1. To Your Health!

2. Shift Work and Your Health Shift Work Requirements Sited as Number One Reason for Physicians Leaving E.M. Shift Work Requirements Sited as Number One Reason for Physicians Leaving E.M.

3. Shift Work and Your Health Shift Work Sleep Disorder 20 to 30% Leave Shift Work

4. Shift Work and Your Health Immune Dysfunction Immune Dysfunction Gastrointestinal Ailments Gastrointestinal Ailments Cardiovascular Disease Cardiovascular Disease Cancer (Breast and Colon) Cancer (Breast and Colon) Trauma Trauma

5. Shift Work and Your Health Depression and Other Mental Illness Depression and Other Mental Illness Pregnancy Related Issues Pregnancy Related Issues Social Disruption (higher divorce rate) Social Disruption (higher divorce rate) Substance Abuse Substance Abuse

6. Shift Work and Your Health Desynchronosis Desynchronosis Blame it On Edison! From a Few Foot Candles to 100,000!

7. Review of Normal Sleep Cycle Stage 1 (initial 10-15 minutes) Stage 2 ( 50% of total) Stage 3 (Slow Wave Sleep)

8. Review of Normal Sleep Cycle Stage 4 (Deeper Slow Wave Sleep) REM (Dreaming) Normal Sleep Contains 5-6 Cycles

9. Typical Shift Worker Sleep One and One Half to Two Hours Shorter REM and Stage 2 Sleep Affected Most Impact of Noise Better Living Through Chemistry?

10. Biorhythms Circadian (About a Day) Ultraradian (Heart and Brainwave Oscillation) Infraradian (Menstrual Cycle)

11. Circadian Rhythms Suprachiasmic Nucleus (The Main Internal Clock) Individual Cellular Clocks Free Running Cycle (25 hours)

12. Circadian Rhythm Markers TemperatureMelatoninCortisol

14. Circadian Rhythms Zeightgebers (Time Givers) Entrainment (Matching of endogenous circadian rhythm to environmental timing cues)

15. Circadian Rhythms Phase Adjustment (Entrainment to a change in the timing of synchronizers to the external environment) Desynchronization

16. The Light Dark Cycle Most Important Human Zeightgeber Driver of Key Circadian Rhythms The Major Barrier to Shift Work Adjustment

17. Human Adaptation to Shift Work Very Poor Quality of Sleep Length of Sleep Failure of Entrainment

18. Human Adaptation to Shift Work Night Owls vs. Morning Larks Tremendous Individual Variation Age: Phase Intolerance! (decreased melatonin production, reduced ability for daytime sleep)

19. Human Adaptation to Shift Work Gender Gender Languidity Languidity Flexibility Flexibility Hardiness Hardiness

20. Human Adaptation to Shift Work Permanent Night Shift Workers Rotators

21. Shift Work Models (E.M.) Ideal (No Night Shifts) Hire Permanent Night Owls (Rare Commodity) Work Large Block of Nights

22. Shift Work Models (E.M.) Work Short Groupings of Nights European Model Shift Timing

23. Shift Work Taboos Phase Advance Rotation Phase Advance Rotation Sporadic Night Strings Interspersed with Sporadic Night Strings Interspersed with Evening/Day Shifts Evening/Day Shifts Long Shift Length Long Shift Length

24. General Guidelines for Sleep Sleep in a DARK Room Sleep in a Quiet Room Sleep in a Cool Room Timing of Stimulants (And Hypnotics!)

25. Circadian Manipulation Light Therapy MelatoninExercise

27. Non-Circadian Aides Sedative Hypnotics Napping (Sleep Debt) Napping (Sleep Debt)Stimulants

28. New Horizons HydrocortisoneModafinil Text Messaging?

29. The Long Haul Be Mindful of Your Schedule Find Your Best Spot Your Sleep Environment Your Sleep Environment Opt for Short Shifts

30. References American College of Emergency Physicians Policy Statement: Circadian Rhythms and Shift Work American College of Emergency Physicians Policy Statement: Circadian Rhythms and Shift Work Kuhn, G. Circadian Rhythm, Shift Work, and Emergency Medicine. Annals of Emergency Medicine 2001;37:88-98 Kuhn, G. Circadian Rhythm, Shift Work, and Emergency Medicine. Annals of Emergency Medicine 2001;37:88-98 NIOSH Training for Nurses on Shift Work and Long Hours: DHHS (NIOSH) Publication No. 2015-115 NIOSH Training for Nurses on Shift Work and Long Hours: DHHS (NIOSH) Publication No. 2015-115