J. Sleep Res. (1995) 4, Suppl.

2, 41-46

Speed and direction of shift rotation

PETER KNAUTH
IP, Abteilung Arbeitswissenschaft, Universität Karlsruhe, D-76187 Karlsruhe, Germany

SUMMARY This review paper deals with the issue of shift rotation, i.e. the number of
consecutive shifts of the same type and the order of change between shifts. To
minimize the disturbances of the circadian system and the accumulation of sleep
deficits, rapidly and clockwise-rotating shift systems would seem to be preferable.
Regarding consecutive night shifts, a week of night shifts seems to be the worst
system with regard to performance and accidents. There is a lack of reliable data on
the effects of permanent vs. rotating-shift systems on alertness, performance and
accidents. This is also true for the comparison of forward (delaying) and backward
(advancing) rotating-shift systems, although the former would seem to be associated
with fewer problems. For both systems, controlled longitudinal studies are
necessary.
KEYWORDS accidents, direction of rotation, performance, permanent nightwork,
rotating shift system, shift system.

INTRODUCTION CHANGE ACROSS CONSECUTIVE NIGHT

The issue of shift rotation concerns the number of
consecutive shifts of the same type and the order of change
between the shifts. Two major causes of nightwork
sleepiness are circadian rhythmicity and sleep loss. Based on
the available evidence, it seems that the circadian
physiological rhythms of shiftworkers never adjust comp-
etely to the night shift (e.g. Knauth et al. 1981; Dahlgren
1981: Knauth and Rutenfranz 1982; Äkerstedt 1985;
Hildebrandt et al. 1987; Czeisler 1990; Eastman 1990). This
is essentially the basic problem of shiftwork and an
argument against slow rotation or permanent nightwork.
Thus, there is no point in working a large number of night
shifts successively, since no adjustment would occur and
sleepiness may accumulate. Furthermore, because the
circadian free-run period exceeds 24 h, a phase-delay will
always be easier for the organism than a phase-advance
(Wever 1979; Czeisler et al. 1982). Therefore, clockwise
rotation (i.e. morning-afternoon-night) would theoretically
be preferable. In the following will be discussed the support
for these notions, organized according to: change across
shifts, permanent nightwork, direction of rotation, and
other possible influences.
Correspondence: Professor Dr Peter Knauth, IIP, Abteilung
Arbeitswissenschaft, Universität Karlsruhe, Hertzstrasse 17,
D-76187 Karlsruhe, Germany. Fax: +49 721 758909.
SHIFTS
The first issue regards the change across shifts. Very little
accident data are available, but at least three studies have
found (Fig. 1) that accidents increase across 4-5 consecutive
night shifts (L. Smith personal communication; Quaas and
Tunsch 1972; Vinogradova et al. 1975). This may be due to
inadequate circadian adjustment and an accumulation of
sleep deficits. However, in one study of seven shifts, with a
peak of accidents on Sunday (day 4), social factors seemed
to play a predominant role (Monk and Wagner 1989). The
authors suggested that post-shift sleep on Sunday morning
was shortened because of church-related social activities.
With regard to real life performance Vidacek et al. (1986)
found an increase in productivity from the first to the third
night shift (Fig. 1). This was interpreted as the effect of an
improving circadian adjustment, whereas a decrease of
productivity toward the fifth night-shift period might be due
to an accumulation of sleep deficits. The second argument
could also explain an increase in human errors in the control
room of a nuclear power plant in up to the sixth night shift
(Dorel 1991). However, a low error rate during the seventh
night shift could not be explained. In a third study the
variation of production quality from the first to the fifth
night shift (Meers 1975) showed an increase in the fifth night
shift. This was attributed to the (partial) adaptation of body
temperature.

