How do the timing and length of a night-shift nap affect sleep inertia?

Napping is one strategy that may assist night shiftworkers to cope with sleepiness and fatigue. However, one potential disadvantage of napping is that awakening from naps is disturbed by sleep inertia, which has also been found to impair performance and/or mood, transiently. The authors examined the effects of the timing and length of a night-shift nap on sleep inertia in a laboratory setting. Twelve male university students (mean +/- SD: 21.6 +/- 2.8 yrs) participated in this 3-day experiment, during which included a simulated night shift (22:00-08:00 h) and subsequent day (11:30-17:30 h) and night sleep (00:00-07:00 h). The simulated night shift was designed to include one of five (four nap/one no-nap) conditions. The napping conditions differed by their timing and duration: 00:00-01:00 h (Early 60 min; E60), 00:00-02:00 h (Early 120 min; E120), 04:00-05:00 h (Late 60 min; L60), 04:00-06:00 h (Late 120 min; L120). Participants completed all the experimental conditions in a counterbalanced order. Rectal temperature (R(T)) was recorded throughout the simulated shift and polysomnography (PSG) was recorded during the nap period. Immediately before and after each nap, participants were required to complete a visual analogue scale (VAS) to assess sleepiness and a visual vigilance test (VVT). During the simulated night shift, a set of tasks (an English transcription task, a performance test battery, and a break) was repeated hourly, except during the periods of napping. For each nap condition, the VAS and VVT (reaction time [RT]; lapses >5 s) results were analyzed by two-way, repeated-measures analysis of variance (ANOVA) (nap [nap versus no-nap] x time point [pre-nap versus post-nap]). PSG and R(T) data were analyzed with one-way repeated-measures ANOVA. Marginally significant interactions were observed for RTs and lapses in VVT for the L60 nap condition (p = .071 and p = .070, respectively). However, those effect sizes were moderate (partial eta(2) = 0.266, 0.268, respectively). Post hoc analyses showed significantly longer RTs (p < .05) and more lapses (p < .05) following the L60 nap compared with no nap. In contrast, there was no significant difference in sleepiness between the L60, or any of the other nap conditions, and the no-nap condition. Our findings suggest the effect of sleep inertia on VVT performance was profound in the L60 condition, although no significant effects on sleepiness were self-reported by VAS. The dissociation between performance and sleepiness might reflect an unstable state where participants cannot perceive decline in their performance. The present findings are significant in terms of occupational safety; the practical implication is that great care is needed when taking a 1-h nap between 04:00 and 05:00 h on the night shift.

Effects of a modified ambulance night shift system on fatigue and physiological function among ambulance paramedics.

OBJECTIVES: In the present study, we modified a night shift system for an ambulance service so that ambulance paramedics were assured of taking a nap, and examined the effects of this new system on the fatigue and physiological function of ambulance paramedics. METHODS: Ten ambulance paramedics at a fire station in the center of a large city in Japan voluntarily enrolled as subjects in this field study. They worked a 24-h shift system. There were two teams of 5 ambulance paramedics in the fire station. Three ambulance paramedics per shift usually provided the emergency services. In the traditional system, the ambulance paramedics had to deal with all emergency calls throughout a 24-h shift (T-shift). In the modified system, 2 ambulance paramedics were allotted time for naps in the 21:00-3:00 (C-shift) or 3:00-8:30 (B-shift) shift by the addition of another a firefighter (D-shift). RESULTS: There were fewer emergency dispatches and nap time was longer in the B- and C-shifts than in the T-shift. Parasympathetic nerve activities during naps in B- and C-shifts were higher than in the T-shift. The results of critical flicker fusion frequency and 3-choice reaction time in the B-shift at 7:30 tended to be higher and shorter than that in T-shift. CONCLUSIONS: The results of this study suggest that the modified night shift which ensured time for ambulance paramedics to take long, restful power naps alleviated subjective fatigue, and improved physiological functions which are often adversely affected by night workload.

