Prevalence and Characterization of Sleep Quality and Insomnia in Security Guards Working on the Day and Night Shift in Delhi-NCR

doi:10.21203/rs.3.rs-3001102/v1

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Prevalence and Characterization of Sleep Quality and Insomnia in Security Guards Working on the Day and Night Shift in Delhi-NCR

https://doi.org/10.21203/rs.3.rs-3001102/v1

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Background

In today’s modern world, shift working has become an important part of society and industrial work; prolonged wakefulness is a widespread phenomenon due to which the sleep patterns of individuals are getting disturbed, and many sleep disorders are arising.

Purpose

This study compared the sleep quality and insomnia in the security guards working the day and night shifts.

Methods

The study comprised 100 security guards from Delhi and the NCR region. Self-administered questionnaires, i.e., PSQI and AIS, were used to assess sleep quality and insomnia. Fifty questionnaires were filled out by the day shift security guards, and the night shift security guards filled out 50. Data were analyzed, and a comparison was made using arithmetic mean and standard deviation.

Results

The result showed a significant difference in sleep quality and insomnia in day shift versus night shift working security guards. The average mean value of sleep quality scoring on the day shift was 6.2 ± 2.38; on the night shift, it was 8.62 ± 6.36. The average mean value of the score of insomnia was 4.44 ± 2.22 in day shift security guards and 6.28 ± 3.18 in night shift security guards.

Conclusion

The study concluded that the night shift working security guards had poorer sleep quality, and insomnia was also more prevalent in them than in day shift working security guards.

Sleep disturbance

Insomnia

Workers

Day shift

Night Shift. Security guards

Sleep is a necessary necessity of life. Sleep is a restorative neurological event essential for the human organism's function. (Zanuto E L et al.2013). Sleep durations on workdays decreased from 9 hours in 1910 to 6.9 hours in 2002, according to studies (Rogers A E, 2008). The need for sleep varies considerably between 5–6 hours average sleep length is between 7 and 8.5 hours per day (Aloha P et al.2007). According to recent studies, approximately 30% of people have difficulty initiating and maintaining sleep (Yazdi Z et al. 2014). A person’s sleep quality can be disrupted for many different reasons; in certain jobs, people face sleep restrictions (Aloha P et al. 2007). Sleep deprivation and sleepiness among shift workers are the most serious health problems. (Yazdi Z et al. 2014) Shift work is practiced in industrialized activities worldwide today. (Begani et al., 2013) Although society's sleeping habits have changed, individual bodies have not. Individuals and their bodies are suffering from a modern epidemic of sleep problems. (Snyder S L, 2003). The prevalence of sleep disturbances among the general population and in general practice has been shown in previous studies. (Doi Y et al. 1999) Medical and psychiatric disorders and primary sleep disorders can inhibit the ability to sleep well. It has been suggested that insomnia may be a risk factor for psychiatric disorders, and insomnia is a common symptom of depression. (Hublin C et al.2001). Insomnia occurs when a person has difficulty initiating and maintaining sleep or is excessively sleepy. Sleep disturbance occurs when an individual's quantity, quality, or timing of sleep is disturbed. Sleep deprivation is characterized by difficulty falling asleep, frequent wakings during the night, waking up too early and not being able to fall back asleep, or sleeping enough hours but waking up tired. (Pereiraa C et al. 2014)

Health-related problems and diminished quality of life are associated with poor sleep quality, including interrupted or non-restorative sleep. Physical and mental health outcomes have been linked to sleep problems. A recent meta-analysis shows a strong correlation between sleep problems and myocardial infarction, and coronary heart disease. Sleep deprivation can also affect metabolic and endocrine function, increasing the risk of diabetes and hypertension. Physical health problems such as muscle pain, headaches, and gastrointestinal problems are also more common among individuals reporting sleep problems. Sleep disorders are also associated with mental health problems, such as depression (Knudsen et al., 2007). Biological clocks and displaced work hours are at odds, which causes health problems in shift workers (Åkerstedt T, 2003).

According to the National Sleep Foundation, increasing global competition has led to a society of chronic sleepers (Steven K, 2015). Chronic sleep restrictions are common in the normal population, but some professionals are more affected, e.g., healthcare providers and security guards. Shift workers are prone to sleep disorders but are often underdiagnosed (Aloha P et al. 2007). Health impairments associated with shift work have been reported, but sleep quality and quantity are the most prevalent problems. (Canuto R et al., 2013). Insomnia, poor sleep quality, and daytime sleepiness are common sleep complaints among shift workers, such as security guards. (Yazdi Z et al. 2014).

