Shift Work Disorder

What is Shift Work Disorder? Identifying Shift Work Disorder & How You Can Manage Symptoms

Shift Work Disorder, which is also known as Shift Work Sleep Disorder (SWSD), is a condition that often affects people working in non-traditional hours, that is, outside the regular hours of 7 am to 6 pm. The shift work schedule goes against your internal body clock or circadian rhythms.

Shift Work Disorder causes difficulties with different wake-up and sleep schedules. As a result, you may experience significant issues when falling asleep, staying asleep, and sleeping when desired. According to the World Health Organization (WHO), about 30% of full-time workers in the US are involved in some shift work Sleep Disorder.

Additionally, an average person with shift work disorder loses one to five hours of sleep per night.

What is Shift Work Disorder?

This is a type of circadian rhythm sleep disorder. It is associated with misalignment between the circadian rhythms, which regulate the sleep and wake cycle. Other circadian rhythm sleep disorders including insomnia, delayed and advanced wake-sleep phase disorder, jet lag, and irregular sleep-wake disorder.

Circadian rhythms are guided by natural light and darkness. During the day, your eye retinas are perceived by sunlight and signal the brain to release cortisol hormones which keep you alert and energized. As the sun sets and darkness enters your eye, the retina signals your brain to release the melatonin hormone, making you feel relaxed and sleepy.

Shift Work Sleep Disorder specifically relates to circadian misalignment related to work schedules that overlap with sleep-wake cycles. Some of the defining symptoms of shift work disorder include insomnia, excessive sleepiness while awake, and recurring sleep loss. To receive a shift work disorder diagnosis, you must report symptoms that frequently occur for at least one month despite your efforts to get enough sleep every day.

Note that these disorders affect people in different ways. For example, if you are used to working during the night shift, you may not experience the same symptoms as working the morning shift. Furthermore, the degree to which daytime performance is impaired varies from one patient to another. Some people with SWSD, in the long run, adapt to working during the night and sleeping in the daytime, but this process can take time.

Work stress, marriage, family, and social pressure are environmental factors that can add to sleep loss to people suffering from shift work disorder. 

What Are the Symptoms of Sleep Work Disorder?

Some of the most common symptoms of sleep work disorder include excessive sleepiness and difficulty in sleeping.

Other symptoms associated with sleep work disorder are:

  • Difficulty concentrating
  • Headaches and lack of energy

Sleeping with a headache can be quite intimidating. Luckily, there are sleep routines you can adopt to help you sleep comfortably. Keep in mind that not every shift worker suffers from sleep work disorder. According to research, this condition is estimated to affect 8% to 45% of shift workers. If you are a shift worker experiencing any of these symptoms, it is advised you seek medical attention as soon as possible.

What are the consequences of sleep work disorder if left untreated?
If you have a sleep work disorder and you fail to seek medical attention then, there is an increased likelihood of:

  • Causing accidents while driving or working.
  • Cause work-related errors and poor work performance.
  • Irritability and mood swings.
  • Impaired social functions.
  • Poor concentration.
  • You may become a drug and alcohol addict.
  • Suffer from health-related complaints such as metabolic issues, cardiovascular, diabetes, and gastrointestinal issues.
  • Low testosterone.

How Can You Deal With or Manage Sleep Work Disorder?

Usually, most shift workers sleep one to five hours less than non-shift workers. As a result, it is recommended to get at least six or nine hours of sleep a day.

If you are a shift worker, you have to make sleep your priority. If you work besides the 9 am to 5 pm routine, it would be of help if you prepare for sleep even if there is daylight outside by:

  1. Minimize the number of times you are exposed to light on your way home after your night shift. This is because the morning sunlight is known to activate your "daytime clock."
  2. Follow your bedtime routine and maintain a regular sleeping schedule both on weekdays and weekends.
  3. Ask your family members to wear headphones while entertaining themselves with movies or music. This will help ensure you sleep in a quiet environment.
  4. Ask those you live with to create a quiet, dark, and peaceful setting during sleep time.
  5. Add "do not disturb" banners on the front door so that delivery personnel and friends will not knock or ring the doorbell.
  6. Encourage your family members to avoid noisy activities such as vacuum cleaning and dishwashing while you sleep.

What can you do to lower the effects of sleep work disorder?

  1. Maintain a good sleep diary to help identify the issue and monitor how it progresses over time.
  2. Reduce the number of nights you work in a row. Doctors recommend shift workers working during the night shift limit the number of night shifts to not more than four and get an off between.
  3.  After working a string of night shifts, you should take more than two days off if possible.
  4. Avoid rotating shifts. Dealing with rotating shifts can be more challenging than working on the same shift for a long time. For this reason, avoiding them can help realign your sleeping patterns.
  5.  Get enough sleep even when you are on your off days.
  6.  Maintain good sleep hygiene by planning and arranging a sleep schedule and avoiding caffeine, alcohol, and nicotine. Do not start the shift with sleep deprivation.
  7. If you plan to drive to work or visit your friends and family, ensure you take a nap before you start driving to avoid drowsiness while you are on your journey.
  8. Get appropriate light exposure during the early part of the shift. This helps to improve alertness during your shift.
  9. Your doctor can prescribe you sleep aid pills if you are experiencing difficulties sleeping.
  10. Use heavy curtains or blinds on your window to prevent sunlight from shining in your room while you sleep.

