A new study led by researchers at the University of Oxford’s Radcliffe Department of Medicine, has found that many NHS staff working shifts experience sleep difficulties, with researchers calling for more accessible, evidence-based support to help staff manage sleep.
The study was funded by the National Institute for Health and Care Research (NIHR) and supported by the NIHR Biomedical Research Centre: Oxford Health.
Researchers surveyed 443 shift workers at two large NHS Foundation Trusts in London and the East Midlands. Registered nurses were the largest professional group, making up 49% of participants.
The study found that 71% of participants met screening criteria for probable shift work disorder, a sleep disorder associated with working hours that overlap with the usual time for sleep. Symptoms include insomnia or excessive sleepiness associated with a person’s work schedule, alongside difficulties with day-to-day functioning.
The research was led by Dr Priya Sugavanam, Senior Research Associate and Programme Manager at the University of Oxford’s Radcliffe Department of Medicine.
Dr Sugavanam said: “Our findings suggest that sleep problems linked to shift work could be affecting a substantial proportion of NHS shift workers who took part in the study. What is particularly striking is that, despite the level of difficulty reported, most of the people identified as having probable shift work disorder had not received support for their sleep problems.
“Shift work is essential to delivering round-the-clock NHS care, so the answer cannot simply be to avoid working shifts. We need to better understand how employers and health services can identify staff who are struggling and provide practical, evidence-based support that works around the realities of shift work.”
Participants reported poorer health-related quality of life
Participants with probable shift work disorder reported poorer health-related quality of life and greater impairment at work and in everyday activities than those who did not meet the screening criteria. After researchers took demographic and shift-related factors into account, they had more than four times the odds of screening positive for possible depression and more than three times the odds of screening positive for possible anxiety.
The researchers emphasise that this study cannot show that shift work disorder caused the differences in quality of life, impairment, depression and anxiety. The survey looked at people at one point in time, so it can show links between these things but not cause and effect. Participants volunteered, and recruitment aimed to reach shift workers with sleep problems. This means people with sleep problems may be over-represented, so the findings cannot be used to estimate how common shift work disorder is across the wider NHS workforce.
Probable shift work disorder was identified using a validated screening questionnaire, and a clinical diagnosis was not made. Some people may therefore have been wrongly classified, and so the results should be read with caution. A more definitive diagnosis would need objective sleep measurements and structured clinical interviews. These take more time and resources, and fewer people may be willing or able to take part.
Study highlights need for support in managing shift work disorder
The study also found a substantial gap in support. Among the 315 participants who met the criteria for probable shift work disorder, 90% had tried at least one strategy to improve their sleep or reduce sleepiness at work, most commonly caffeine or naps. However, 91% reported that they had not received support for their sleep difficulties.
Busy schedules or lack of time, long waits for appointments and lack of awareness of available support were the most commonly reported barriers to seeking help.
The researchers say the findings highlight the need for accessible, evidence-based approaches to recognising and managing shift work disorder. The paper discusses measures including education for shift workers and managers, occupational health screening and clearer routes to appropriate support and treatment.
The study, Prevalence and associated burden of shift work disorder (SWD) in healthcare shift workers in the UK National Health Service (NHS): a cross-sectional survey, is published in BMJ Open.
