Fact 1: Shift work disorder is caused by an irregular work schedule.
People who work outside of normal daytime hours, including evening shifts, night shifts, extended hours or overtime, and those who work rotating shifts or swing shifts are at increased risk for shift work disorder and other sleeping disorders.
Fact 2: Shift work disorder is common in industrialized areas.
In the United States, almost 15 million individuals work evenings, nights, or on a rotating schedule. Many people can adjust to working abnormal hours, but in some, especially those who work a rotating schedule, shift work sleep disorder can occur.
Fact 3: Certain medical conditions can worsen the effects of shift work.
Sleep apnea, abnormal hormone levels and psychological disorders like depression can increase symptoms of shift work disorder. Lifestyle choices and the responsibilities of family life also can contribute to symptoms.
Fact 4: Shift work disorder can cause a number of symptoms.
Symptoms of shift work disorder include excessive sleepiness, difficulty falling or staying asleep, problems concentrating, irritability, headaches, and an increased risk for making mistakes and having accidents.
Fact 5: Untreated shift work sleep disorder can lead to complications.
Chronic shift work disorder can cause high blood pressure, heart disease and digestive problems. People with the disorder often have difficulty functioning, which can lead to relationship problems, decreased productivity and job loss, and psychological disorders like depression.
Fact 6: Some jobs have a higher risk for shift work disorder.
Certain occupations are affected by shift work more often than others. People who work in health care, the military, the postal service, public safety, security, service industries, manufacturing, shipping and receiving, transportation, utilities and other areas frequently work off-shifts.
Fact 7: Treatment is available for shift work sleep disorder.
Shift workers should practice good sleep hygiene and make sure to get enough sleep on days off. Stress reduction techniques may be helpful. Treatment also may include medications to help readjust sleep-wake cycles, reduce excessive sleepiness, and improve sleep.
Shift Work Sleep Disorder Signs and Symptoms
Circadian rhythm, which occurs on a 24-hour schedule and is largely influenced by daylight, affects energy levels and alertness. A person’s sleep-wake cycle or internal clock helps to determine when he or she is awake and alert, has the most energy, feels tired, sleeps, experiences hunger, etc. When an irregular work schedule disrupts the natural sleep-wake cycle or internal clock, symptoms related to shift work sleep disorder (SWSD) often can result.
The primary symptom of shift work sleep disorder and other circadian rhythm disorders is excessive sleepiness (ES). People who are more tired and less alert than normal are at increased risk for stress-related medical conditions and for accidental injuries. Other symptoms of shift work sleep disorder include irritability, decreased appetite, difficulty concentrating, and memory loss.
Shift Work Doctor Discussion Planner
Questions To Ask Your Doctor about Shift Work Sleep Disorder (SWSD0
- How will you determine if I have shift work sleep disorder? Do you recommend that I keep a sleep diary and/or undergo sleep studies to evaluate my quality of sleep?
- Do you have any tips to help reduce excessive sleepiness associated with shift work?
- What kinds of changes to my home environment and lifestyle might be beneficial?
- In addition to lifestyle changes, might I benefit from stress reduction techniques, such as massage therapy, meditation, or yoga?
- What is light therapy? Might this treatment be helpful?
- Might I benefit from taking medications to reduce the effects of shift work sleep disorder? If so, what types of medication might you prescribe?
- Are there any potential side effects associated with these medications?
- How will you monitor my condition to determine if I have developed health problems that are related to SWSD, such as heart disease and high blood pressure?
- If a chronic lack of sleep is affecting my overall health, what kinds of treatment might be necessary?
- Do you recommend that I see a sleep specialist?
Shift Work Sleep Disorder Diagnosis
People who work irregular or rotating shifts and experience symptoms of shift work sleep disorder (SWSD) should contact a physician or sleep specialist. A diagnosis of shift work disorder often includes taking a medical and sleep history, evaluating sleep hygiene, and performing a physical examination and sleep studies.
Sleep studies are painless, noninvasive tests that are used to measure how much and how well a person sleeps. Some of these tests are performed in a sleep center, sleep clinic, or sleep laboratory (sleep lab). Types of sleep studies include polysomnography, multiple sleep latency tests (MSLT), maintenance and wakefulness tests (MWT), and actigraphy.
Shift Work Tips & Guidelines
Some broad tips for reducing the consequences of shift work include:
- Reduce the amount of consecutive night shifts worked. Shift workers who work the night shift sleep less than day employees and get increasingly sleep deprived over the course of many days. If one can limit the number of third shifts to five or less, with days off in between, recovery from sleep deprivation is more likely. If working a 12-hour shift instead of the usual 8 hours, it is recommended that one limit work to four shifts in a row. Furthermore, one should optimally have more than 48 hours off after a string of night shifts.
- Avoid extended work hours; this includes working prolonged shifts and excessive overtime, and taking short breaks.
- Avoid long commutes; they use up valuable time that could be spent sleeping.
- Avoid, rotating shifts more than once a week. It is more difficult to deal with such alteration than it is to work the same shift for a longer period of time. The order of shift rotation is also significant. Working the first shift, then the second shift, and then the third shift is easier than working the first, the third, and then the second shifts.
