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Work Stress and Overtime Work – Effects on Cortisol, Sleep, Sleepiness and Health

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Work Stress and Overtime Work – Effects on Cortisol, Sleep, Sleepiness and Health Work stress and overtime work – effects on cortisol, sleep, sleepiness and health Anna Dahlgren Department of Psychology Stockholm University The work reported in this thesis was carried out at the National Institute for Psychosocial Medicine, IPM. Published articles have been printed with permission from the publisher. ©Anna Dahlgren, Stockholm 2006 ISBN 91-7155-374-9 Printed in Sweden by Universitetsservice US-AB, Stockholm 2006 Department of Psychology Stockholm University 2 Work stress and overtime work – effects on cortisol, sleep, sleepiness and health Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Stockholms Universitet offentligen försvaras på det engelska språket i David Magnussonsalen, Psykologiska Institutionen, Stockholms Universitet, fredagen den 15 december kl. 10.00 Anna Dahlgren In Sweden the National Bureau of Statistics has reported an increase in stress-related disorders and sleep problems since the mid-1990’s. They also report that the number of hours of overtime worked has increased. Previous research on work-related stress and overtime work has demonstrated associations with altered physiological arousal, increased risk for stress related diseases, shorter sleep, greater fatigue and impaired performance. However, there is a lack of knowledge on the effects within individuals. The general aim of the thesis was to investigate the effect of overtime work and increased work stress on sleep, the diurnal pattern of cortisol, sleepiness and subjective stress in a within-subject design. In addition, it examined individual differences in the diurnal cortisol response to stress. We used a combination of methods – questionnaires, sleep and wake diaries, objective measures of sleep, stress hormones (salivary cortisol) and ambulatory measures of heart rate and blood pressure. Studies followed office workers during two different conditions of (I) high/low work stress and (II) overtime work respectively. The individual differences in the cortisol response to stress from study I prompted study III. In this study we examined two groups that showed different cortisol responses to stress. In conclusion, the results (I) demonstrated that a week with higher workload and stress affects physiological stress markers such as cortisol, and is associated with increased sleepiness and problems of unwinding at bedtime, shorter sleep duration and longer work hours. Furthermore (II) overtime work, under conditions of relatively low workload, was shown to be associated with modest effects on physiological markers of arousal. More pronounced effects were found on sleep and fatigue, with greater problems during overtime work. Study III indicated that individual differences in cortisol response to stress maybe related to fatigue and exhaustion. Key words: work stress, overtime work, cortisol, sleep, sleepiness, fatigue, individual differences, within-subjects design, field study ©Anna Dahlgren, Stockholm 2006 ISBN- 91-7155-374-9 3 4 Acknowledgements There are a lot of people who in different ways have contributed to this work and to whom I am deeply grateful. First of all I want to thank all the people that have participated in my projects. Without your effort these projects would not have been viable. And I am also thankful to all the people at SIF and HTF who have supported this work. I would like to express my gratitude to my supervisor professor Torbjörn Åkerstedt for his invaluable guidance and inspiration. Thank you for sharing your knowledge and for teaching me how to improve my manuscripts. Further thanks to my second supervisor Dr. Göran Kecklund who in an excellent way has supported me through all the steps in my research. Your help has always been available and your ability to give definite advice has been precious. I have also had the privilege to share an office with Dr. Mirjam Ekstedt, whose company always has been inspiring, both for research and for life. Thank you for your beautiful friendship. I also want to express thanks to Christian Portin for all the technical support and for contributing to the nice atmosphere at IPM. I also appreciate all the help I have got from Mona Martinsson and Anette Hedberg. Thank you for ordering tickets, setting up the library and above all for sorting out the End Note system. And I am of course deeply grateful to all my other colleagues at IPM – John Axlesson, Paolo DonOffrio, Claire-Anne Eriksen, Mats Gillberg, Michael Ingre, Kerstin Jeding, Arne Lowden, Jens Nilsson, Sara Ohlsson, Helena Pernler, and Marie Söderström. It has been a privilege to work with you. Two extraordinary women and great researcher that have been a great support through the years are my mother Kerstin Dahlgren and grandmother Ulla Pettersson. I am very privileged to have such inspiring and cool role models. Thank you! Also many thanks to PeO Dahlgren, Per Dahlgren, Fanny, Alexander, Björn Persson, Kerstin Hägglund, and the rest of the family. To my friends, for all your encouragement! And a very special thanks to Phil Tucker for all your love and support! 