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Shift Work Sleep Disorder: Causes, Symptoms, Treatments

Humans are meant to be awake when the sun comes up sleep when it sets – this is common sense, yet highly important to maintain healthy functioning. Although most people are able to adhere to the biological instinct of sleeping when it’s dark, and waking when it’s light, some people are assigned to “shift work.” Shift work was designed to allow companies to operate 24 hours a day by assigning workers to specific “shifts.”

Many standard jobs begin between 6 and 9 AM and end between 2 and 5 PM; this is considered a “day shift.” Unfortunately other workers don’t have the fortune of working standard daytime hours and get assigned other shifts. Shift work generally involves rotating between one of three common shifts in the 24 hour period: 7 AM to 3 PM; 3 PM to 11 PM; and 11 PM to 7 AM.

One day a shift worker may work a shift of 3 PM to 11 PM and another day they may work from 11 PM to 7 AM. Other days they may “shift” back to the 7 AM to 3 PM standard day shift. While rare individuals don’t mind the perils associated with shift work, many people find that it can significantly affect their functioning and overall health. In severe cases, it can lead to a condition referred to as “shift work sleep disorder.”

What is Shift Work Sleep Disorder (SWSD)?

Shift work sleep disorder is considered a disorder of the circadian rhythm characterized by insomnia and excessive sleepiness. All people have a biological mechanism that causes them to become sleepy at certain times of the day and alert at others – this is known as the body’s circadian rhythm When working shift work, this natural biological mechanism becomes disrupted or thrown off of its natural course.

These generally become disrupted and lead to shift work sleep disorder when people are working when their bodies are naturally programmed to sleep. Due to differences in sleep schedules, shift work schedules, it is possible for certain people to have more severe symptoms of shift work sleep disorder than others. Additionally, it is important to mention that not everyone who works shift work develops insomnia in tandem with excessive sleepiness to get diagnosed as having SWSD.

Shift Work Disorder Symptoms

There are many symptoms associated with “Shift Work Sleep Disorder.” It is considered a relatively new “disorder.” Some speculate that it was created simply to boost pharmaceutical profits whereas others suggest that it is a valid condition that was previously unrecognized. It is generally difficult to distinguish the normal toll of shift work versus an actual shift work disorder. In general, shift work disorder is characterized by a combination of insomnia and excessive sleepiness, each at unwanted or inappropriate times.

  • Insomnia: In cases of shift work sleep disorder, people often have difficulty sleeping because they work night shifts or have been switching shifts. This leads certain individuals to experience insomnia even after they’ve rotated off of the night shift.
  • Excessive sleepiness: In other cases, individuals end up rotating to a different shift and have significant difficulty staying awake. During a shift rotation, a person may feel extremely sleepy and be unable to maintain alertness or mental performance. In extreme cases they may fall asleep on the job. The excessive sleepiness is demonstrated by increasing desire to nap, dozing unintentionally, irritability, and poor waking performance.
  • Insufficient sleep quantity: Many individuals with SWSD typically find that their average sleep time is shorter than before they worked shift work. This generally leads to a person getting an insufficient quantity of sleep for optimal physical and mental health.
  • Poor sleep quality: Something that’s not often mentioned is that the sleep an individual gets with this condition is often of lower quality than those who don’t work shift work. The circadian rhythm has been disrupted and may have a difficult time providing individuals with the necessary neurotransmitters and biological processes that regulate sleep. In many cases a person may get sleep while off of their shift and feel as if the quality is extremely low.
  • Cognitive impairment: Many individuals feel as if their cognition and alertness has become impaired as a result of a reduction in sleep quality. Working shift work can take a significant toll on mental functioning and performance over the long-term. This cognitive impairment becomes a major problem for many individuals.

Most individuals with this particular disorder will consult their doctor and claim to have disrupted sleep due to their shift work. A doctor may encourage you to keep a sleep journal and/or seek a sleep specialist (in a sleep lab) to get a better idea of what is going on inside your brain. He may also ask you a panel of questions such as whether you doze at work and/or if you are unable to sleep when you get home.  Current symptoms required for a diagnosis remain relatively vague.

