“Sleep Was Easier to Give Up Than the Job”

Several people I interviewed for The Savvy Insomniac blamed their insomnia on stress at work. A trial lawyer attributed his nighttime wake-ups to “mostly job related stress.” A 52-year-old woman on Social Security disability saw her insomnia as resulting from 14 years of shift work as a dispatcher with emergency services.

Work can interfere with sleep in many ways, including shortening sleep duration. The CDC has just released a report on the categories of work most likely to shorten people’s sleep. Here’s what they are and how they may relate to chronic insomnia.

Persistent trouble sleeping can develop from years of shift workSeveral people I interviewed for The Savvy Insomniac blamed their insomnia on stress at work. A trial lawyer attributed his nighttime wake-ups to “mostly job related stress.” A 52-year-old woman on Social Security disability saw her insomnia as resulting from 14 years of shift work as a dispatcher with emergency services.

Work can interfere with sleep in many ways, including shortening sleep duration. The CDC has just released a report on the categories of work most likely to shorten people’s sleep. Here’s what they are and how they may relate to chronic insomnia.

Occupations Associated With Short Sleep

The findings are based on surveys conducted on working adults in 2013 and 2014. By telephone, workers answered questions about the kind of work they did and how much sleep they normally got in 24-hour period. In all, the CDC analyzed the responses of nearly 180,000 people. The data show a high percentage of workers in these five broad categories typically slept less than 7 hours a night:

  1. Production (printing workers, plant and system operators, supervisors, and production workers), about 43%
  2. Healthcare Support (nursing, psychiatric, and home health aides), about 40%
  3. Healthcare Practitioners and Technical (health technologists and technicians, health diagnosing and treating practitioners), about 40%
  4. Food Preparation and Food-Related (supervisors, food preparation and serving workers, cooks), about 40%
  5. Protective Service (fire fighting and prevention workers, law enforcement officers), about 39%

Occupations Involving Shift Work

The jobs in all five categories often involve shift work. Round-the-clock operations in hospitals, factories, restaurants, and police and fire departments make it necessary for some employees to work at times when we’re normally at rest. In other work situations employees regularly rotate from one shift to the next.

Shift work is known to interfere with sleep, contributing to shortened sleep and excessive sleepiness. It disrupts circadian rhythms and has a negative effect on health, contributing to a rise in certain cancers, obesity, and impaired glucose tolerance. It also increases the risk of injury.

Could Shift Work or Work-Related Short Sleep Lead to Chronic Insomnia?

Lynda, the retired dispatcher on disability, felt there was a direct link between her insomnia and her work in emergency services. Day jobs she’d held previously gave her “no trouble sleeping at night.” But the dispatch job was different:

I really do believe that the shift work was a major contribution to my sleeping problems. I base this on comparisons with my coworkers. I don’t know any policeman, fireman, or dispatcher who didn’t have trouble sleeping while swinging shifts on a regular basis. I loved this line of work because it was always rewarding to be able to help someone, or be responsible for saving someone’s life. Sometimes, depending on the size of the catastrophe, it could be very intense. You could feel the adrenaline pumping. . . . It just gave you a great feeling knowing that YOU were the one who made a difference. I guess that would explain why I couldn’t sleep after coming off of working something major. Sleep was easier to give up than the job.

How It Could Happen

The neurocognitive model of insomnia suggests how chronic insomnia might develop from work-related stress and short sleep. In fact any stressful situation can trigger acute (or temporary) insomnia, including stress at work. But acute insomnia does not necessarily become chronic. Sleep can—and, in many people, does—return to normal once the situational triggers for insomnia get resolved.

But in the five categories of jobs identified by the CDC, less-than-perfect conditions of employment may be a given when you accept the job. Want to work in emergency services? Fine. You’ll work rotating shifts.

If you find this situation stressful because it interferes with your sleep, you may be tempted to resort to measures that often make sleep worse—using alcohol to get to sleep, for example, or spending long stretches lying awake in bed.

Lying awake in bed often leads to worry and rumination, and to high-frequency brain activity during sleep onset and beyond. Eventually you wind up conditioning arousal in your body and brain. Et voilà, you’re saddled with chronic insomnia—all because you were a good citizen and willing to work around the clock.