5 Contents LIST OF PAPERS 8 INTRODUCTION 9 BACKGROUND 11 Stress 11 The stress response 11 The secretion of cortisol 13 Methodological issues in the assessment of cortsiol 14 Studies of the HPA-axis in response to stress 15 Stress and the cardiovascular system 16 Sleep 17 The interaction between stress and sleep 18 Need for recovery, sleepiness and fatigue 18 Work related stress 19 Measuring work related stress 19 Work related stress and stress related diseases 21 Work related stress in relation to sleep, fatigue and performance 21 Work time control as moderator of work stress 22 Summary 22 Overtime work and long work hours 23 Long hours in shiftwork 24 Overtime work and long hours in relation to stress and stress related diseases 24 Overtime work and long hours in relation to sleep, fatigue and performance 26 Overtime work and the home-work balance 27 Methodological problems in the study of overtime work 28 Summary 29 GENERAL AIM OF THE THESIS 30 Study I 30 Study II 30 Study III 30 METHOD 31 Design of the studies 31 Participants and settings 31 Procedure 32 Measurements 33 Sleep diary 33 Wake diary 33 Questionnaire 34 Actigraphy 34 Cortisol in saliva 34 Ambulatory heart rate and blood pressure 35 Statistics 35 6 RESULTS – SUMMARY OF STUDIES 36 Study I - Different levels of work-related stress and the effects on sleep, fatigue and cortisol 36 Study II- Overtime work and its effect on sleep, sleepiness, cortisol and blood pressure 38 Study III - Individual differences in the diurnal cortisol response to stress 41 DISCUSSION 43 Work stress 44 Work stress and physiological and psychological stress symptoms 44 Work stress and sleep 45 Work stress and sleepiness 46 Work stress and the balance of rest and activity 47 Overtime work 47 Overtime work and sleep 47 Overtime work and sleepiness 48 Overtime work and physiological and psychological stress symptoms 48 Overtime work and the balance of rest and activity 49 Individual differences in the cortisol response to work stress 50 Cortisol and fatigue/exhaustion 50 Sleepiness, sleep and cortisol secretion in relation to work stress and overtime work 51 Comparisons of work stress versus overtime work 51 Individual differences in physiological markers of stress 54 The work-home balance during work stress and overtime work 54 Work time control and stress and overtime work 54 LIMITS AND WEAKNESSES 56 Study I 57 Study II 57 Study III 58 IMPLICATIONS 59 CONCLUSIONS 60 REFERENCES 61 7 List of papers The present thesis is based on the following three studies: I Dahlgren, A., Kecklund, G., & Akerstedt, T. (2005). Different levels of work-related stress and the effects on sleep, fatigue and cortisol. Scandinavian Journal of Work, Environment and Health, 31(4), 277-285. II Dahlgren, A., Kecklund, G., & Akerstedt, T. (2006). Overtime work and its effects on sleep, sleepiness, cortisol and blood pressure in an experimental field study. Scandinavian Journal of Work, Environment and Health, 32(4), 318-327 III Dahlgren, A., Åkerstedt, T., & Kecklund, G. (2004). Individual differences in the diurnal cortisol response to stress. Chronobiology International, 21, 913-922. This work has been supported by: The National Institute for Psychosocial Medicine, IPM. Swedish Council for Working Life and Social Research, FAS. 8 Introduction The present thesis is focused on work related stress and long work hours. In 2005 24.4% of the Swedish workforce was experiencing work-related disorders (SCB, 2005). Stress and mental strain were the most common causes of work-related disorders among women and the third most common among men, with 13 per cent of the women having stress related disorders and 7.4 per cent of the men. Stress in working life can be associated with several factors related to work characteristics. This has been the topic of a large body of research and from this several models of work-related stress and health have emerged. What most models have in common is a focus on the balance between work demands and the individual’s ability to “cope”, for example between the demands/effort and the level of job control and rewards (Karasek & Theorell, 1990; Karasek, 1979; Siegrist, 1996; Siegrist & Peter, 2000). Based on these models, studies have shown a relation between work-related stress and cardiovascular diseases (Alfredsson & Theorell, 1983; Hammar et al., 1994; Siegrist, 2000; Theorell et al., 1998) as well as with burnout (Bakker et al., 2000), and musculoskeletal symptoms (Bongers et al., 1993; Toomingas et al., 1997). The prevalence of stress-related disorders has increased considerably since the middle of the nineties (SCB, 2005). At the same time there have also been several changes within working life. Some of these workplace developments could be related to the increase in stress related disorders such as the increased use of information technology, the globalization of the economy, more dual earner couples, changing boundaries between work and home, flexibilization and the creation of the 24-hour economy (Kompier, 2005).
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