Shift Work Syndrome
About 20 million Americans (20 to 25 percent of workers) perform shift work. Most shift workers get less sleep over 24 hours than day workers. Sleep loss is greatest for night shift workers, those who work early morning shifts, and female shift workers with children at home. About 60 to 70 percent of shift workers have difficulty sleeping and/or problem sleepiness.
The human sleep-wake system is designed to prepare the body and mind for sleep at night and wakefulness during the day. These natural rhythms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested. It is possible that the human body never completely adjusts to nighttime activity and daytime sleep, even in those who work permanent night shifts.
In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Because our society is strongly day-oriented, shift workers who try to sleep during the day are often interrupted by noise, light, telephones, family members, and other distractions. In contrast, the nighttime sleep of day workers is largely protected by social customs that keep noises and interruptions to a minimum.
Problem sleepiness in shift workers may result in:
- increased risk for automobile crashes, especially while driving home after the night shift;
- decreased quality of life;
- decreased productivity (night work performance may be slower and less accurate than day performance); and/or
increased risk of accidents and injuries at work.
WHAT CAN HELP? Sleep—There Is No Substitute!
Many people simply do not allow enough time for sleep on a regular basis. A first step may be to evaluate daily activities and sleep-wake patterns to determine how much sleep is obtained. If you are consistently getting less than 8 hours of sleep per night, more sleep may be needed. A good approach is to gradually move to an earlier bed-time. For example, if an extra hour of sleep is needed, try going to bed 15 minutes earlier each night for four nights and then keep the last bedtime. This method will increase the amount of time in bed without causing a sudden change in sched- ule. However, if work or family schedules do not permit the earlier bedtime, a 30- to 60-minute daily nap may help.
In general, medications do not help problem sleepiness, and some make it worse. Caffeine can reduce sleepiness and increase alertness, but only temporarily. It can also cause problem sleepiness to become worse by interrupting sleep.
While alcohol may shorten the time it takes to fall asleep, it can disrupt sleep later in the night, and therefore add to the problem sleepiness.
Medications may be prescribed for patients in certain situations. For example, the short-term use of sleeping pills has been shown to be helpful in patients diagnosed with acute insomnia. Long-term use of sleep medication is recommended only for the treatment of specific sleep disorders.
If You’re Sleepy—Don’t Drive!
- A person who is sleepy and drives is at high risk for an automobile crash. Planning ahead may help reduce that risk. For example, the following tips may help when planning a long distance car trip:
- Get a good night’s sleep before leaving.
- Avoid driving between midnight and 7 a.m.
- Change drivers often to allow for rest periods.
- Schedule frequent breaks.
If you are a shift worker, the following may help:
- decreasing the amount of night work;
- increasing the total amount of sleep by adding naps and lengthening the amount of time allotted for sleep;
- increasing the intensity of light at work;
- having a predictable schedule of night shifts;
- eliminating sound and light in the bedroom during daytime sleep;
- using caffeine (only during the first part of the shift) to promote alertness at night; or
- possibly using prescription sleeping pills to help daytime sleep on an occasional basis (check with your doctor).
Shift Work Syndrome Treatment Tips
- Maintain the same wake/sleep schedule regardless if you are working or “off”
- Map out a wake/sleep schedule and live by it
- Get 7 hours of sleep a “night”, 50 hours of sleep a week
- Avoid sunlight into your eyes for 3-4 hours before sleep onset
- Use 1 mg Melatonin 30 minutes before sleep onset
- Maintain a 30 minute “down time” ritual before sleep onset (No TV, computer, exercise, eating, or excitement)
- Avoid a heavy meal and/or alcohol before 2-3 hours before sleep onset
- Talk to your Doctor if “Insomnia” (can not go to sleep) is problematic
- Awaken the same time each “day”/ wake cycle after at least 7 hours of sleep
- Attempt bright light or sunlight exposure for the first part of your wake cycle (>5,000 lux)
- Exercise and Eat early in your wake cycle
- If sleepy, caffeine may be helpful for wakefulness and performance (1 cup, 250 mg)
- A 30 minute nap before work or if sleepy is helpful to reach 7 hours or “bank” sleep
- If still sleepy despite this regimen, discuss sleep testing or prescription wakefulness medications with your Doctor for “Shift Work Syndrome”.
- Never drive drowsy- it is like driving drunk. Very high risk of accidents and poor decisions