Recent studies have shown that individuals who work at night and rotate shifts rarely get adequate sleep. According to an early objective study, night shift workers obtained 1 to 4 fewer hours of sleep than usual (Roger A E, 2008). Their ability to perform safely on the job is often affected by this. Even one or two hours of sleep loss can significantly affect alertness and performance (Howard S K, 2015). In the medical and psychological fields, shiftwork is almost universally accepted as unhealthy and dangerous. Legal scholars largely ignore this fact. It is the same for shift workers, including security guards and health care professionals. Shift workers suffer the most from sleep disruption and loss. Longer shifts have more serious consequences (Bird R C, 2006). Sleep-related problems associated with shift work are usually transient phenomena. In most cases, complaints arise from the inability to sleep well after a night shift. The conditions can be accompanied by intense fatigue, drowsiness, sleep deprivation, and a reduced capacity for mental functioning (Bajraktarov S et al. 2011). Security guards aim to ensure the safety and physical integrity of employees, workers, and visitors. There are many different types of workplaces for private security guards, including shopping malls, offices, schools, private homes, and even personal residences (Marluce et al., 2016). Security guards are among the fastest-growing occupations worldwide (Ahmad. A et al. 2012). Security guards must wear uniforms, display authority badges, and carry weapons. Thus, the security guard profession involves physical and psychological stress. Sleep disruption is unavoidable in rotating shift workers’ essential services such as medical, transport, and security services. Sometimes, the body cannot adjust to these external changes each week, and one’s scheduled sleep-wake cycle is constantly disturbed (Develia J et al. 2017). Numerous studies have examined the effects of this alarming problem on employees' physical and psychological health, including employers. In contrast, little is known about specific occupations such as security guards. Many security guards with sleep disorders have excessive daytime sleepiness (Lajoie P et al.2014). Besides sleep deprivation, fatigue and stress are also prevalent in security guards. Lack of sleep is the primary cause of sleepiness and cognitive fatigue. Without adequate sleep, people may experience excessive cognitive fatigue when awake (Miller J C, 2010). Fatigue is a state of exhaustion resulting from excessive physical and mental labor, and excessive fatigue can lead to illness (Lee J J et al. 2014). Sleep deprivation also contributes to stress. Occupational stress occurs when the demands of the job do not match the workers' capabilities, resources, or needs (Kiran U V et al. 2015). The lack of sleep also affects mood: negative emotions, such as anger, hostility, depression, confusion, tension, and sadness, increase, while positive emotions, such as vigor and happiness, decrease (Howard S K, 2005). Sleepiness during the rest of the day is also strongly associated with rising late in the morning (between 04:00 and 05:00 h). One-third of workers take an early afternoon nap because of sleepiness (Åkerstedt T, 2003). The cumulative effect of sleep loss can impair decision-making, initiative, information integration, planning and plan execution, and vigilance by the end of the workweek. Sleep loss is insidious and, until severe, is not usually recognized by the sleep-deprived individual (Roger A E, 2008).

Sound physical and psychological health is needed in professions involving shift work; many disabilities occur due to sleep disorders; generally, It is associated with decreased sleep quality. A lack of sleep can lead to increased accidents, errors, absenteeism at work, decreased productivity, and deterioration of personal and professional relationships. Many health-related problems arise from lack of sleep and poor sleep quality. Sleep disorders remain undiagnosed in this group of professionals. The health of security guards is at risk due to prevailing sleep disorders, so it is important to study and collect data on the number of guards living with poor sleep quality and insomnia.

Therefore, this study aimed to compare the sleep parameters and insomnia in security guards working the day and night shifts. The study hypothesis is that there would be a significant difference in sleep parameters and insomnia in day shift versus night shift security guards. This study will provide the data that enables us to prevent, reduce, and control the decline in work abilities and health-related issues in security guards. This study contributes to the growing literature on sleep parameters in shift workers. There is a possibility that studying security guards will improve their working conditions, as well as their health, which may ultimately affect their quality of life.

Study Design

The study was based on an observational design which was comparative in nature.

Study settings

The study participants (shift-wise working security guards) were approached one-to-one at various Delhi and National Capital Region (NCR) companies. Over one-hundred fifty companies were approached in search of the study participants. The participants completed a self-administered questionnaire to participate in the study to assess their sleep quality and insomnia. The study was completed within three months of exploring the target area, starting from October 2019 till January 2020.

Ethical consideration

The study was carried out in accordance with the Declaration of Helsinki (1975) and has been approved by the ethics sub-committee of King Saud University under file ID: RRC-2019-19. All participants returned the signed informed consent form indicating their consent to participate in the study.

