Creeping fatigue is more dangerous than you think

Not all fatigue is the same. Fast fatigue builds up quickly and is predictable. Creeping fatigue builds up slowly, it is easy to overlook and it can reach extreme levels. Creeping fatigue may be one of the bigger fatigue risks in healthcare.
Some research you need to know about.
Research found that people who had six hours sleep a night for fourteen nights in a row became so fatigued they performed like they had not slept for two days! Many people think six hours sleep a night is not too bad, but after 14 nights in a row, six hours sleep can leave you a real danger to yourself and others.  The real kicker however was when these people were asked how fatigued they were they all said they were not fatigued – even though their performance tests showed they were severely fatigued.
The key points

1. Creeping fatigue builds to extreme levels when, night after night, sleep is long but not quite long enough to fully recharge your batteries (e.g. 6 hours a night).


2. Fourteen consecutive six hour sleeps can be as dangerous as going without sleep for two days.


3. People with severe creeping fatigue will report that they are OK.
   


4. Creeping fatigue is not limited to shift workers, it can affect people on permanent days.

It seems that creeping fatigue, because it builds gradually, is much harder to notice. This is very different to fast fatigue which is much more noticeable and predictable. For example, on the first night shift, employees know they will “hit the fatigue wall” at about 3-5 am. They can anticipate fast fatigue and take steps to manage the risks.
There are natural patterns of behavior that can limit creeping fatigue. In many cases, employees have longer sleeps every four or five days on their days off or on weekends. There are however many circumstances where these longer sleeps do not occur.
Guidelines for designing shifts that work
There are two basic guidelines for how to manage shift work. The first is shift management. The hospital needs to manage shifts well by ensuring people are rostered appropriately with adequate time off and that shifts are rotated forward. The second comes down to the individual. Anyone working shifts needs to ensure that the people they live with understand that when they are at home they need to sleep undisturbed, in a quiet, dark and comfortable environment. Even though a person who has worked a night shift is at home during the day, they can’t engage in normal daytime activities.
While employers do have a responsibility to ensure their employees are in a safe and healthy work environment, employees need to ensure that when they are at home they go to sleep. They need a dark room to sleep in quietly, free from phones and computers that may disturb their sleep. Just as you wouldn’t wake someone at 1am to help you find the butter in the fridge, it’s not OK to wake a shift worker during the day unless there is an emergency.
Getting 7 or 8 hours of good quality sleep is not an optional activity – it’s an absolute necessity both for a shift worker’s productivity and their own personal health. Too many people think that they can get home at 3am, sleep for a few hours, then get up at 7am and get the kids off to school. That is just not going to work, either for themselves or the family.
By not taking care of your sleep, your health can suffer. Patients with insomnia have an increased risk of developing cardiovascular disease, for example, high blood pressure. There is a trial underway at the moment at the University of Pittsburgh looking at whether treating insomnia helps to lower blood pressure. There are many health consequences of having insufficient or poor sleep.
The final word
The advice for anyone working shifts is that you need to make time to sleep. No matter what time you get home, if it’s 6pm or 6am, ensure that you have your meal at least two or three hours before going to bed and give yourself some wind-down time. Ensure that your sleeping environment is quiet, dark and protected from disturbance and observe the three pillars of health; diet, exercise and good quality sleep.
For nurses struggling to adjust to a shift cycle, I would recommend you talk to your nurse unit manager. If your shifts have been optimised and you are still having sleep problems, consult a sleep psychologist. A sleep psychologist can be of enormous benefit in helping you to improve the quantity and the quality of your sleep.