Impact of nap length, nap timing and sleep quality on sustaining early morning performance.

The study examined how nap length, nap timing and sleep quality affect early morning performance (6:00 to 8:00). Twelve students participated in a simulated nightshift schedule (22:00 to 8:00) where the length and timing of nocturnal naps were manipulated (0:00-1:00, 0:00-2:00, 4:00-5:00 and 4:00-6:00). A performance test battery was administered consisting of a psychomotor vigilance test, a logical reasoning test, and a visual analogue scale for subjective fatigue and sleepiness. The results showed that a 120-min nap sustained early morning performance better than a 60-min nap. Taking a nap earlier or later did not affect the neurobehavioral performance tests, although participants slept more efficiently during naps later in the night shift. A negative effect of a nocturnal nap during the night shift on subsequent daytime and nocturnal sleep was not observed in the sleep architecture. It still remains unclear whether slow wave sleep plays an important role in sustaining early morning performance. In terms of work safety and sleep health, the results suggest that a longer and later nap is beneficial during night shifts.

Impact of ISO/TS 20646-1 "Ergonomic procedures for the improvement of local muscular workloads" on work-related musculoskeletal disorders.

The International Organization for Standardization (ISO) published a new Technical Specification (TS), ISO/TS 20646-1 "Ergonomic procedures for the improvement of local muscular workloads (LMWL)--Part 1: Guidelines for reducing local muscular workloads" in 2004. However, little is known about whether the ISO/TS is really effective in taking action to improve the work conditions in real workplaces. This paper discussed the impact of preventive activities planned and carried out according to the ISO/TS in 17 enterprises. Results indicated that 61 improvements (96%) had already been implemented (63%) or in progress (33%) within 6 months of the start of the activities. Besides the initial improvements, new improvements added within one year reached 84 cases and 10 cases were in progress in 15 enterprises. Comprehensive risk analysis, which consisted of a series of applications of action oriented checklist and group discussions, contributed to the detection of widely diversified risks in each local workplace, and this seems to lead to sustainable activities for prevention of WMSDs. These results suggest that the ISO/TS 20646-1 help managers and workers to control multiple work-related musculoskeletal disorder (WMSD) risks on their own initiative and promote sustainable activities.

Approaches to occupational health based on participatory methodology in small workplaces.

An intervention based on the methodology developed by the International Labour Office, the Work Improvement in Small Enterprises (WISE) was carried out to improve work condition of small-scale enterprises and the informal sector in the Philippines, Thailand and Japan. Through the evaluation of the efficacy of the approaches based on participatory methodology, it is concluded that the method is an efficient measure to improve work condition in small workplaces. It is also pointed out that the activities of supporting experts such as introduction of the methodology and evaluation of the activity are necessary. The important roles of the experts are 1) to encourage managers and workers to sustain the activities for work improvement, 2) to analyse the effectiveness and problems of the implemented improvements, 3) to give appropriate suggestions for the further improvement, and 4) to get materials for demonstrating the effectiveness of WISE activities on improving work conditions and productivity to other managers and workers who have not participated in the activity.

A case study on evaluations of improvements implemented by WISE projects in the Philippines.

The aim of this study is to evaluate the effects of work improvements in small enterprises (WISE) on workloads and productivity, and managers' satisfaction with those projects. Participating in this study from 1994 to 1996 were 9 small enterprises, 3 metal industries, 1 car parts manufacturing, 1 garment manufacturing, 1 food processing, and a few others. Upon visiting these worksites, we carried out interviews on the implemented WISE improvements and made objective evaluations of their effect on workloads and productivity. Reductions in physical workloads were found in 4 of 6 enterprises where that factor was estimated. Productivity in most of the enterprises increased after WISE improvements. Managers' subjective satisfaction with WISE activity ranged between 50-80% on each technical item. More than 50 percent of managers came to understand the necessity of workers' involvement and understanding of the activities in order to sustain activity for improvement. WISE activity can exert a beneficial influence on workload and productivity. Most of the managers were satisfied with the results. It is presumed that follow-up visits with objective estimation will provide both managers and workers with encouragement to maintain their efforts.

