Women as a Population at High Risk for Experiencing the Decreased Quality of Sleep - Research Paper Example

?Running Head: SLEEP AND SHIFTWORK Sleep Deprivation, Shift work and Women Shift-workers with domestic and social obligations i.e. women, have been described as a population at high risk for experiencing the consequences of decreased quality of sleep. These women were characterized as being uniquely vulnerable to common stressors (life events, role and job strain, perimenopausal symptoms, and shift-work). Literature has highlighted that the majority of women were reported to have experienced difficulty sleeping, tiredness, and fatigue. The literature reviewed in this paper also confirmed that working women have the potential to experience common stressors, putting them at risk for compromised sleep quality. Table of Contents Sleep Deprivation, Shift work and Women Introduction During the agricultural era, humans structured their sleep-wake patterns with nature's dark-light cycle. They worked during the day and slept at night. Dramatic changes in this natural pattern occurred with the discovery of artificial light and the productivity of the industrial era. Artificial light made it possible for industry to operate 24 hours a day. Thus, employees were scheduled into varying shifts, including evening, night, and rotating shifts. With the information era, carne the reality of cyberspace, and it became possible to work anytime, anywhere. The workplace expanded into homes, and disrupted family and leisure time as well as sleep. Natural sleep-wake patterns were compromised and America evolved into a sleep-deprived society (LeBlond, 2008). Background Between 50 million and 70 million individuals experience frequent sleep problems (LeBlond, 2008), and significant number of workers compromise their health and safety because they mismanage or do not know how to manage sleep. Significant number of Americans are categorized as shift-workers, and most report both decreased quantity and quality of sleep, plus family and social life disruption, and impaired physical and emotional health (Bridges, 2008).Medically, problems with decreased quantity and quality of sleep associated with shift-work are diagnosed as Shift-Work Sleep Disorder, and are clinically diagnosed, by professional nurses, as Sleep Pattern Disturbance (LeBlond, 2008). The ability to cope with shift-work is influenced by a variety of inter-, intra-, and extra-personal factors, including (a) one's attitudes and beliefs about sleep, (b) one's biological clock, (c) domestic and social circumstances, and (d) sleep factors (Monk, 2000). Shift-work specifically impacts biological rhythms, negatively influences the shift-worker's quality of sleep, and disrupts family and social life. In reverse, the quality of sleep, social, and domestic demands influence the shift-worker's ability to cope with an unnatural sleep pattern (Monk, 2000; Bridges, 2008). Problem Statement Shift-workers have been reported to experience decreased quality of sleep comparable to people suffering from jet lag, except shift-workers chronically live at odds with natural sleep-wake patterns. Shift-workers predominantly report increased sleep problems, and many shift-workers may exhibit pathological sleepiness levels on the way to and from work as well as during the work shift (Sekine et al., 2006). The most common problems reported are an increased tendency to fall asleep, increased risk of accidents, impaired mood, and reduced psychomotor performance. Shift-workers, who are able to work away from domestic and social obligations, such as on oil-rigs, report adjusting to this unnatural schedule in 5-7 days. However, shift-workers with domestic and social obligations have major difficulty adjusting, leaving them at high risk for suffering the consequences of poor quantity and quality of sleep (Bridges, 2008; Taskar & Hirshkowitz, 2003). At first, men made up most of the American workforce, but women joined the ranks of the employed during World War II (WWII), and by the 1990's, women's employment patterns replicated men’s. Women, more than men, retain primary responsibility for duties related to domestic and social obligations. This leaves female shift-workers more vulnerable to role and job strain, as well as decreased quality of sleep (Monk, 2000; Bridges, 2008). Discussion Shift-Work and Sleep Hard-wired sleep-wake cycles were compromised when artificial lighting made it possible to work during darkness, which altered natural sleep-wake patterns. Altering inherent sleep-wake patterns is associated with decreased sleep quality (Monk, 2000). Sleep quality encompasses more than just the amount of sleep, and includes such factors as difficulty falling asleep, difficulty maintaining sleep, waking up too early, and/or non refreshing sleep. Moderate levels of sleep deprivation has been shown to impair cognitive and motor performance similar to that of being legally intoxicated (Williamson & Feyer, 2000) The high proportions of population engage in shift-work and subsequently alter their natural sleep-wake patterns. Adults, who work rotating or night shifts, represent a high risk group for developing health and safety problems related to altered sleep patterns (Smith, et al., 1999). Shift-workers are required to be active when their endogenous circadian clock is programmed to sleep, and to sleep when they are programmed to be active (Monk, 2000). In several studies shift-workers reported decreased quantity and quality of sleep, family and social life disruption, and impaired physical and emotional health (Martica, et al, 2008). Women and Shift-work Factors most disrupting women's sleep, identified in the Omnibus Sleep in America Poll (2000), include stress (26%), pain (25%), children (21%), and partner's snoring (22%). Professional nurses