Shift Work Disorder Causes

What causes shift work disorder to manifest? In most cases, it’s common sense – “shift work.” The constant switching of shifts leads to disruption in natural biological processes and the circadian rhythm. Those who work shifts may also come home during a time when other family members are awake. The family members that have been awake may be inadvertently disrupting the shift worker in both sleep quantity and quality.

  • Shift work: Obviously a major cause of SWSD is the actual shift work. Without the night shift or constant rotation of shifts, most people wouldn’t have circadian rhythm disruptions. This condition may manifest among individuals who have set up routines in which they stay awake at night and sleep during the day. However, individuals that aren’t required to work at night still have the opportunity to adjust their sleep schedule so that their circadian rhythm resets itself.
  • Sunlight: The sun plays a huge role in causing SWSD. If those working shift work could manipulate the sun to rise when they have their shift and set when their shift ends, the disorder wouldn’t be as big of a problem. The fact that shift workers see the sun rise after a night shift stimulates the brain to stay awake despite feeling tired. When the sun sets and a person has to work the night shift, it stimulates sleepiness in the brain, leading to grogginess on the job.
  • Circadian rhythm disruption: The combination of hormonal changes, neurotransmitter changes, brain activity, etc. all lead the circadian rhythm to become disrupted or imbalanced. It is your circadian rhythm that is responsible for helping people sleep when it’s dark and wake up when it’s light.
  • Suprachiamatic Nucleus (SCN): A specific part of the brain called the “Suprachiasmatic Nucleus” is responsible for maintaining circadian sleep rhythms at night. This specific component is located within the anterior hypothalamus and essentially synchronizes itself with the time of day. Neurons within the suprachiasmatic nucleus contain genetic transcription loops that influence biological timekeeping. The circadian rhythm is highly influenced by schedules of light exposure, both intensity and previous exposure. When a person works shift work, the varied light exposure can alter rhythms in the suprachiasmatic nucleus (either speeding them up or postponing them).
  • Melatonin: A hormone that is produced by the body to help us sleep is known as melatonin. Interestingly enough, the production of melatonin is influenced directly by the SCN and light exposure. When light enters the eye it travels to the SCN, the SCN is then responsible for influencing the pineal gland which produces melatonin. Melatonin is generally produced within a couple hours of when a person typically goes to bed. In the case of those with shift work sleep disorders, it is believed that melatonin production becomes altered due to the SCN changes. This leads to inadequate melatonin production before they sleep and possibly ramped up melatonin production when the person needs to be awake.

Other possible contributing factors:

  • Family members: If you have family, it is best to discuss the importance of your sleep with them. Many family members are unintentionally noisy during times when shift workers need to sleep. If you have kids, it may be nearly impossible to avoid their relentless noise during the day, but do your best to discuss the importance of sleep with them.
  • Environmental noise: Since the majority of the world is awake during the day, environmental noise can be difficult to sleep through. You may be disrupted by a neighbor’s lawn mower, vehicles, phone calls, etc. This noise can lead to significant disruptions in your sleep during the day after a night shift.
  • Obligations: If you have various obligations that need to be taken care of during the day, and you work night shift, these may contribute to SWSD. Obligations such as appointments, meetings, hanging out with friends, etc. all lead to inadequate sleep throughout the day. It is recommended to minimize daily obligations with family and friends and get sleep instead.

Shift Work Disorder Treatments

Before treatment options are discussed, it is important to weigh the pros and cons of your current job. Although you may be getting paid money to support yourself (and/or a family), you may not realize the toll that shift work is taking on your health. Foremost, if you have other options in terms of work, you may want to jump ship to a company that allows you to work only standard daylight hours. Below are some strategies that you could implement to help you cope with SWSD.

