaciones familiares.
    Pero me permito opinar con humildad, que una persona que no hace ejercicios físicos habituales, y por lo tanto no manifiesta salud corporal funcional, aumenta exponencialmente el riesgo mencionado a presentar problemas familiares.
    Lo digo por experiencia personal y profesional, ya que mi esposa es enfermera y yo Profesor de Educación Física, y he volcado algunos de estos conocimientos combinados en mi blog.

    We are health care personal in Colombia , and sleep is priority in home, the work is not for sleep and with exercise and good alimentation you can be active everywhere.

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