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Shift-Work Sleep Disorder

Shift-Work Sleep Disorder. Approximately 25% of the American work force works on a rotating or night shift schedule. Shift work sleep disorder is characterized by excessive sleepiness when you wish to be awake (often during the night shift) and difficultly sleeping when you wish to be in bed.

Approximately 25% of employed men and 17% of employed women in the United States currently work either on the night shift or on a rotating shift schedule. Shift workers perform critical functions in hospitals, on police forces, as emergency personnel, and in the transportation and manufacturing industries. Shift workers battle the natural sleep-wake rhythm of the body. There is a natural inclination to sleep between the hours of midnight and 6:00 AM, just when they need to be most alert to maximize their productivity. Shift work is generally defined as night work or any time other than the usual “nine-to-five” business day. However, it also includes shifts that call for rotating or periodically changing hours, split shifts when an employee works all or part of two consecutive shifts, and extended shifts when working longer than the typical eight-hour day.

Shift-work sleep disorder is characterized by excessive sleepiness when you wish to be awake (often during the night shift) and difficultly sleeping or insomnia when you wish to be in bed. The insomnia may occur either when trying to sleep during the day after a night shift, or when trying to shift back to a regular schedule of sleeping at night. Indeed, problems can also be exacerbated when trying to shift back to a normal schedule on days off from work when trying to be on the same schedule as the rest of the family. The constant rotation of schedules prevents the brain’s internal clock from synchronizing with the external environment leading to excessive sleepiness or insomnia.

Effects of Shift Work
Of those who work the night shift, 40-80% have sleep complaints, and 5-20% report moderate to severe sleep problems. Excessive sleepiness while working on the night shift not only leads to decreased productivity, but can have disastrous consequences as has been well documented from several famous man-made disasters caused by fatal errors that have occurred while working on the night shift. The Chernobyl (1986) and 3-Mile Island (1979) nuclear disasters, as well as the Exxon Valdez oil tanker grounding (1989), all occurred between the hours of 12:00 and 4:00 AM and were found to be caused errors made secondary to excessive sleepiness while working on the night shift. Although the space shuttle Challenger explosion (1986) occurred at 11:38 AM, the erroneous decision to launch the shuttle was made by the team working during the night shift.

Sleep deprivation can lead people to think and move more slowly, make more mistakes, and become more forgetful. Lack of sufficient sleep can cause irritability, impatience, anxiety, depression and lowered productivity. Sleep deprivation costs U.S. businesses $150 billion a year in accidents and decreased productivity. Shift workers are also more likely to experience stomach problems, menstrual irregularities, illness, weight gain, heart problems, high blood pressure, and a higher risk for diabetes than day workers.

Tips and treatment for night shift workers
There are several tips and interventions that may be very helpful for patients who work the night shift. As much as possible, you should try to maintain a strict sleep-wake schedule. Keeping the same schedule, even on days off from work, is the ideal way to synchronize your brain’s internal clock with the desired external schedule. Although it is sometimes not possible to maintain the same schedule on days off, you should avoid frequently rotating shifts. The more the schedule shifts, the more difficult your brain’s internal circadian clock will have in adapting to the schedule, and the more insomnia or excessive sleepiness you will experience.

While working the night shift, it is important to minimize or avoid caffeine-containing products, especially during second half of the shift before going home, since any stimulant consumption will prevent you from being able to initiate or maintain sleep once going to bed at the end of the shift. Although keeping the work environment well lit with bright light can help maintain alertness while working at night, you should also avoid bright light exposure prior to going to bed since it will decrease your ability to sleep. If there is daylight at the end of the shift and you plan on sleeping once you get home, it is recommended to wear sunglasses during the drive home. It is also very important to keep the bedroom dark and quiet by using heavy curtains to keep out sunlight and turning off or unplugging the telephone so that sleep will not be disrupted.

Bedtime Tips

  • Darken the bedroom and adjust the bedroom temperature to simulate nighttime.
  • Unplug the telephone and eliminate other potential distractions as much as possible
  • Avoid caffeine for at least five hours before bedtime
  • Avoid exercising within at least three hours of bedtime

Driving Tips

  • Do not drive a motor vehicle if excessively sleepy
  • Nap before driving home, if possible, if you are excessively sleepy
  • Car pool, if possible, and have the most alert person do the driving
  • Consider taking public transportation if available
  • Wear sunglasses at the end of the shift when driving home if there is sunlight and you wish to sleep when getting home.

Tips for Work

  • Take short breaks throughout your shift to break up monotony
  • Exercise during breaks if possible
  • Try to work with a partner since conversation can keep you more alert
  • Don’t leave the most boring tasks for the end of your shift since this is when you feel most drowsy


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