are the most frequent female subjects in studies addressing women shift-workers, however the mean age in such studies is less than "middle-age." In the studies including RNs, those working the night shift were almost two times more likely to experience inferior sleep quality, and nurses working rotating shifts were almost three times more likely to experience inferior sleep quality when compared to nurses working permanent day shifts. Sleep quality also decreases with alternating shift-work when the night shift is included. The relationship between poor quality of sleep and working the night shift disappeared when nurses remained on nights over an extended period of time (Niedhammer, Lert, & Marne, 1994). However, in Pilcher, Lambert, and Huffcutt's (2000) meta-analysis, rotating shifts and permanent night shifts had the same negative effect on sleep. Sixteen hours between work shifts proved conducive to obtaining more than seven hours of total sleep time. In comparing performance in older and younger RNs working 12 hour and 8 hour rotating shifts (2 day shifts and 2 night shifts), Reid & Dawson, (2001) reported similar degrees of sleep disruption. However, performance of "older" (40 years of age) nurses working the longer shift (12-hour) differed significantly. Performance in older nurses was lower at the baseline, and changed significantly across both 12 and 8 hour shifts. Empirically, older female shift-workers are a high-risk group for experiencing decreased sleep quality. Role Strain Most stress-related research includes predominantly male subjects, but women have been investigated from the aspect of stress related to multiple roles and role and job strain. Research related to women and multiple role strain shows both negative and positive effects related to occupying multiple roles. Female studies first focused on the adverse effects of multiple roles by adding up the different roles and their obligations, with the expectation that role overload, role conflict, role distress, and eventually ill health would result. However, the findings were not consistent. Role-related stress was viewed and measured from several perspectives. Thoits (1992) asserts that the social self embodies multiple role identities, such as parent, spouse, employee, and/or volunteer. Holding fewer role identities (social isolation) correlates with higher psychological stress. Salient social roles refer to roles embedded with networks and represent high commitment to the role. Salient social roles show high potential for reducing psychological stress, because they provide meaning, purpose and structure to one's life, and guide one's behavior. It was reported that women possess fewer salient social roles than men possess. The premise that fewer roles relates to more psychological distress is supported for women in general, yet many role combinations are gender-specific, and gender differences need to be studied. Higher role strain, reported by women, when employment was combined with marriage and parenthood, may reflect role strain rather than less meaning and purpose derived from the work role. Multiple roles and psychological stress may have a curvilinear relationship, rather than a linear one. Too low and too many salient social roles relate to higher psychological stress in women, and both married and divorced women report significantly higher perceived stress than comparable men in most role domains (Thoits, 1992). Thus, some of the psychological benefits obtained from combining parent and worker identities may be "canceled by the effects of higher stress in these roles or by stress due to conflicting expectations and overload" (p. 251) . Other research study support the premise that multiple roles are related to higher levels of stress (Lengacher, 1997). More and more women engage simultaneously in multiple roles that, even twenty years ago, were more sequential, no longer evolving evolve through successive roles such as daughter, student, worker, then full time wives and mothers, Simultaneous, multiple roles may lead to role strain (Lengacher, 1997). Unrelieved role strain sometimes, but not always, resulted in adverse effects such as marital conflict, illness, and dissatisfaction. Positive effects of working included stimulating and supportive colleagues, personal growth and achievements, and an increased sense of autonomy. Female social workers and practical nurses reported high reward with helping others and this group showed fewer physical symptoms (Lengacher, 1997). Overall, employed women were reported to be healthier than non-employed women; however, women with significant family obligations experienced a greater risk for heart disease. Sharing or dividing domestic duties was also a crucial influence in role relationships and ill health in women. Stress related to the role of mother was also a contributing factor to ill health (Reid & Hardy, 1999). Job Strain Jobs with high demands and low control over work produced more stress than jobs with high demands and high control (Karasek & Theorell, 1990). Women, compared to men, held lower level positions, which were typically high demand and low control. Women earned less than male counterparts, and lower proportion of women held management positions in the private sector. All of these factors put the female worker at a higher risk for job strain. Professional nurses have been studied and were shown to experience many occupational events and circumstances that correlated with increased job strain. Events or circumstances that increase job strain include: (a) increase work loads and short staffing, (b) physically demanding work, (c) assisting families and patients in the death and dying experience, (d) conflicts with physicians, and (e) shift-work (Trinkoff, Storr, & Lipscomb, 2001) In Trinkoff, Storr, & Lipscomb's (2001) study, a secondary analysis was completed on the Nurses Worklife and Health Study of 1994-1995. The effects of physically demanding work were examined. Longer hours resulted in "fatigue due to extended exposure to physical demands combined with insufficient recovery time" (p. 361). Nurses engaged in schedules requiring frequent shift rotation and longer than 8 hour shifts were also at a higher risk for injuries. Overtime and long hours were also shown to be associated with stress, chronic fatigue, burnout, and health problems across different working populations. Women reported role overload, role conflict, and under utilization of skills as job related strain. Karasek's (1979) Job Strain Model described high strain jobs as those where the employee experienced little job control or psychologically demanding tasks, such as time pressure tasks. Karasek's model projects that high strain jobs result in "increased heart rates, depression, sleep problems, exhaustion, use of medication, dissatisfaction, and illnesses" (Seago & Faucett, 1997, p. 19), especially cardiovascular and musculoskeletal problems. With the nursing shortage and economical restraints on the health care system, nurses commonly experienced increased patient acuity, high patient workloads, and poor staffing. Professional nurses generally fell into Karasek's category of doing active" jobs (Spence-Laschinger, Finegan, Shamian, & Almost, 2001). Active jobs were characterized as those having high psychological demands but also high decision latitude. Workers in this category felt a sense of high control and the freedom to use all available skills, energy is directed into the action of effective problem solving, creating little residual psychological strain. Seago and Faucett (1997) reported that nurses scored in the "active work" category, and demonstrated less psychological strain than nurse assistants and clerks. Working in the high pace, high stress, and very uncontrolled settings such as ER, ICU, NICU, also increased job strain, but decision latitude moderated the impact of psychological demand. Two predominant groups emerged, low strain (63.3%) and high strain (9.7%) work. Nurses in the high strain work group reported feeling significantly less empowered, less committed, and less satisfied. The areas that nurse's worked in were not found to be as salient as the individual's perceptions about work (Seago & Faucett, 1997; Spence-Laschinger, et al., 2001). Perimenopausal Symptoms Perimenopause encompasses the transitional years before, during, and after menopause, and the occurrence ranges in age from 45 to 59 (Shaver, 1998). The classic definition of Menopause (an absence of menstrual periods for a period of one year) ignores the physical, emotional, and sexual changes that can occur during the perimenopausal years (Mansfield & Voda, 1997). Symptoms such as tiredness, irritability, tension, and trouble sleeping have been reported to increase during perimenopause. Mid-life women report a variety of perimenopausal symptoms that may interfere with sleep. Physical symptoms include hot flashes and night sweats, cold sweats, discomfort or pain, periodic limb movements and cold hands and feet (Shaver & Zenk, 2000). Psychosocial symptoms include fatigue, irritability, worry or anxiety, and inability to concentrate. Women employed outside the home report more perimenopausal symptoms than other women. These women report a significant increase in sleep disturbances described as difficulty falling asleep, frequent awakenings, less "restful" sleep, daytime sleepiness, and fatigue (Moe, 1999). Older women, who are experiencing perimenopause and are engaged in shift work, represent a subgroup of the adult population uniquely vulnerable to sleep pattern disturbance and decreased quality of sleep. For perimenopausal women, two emerging patterns relating to quality of sleep are identified in the literature: (a) perceived poor or inadequate sleep quality without objective evidence of disturbed sleep, and (b) perceived poor or inadequate sleep quality with accompanying objective evidence (Shaver, 1998). The group without objective evidence scored high on psychological distress and somatic symptoms, but not on menopausal symptoms. The group with objective evidence scored high on menopausal symptoms but not as high on psychological distress or somatic symptoms (Shaver, 1998). No research study describes the sleep experience in the high-risk group of order or perimenopausal women who are engaged in shift work. Perimenopause is a physical, emotional, and socio-cultural experience, and it is not the same across different cultural groups. North American women believe that perimenopause is more laden with symptoms than other cultures, while other cultures view it as symptom-free. Stereotypical beliefs about perimenopause influence answers to symptom checklists (Kaufert, Gilbert & Hassard, 1988). It is important to assess culture when perimenopause is a variable under study. American women begin perimenopause earlier than Japanese and Canadian women. Japanese women report less symptoms and use less medication, and there are no marked prevalence rates among these groups for hot flashes and night sweats (Robinson, 1996). In summary, the vast majority of older American women experiencing perimenopause report sleeping difficulties, tiredness, and fatigue. Difficulty sleeping is attributed to hot flashes and musculoskeletal symptoms. Psychological stress is also closely associated with perimenopause (Mansfield & Voda, 1997). Physiologic changes are associated with loss of estrogen and the aging process (Monk, 2000). Conclusion In conclusion, working women experience common stressors such as life event stress, role and job strain, and perimenopausal symptoms. 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