key: cord-0043336-52ad6o2y
authors: Buxton, Orfeu M.; Shea, Steven A.
title: Bidirectional Relationships of Sleep and Work
date: 2020-05-12
journal: Sleep Health
DOI: 10.1016/j.sleh.2020.04.012
sha: a928ec6c41198a88154b634c3a4cf056f1024881
doc_id: 43336
cord_uid: 52ad6o2y

nan

For most people, work is inextricably linked with home life and with the amount, timing and quality of sleep. While the recent novel coronavirus pandemic changed work practices for many months for billions of people, this global change had already started with more and more people working at home, sometimes morning, evening, and night and under increasingly uncertain employment conditions. In addition, our work, home life, and sleep can create competing demands for time, particularly in the face of second and third jobs, flexible schedules, night shift work, unstable work practices, and the emergence of the gig economy. The inevitable compromises, when not well-managed, can result in suboptimal sleep, suboptimal work, and suboptimal home life. Even if time for work, sleep, and leisure can be effectively separated, they still all affect each other. For instance, stress at work can affect subsequent sleep, and the quality and amount of sleep, in turn, can affect subsequent work performance. In this special issue of Sleep Health, there are 14 original research articles from 7 countries that describe the enormity of the sleep health across work settings, populations, and specific conditions; their impact on workplace productivity and worker health; and interventions designed to help workers, managers, and workplaces address their priorities and manage these competing demands. By recognizing and publicizing the importance of these interactions, we hope to stimulate researchers to develop and evaluate solutions to the global concern of poor sleep degrading work and quality of life and work degrading health, including sleep health.

Varied facets of sleep health are associated with work characteristics, although specific challenges differ among workers from different industries, contexts, and countries, as addressed in the papers in this special issue on sleep & work, work & sleep. For example, Dr. Salas-Nicás and colleagues conducted a survey of Spanish salaried workers and identified associations between job insecurity (salary decrease or recent restructuring at work) and sleep problems. Furthermore, recent or current household economic hardship was a primary factor associated with sleep problems (Salas-Nicás et al., this issue) . This is an ominous finding, given the ongoing severe impact of the COVID-19 pandemic on job stability for a much larger proportion of workers. Dr. Shimura and colleagues examined a wide range of lifestyle and sleep hygienerelated factors associated with sleep disturbances in a large sample of employees from 29 companies in Japan. Long commute times, regular nightcaps, irregular meal times, inadequate morning light, and excessive evening light from devices were among the potentially modifiable factors strongly related to sleep disturbances. (Shimura et al., this issue) Dr. Visvalingam and colleagues evaluated the self-reported sleep of a multi-ethnic sample of full-time employees in Singapore. The prevalence of poor sleep quality was over 40%, and two thirds obtained less than the recommended amount of sleep. As other authors did, they recommend workplace policies and intervention programs to improve worker sleep health. (Visvalingam et al., this issue) Drs. Ishibashi and Shimuraexamined the impact of sleep health on productivity in a sample of working adults in Japan. In fully adjusted models, poor sleep quality, sleep disturbances, and use of sleep medications were each associated with greater presenteeism, a measure of reduced productivity while at work (Ishibashi & Shimura, this issue). Dr. Taylor and colleagues evaluated, in a sample of over 200,000 United States Air force recruits, the impact of "difficulty sleeping at night" on the likelihood of being discharged for any reason within 1 year. In trainees discharged within one year, difficulty with sleep was a strong predictor of attrition. (Taylor et al., this issue) Dr. Stimpfel and colleagues studied a cohort of registered nurses in the US, finding that the prevalence of short sleep was high; a majority of these nurses were sleeping less than the recommended amount (7 or more hours per night) on a regular basis. Stimpfel and colleagues also identified cross-sectional associations of shorter sleep duration with lower reported quality of patient care and reduced patient safety. (Stimpfel, Fatehi, & Kovner, this issue) Current conditions in the US healthcare system with the COVID-19 pandemic are likely to make this situation even worse. Future surveillance of the health and well-being of health care workers, a particularly vulnerable group in a pandemic, should include sleep health as a modifiable factor that may impact workforce health and potentially patient care quality. Dr. Howard and colleagues examined how a simple noninvasive wrist-worn heart rate monitor could be used to detect drowsiness in heavy vehicle drivers in Malaysia. Even though the device could not always reliably detect the occurrence of a drowsy driving event, simply wearing the device appeared to have altered the drivers' behaviors and resulted in a decrease in the rate of harsh braking events in naturalistic conditions (ref: The impact of heart rate-based drowsiness monitoring on adverse driving events in heavy vehicle drivers under naturalistic conditions). Sleep scientists often talk about the "drive to sleep" that increases as a consequence of staying awake for long periods, a process modulated by the internal circadian system, which leads to especially decreased vigilance. Long-haul drivers often drive through this vulnerable period of increased sleepiness when the circadian body temperature is lowest, usually in the early morning. Diez and colleagues reported that longhaul bus drivers in Argentina combine sleep at different locations (bus, destination, and home) to obtain on average 6-7 hours of sleep, but those exposed to higher risk working schedules (e.g., overnight shifts) had disrupted circadian temperature rhythms (REF: Sleep misalignment and circadian rhythms impairment in professional long-haul drivers under a two-up operations system). Such studies are important for helping to design optimal fatigue management systems for drivers.