I never had an easy time working split shifts and I avoided other jobs that might disrupt my sleep. People like Lynda are more adaptable. But . . . at what cost?

If you’ve had a job that shortened or otherwise interfered with your sleep, how did you manage the situation, and were their any long-term effects?

What Makes You Vulnerable to Insomnia?

The causes of insomnia are still unknown, but many factors can make people more and less vulnerable to it.

A prospective study of Norwegian nurses offers new evidence of several factors, some well known and others that have gotten less attention in the past.

vulnerability to insomnia depends on several thingsWhen I set out to write my book about insomnia, I asked dozens of insomniacs what they thought had caused their insomnia. Several mentioned constitutional factors.

There are certainly grounds for thinking that a genetic component is involved. People who have a first-degree relative with insomnia are 7 times as likely to suffer insomnia as people without insomnia in the immediate family.

Other people I interviewed attributed their insomnia to stress at work or to family problems. Still others blamed their insomnia on an inability to quiet their mind at night.

The causes of insomnia are still unknown, but many factors can make people more and less vulnerable to it. A prospective study of Norwegian nurses offers new evidence of several factors, some well known and others that have gotten less attention in the past.

Anxiety and Depression

There’s plenty of evidence pointing to a relationship between insomnia and mood disorders. In the nurses’ study, where investigators reviewed data on 799 nurses collected at 2 time points 2 years apart, nurses higher on anxiety and depression measures in 2009 were significantly more likely to report insomnia symptoms in 2011.

The reverse relationship also held for insomnia and anxiety: nurses reporting insomnia in 2009 were more likely to have developed anxiety 2 years later. Surprisingly, although insomnia is widely understood to be a causal factor in depression, the nurses’ study found no evidence of this.

Morningness and Eveningness

The nurses in this study were all shift workers. Other research has suggested that people who dislike getting up early in the morning have an easier time adapting to shift work, where work at night is required.

In the current study, though, the nurses who disliked getting up early in the morning were actually more inclined to develop insomnia than the early risers. Other research has shown that people who like to get up early tend to have better lifestyle regularity and more regular sleep habits. Both these things tend to protect people from developing insomnia.

Personality Traits

Some people function quite well despite sleep loss while others feel drowsy and lethargic. (This is largely determined by genetic factors and is thus a stable trait.) Languidity—the tendency to experience drowsiness and lethargy after losing sleep—was found in the nurses’ study to predict an increase in insomnia symptoms over the 2-year period. No surprises here. Impairments in daytime functioning are classic symptoms of insomnia.

Another personality trait—flexibility, or the ability to sleep or stay awake at odd hours—has generally been known to protect against the development of insomnia. Among shift workers, this would be an especially useful trait. But in this study, a high score on flexibility had no positive or negative relationship with insomnia.

Smoking, Drinking, and Caffeine

The overall harmful effects of tobacco, alcohol, and caffeine on sleep are now well known. For many years insomnia was attributed to people drinking too much scotch or too much coffee.

More recently, studies have shown that people with insomnia do not typically drink more alcohol or caffeinated drinks than people who sleep well, and the nurses’ study supports this finding. None of these lifestyle factors predicted an increase in insomnia over time. In fact, nurses reporting insomnia symptoms in 2009 actually reported drinking less caffeine in 2011.

Bullying at Work

Several work-related stressors are known to increase the risk of poor quality sleep, and bullying—persistent exposure to negative actions from others—is one. Day-to-day contact with tyrannical bosses and manipulative supervisors often leads to psychological distress.

Nurses subjected to bullying at work reported more insomnia symptoms over time than the nurses working under better conditions. No surprises here: the worry and stress that result from bullying are two of the leading causes of sleep problems among workers.

Spillover Between Work and Family

Stress in one domain can affect another. In the nurses’ study, negative spillover from work to family and from family to work predicted an increase in insomnia symptoms over time. Conversely, insomnia led to reports of more work-to-family conflicts over time.

Shift Work

Finally, shift work, involving night work and rotating shifts, is known to precipitate insomnia. But in this group of nurses, the association did not hold. This unexpected result might be due to the young age of the nurses (average age 33) and their overall good health compared with shift-working nurses overall, many of whom likely self-selected out of the study.

What factors do you think led to your insomnia?