  • Sleep scheduling: Despite the fact that there is no “perfect” shift at night, certain protocols of shift work may be superior to others. If you are working shift work, it is best to strictly follow a sleep-wake protocol and schedule your sleep to ensure that you are getting a sufficient amount. Plan the time that you will fall asleep as well as the time that you will wake up. Do your best to optimize sleep quality as well.
  • Strategic “shift rotation”: Experts have suggested that rotating shifts in 2 week intervals in a forward direction (i.e. delay) was less taxing than shifting backwards. Other experts believe that it could be beneficial to work in short stints such as 2 consecutive nights followed by recovery time. That said, most companies do not allow for such short-term shift assignments.
  • Power naps: Some workers take strategic naps during their short breaks that they have on a shift. The only problem with naps is that they can actually make some individuals less alert and groggy. While naps can be an effective way to replenish your body and brain, it is recommended to keep them short such as between 10 and 30 minutes. There are many notable psychological benefits of napping at work, so a power nap would be recommended if your company has a sleeping area or permits you sleep breaks.
  • Bright light treatment: Most experts agree that the sun is the most important factor in this type of disorder. Those working nights typically work when the sun is down and sleep when the sun is up. Researchers have figured out that in order to improve the circadian rhythm adaptations associated with shift work, bright light exposure can help if conducted properly. Most recommend bright light exposure being beneficial in the first part of the night and should be completely avoided during the morning. The artificial light helps those working nights by tricking the brain into thinking daylight (when it’s actually night) and night (when it’s actually day).
  • Light blocking: While night shift workers benefit from tricking the brain into thinking its day (when it’s actually night) via the usage of bright lights, it is recommended to do the opposite when a person’s shift ends. In other words, it is important to block bright light in the morning – even from the sun. Some have gone as far as to recommend wearing dark “welding goggles” or other light filtration goggles during the morning commute from work; this should help improve the circadian rhythm.
  • Melatonin supplementation: As was mentioned, disruptions in melatonin production can lead to insomnia when sleep is needed and sleepiness when alertness is required. Some experts have recommended taking melatonin to help restore the homeostatic circadian rhythm. It is believed that melatonin should be taken at night to reset your circadian rhythm to an earlier time, while taking melatonin in the morning is believed to reset it to a later time. Fortunately this is a relatively safe supplement and can be used effectively to manage certain symptoms of SWSD.
  • Pharmaceutical medications: There are a couple of different types of medications that are prescribed to individuals with SWSD. These include stimulating drugs like eugeroics to increase alertness on the job and sleeping pills (Z-drugs) to improve sleep quality when off work. Unfortunately these medications can carry side effects and the long term effects of their usage remain unclear.
    • Eugeroics (Alertness component): These are considered wakefulness-promoting drugs and were specifically designed to keep people with excessive sleepiness awake. They are highly effective and are considered by many to have minimal addiction potential and no major safety concerns. Despite their efficacy, many are skeptical to use these drugs due to the unknown long-term effects.
    • Hypnotics (Sleep component): In some cases, doctors will prescribe Z-drugs like Ambien to help a person fall asleep when necessary. Some evidence supports the idea that if a shift worker takes a sleeping pill in the morning, they may be able to increase their daytime sleep time. Unfortunately the sleepiness that a person incurs at night is not always affected by the amount of sleep that they get during the day.

Other solutions to consider

  • Quit your job: Some individuals may want to consider quitting their job if the shift work is taking a toll on their overall health and wellbeing. There are significant drawbacks associated with working shift work including: poorer mental performance, less restful sleep, and development of various health conditions.
  • Only work the “day”-shift: If you have the option of working the day shift, this would be ideal for your biological clock. Regardless of whether working the night shift pays more, it is important to first think about your health and ability to perform. Unfortunately many companies do not give you the ability to choose your shift.

How to Cope with Shift Work Sleep Disorder (SWSD)

Anyone working shift work could theoretically make the argument that they have shift work disorder. The problem is that in a majority of cases, it can be difficult for a physician to distinguish between an individual who is experiencing some common effects of shift work and someone who is legitimately disordered.  There is no clear-cut line drawn to diagnose this condition, therefore anyone who works different shift could argue they have this disorder.

The best way to overcome shift work disorder is to simply find a new job and/or only agree to work the “daytime” shift. Most people do not realize the detrimental effects of shift work on physical and mental health over the long-term. If you must work shift work, be sure to get adequate sleep and good quality sleep when you can.

In the event that your alertness is compromised on the job by SWSD, you could consider consulting a doctor to talk more about some possible coping strategies and treatments. Additionally if you have a tough time coping with the insomnia, pharmaceutical intervention may be helpful. In general, it is recommended to exercise every alternative prior to resorting to a pharmaceutical.

If you have shift work sleep disorder (SWSD) and would like to share your experience, feel free to do so in the comments section below. Additionally, if you work shift work and/or have previously worked shift work and know of any tricks that helped you improve your sleep, be sure to share.

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