Sleep and the Night Shift

Could you have shift work sleep disorder?

From the WebMD Archives

What do firefighters, police officers, doctors, nurses, paramedics, factory workers, and office cleaning staff have in common? They all are at risk for shift work sleep disorder. If you work at night or often rotate shifts, you may share that risk. Working at night or irregular shifts can keep you from getting the regular snooze time that most daytime workers take for granted.

Working non-traditional hours is more common than you might think. In industrialized nations, up to 20% of workers work either night or rotating shifts, according to an editorial published in the New England Journal of Medicine.

Although not everyone who works odd hours has shift work sleep disorder, a lot can be at stake. People with shift work disorder have higher rates of absenteeism and accidents related to sleepiness than night workers without the disorder.

Memory and ability to focus can become impaired, and shift workers who are sleep-deprived often get irritable or depressed, says Wesley Elon Fleming, MD, clinical assistant professor at Loma Linda University and director of the Sleep Center Orange County in Southern California. Their relationships and social life can suffer, too.

Shift workers also face potential health problems, researchers have found. Overall, those who work night or rotating shifts seem to have a higher risk of ulcers, insulin resistance, metabolic syndrome, and heart disease.

Working Shifts: 9 Tips for Better Sleep

If your job requires that you work the night shift or hours other than the traditional 9 to 5, you need to pay close attention to your sleep. These tips can help you get good sleep:

  1. Try not to work a number of night shifts in a row. You may become increasingly more sleep-deprived over several nights on the job. You're more likely to recover if you can limit night shifts and schedule days off in between.
  2. Avoid frequently rotating shifts. If you can't, it's easier to adjust to a schedule that rotates from day shift to evening to night rather than the reverse order.
  3. Try to avoid long commutes that take time away from sleeping.
  4. Keep your workplace brightly lighted to promote alertness. If you're working the night shift, expose yourself to bright light, such as that from special light boxes, lamps, and visors designed for people with circadian-related sleep problems, when you wake up. Circadian rhythms are the body's internal clock that tells us when to be awake and when to sleep. These rhythms are controlled by a part of the brain that is influenced by light. Fleming says that being exposed to bright light when you start your "day" can help train your body's internal clock to adjust.
  5. Limit caffeine. Drinking a cup of coffee at the beginning of your shift will help promote alertness. But don't consume caffeine later in the shift or you may have trouble falling asleep when you get home.
  6. Avoid bright light on the way home from work, which will make it easier for you to fall asleep once you hit the pillow. Wear dark, wraparound sunglasses and a hat to shield yourself from sunlight. Don't stop to run errands, tempting as that may be.
  7. Stick to a regular sleep-wake schedule as much as you can.
  8. Ask your family to limit phone calls and visitors during your sleep hours.
  9. Use blackout blinds or heavy curtains to block sunlight when you sleep during the day. "Sunlight is a potent stimulator of the circadian rhythm," Fleming says. "Even if your eyes are closed, the sunlight coming into the room tells your brain that it's daytime. Yet your body is exhausted and you're trying to sleep. That discrepancy ... is not a healthy thing for the body to be exposed to."

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Why the Night Shift Makes You Sleepy

Why do night shifts wreak havoc on sleep? "The circadian rhythm is so [ingrained] in each one of us that what we're doing is going against the body's natural desire to be asleep at nighttime and to be awake during the daytime," says Fleming. "Some people have ways of coping that are better than others, but for the most part, it's very difficult to feel your optimal self when you work the night shift."

Rotating shifts are even harder on the body, Fleming adds. "The body likes to operate on a routine schedule. The body likes to know what to expect in terms of production of certain hormones," he says. "When you expose yourself to sunlight at some times during the week, but not others -- when you're sleeping at nighttime some nights and then during daytime at others -- the body has difficulty knowing what to anticipate and when to produce those transmitters and neurochemicals for sleep and digestion and proper functioning of the human body."

Regular, restful sleep is crucial for the body's repair, Fleming says. "The body's ability to recover and recuperate from the damage done during the daytime on a cellular level is affected by the night shift --because that's the purpose of sleep. If our sleep schedule is erratic or irregular, that synchrony of repair that's supposed to happen at nighttime doesn't get played out the way it's supposed to."

Treating Shift Work Sleep Disorder

Despite the prevalence of irregular work hours in our 'round-the-clock, technological society, sleep experts told WebMD that people usually don't show up at sleep labs with complaints about topsy-turvy schedules. "Most patients feel that there's nothing they can do about it," Fleming says. "It's not a very common source of referrals to a sleep center, even though it should be."

The hallmarks of shift work sleep disorder are excessive sleepiness during night work and insomnia when a worker tries to sleep during the daytime. Workers with significant symptoms -- including headaches, lack of energy and trouble concentrating -- should talk to their doctors.

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Dennis Nicholson, MD, medical director of the Pomona Valley Hospital Sleep Disorders Center in Claremont, Calif., and a fellow of the American Academy of Sleep Medicine, estimates that patients with shift work sleep disorder make up 5% to 10% of his practice.

The problem affects various age groups, but older workers have the toughest time coping, he says. "As people get older, they sometimes have medical conditions that make it more and more difficult for them to stay in shift work. Generally, when I see patients above 50 doing shift work, I find that they have a devil of a time."

To treat shift work disorder, doctors usually start with improving sleep hygiene with the nine tips covered at the beginning of this article. Using blackout curtains and keeping a regular sleep-wake schedule can help your body adjust to sleeping during the day.

If those behavioral changes don’t help, doctors can prescribe medications to help people stay alert when they need to be awake and help shift workers fall asleep.

Stimulant medications such as Nuvigil and Provigil can relieve sleepiness when people need to be awake. These drugs are approved for the treatment of excessive sleepiness related to shift work disorder, among other conditions.

Sleep aids such as Ambien, Lunesta, and Sonata may be prescribed to help with falling asleep. Certain antidepressants and benzodiazepines may also be used to help with sleep.

Doctors such as Fleming recommend that shift workers try proper sleep hygiene first. If that doesn’t work, talk to the doctor about medications or a referral to a sleep lab.

WebMD Feature Reviewed by Brunilda Nazario, MD on November 29, 2011

Sources

SOURCES:

Wesley Elon Fleming, MD, clinical assistant professor, Loma Linda University; director, Sleep Center Orange County, California.

Dennis Nicholson, MD, medical director, Pomona Valley Hospital Sleep Disorders Center. 

Czeisler, C. New England Journal of Medicine, Aug. 4, 2005; vol 353: pp 476-486.

Cleveland Clinic: "Shift Work Sleep Disorder."

Basner, R.C. New England Journal of Medicine, Aug. 4, 2005; vol 353: pp 519-521.

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