© 1995 European Sleep Research Society 41

fi
42P. Knauth
500 A 1000
450
400
950-
350 900 -
850
1st 2nd 3rd 4th Night shift Productivity

Mon Tue Wed Thu Day of week

1st and 3rd 4th 5th Night shift
100 B Mon Tue Wed The Fri Day of week

75
50 Ar
1st 2nd 3rd 4th 5th Night shift 3-
80 C 2-
human errors

§8
O 1st 2nd 3rd Ath 5th 6th7th Night shift
20
Number of accidents Number of important

Fri SatSun Mon Tue Wed Thy Day of week

0 ist 2nd 3rd Ath Night shift
# difference signi cant

100 г D 17.2 fIl.

80 17.0
§ 16.8
60
16.6
40
16.4
20
§ 16.25
oduction

1st 2nd 3rd 4th 5th 6th 7th Night shift 1st 2nd 3rd 4th 5th Night shift
The Fri Sat Sun Mon Tue Wed Day of week MonTue Wed Thu.Fri Day of week
Figure I. Left: Frequency of accidents during consecutive night shifts. A = Smith 1994; B = Vinogradova et al. 1975; C = Quaas and Tunsch
1972; D = Monk and Wagner 1989.
Right: Performance in real tasks during consecutive night shifts, I = Vidacek et al. 1986; II = Dorel 1991; III = Meers 1975.

In several studies (Äkerstedt et al. 1977; Bohle and Tilley
1993; Dahlgren 1981; Folkard et al. 1978; Fröberg et al.
1972; Minors and Waterhouse 1985; Platzer 1987) alertness
has shown no or only a marginal adjustment over
consecutive night shifts, whereas 'night-shift paralysis'
increased over several night shifts in a row (Folkard et al.
1984; Folkard and Condon 1987). Negative effects of a week
of night shifts have also been detected in simple but not in
choice reaction time (M. Wallace personal communication;
Dahlgren 1981; Tilley et al. 1982; Wilkinson et al. 1989).
One may also assume that a large number of working days
preceding night shifts may lead to an accumulation of
fatigue. However, the author is not aware of any studies
supporting this assumption.
It is also plausible to assume that performance will
deteriorate over consecutive 12-h night shifts because of an
accumulation of fatigue. Rosa (1991a, b) used laboratory-
type measures of performance and alertness. Seven months
after having changed from an 8-h to a 12-h shift system, test
performance and alertness were generally lower after 12-h
than after 8-h shifts. The lowest scores were evident at the
end of the 12-h night shifts. A 35-year follow-up of the 12-h
studies revealed persistent decreases in performance and
alertness. However, there is a lack of observed decreases in
performance or alertness across the work week (Rosa, this
issue pp. 51-56). Finally, Campell (1980) asked plant
managers in the US and Canada to compare experience with
12-h and 8-h schedules. Out of 70 replies, five locations
indicated an increase in industrial accidents, eight locations
a decrease, and 57 locations experienced no change.
Altogether, in most studies a week of night shifts has
more detrimental than positive effects on performance and
accidents.
PERMANENT NIGHTWORK VS. ROTATING
SHIFTWORK
The main methodological problem when comparing rotating
and permanent shiftworkers, is the fact that the groups are
never completely comparable. Often they differ with regard
to the age structure, marital status, responsibility for

© 1995 European Sleep Research Society, J. Sleep Res., 4 (Suppl. 2), 41-46.

