A field investigation of the relationship between rotating shifts, sleep, mental health and physical activity of Australian paramedics

Abstract

Paramedics working on a rotating shift are at an increased risk of developing chronic health issues due to continuous circadian rhythm disruption. The acute effects of shift rotation and objectively measured sleep have rarely been reported in paramedics. This study investigated the relationships between a rotating shift schedule and sleep (using actigraphy), subjective reports of sleepiness, mood, stress and fatigue. Galvanic Skin Response, energy expenditure and physical activity (BodyMedia SenseWear Armband) were also recorded across the shift schedule. Paramedics were monitored for a period of eight consecutive days across pre-shift, day shift, night shift, and 2 days off. Fifteen paramedics (M age = 39.5 and SD = 10.7 years) who worked rotational shifts experienced sleep restriction during night shift compared to pre-shift, day shift and days off (p < 0.001). Night shift was also associated with higher levels of stress (p < 0.05), fatigue (p < 0.05), and sleepiness (p < 0.05). One day off was related to a return to pre-shift functioning. Such shift-related issues have a compounding negative impact on an already stressful occupation with high rates of physical and mental health issues. Therefore, there is an urgent need to investigate methods to reduce rotating shift burden on the health of paramedics. This could be through further research aimed at providing recommendations for shift work schedules with sufficient periods for sleep and recovery from stress.

Figure 1

The study procedure and duration throughout a rotating shift schedule. S (Pittsburgh Sleep Diary), Q (Work diary; Samn–Perelli Fatigue Checklist, Karolinska Sleepiness Scale, and self-reported stress rating), orange bars (scheduled work time), and grey bars (sleep opportunity).

Figure 2

The (A) total sleep time in hours (daytime naps included), (B) time in bed in hours, (C) number of awakenings, and (D) WASO measured by actigraphy during a rotating shift schedule across 5-time points within the schedule starting from (1) pre-shift, (2) day shift one, (3) night shift one, (4) day off one, and (5) day off two. Note, *(A) night shift one significantly lower than all days (p < 0.001), (B) night shift one significantly lower than all days (p < 0.05), (C) day off one significantly higher than night shift one (p < 0.05), and (D) day off one significantly higher than night shift one (p < 0.05). **(WASO) wake after sleep onset.

Figure 3

The sleepiness level reported (A) before work, (B) during work, and (C) after work during a rotating shift schedule across 5-time points within the schedule starting from (1) pre-shift, (2) day shift one, (3) night shift one, (4) day off one, and (5) day off two. Note, *(A) day off one significantly higher than day off two (p < 0.05), (B) night shift one and day off one significantly higher than pre shift (p < 0.05), and (C) night shift one and day off one significantly higher than pre-shift and day off two (p < 0.05).

Figure 4

The stress level reported (A) before work, (B) during work, and (C) after work during a rotating shift schedule across 5-time points within the schedule starting from (1) pre-shift, (2) day shift one, (3) night shift one, (4) day off one, and (5) day off two. Note, *(A) day off one significantly higher than pre-shift and day shift one (p < 0.05), (B) day off one significantly higher than pre-shift and day shift one (p < 0.05), and (C) night shift one and day off one significantly higher than all other days (p < 0.001).

Figure 5

The fatigue level reported (A) before work, (B) during work, and (C) after work during a rotating shift schedule across 5-time points within the schedule starting from (1) pre-shift, (2) day shift one, (3) night shift one, (4) day off one, and (5) day off two. Note, *(A) day off one significantly higher than pre-shift (p < 0.05), (B) night shift one and day off one significantly higher than pre-shift (p < 0.05), and (C) day shift one, night shift one and day off one significantly higher than pre-shift and day off two (p < 0.05).