Sleep management intervention for shift workers and their employers

Lead Research Organisation: University of Warwick
Department Name: Warwick Medical School


Describe the research in simple terms in a way that could be publicised to a general audience. If awarded, this will be made publicly available, and applicants are responsible for ensuring that the content is suitable for publication.? 4000 characters, including spaces and returns

Many office-based jobs follow a Monday-Friday 9-5 working pattern that matches up with the natural day-night, light-dark cycle. However, some jobs such as healthcare, farming, manufacturing, transport, and military, require different working hours, and 15-20% of working people in the UK work non-standard or shift work hours. Working in shifts and having to sleep and be awake at different times can mean lower quality sleep and struggles with alertness and concentration when awake. One in three shift workers are affected by insomnia symptoms. These symptoms include difficulty falling asleep, fatigue, excessive sleepiness when required to stay awake and emotional problems such as irritability. All of this has a big impact on shift-workers' mental and physical health and can impact wider safety factors such as contributing to more accidents at work or on the roads.

In the UK, around 75% of adults are in employment and spend on average a third of their waking hours working, making the workplace a good place to deliver support. The objective of this study is to create a new sleep management intervention to prevent sleep problems developing. The intervention will be created with the help of people working shifts and their employers and will be delivered through the workplace to new starters or current staff. The programme will be for all staff working shifts, whether they have existing problems with mental health and sleep or not. The intervention will aim to provide them with the skills and knowledge to manage their sleep and prevent problems developing.

Research shows that women, older people, and people from socially or economically challenged backgrounds are more likely to have insomnia. We will ensure that those we recruit to help us with this work are diverse so that project outputs are relevant and can benefit all those affected.

To create the programme, we will develop a theory of change to describe what it is about shift work that actually impacts sleep. We will define the ways in which the intervention can impact those factors, and the things we will measure in order to see if the intervention has worked in the way we expected. We will recruit shift workers and employers to help us create the intervention from those we already work with in the Midlands Engine region of the UK. Our team's experience in creating and delivering sleep interventions (e.g., for people with chronic pain, and people working non shift hours) will be combined with existing evidence about the behaviours that affect sleep health to produce the intervention with our partners.

We will create the content with shift workers during several workshops. Different groups of workers will be asked to review the content created to make improvements and make sure the intervention is easy to understand and follow. To make sure the final intervention is practical for employers to offer, we will also discuss delivery challenges with both employers and staff. A focus group and interviews with employers will aim to improve their awareness of how best to address mental health and sleep problems for shift-work employees. A training handbook will also be developed for employers, which will help guide the delivery of the programme after the research development has finished.

Technical Summary

Describe the research in a manner suitable for a specialist reader. If awarded, this content will be made publicly available, and applicants are responsible for ensuring that the content is suitable for publication.? 2000 characters, including spaces and returns

Shift work can disrupt the brain and body's "biological clock" which normally promotes daytime alertness and night-time sleepiness. This causes misalignment between the homeostatic and circadian pacemaker (desynchronisation between the biological clock and the natural day-night environmental cycles) which reduces quality and duration of sleep and cause impaired alertness during the night shift. In fact, one in three shift workers report having at least one clinically relevant sleep disorder, with 8-32% of shift workers suffering from shift work sleep disorder, suggesting a public health concern that needs addressing.

The objective is to co-produce and develop an early intervention sleep management programme for delivery to shift-worker populations regardless of the presence or absence of any existing mental health or sleep problems. The intervention will aim to provide populations of shift workers with the skills and knowledge to manage their sleep and prevent clinical problems developing. According to a Labour Force Survey in the UK, 75.5% of adults are in employment, on average spending a third of their waking hours in the workplace, making the workplace a strategic setting to deliver population-based interventions.

We will develop a theory of change and model processes and outcomes of the proposed intervention. We will recruit shift workers and employers as part of our stakeholder group from our existing employer network in the Midlands Engine region of the UK. To ensure representative results, stakeholder groups will be diverse in terms of socioeconomic background, ethnicity, age group, and gender.

Based on theories for sleep health behaviour, and the team's experience of co-production and expertise in developing and delivering sleep intervention programmes for other populations and in different settings, we will co-produce a shift-work specific preventative intervention for the workplace that can have significant changes at the population level.


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Title Co-produced intervention review outcomes 
Description A live scribe (illustrator) attended the employer focus group session in Feb 2024 to document the event. The resulting artwork provides an illustrative summary of our work so far, including the intervention development process, resulting intervention protocol, and suggestions for increasing participant engagement (including stakeholder outputs). 
Type Of Art Artwork 
Year Produced 2024 
Impact The resulting artwork will help to provide an illustrative summary of the intervention co-development process and protocol, which can be shared with public audiences and organisational partners to engage them further with this important work (i.e., raising awareness and facilitating recruitment for the next phase). The artwork will also support our next funding bid to UKRI MRC to provide an illustrative summary of our developed programme and plans for intervention. If successful, this funding will have a substantial impact by facilitating the implantation and assessment of the programme (feasibility trial). 
Description Employee Co-production Workshops (PPI) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact We ran a series of employee co-production workshops across four organisational sites (5 separate workshops, n = 3-8 employees per workshop; N = 26). Employees discussed the impacts of shift work on them as well as their current sleep management techniques (personal and organisational). Employees were presented a series of research-backed intervention methods (for the improvement of sleep and fatigue in shift workers) and gave their thoughts and feedback on the practicalities of each. Employees also discussed what a good sleep management programme should (or should not) look like for them in terms of delivery and format. These workshops enabled us to identify the needs, wants, and preferences of shift workers, and informed the co-development of a sleep management programme protocol. Workshops gave employees the opportunity to voice their opinions and engage in collaborative research. Afterwards, employees were more interested in sleep and were enthusiastic about the creation and implementation of a new sleep management programme for shift workers.
Employees (some same, some different) were later (re)visited for another series of workshops, where they were shown the draft sleep management programme they had helped to create and asked to provide their thoughts and feedback. Employees felt that their insights had been taken on board and gave positive feedback about the programme.
Year(s) Of Engagement Activity 2023,2024
Description Employer Representative Focus Group (PPI) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact 10 Employer representatives from 4 organisational partners attended a focus group hosted at the university. The session included raising sleep education and awareness, and the need to improve sleep in shift workers. During the session, employers were also presented with a draft intervention protocol (that had been co-produced by researchers, employees and interviews with the same employers), and gave their thoughts and feedback on the practicalities of implementation within the workplace setting. Afterwards, employers were keen to take part in future stages of intervention development (including feasibility assessment) and provided letters of support for a future funding application. Employers also left with an increased awareness and understanding of the sleep issues that shift workers face, and advocated the need for change, intervention and policy-level support.
Year(s) Of Engagement Activity 2024