Shift Work Sleep Disorder

Millions of Americans are considered shift workers which includes doctors, nurses, pilots, firefighters, police officers, and commercial drivers. 

A shift worker is characterized as someone who follows a work schedule outside the typical 9 am to 5 pm day. When compared to individuals who work a normal work day, shift workers get less sleep on a regular basis.

Shift work intolerance, although listed as a circadian rhythm-related sleep disorder, should not be regarded as an internal biological clock issue or a sleep disorder alone. It can actually be a complex of three factors, which include, circadian, sleep, and domestic/social factors.

Circadian rhythm refers to the 24-hour rhythmic output of the body’s internal clock that regulates our biological processes. The circadian rhythm is the body’s internal resting/wakefulness schedule over the course of a day. It is considered a disorder because so many people suffer from excessive sleepiness and sleep disturbance in trying to adapt to a shift work schedule.

In the past few decades, the nation has become increasingly dependent upon shift workers to meet the demand of our 24-hour society. As a result, shift work tends to leave limited time for sleep.

Many individuals in today’s workforce are obliged to work irregular shifts and may be working more than one shift in a day’s time. It is estimated that 20% of the work force engages in some sort of shift work.

Sleep centers have seen an increase in the number of patients with the complaint of inadequate sleep and difficulty coping with shift work.

Some of the most serious and persistent problems shift workers face are frequent sleep disturbances and associated excessive sleepiness. As a result, this can lead to poor concentration, accidents, absenteeism, errors, injury and fatalities.

This is an alarming situation since most shift workers in the United States are involved in dangerous occupations. Such catastrophes as the failure of the Space Shuttle Columbia and the crash of the Exxon Valdez have been attributed to human fatigue, in part.

There are solutions for the person who must work late night or early morning shifts and may be as simple as adjusting the bedroom environment to promote a more restful atmosphere, allowing for a better quality of sleep. This would include proper bedroom lighting and eliminating environmental factors such as noise that can disrupt sleep.

Domestic and social factors include individuals keeping a set sleep schedule throughout the week. Problems arise when a person tries to switch back to a normal day schedule.

Many people who work night shifts try to run errands, and take care of children during the hours that should be used to get an adequate amount of sleep. Working the night shift and using the day time hours to get other things accomplished can make a person feel more productive, but will result in sleep problems. When sleep becomes a low priority a person will not feel their best, and may suffer from a list of symptoms that can become debilitating over time.

Symptoms

The most common ailment that afflicts people with shift work sleep disorders is excessive sleepiness, while other symptoms may include:

  • Insomnia
  • Disrupted sleep schedule
  • Difficulties with personal relationships
  • Irritability or a depressed mood
  • Reduced work performance
  • Sleepiness at work

Diagnosis

Although some people cope well with shift work, others may need to see a sleep medicine specialist. Often there are underlying sleep disorders contributing to the lack of sleep that make it more difficult to work an alternate shift.

The sleep specialist will take a complete sleep history and physical to determine whether or not a sleep study is indicated. The sleep center physician may also want the patient to meet with the behavioral therapist to work on strategies to better improve the quality of sleep and to make adjustments to the patient’s current work schedule.

Treatment

Treatment will be discussed at the time of the consultation and/or after the sleep study if indicated. Treatments may include behavioral or pharmacological remedies that can help alleviate symptoms.

Some people may never fully adapt to shift work, but there are ways of getting adequate sleep while doing shift work that can be beneficial.

For a consultation or testing for your patients with a sleep medicine specialist, or to refer a patient’s medical management, please call the Sleep Medicine Center at 314-362-4342.