2. The Night Shift

2. The Night Shift

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Background: Rotating night shift work disrupts circadian rhythms and has been associated with obesity, metabolic syndrome, and glucose dysregulation. However, its association with type 2 diabetes remains unclear. Therefore, we aimed to evaluate this association in two cohorts of US women.

Conclusions: Our results suggest that an extended period of rotating night shift work is associated with a modestly increased risk of type 2 diabetes in women, which appears to be partly mediated through body weight. Proper screening and intervention strategies in rotating night shift workers are needed for prevention of diabetes.

Research design and methods: In the UK Biobank, we examined associations of current (N = 272,214) and lifetime (N = 70,480) night shift work exposure with type 2 diabetes risk (6,770 and 1,191 prevalent cases, respectively). For 180,704 and 44,141 unrelated participants of European ancestry (4,002 and 726 cases, respectively) with genetic data, we assessed whether shift work exposure modified the relationship between a genetic risk score (comprising 110 single-nucleotide polymorphisms) for type 2 diabetes and prevalent diabetes.

Conclusions: Our findings show that night shift work, especially rotating shift work including night shifts, is associated with higher type 2 diabetes odds and that the number of night shifts worked per month appears most relevant for type 2 diabetes odds. Also, shift work exposure does not modify genetic risk for type 2 diabetes, a novel finding that warrants replication.

Night shift differential means the differential paid for work performed when the majority of a prevailing rate employee's regularly scheduled nonovertime hours fall between 3 p.m. and 8 a.m. It is computed as a percentage of the employee's rate of basic pay.

Night shift differential is paid for regularly scheduled work performed at night. This generally means work scheduled before the beginning of the administrative workweek. Overtime hours do not count toward an employee's entitlement to receive a night shift differential.

Night shift differential is included in the rates of basic pay for prevailing rate employees and is used as a basis for computing overtime pay, Sunday pay, holiday pay, and amounts of deductions for retirement and group life insurance.

A prevailing rate employee regularly assigned to a day shift who is temporarily assigned to a night shift will be paid a night shift differential for any leave with pay taken when scheduled to work night shifts.

A prevailing rate employee assigned to a regular rotating schedule involving work on both day and night shifts will be paid a night shift differential for any leave with pay taken when scheduled to work night shifts.

A prevailing rate employee who is not regularly assigned to a day shift or a night shift but whose shift is changed at irregular intervals will be paid a night shift differential during leave with pay if the employee received a night shift differential for the last shift worked preceding the leave with pay.

A prevailing rate employee is entitled to the night shift differential for periods of excused absence on a holiday, while in official travel status during the hours of the employee's regular night shift, or on court leave.

A prevailing rate employee who works on a regularly scheduled shift of less than 8 hours duration (such as a part-time or intermittent employee) is entitled to a night shift differential if a majority of the employee's hours are worked during a period in which a night shift differential is payable.

There is no authority to permit a splitting of the night shift differential. An employee will either receive a 7 percent differential for an entire shift or a 10 percent differential for an entire shift if a majority of hours worked occur during the hours authorized for a night shift differential.

Meal breaks of 1 hour or less that occur when a night shift differential is authorized should be included for purposes of determining a prevailing rate employee's entitlement to a night shift differential. Thus, when an employee works from 11:30 a.m. to 8 p.m., with a meal break from 3:30 p.m. to 4 p.m., the 30-minute meal break is included to determine that a majority of hours of work occur during the second shift and a 7 percent night shift differential is payable.

Night shift differential will not be paid solely because a prevailing rate employee elects to work credit hours, or elects a time of arrival or departure at a time of day when night shift differential is otherwise authorized, except that prevailing rate employees are entitled to night shift differential for regularly scheduled nonovertime work when a majority of the hours of a flexible work schedule for a daily tour of duty occur during the night.

Circadian disruption can harm biologic systems that help prevent cancer. For example, in addition to promoting sleep, melatonin can also stop tumor growth and protect against the spread of cancer cells. Laboratory animals whose days and nights were disrupted in scientific experiments had reduced levels of melatonin and increased rates of cancer or tumor growth.

Animal studies have shown that exposure to light at night led to the growth of breast or mammary-gland cancer. Moreover, studies among nurses and other night shift workers showed increased risk of breast cancer that was unexplained by reproductive history, lifestyle factors, body mass index, or socioeconomic status. In most studies, an excess risk of breast cancer was found mainly among women who had worked night shifts for many years or at a high frequency, or who had worked a large number of night shifts over their lifetimes.

In addition to cancer, night shift work has been associated with type 2 diabetes, heart disease, stroke, metabolic disorders, and sleep disorders (4). Night shift workers might also have an increased risk for reproductive issues, such as irregular menstrual cycles, miscarriage, and preterm birth. Digestive problems and some psychological issues, such as stress and depression are more common among night shift workers. The fatigue associated with nightshift can lead to injuries, vehicle crashes, and industrial disasters (5).

Your recommendations fail to mention the key role of circadian lighting in mitigating the cancer risk of shift work. Too much blue-rich LED or florescent light at night, and too little exposure to blue-rich natural day light or electric light during the day are documented by the NTP report as the key causes of the circadian disruption which exacerbates breast and prostate cancer. Spectrally engineered circadian lighting with rich blue light during the day and removal of blue light during the night is now readily available as recently discussed in LEDs Magazine, and already installed in hundreds of shift work operations.

As a practical matter changing the lights is a far easier solution, than changing shift work schedules and work-rest patterns. It is something the CDC should consider adding to their list of recommendations to address the 12,000 extra cases per year of breast cancer resulting from shift worker light exposure at night. Already the American Petroleum Institute (API) has set the standard in their RP-755 recommendation that lighting fixtures at night should not cause circadian disruption.

Thank you for your viewpoint. Shift work is a complex exposure and light at night is only one of the factors that causes circadian disruption. More research is needed in this area. Please see the related blog:Lighting Interventions to Reduce Circadian Disruption in Rotating Shift Workers

Shift workers must be willing to make sleep a priority. People who work shifts other than a 9 a.m. to 5 p.m. routine might have to prepare for sleep even though it might be daylight outside. This can be done in the following ways:

Work schedules that fall anywhere outside the hours of 7 am to 6 pm Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source are considered shift work. These schedules may consist of fixed hours, rotating or split shifts, or irregular work times. According to the Bureau of Labor Statistics, roughly 16% of full-time salary and wage workers Trusted Source U.S. Bureau of Labor Statistics The Bureau of Labor Statistics measures labor market activity, working conditions, price changes, and productivity in the U.S. economy to support public and private decision making. View Source in the U.S. worked non-daytime shifts in 2017 and 2018. Recently, many employees have also been forced to take on shift work in recent months due to the COVID-19 pandemic.

Common occupations Trusted Source U.S. Bureau of Labor Statistics The Bureau of Labor Statistics measures labor market activity, working conditions, price changes, and productivity in the U.S. economy to support public and private decision making. View Source that require shift work include:

Sleep consistency Trusted Source National Center for Biotechnology Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source is key for many employees working night shift schedules. If you wake up at 5 pm for your night shift and normally go to sleep at 8 am after getting home from work, then you also should maintain this sleep-wake schedule on your days off.

Before going to bed, consider a hot shower or bath, meditation, or another relaxing activity. Consuming alcohol before bed can lead to sleep disruptions. Although alcohol has sedative properties that help you fall asleep more easily, you may experience sleep disturbances or fragmented sleep as your body breaks down the alcohol. Some shift workers take melatonin supplements to fall asleep during the day, but you should consult with your doctor or another l