Effects of the length and timing of nighttime naps on task performance and physiological function.

OBJECTIVE: To examine the effects of the length and timing of nighttime naps on performance and physiological functions, an experimental study was carried out under simulated night shift schedules. METHODS: Six students were recruited for this study that was composed of 5 experiments. Each experiment involved 3 consecutive days with one night shift (22:00-8:00) followed by daytime sleep and night sleep. The experiments had 5 conditions in which the length and timing of naps were manipulated: 0:00-1:00 (E60), 0:00-2:00 (E120), 4:00-5:00 (L60), 4:00-6:00 (L120), and no nap (No-nap). During the night shifts, participants underwent performance tests. A questionnaire on subjective fatigue and a critical flicker fusion frequency test were administered after the performance tests. Heart rate variability and rectal temperature were recorded continuously during the experiments. Polysomnography was also recorded during the nap. RESULTS: Sleep latency was shorter and sleep efficiency was higher in the nap in L60 and L120 than that in E60 and E120. Slow wave sleep in the naps in E120 and L120 was longer than that in E60 and L60. The mean reaction time in L60 became longer after the nap, and faster in E60 and E120. Earlier naps serve to counteract the decrement in performance and physiological functions during night shifts. Performance was somewhat improved by taking a 2-hour nap later in the shift, but deteriorated after a one-hour nap. CONCLUSIONS: Naps in the latter half of the night shift were superior to earlier naps in terms of sleep quality. However performance declined after a 1-hour nap taken later in the night shift due to sleep inertia. This study suggests that appropriate timing of a short nap must be carefully considered, such as a 60-min nap during the night shift.

Effects of the length and timing of nighttime naps on task performance and physiological function

OBJETIVO: Para investigar os efeitos da duração e horário de cochilos noturnos sobre o desempenho e as funções fisiológicas foi realizado um estudo experimental por meio do trabalho noturno simulado. MÉTODOS: Seis estudantes foram recrutados para o estudo que consistiu de cinco experimentos. Cada experimento consistia de três dias consecutivos com um turno noturno (22:00-8:00h) seguido por um período de sono diurno e noturno. Os experimentos compreendiam cinco condições em que a duração e o horário dos cochilos eram manipulados: 0:00-1:00 (E60), 0:00-2:00 (E120), 4:00-5:00 (L60), 4:00-6:00 (L120) e sem cochilo (N-nap). Durante os turnos noturnos, os participantes foram submetidos a testes de desempenho. Um questionário sobre cansaço subjetivo e um teste de freqüência crítica de luz foram aplicados depois dos testes de desempenho. A variabilidade da freqüência cardíaca e a temperatura retal foram registrados continuamente durante os experimentos. Polissonografia também foi realizada durante o cochilo. RESULTADOS: A latência de sono foi menor e a eficiência do sono maior no cochilo em L60 e L120 que em E60 e E120. O sono de ondas lentas nos cochilos em E120 e L120 foi mais longo que em E60 e L60. O tempo médio de reação em L60 ficou mais longo depois do cochilo e mais rápido em E60 e E120. Os cochilos em horário mais cedo serviram para neutralizar a queda no desempenho e funções fisiológicas durante o turno noturno. Houve uma ligeira melhora do desempenho ao se tirar um cochilo de duas horas num horário mais tarde durante o turno, mas houve piora depois de um cochilo de uma hora. CONCLUSÕES: Os cochilos na última metade do turno noturno foram melhores em termos de qualidade de sono do que os cochilos em um horário mais cedo. O desempenho, no entanto, piorou depois de um cochilo de uma hora em um horário mais tarde durante o turno por causa da inércia do sono. O estudo indica que o horário adequado de um cochilo curto deve ser cuidadosamente considerado, tal como um cochilo de 60 minutos durante o turno noturno.