- Get sufficient sleep on days off. Maintain proper sleep hygiene by creating a sleep regimen and avoiding coffee, alcohol, and nicotine.
- Avoid reliance on stimulants, both over-the-counter and otherwise. At best, caffeine, uppers, and up-all-night agents only temporarily fool the body into thinking its functioning properly, which further complicates sleep disorder.
Treatment for Shift Work Disorder
In addition to the guidelines, the practice of proper sleep hygiene, and the adherence to an optimal shift-work schedule, some patients of SWC find medication to be helpful. Antidepressants, which are used in the treatment of various sleep disorders, are known to positively affect and sometimes readjust circadian rhythm.
Patients who experience the effects of SWC often find that the use of benzodiazepines results in predictable, easier sleep. Treatment for patients with SWC who suffer from insomnia or excessive daytime sleepiness can involve varying the levels of drug dosage, entrainment, and stress-reduction therapy.
Although substance abuse worsens the effects of sleep disorders, some experimental approaches to the treatment of sleep-phase syndromes involve the use of caffeine to regulate wake times and eating schedules. Perhaps entrainment is possible through the use of artificial cues, which assume the role played by conventional indicators, like light and dark.
Industry Response to Shift Work Change
Many people work shifts because of socioeconomic considerations and, for them, stopping shift work is not a realistic option. As a result, industry is currently consulting with companies who specialize in industrial operations management. Companies that operate 24 hours a day are establishing policies to standardize the frequency, duration, and type of shift work.
These measures usually involve personal diagnostic surveys and employee interviews that are aimed at understanding employee needs and concerns. Many shift-work employees are finding that their complaints are being heard.
Shift Work Disorder Treatment Options
When lifestyle changes, such as good sleep hygiene, do not effectively reduce the effects of shift work change and irregular work hours cannot be avoided, treatment for shift work sleep disorder (SWSD) may be necessary. Treatment options include bright light therapy, also called chronotherapy, and medications.
In light therapy, shift workers are exposed to artificial lighting, for example, to simulate daytime during the night. Bright light therapy can help people with shift work disorder and other circadian rhythm disorders adjust their sleep-wake cycle and get better sleep.
This treatment involves exposure to bright lighting at regular times of the day, for a certain length of time. Light boxes, special lamps, and devices that can be regulated to gradually dim or brighten lights in a sleeping area (e.g., to simulate sunrise or sunset) can be used in light therapy.
Shift work sleep disorder treatment also may involve medications. Types of medications that may be used include the following:
- Benzodiazepines (e.g., temazepam [Restoril])
- Benzodiazepine agonists (e.g., zolpidem [Ambien], [Ambien CR], [Sonata], eszopidone [Lunesta])
- Stimulants (e.g., modafinil [Provigil], armodafinil [Nuvigil])
These medications should be used only as directed. Side effects include headache, nausea, dizziness, and nervousness. Serious side effects, such as psychiatric symptoms (e.g., hallucinations, suicidal thoughts) and severe skin rash (e.g., Stevens-Johnson syndrome), also may occur with some medications used to treat shift work sleep disorder.
Temazepam, zolpidem, and eszopidone, which also may be used to treat other sleep disorders, such as insomnia, are taken before bed to induce sleep.
Modafinil and armodafinil are used to reduce excessive sleepiness (ES) and promote wakefulness in people with shift work sleep disorder. These medications are taken once per day, usually about 1 hour prior to the start of the person’s shift.
Shift Work Lifestyle Adjustments
Shift work sleep disorder (SWSD) can be avoided by working conventional daytime hours. However, many people must work irregular shifts and long hours because of occupational requirements and/or socioeconomic considerations. For example, services provided by health care professionals (e.g., doctors, nurses, paramedics), military personnel, public safety workers (e.g., police officers, fire fighters, security guards), utility workers (e.g., linemen), transportation workers (e.g., airline personnel, bus drivers, taxi drivers), and other occupations (e.g., gas station attendants, waiters/waitresses) often are needed 24 hours per day, 7 days per week.
Also, many companies in the manufacturing industry must operate continuously to be profitable. In some cases, companies pay employees a higher wage to work irregular shifts, which can be very attractive for workers. These companies often conduct surveys and interviews to address the needs and concerns of shift workers.
When shift work is unavoidable, lifestyle changes, such as practicing good sleep hygiene (healthy sleep habits) and taking steps to reduce stress, can help diminish the effects of working irregular hours. Good sleep hygiene involves following a regular sleep schedule; exercising daily (speak with your doctor before beginning an exercise program); eating a healthy diet (may include sleep-inducing foods); and avoiding caffeine, smoking, and alcohol. Stress reduction therapies include meditation, yoga, massage, and biofeedback.
Shift workers should be sure to take short breaks frequently and avoid rotating schedules and long commutes if possible. If you work irregular hours and develop symptoms of shift work sleep disorder, contact your physician or a sleep specialist for diagnosis and treatment.