children at home, degree of self-selection, freedom to
choose the working time arrangement or type of task.
Therefore, all published results have to be interpreted
cautiously.
Wilkinson (1992) reviewed a number of studies
concerning day sleep after night shifts of three groups of
shiftworkers. He calculated average values and found that
the mean day-sleep duration for permanent and prolonged
nightworkers (6.72 h) was longer than that of weekly
(6.31 h) and rapidly-rotating shiftworkers (5.80 h).
However--as Folkard (1992) points out- -this comparison
fails to take account of either the number of successive
shortened day-sleeps or the durations of other sleeps taken
within the shift cycle and if there are many night shifts in a
row, a cumulative sleep debt on the last night shift has to be
expected (Foret and Benoit 1978; Kiesswetter et al. 1985;
Folkard et al. 1990; Tepas and Carvalhais 1990; Escriba et al.
1992). A few diary studies have obtained sleep-duration
estimates for all sleeps in a complete cycle of a shift system
(Verhaegen et al. 1987; Folkard et al. 1990; Totterdell and
Folkard 1990; Tepas and Carvalhais 1990). They found that
the average sleep duration per 24 h over complete shift
cycles was lower for permanent nightworkers than for either
rapidly rotating or slowly rotating shiftworkers.
Taking these results into consideration, it might be
expected that permanent nightworkers complain more about
fatigue. Alfredsson et al. (1991) compared permanent
nightworkers with the rest of the working population and
found a much higher prevalence of fatigue in the
nightworkers. Patkai et al. (1977) studied permanent
nightworkers during the first, third and fifth nightshift. They
observed a steady decline of alertness during each night shift
and no tendency to change from the first to the fifth day. In
another study a rather marginal adjustment was found over
successive night shifts (e.g. Fröberg et al. 1972). However
the change from an old slowly rotating (seven equal shifts)
system to a shift system with a 2-to-3-day rotation improved
rated alertness and general well-being in 3-shiftworkers
(Williamson and Sanderson 1986).
Monk and Embrey (1981) studied process controllers
whose temperature rhythms were unadjusted to their
rapidly-rotating shift system. The "on-the-job' performance
in the memory-loaded task of these shiftworkers was better
at night than during the day. Therefore, the authors
conclude that rapidly-rotating shift systems are the most
preferable for jobs that involve a high memory load'.
However, this conclusion is not supported by Johnson et al.
(1992). Their findings seem to suggest that tasks demanding
short-term memory are best performed during normal
waking hours. For perceptual-motor tasks involving little
storage load, Folkard and Monk (1979) recommend the use
of permanent shift systems that may maximize adjustment.
Wyatt and Marriott (1953) studied the production of
railway-wagon wheels and motor vehicles as well as
machining operations. Although there was a slight increase
from the first to the second night shift week and
© 1995 European Sleep Research Society, J. Sleep Res., 4 (Suppl. 2), 41-46.
Speed and direction of shift rotation 43
from the second to the fourth night-shift week, they found a
decrease in the relative hourly output in the first day-shift
week after a fortnight, or after four weeks on night shift.
Wyatt and Marriott speculate that this decrease in output
might be an after-effect of the long preceding night-shift
periods.
After several studies in munition factories the Health of
Munition Workers Committee (1918) came to the
conclusion that continuous nightwork of women results in a
lower output than the discontinuous (rotating) system and
that also with men the discontinuous system is preferable to
continuous nightwork.
Some authors have found a lower accident rate, a higher
rating of performance and a lower rating of effort in
permanent night workers compared with rotators (Tasto
et al. 1978; Jamal and Jamal 1982; Coffey et al. 1988;, Alward
and Monk 1990; Gold et al. 1992; Totterdell et al. 1994).
In summary, there is a lack of conclusive data on the
effects of permanent-shift systems vs. rotating-shift systems
on alertness, performance and accidents. Well-controlled
studies avoiding the methodological faults mentioned above
are urgently needed (Knauth 1993).
DIRECTION OF ROTATION
Besides the speed of rotation, the direction of rotation might
also influence the fatigue of shiftworkers. Comparable to
long-distance westward flights (with a 'prolongation' of the
day), the forward rotation (i.e. morning-afternoon-night)
seems to correspond better to the endogenous circadian
rhythm, which has a period of more than 24 h (Czeisler et al.
1982). Thus, schedules that delay are assumed to be easier
to handle. However, the author is only aware of two studies
directly comparing the effects of advancing and delaying
systems. In these there appeared to be fewer physical, social
and psychological problems (Landén et al. 1981), and
improved sleep quality (Epstein et al. 1991) with delaying
systems compared to advancing systems.
In two other studies, the direction of rotation and the
speed of rotation were changed simultaneously (Czeisler