Study participants

One-hundred security guards working in shifts (50-day shift, 50-night shift) were included in this study. A simple random sampling method of selecting companies with security workers was applied to include the participants in this study. The participants were recruited in this study based on study inclusion and exclusion criteria. The male security guards working either day or night shifts (equal to or less than 12 hours daily) showed the ability to understand and respond to the self-administered questionnaire for assessing their sleep quality and insomnia included in this study. The male security guards working either day or night shifts more than 12 hours daily or doing both shifts showed an inability to understand and respond to the self-administered questionnaire for assessing their sleep quality and insomnia, had a neurological deficit, and taking sleep-inducing medicines, were excluded from this study.

Outcome measures

Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) questionnaires assessed sleep quality and insomnia outcomes.

Pittsburgh sleep quality index (PSQI)

An assessment of sleep quality and disturbances over a month is provided by the Pittsburgh Sleep Quality Index (PSQI). 19 items are used to generate seven “component” scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, sleep medication use, and daytime dysfunction. One global score is derived from the sum of the seven components. Psychiatric clinical practice and research can benefit from the PSQI's clinical properties. A maximum score of 21 is valid and reliable. Having a total score of > 5 indicates poor sleep quality. (Theodore A. Omachi et al., 2011)

Athens insomnia scale (AIS)

Insomnia is quantified with the AIS, a self-assessment psychometric instrument. Eight items comprise the questionnaire: The first five deal with sleep induction, awakenings during the night, waking at the end of the night, total sleep duration, and sleep quality, whereas the last three deal with well-being, functioning capacity, and daytime sleepiness. Insomniacs are defined as those with a score of 6 or higher (Constantin et al., 1999).

Procedure

One-hundred security guards were recruited after screening based on the study’s initiation and exclusion criteria. Participants included randomly taken from the security guards’ general population in Delhi NCR. This study was explained to participants in detail, and they were asked to sign an informed consent form before participating. The assessor presented self-administered questionnaires to participants to read, understand, and tick out the option directly related to their sleep quality and insomnia. Once the participants completed the self-administered questionnaires, it was collected back for evaluating the results.

Data analysis

A statistical tool (IBM SPSS version 28, IBM SPSS Inc., Armonk, USA) was used to analyze the study data. Mean scores and standard deviations were obtained for the demographic characteristics and dependent variables (sleep quality and insomnia) to compare between shifts.

With a response rate of 68.49%, one-hundred security guards working day and night shifts were returned with the completed self-administered questionnaires. These descriptive statistics shed light on the quantity and quality of insomnia that people in various working groups suffer. Others who work night shifts typically have higher mean scores for insomnia, poor sleep quality, and greater standard deviations, indicating more substantial variability in their experiences than others who do not. A measure of the mean and standard deviation of the scores of PSQI and AIS obtained by the Day and Night-shifts groups are presented in Table 1 and Fig. 1.

Table 1

Comparison of sleep quality and insomnia score of security guards working day and night shift.
Working Groups	Sleep quality (PSQI scores)		Insomnia (AIS scores)
Working Groups	Mean	SD	Mean	SD
Day shift	6.2	2.28	4.44	2.22
Night shift	8.62	6.36	6.28	3.18
SD: Standard deviations

In addition, the findings demonstrate that security guards working night shifts are likelier to experience insomnia and poor sleep quality than those working day shifts. The comparison of sleep quality and insomnia between the two groups is presented in Table 2 and Fig. 2.

Table 2

Shows the percentage prevalence of insomnia and poor sleep quality among security guards working Day and Night shifts.
Category	Poor sleep quality	Have insomnia
Day shift	58%	32%
Night shift	74%	48%

This study compared the insomnia and sleep quality of security guards working the day and night shifts. Pittsburgh sleep quality index was used to assess sleep quality, and the Athens insomnia scale was used to assess insomnia in both groups.

The quality of sleep differs significantly, and insomnia between day-shift and night-shift working security guards. The average mean sleep quality scoring on the day shift was 6.2 ± 2.38; on the night shift, it was 8.62 ± 6.36. The average mean insomnia score was 4.44 ± 2.22 in day shift security guards and 6.28 ± 3.18 in night shift security guards. By further analyzing, it came to light that 58% of security guards working on the day shift had poor sleep quality; out of them, 32% had insomnia, whereas, on the night shift, it was found that 74% had poor sleep quality, out of them, 48% had insomnia.

