Disorders & Treatments

Shift Work Disorders

shift workA shift worker is anyone who follows a work schedule that is outside of the typical
"9 to 5" business day. In the past few decades the United States has become
increasingly dependent upon shift workers to meet the demands of globalization
and our 24-hour society. This affects a person’s natural circadian rhythm. 

What are the signs and symptoms of Shift Work?

The main complaint for people with shift work sleep disorder or any circadian rhythm disorder is excessive sleepiness. Other symptoms include:

  • Insomnia
  • Disrupted sleep schedules
  • Reduced performance
  • Difficulties with personal relationships
  • Irritability/depressed mood

 

Who does Shift Work affect?

Shift work problems can affect millions of Americans who work outside of the normal “9-5” work schedule. It can affect any person or any age. According to the Bureau of Labor Statistics, millions of Americans are considered shift workers, including doctors and nurses, pilots, bridge-builders, police officers, customer service representatives and commercial drivers.

What are the treatments of Shift Work?

Unfortunately, treatment for shift work sleep disorder is limited. Both behavioral and pharmacological remedies can help alleviate symptoms. Some research indicates that the body may never fully adapt to shift work, especially for those who switch to a normal weekend sleep schedule. But there are ways of getting adequate sleep while doing shift work.

If you are a shift worker and have difficulty sleeping during the day, chances are you also have difficulty staying awake at work. Also, the more sleepy/fatigued you are, the more likely you are to experience a "microsleep," an involuntary bout of sleep brought on by sleep deprivation that lasts for a few seconds.

For some shift workers, napping is essential. It can be extremely effective at eliminating fatigue-related accidents and injuries and reducing workers compensation costs. Although most employers do not allow napping in the workplace, a ban on napping may soon prove to be a legal liability. Thus, efforts to make workplace policies nap-friendly may soon gain popularity as the issue increases in global significance.

Here are some tips for sleeping during the day:
  • Wear dark glasses to block out the sunlight on your way home.
  • Keep to the same bedtime and wake time schedule, even on weekends.
  • Eliminate noise and light from your sleep environment (use eye masks and ear plugs). Avoid caffeinated beverages and foods close to bedtime.
  • Avoid alcohol; although it may seem to improve sleep initially, tolerance develops quickly and it will soon disturb sleep.

 

What are the consequences of Shift Work?

While shift work does create potential productivity advantages, it also has many inherent risks. Some of the most serious and persistent problems shift workers face are frequent sleep disturbance and associated excessive sleepiness. Sleepiness/fatigue in the work place can lead to poor concentration, absenteeism, accidents, errors, injuries, and fatalities. The issue becomes more alarming when you consider that shift workers are often employed in the most dangerous of jobs, such as firefighting, emergency medical services, law enforcement and security.

People who work in the transportation industry face some of the most serious challenges. They battle fatigue because of their irregular sleep schedules and endure long tedious hours at the controls or behind the wheel. In fact, research suggests that driver fatigue behind the wheel caused by sleep deprivation is one of the leading safety hazards in the transportation industry.

Circadian Rhythm Sleep Disorder

A person's circadian rhythm is an internal biological clock that regulates a variety of biological processes according to an approximate 24-hour period. The malfunctioning of a person's circadian system, or biological clock, causes circadian rhythm disorders. The circadian rhythm disorder related to the sleep-wake cycle can be categorized into the following 2 main groups: transient or chronic disorders.

A circadian rhythm sleep disorder that would be considered transient is when jet lag or an altered sleep schedule due to work hours affects a person’s sleep. Illness can do this to a person as well.

Circadian rhythm sleep disorders that are considered chronic include disorders that show a mismatch between the body’s internal clock and the world’s 24 hour clock. These disorders affect the timing of sleep. A person will want to fall asleep too early or maybe too late. 

A common disorder is Delayed Sleep-Phase syndrome (DSPS). This is characterized by a persistent (that is, lasting longer than 6 months) inability to fall asleep and awaken at socially acceptable times. Individuals with DSPS fall asleep late (for example, in the early morning hours) and wake up late (for example, in the late morning hours or in the early afternoon hours). Once asleep, however, persons with DSPS are able to maintain their sleep and have normal total sleep times.

Another disorder is Advanced Sleep-Phase Syndrome (ASPS). ASPS is characterized by a persistent early evening sleep onset time (between 6:00 pm and 9:00 pm) and an early morning wake-up time (between 3:00 am and 5:00 am).

What are the signs and symptoms of Circadian Rhythm Disorders?

Common signs and symptoms for DSPS is:

  • Difficulty falling and staying asleep, and or late night insomnia.
  • A general lack of energy in the morning.
  • An increase of energy in the evening or late at night.
  • Difficulty concentrating, being alert, or accomplishing tasks
  • Some DSPS sufferers oversleep and have trouble getting up

Commons signs and symptoms for ASPS is:
  • Early morning awakening and/or early morning Insomnia
  • Inconsistent sleep with one or more awake periods during the night
  • Lack of energy during the day, feeling tired in the early afternoon and/or evening
  • Alertness and ability to function may also be diminished
  • Some ASPS sufferers may not notice a sleep problem but lose energy and feel tired or down in the afternoon or evening time.

 

Who does Circadian Rhythm Disorders affect?

DSPS is more common among adolescents and young adults with a reported prevalence of 7-16%. It is estimated that DSPS is seen in approximately 10% of patients with chronic insomnia in sleep clinics. A positive family history may be present in approximately 40% of individuals with DSPS.

ASPS affects approximately 1% in middle-aged and older adults and increases with age.

What are the treatments of Circadian Rhythm Disorders?

  • Lifestyle changes: People may cope better with certain circadian rhythm sleep disorders by doing such things as adjusting their exposure to daylight, making changes in the timing of their daily routines, and strategically scheduling naps
  • Sleep hygiene: These instructions help patients develop healthy sleep habits and teach them to avoid making the problem worse by attempting to self-medicate with drugs or alcohol.
  • Bright light therapy: This therapy synchronizes the body clock by exposing the eyes to safe levels of intense, bright light for brief durations at strategic times of day.
  • Medications: A hypnotic may be prescribed to promote sleep or a stimulant may be used to promote wakefulness
  • Melatonin: This hormone is produced by the brain at night and seems to play a role in maintaining the sleep-wake cycle. Taking melatonin at precise times and doses may alleviate the symptoms of some circadian rhythm sleep disorders.

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