In addition to the long-haul driver study that examined circadian rhythmicity, two other papers study shift work in relation to circadian rhythms and sleep. Shift Work Disorder (SWD), a medical diagnosis that involves excessive sleepiness or insomnia caused by the work schedule, is common. Given the strength of the circadian system and the amount of sleep disruption caused by shift work, it is perhaps surprising that more night shift workers do not complain of SWD symptoms. Dr. Bastille-Denis and colleagues found that, when compared to shift workers who slept well, those shift workers with SWD had more thoughts that kept them awake, including pre-sleep cognitive arousal and worries. This suggests that cognitive variables may provide an avenue for SWD therapies. Relatedly, Dr Conduit and colleagues found that paramedics, who often perform shift work, had higher symptoms of depression, anxiety, fatigue, PTSD, and insomnia and lower well-being than the general population in Australia. These symptoms were particularly apparent in those shift workers who were "night owls" (evening chronotypes), compared to those who were morning chronotypes [REF] . Thus, addressing sleep issues and, perhaps. matching chronotype to shift preference could help to improve mental health and well-being in shift workers.

In an intriguing article on sleep and leadership, Dr. Barnes and colleagues describe a series of studies evaluating the relationship of workplace leadership behaviors with subordinates' sleep and ethical behaviors. Leaders exhibiting behaviors that "devalue" sleep have employees with poorer sleep quality, "above and beyond the effects of abusive supervision and other alternative explanations." Further, in mediation analyses, poorer sleep quality mediated the effect of leaders' devaluing of sleep on their subordinates' self-reported unethical behavior. (Barnes et al., this issue) Unpacking the many facets of sleep health encompassed by "difficulty sleeping" in workers could be a fruitful area for investigations and intervention efforts. Future studies are needed to assess the impact of the global downturn, pandemic mitigation practices, and related anxiety on sleep health. Interventions will need to consider the effects of economic hardship on sleep health, mental health, and physical health and recognize the existence of major disparities in the extent and impact of these hardships.

UH2/UH3 AG052167 (Almeida & Smyth, mPIs), R01 DK103663 (Wagner, PI), UL1 TR002014 (Sinoway, PI/PD), R01 MD011600 (Grandner, PI)

DoD grant PT150133 (Hammer, PI), CDC grant U19 OH010154 (Anger, PI), and the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University via funds from the Division of Consumer and

Bux-ton dis-closes that he re-ceived two sub-con-tract grants to Penn State from Mo-bile Sleep Tech-nolo-gies / Proactive Life / Sonic Sleep (NSF/ STTR #1622766, NIH/NIA SBIR R43AG056250), re-ceived hon-o-raria/travel sup-port for lec-tures from Boston Uni-ver-sity, Boston Col-lege, Tufts School of Den-tal Med-i-cine, and All-state, and re-ceives an hon-o-rar-ium for his role as the Ed-i-tor in Chief (des-ig-nate) of Sleep Health sleephealthjournal