Health Risks Associated with Sleep Work Disorder

Lifestyle Effects

Most people overlook the lifestyle changes that those shift work schedules can cause, especially night shift workers. Most night workers usually feel isolated from their friends and families due to having their schedule misaligned with their loved ones, making socialization extremely challenging. Shift workers usually find it harder to exercise more often and eat healthy meals since they are likely to eat fast food chains that work round the clock. Other health effects include:

Long Term Health Effects

The long-term effects are the most challenging to measure. However, research shows that there might be a connection between shift workers and increased risk of severe health conditions like:

  • Increased cardiovascular disease
  • Diabetes
  • Obesity
  • Cancer
  • Depression and mood disorders
  • Internal gastrointestinal disorders
  • Depression
  • Increased chances of getting cold flu
  • Menstrual irregularities and fertility issues.

Most of these health risks are believed to be associated with the reduced body ability to produce melatonin. This is a hormone responsible for controlling your circadian rhythms and sleeping and waking cycles.

Short Term Health Effects

Even if you're not a shift worker, you might have experienced equivalent effects. This is especially after a transatlantic flight, studying for exams all night in college, or a few nights while caring for a newborn. Apart from feeling tired, other effects include:

  • Insomnia
  • Decreased quality life
  • General feeling sick
  • Increased risks of accidents and injuries

How Is Shift Work Disorder Diagnosed?

Your doctor will use diagnostic procedures to determine whether you will have a shift work disorder diagnosed or not. Your doctor can either use international classification of disorders, the newest edition of the diagnostic and statistical manual of mental disorders, or both.

Your doctor will also ask you a series of questions about your sleep patterns, disturbances, and your current work shift. After this, your doctor will likely ask you for a sleep diary covering at least seven days of your sleep. Your doctor will also ask for your medical history.

Since this shit work disorder mimics other disorders, your doctor might first rule out conditions such as obstructive sleep apnea and narcolepsy. Your doctor might request a sleep study to rule out these other sleep disorders.

During the sleep study, you will have to sleep in the hospital overnight with monitors and sensors placed in your face or chest. These sensors and monitors evaluate things like:

  • Sleep quality
  • Number of sleep disturbance
  • Heart rate
  • Breathing

What lifestyle changes can help you manage shift work disorder
While most workers are unable to change their working hours, there are several ways to lessen the effect of the SWSD. These lifestyle changes can help you relieve some of your sleep disorder symptoms:

  • Ensure you keep a regular sleep schedule, including your off days.
  • Wear sunglasses when leaving your night shift to minimize light exposure. It helps to prevent activating your "daytime clock."
  • Maintain a healthy diet.
  • Limit your caffeine intake before bedtime.
  • Take frequent naps whenever possible.
  • Avoid long commutes.
  • Ensure you sleep in a quiet environment with fewer disturbances. If you live in a noisy environment, buy earbuds and use them to drown out sound while you sleep.
  • Take about an hour nap before you begin your shift. Use a lightbox for light therapy to expose your eyes to bright light but safe before working.

How to Treat Shift Work Disorder

Lifestyle changes play a critical role in promoting healthy sleep, but some may turn to sleep medicines. Scientists and doctors consider melatonin safe, and numerous workers find it greatly useful to improve sleep quality.

Sedatives and Hypnotics should be used sparingly, and for a short period, this includes Ambien and Lunesta, which a doctor often prescribes. The FDA approved Modafinil (Provigil) as a wake-promoting drug with the lowest abuse potential. In a clinical trial, the drug has shown to improve lessen and reduce morning sleepiness. Additionally, the drug has been shown to reduce long-term memory impairment.

To improve sleep quality, block and avoid disruption as much as possible. You can do this by avoiding looking at your bright phone screen as much as possible an hour before bedtime.

You can use caffeine to help you stay alert on the job or during the day. Caffeine together with naps before you begin your shift helps to promote alertness.

Suppose you are having trouble sleeping during the day. You can use medication that promotes daytime sleep. Hypotonic is a drug given to patients to help lengthen daytime sleep. Other studies show that patients who take hypotonic enjoy sound sleep at night.
Is it possible to live with the shift sleep disorder?

Yes, it is possible to live with a shift sleep disorder; however, with the increasing workforce in the US and advances in technology, non-traditional work schedules are expected to decline significantly. Additionally, making life changes and taking sleep medication can help you get quality sleep during your time off.

Conclusion

If you are suffering the symptoms above, do not go ahead and buy over-the-counter sleeping pills. Your doctor will diagnose you and suggest the type of medicine that can help you stay awake. Additionally, if you are more concerned about your health, your doctor will closely examine the health effects caused by shift work, especially if you have other health issues.

If you are suffering from excessive sleepiness and gaining weight fast, this could be a sign that you are suffering from Shift Work Disorder. If your doctor does not see any issues, you can perform your shift work with more confidence.

Other Sleep Disorders:

References

1. Shift Work and Shift Work Sleep Disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859247/

2. Jet Lag and Shift Work
http://healthysleep.med.harvard.edu/healthy/science/variations/jet-lag-and-shift-work

3. Main effects of sleep disorders related to shift work
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405401/

4. Insomnia and Fatigue in Shift Work and Shift Work Disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904525/

5. Sleep issues and Sleep Deprivation: An Unmet Public Health Problem.
https://www.ncbi.nlm.nih.gov/books/NBK19961/