When Debbie Toms first started working nights as a respiratory therapist, co-workers teased her that the graveyard shift would "take 10 years off your life," she said.It never occurred to her that there might be some truth to the statement.While Toms has managed to stay healthy in the 30 years that she's worked off and on night shifts, most recently at Kaiser Permanente's Regional Center for Sleep Medicine in San Jose, Calif., the graveyard shift has been associated with everything from ulcers and depression to heart disease and cancer. There's even a formal diagnosis called shift-work disorder, which applies to people who suffer insomnia and excessive sleepiness from working nights."It's not surprising," said Dr. Louis Ptacek, a University of California-San Francisco neurologist studying genes and sleep behaviors. "We evolved on a planet that is rotating every 24 hours. Our internal clock is more than just when we sleep and wake. It's related to cell division and it regulates our immune systems."Most researchers agree that a fatigue factor undoubtedly goes along with working the graveyard shift. It's more difficult to get a good night's, or rather day's, sleep, and it can be a challenge to force the mind and body to be at their best in the middle of the night.Roughly 15 million people, or 15 percent of American workers, regularly work a shift that's outside the typical daytime schedule, according to the U.S. Department of Labor. Studies have shown that between 10 percent and 20 percent of shift workers have trouble with insomnia when they're trying to sleep and feeling sleepy on the job when they're trying to stay awake.That leads to the obvious connection between sleepiness and the risk of accident -- either on the job or driving to and from work. People who are sleep-deprived can succumb to "microsleeps," where they fall asleep for just a few seconds and don't even realize it, said Dr. Clete Kushida, director of the Stanford University Center for Human Sleep Research.Not everyone agrees that shift work is much of a health concern."The data here is not extremely firm," said Dr. Allan Pont, vice president of medical affairs at California Pacific Medical Center, who ran the hospital's residency-training program for 20 years. Pont, who has worked many night shifts himself, said he's skeptical of the idea that many health problems are related to work schedule."Obviously it's difficult when people change from a day shift to a night shift," he said. "There are those who can adapt to it and those who don't. Those who adapt probably do just fine, and the others quit."Still, there are dozens of studies that have demonstrated risks associated with the night shift.Most of the risks associated with night work are related to a simple lack of sleep and not being able to keep up steady, healthy behaviors -- such as eating right and getting exercise. That could explain some studies that show higher rates of cardiac disease and metabolic syndromes in night-shift workers.Graveyard workers also tend to be more stressed out from fatigue and from not getting to spend enough time with friends or family, doctors say. That stress could play a role in higher rates of ulcers and high blood pressure."A reasonable percentage of Americans work a night shift, and a majority of them have health issues related to it," said Dr. Sunil Rama, medical director of the Kaiser sleep lab. "It's been linked to arteriosclerosis, headaches, insomnia, excessive sleepiness. You ask anyone who's worked nights, and they're usually a wreck the next day."The focus of much research on shift-work disorder is on the circadian rhythm -- the body's internal clock that keeps everyone on roughly a 24-hour schedule. It's possible, doctors say, for people to alter their circadian rhythm so that they are perfectly healthy and comfortable working a night shift regularly.Toms said that after 30 years of off-and-on graveyard duty, she's adjusted pretty well to her overnight shifts. The key to staying healthy, she said, is to prioritize."You have to really be aware of your health -- am I eating well, am I sleeping enough, am I exercising?" Toms said. "It just takes planning. You have to realize this is your lifestyle and be ready for it."(E-mail Erin Allday at eallday(at)sfchronicle.com.)(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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