The effects of shift work and other related factors on insomnia symptoms among registered nurses in Thailand

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Terdsak Namjaroen
Krisada Sawaengdee
Supannee Promthet
Wilaiphorn Thinkhamrop
Cameron Hurst


Insomnia is the most common sleep disorder and can substantially impact quality of life. The nursing profession often involves working in shifts which may lead to increased risk of insomnia symptoms. Understanding the factors associated with insomnia in nurses is important for improving the sleep health and quality of working life of registered nurses in Thailand. The baseline data of the Thai Nurse Cohort Study which included the responses of 18,189 registered nurses collected in 2009 was employed. The authors considered the three insomnia symptoms: Difficulty Initiating Sleep, Difficulty Maintaining Sleep, and Early Morning Awakening. Workplace burden variables and other potentially important factors were also collected. Multiple logistic regression using mixed effect models was applied for the data analysis.

The response rate of this sudy was 58.6%. Most participants were females (96.7%) with mean age of 43.4 years (s.d.= 9.7) and worked predominantly in the day shift (71.3%). Almost one-quarter (24.6%; 95% CI = 23.3 - 25.9) reported experiencing at least one insomnia symptoms. The prevalence of difficulty initiating sleep, difficulty maintaining sleep and early morning awakening were 5.2% (95% CI = 3.7 - 6.7), 8.0% (95% CI = 6.5 - 9.4) and 6.5% (95% CI = 5.0 - 8.0), respectively. Evening and Night shift were associated with a higher risk of both difficulty initiating sleep (Adj. ORevening = 2.11, 95% CI = 1.45 - 3.07; Adj. ORnight = 1.72, 95% CI = 1.01 - 2.94, respectively) and early morning awakening (Adj. ORevening = 1.46, 95% CI = 1.01 - 2.11and Adj. ORnight = 0.41, 95% CI = 0.18 - 0.95, respectively). No workplace burden factors were associated with difficulty maintaining sleep. Perceived mental health and perceived pain were highly associated with all three insomnia symptoms.

The authors demonstrate shift work substantially impacts insomnia symptoms among Thai nurses. Policy-making for nursing personnel recruitment and retention should include the optimization of shift work
schedule allocation to promote good sleep health.


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Article Details

Original Articles
Author Biographies

Terdsak Namjaroen, Boromrajonani College of Nursing Songkhla, Songkhla, Thailand

Faculty of Public Health, Khon Kaen University, Thailand

Supannee Promthet, Faculty of Public Health, KhonKaen University, Khon Kaen, Thailand

Department of Epidemiology and Biostatistics, Faculty of Public Health, KhonKaen University, KhonKaen

Wilaiphorn Thinkhamrop, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand

Dr.P.H.., Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University, Thailand

Cameron Hurst, Statistics Unit, QIMR Berghofer Medical Research Institute, Queensland, Australia.

Statistics Unit,QIMR Berghofer Medical ResearchInstitute,300 Herston Rd, Brisbane City, Queensland, 4006, Australia Tel.:38453579


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