Sleep, Pain, and Hospital Workers

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.