et al. 1982; Knauth and Kiesswetter 1987). Although the
effects cannot clearly be attributed to either of these factors,
the combined effects were positive. Barton and Folkard
(1993) analysed the effects of different advancing or delaying
shift systems in a cross-sectional study. They conclude that
delaying systems may be least problematic, and that
advancing systems which include a quick return (i.e. a break
of only 8 h) may be the most problematic.
Although forward rotation seems to be associated with
fewer problems, there are no controlled longitudinal studies
comparing performance or accidents in forward and
backward-rotating shift systems (without changing other
important parameters of the shift system simultaneously).
44 P. Knauth
MODIFYING FACTORS
There are many factors outside scheduling that may affect
the response to rotating shiftwork. Thus, family and social
life may cause a further reduction of sleep. If, for instance, a
woman has to take care of small children, her day sleep after
night shifts will be much shorter than that of colleagues who
do not have children (Estryn-Behar et al. 1978). However, it
is very difficult to find any evidence for the connection
between social factors and performance. As Folkard et al.
(1978) have shown, commitment to nightwork may enhance
short-term adjustment and, as a consequence, improve
alertness during night shifts. Although authors like Monk
and Leng (1986) or Craig et al. (1987) assume that there is a
change of strategy in complex information processing over
the 24 h, there is no hint in the literature that there could
also be additional changes of strategy over consecutive night
shifts.
Several studies have found a deterioration in health after
many years of shiftwork in some shiftworkers
(e.g. Angersbach et al. 1980; Costa et al. 1981; Kundi et al.
1986). This deterioration in health could have a negative
influence on performance. However, adequate longitudinal
studies are lacking. Queinnec et al. (1986) argue that the fact
that a worker can organize his own work might to some
extent influence performance if he adjusts work to his
functional capacity. Meers (1975) found that the time lost
due to machine-defects in wire production, which was 5%
higher on night shifts than on other shifts, could be
explained by the fact that during the night no maintenance
personnel was available.
Furthermore, Meers (1975), as well as Fishwick et al.
(1974), showed that output was not affected by nightwork if
the work was machine-paced. However, the 'human costs°
will be higher in the circadian trough of performance
compared with other periods of the day when it is easier to
accomplish the same performance. This is supported by the
findings of Smith et al. (1994) that accidents resulting in
injury are more frequent in machine-paced workers at night.
Smith et al. state that it would seem probable that the
increased injury rates at night reflected on the individuals
circadian rhythms in performance capabilities and alertness
which had failed to adjust sufficiently to the nightshift'
(seven equal shifts). In contrast, self-paced work injuries in
the same study were more serious in nature.
The fact that some shiftworkers like nightwork, because
of the absence of supervision and the increased respon-
sibility, might improve the performance of motivated
workers and impair the performance of workers who are
not motivated. Queinnec et al. (1984) found some evidence,
that the presence of colleagues might have a positive effect
and that the appearance of an incident might have a
negative effect on performance. To be more precise:
Queinnec et al. (1984) found that the presence of a
colleague contributed to the reduction of the variability of
the work procedure and therefore to a situation closer to the
theoretical conditions of work organisation'. The activity of
the operators in the same study also depended on the
occurrence, or not, of technical disturbances. In highly-
automated situations the operators are rarely called upon.
Therefore, particularly during night-time, he is poorly
prepared to solve the problems caused by an incident. The
'risk of making mistakes is increased especially when the
situation requires urgent decisions to be taken and action
made' (Queinnec et al. 1984).
In summary, there are many possible influences of factors
other than the characteristics of the shift systems, which may
improve or impair alertness and performance. The number
of studies providing relevant data is very small.
CONCLUSION
In spite of the partly contradictory result, performance/
alertness seems to be worst for a week of night shifts
(intermediate speed of rotation) and for clockwise rotation.
This conclusion is very tentative, however, and there is a
clear need for longitudinal intervention studies on
performance in real tasks, comparing the effects of different
shift systems (Wilkinson 1992) while controlling for other
than scheduling influences. Besides performance, other
criteria, such as social factors, have to be taken into
consideration when choosing an adequate shift system. Only
in exceptional cases should performance be the only decisive
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