In their study, Zohreh et al. 2014 found poor sleep quality; as a result, poor work performance and accidents occur, according to Ann. E. et al., 2004 found that hospital staff nurses generally worked more than forty hours per week when working in shifts. Over half of the shifts worked exceeded ten and a half hours despite 31% of scheduled shifts being longer than or equal to 12.5 hours. Another study by Gau S S F et al. 2006 concluded that sleep problems might cause daytime sleepiness and behavioral problems, perhaps through sleep disruption and deprivation, resulting in hyperactive and inattentive behavior. One night of sleep deprivation diminishes human brain activity, altering attention and higher-order cognitive processes. Knudsen et al. 2007, Researchers found that workers who experienced work accidents in the past year were likelier to suffer from insomnia disorder and poor sleep quality. Jane. F Gaultney’s 2010 study showed that adequate, uninterrupted sleep might optimize learning and cognitive functioning. A study by Lee et al. in 2014 showed that in this modern society, where professional carriers and shift work are increasing, rotational shift work harms health, disruption of family life, and sleep disorders are also increasing due to this practice. Harma M et al. in 1998 showed in their result that slowly rotating shift schedules hinder sleepiness and sleepiness-related benefits of leisure-time physical activity. According to Christer Hublin et al., insufficient sleep also negatively impacts life quality and health at both the individual and community levels. As a result of the increased burden, there may be an increased risk of psychiatric and other disorders and a greater risk of accidents during the daytime. The effects of shift work on work absenteeism and social aspects of quality of life were found to be exacerbated by insomnia symptoms and excessive sleepiness, according to Christopher et al. 2004. Additionally, this differential increase in morbidity in shift workers is related to insomnia in the case of social consequences and the combined effects of insomnia and excessive sleepiness in the case of missed work.

Sleep quality and insomnia significantly differed in this study between day and night-shift working security guards. According to the minimum wages act, 1948 maximum working hours are 10-10.5 hours per day, but most security guards in this study worked for 12 continuous hours. The main reason for insomnia and poor sleep quality in security guards is the non-standard working hours. (Ann E et al. 2004). One reason for this result is that they might have improperly filled out the questionnaires because they were busy with work. There could be difficulty in understanding the questionnaires, and another reason can be their biased behavior towards the questions as they were on duty when they were filling out the questionnaires. If the study’s sample size was larger, we might get more differences between the two shifts. Apart from poor sleep quality and insomnia, snoring- a sign of sleep apnoea, was also present in a few of them. It was also found that there was insufficient sleep duration because their mental and physical functioning got hampered. (June J P et al. 1996). Most of them feel sleepy during their work, and apart from it due to prolonged standing, they also start having muscular problems like pain in their legs. (MR. Chester et al.2002).

Sleep quality may be affected by shift work. Circadian rhythms are disrupted by shift work, causing adverse health effects. Shift workers need effective interventions to prevent sleep loss. By this, the security of the public or institute is also at risk. The need of the hour is to improve the condition of the shift workers by, first of all, making them aware of the prevailing health issues due to insufficient sleep and then telling them about the countermeasures to combat it.

The study was limited to a relatively small sample. The comparison was not carried out between both genders. This study did not differentiate shift workers as permanent, temporary, or roaster-wise shift workers for day or night. Therefore, a future study must address these limitations by adding an effective sample number and comparing sleep quality and insomnia with other sleep conditions between genders, including different age groups/professionals working in permanent, temporary, and roaster-wise shifts.

From the study, it can be concluded that night-shift working guards have significantly worse sleep quality than day-shift guards. Night-shift security guards are likelier to suffer from insomnia and poor sleep quality.

Ethical approval and consent to participate

Consent for publication

Not applicable

Availability of data and materials

All data generated or analyzed during this study are presented in the manuscript. Please contact the corresponding author for access to the data presented in this study.

Competing interests

The authors declare that they have no competing interests.

Funding

Researchers Supporting Project number (RSP2023R382), King Saud University, Riyadh, Saudi Arabia.

Authors contributions

M.S, F.J.S, T.A, M.K.R, and A.R.K contributed to the study’s conception, design, and methodology; M.S did data curation; A.I, F.A, R.A.B, and M.A.S contributed in data analysis and interpretation; A.H.A, M.A.S, A.I, F.J.S, M.S, and R.A.B contributed to manuscript initial drafting and preparing; A.H.A, M.A.S, A.I, F.J.S, M.K.R, M.S, T.A, A.R.K, and R.A.B reviewed and edited the manuscript final draft. All authors read, understood, and approved the manuscript’s final version to be submitted/published.

Acknowledgment

The authors are grateful to the Researchers Supporting Project number (RSP2023R382), King Saud University, Riyadh, Saudi Arabia for funding this research.

Authors’ information (optional)

Not Applicable

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No competing interests reported.

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Prevalence and Characterization of Sleep Quality and Insomnia in Security Guards Working on the Day and Night Shift in Delhi-NCR

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Version 1

Abstract

Background

Purpose

Methods

Results

Conclusion

Figures

Introduction

Methods and materials

Study Design

Study settings

Ethical consideration

Study participants

Outcome measures

Pittsburgh sleep quality index (PSQI)

Athens insomnia scale (AIS)

Procedure

Data analysis

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

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