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Sleep and Shift Work Disorder

Sleep and Shift Work Disorder

By: Phillip Holman MD

Are you working two jobs or more? Are you working one job with irregular shifts? Do you have a sleep/wake schedule that differs by more than two to four hours on work days compared to days off?

Psychiatrists frequently see patients with disturbed sleep, which includes ongoing generalized fatigue, daytime sleepiness, inability to sleep, fragmented sleep, sleep apnea, inability to function and sometimes people just sleeping the day away. Karl Doghramji, M.D. (2004) noted that “almost 1900 depressed subjects in a European survey, 73% reported tiredness and 63% reported sleep problems during the previous 6 months”. Sleep problems can be the result of pre-existing medical conditions, psychiatric disorders, medications, stress and anxiety, jet lag, long work hours and a job that involves shift work.

Shift Work Disorder (SWD) is often found in people whose jobs require them to rotate their day and night time schedules. Andrew D. Krystal, MD., MS (2011) notes shift work schedules are greatest seen “among workers in protective services (such as police, firefighters, security guards) (50.6%), food preparation/ serving (40.4%), health care support (28%), personal care and service (28%), and transportation and material moving (28%). Typically, it is a subgroup of these people who will develop SWD.

SWD is considered to be a circadian (refers to our 24 hours internal biological clock) rhythm sleep disorder that affects people who work night shifts or regular shift rotations. We can think of it as an interruption of sleep that disrupts our body’s natural sleep patterns. Thomas Roth, PhD. (2011) appropriately states that “the major feature of circadian rhythm sleep disorders is a misalignment between the patient’s sleep/wake cycle and the sleep pattern that is desired or regarded as societal norm”.

So what are some practical strategies that you can use to manage sleep? Some strategies worth trying are:

  1. Put the technology away. Eastern Iowa Sleep Center Dr. Scott Geisler (2011) states that “even that little bit of light you get from a portable device an IPAD or I-phone, smartphone is enough to send messages to your brain that it’s time to wake up.” Research by the Sleep Disorder Center at JKF Medical Center (2010) discovered that teenagers who watch television, surf the internet and text late at night have “more chances of developing sleep disorders compared to teenagers who don’t.” Also, this study has linked these late night activities to ADHD, mood swings, and even depression.
  2. Commit to a sleep routine. Opt for calming and relaxing unwinding routines.
  3. Avoid nicotine, caffeine and alcohol in the evening hours especially.
  4. Keep a sleep diary to track issues associated with sleeping, so that you can find solutions and set goals to encourage sleep.
  5. Avoid stressful circumstances and discussions before bedtime.
  6. Try to get a more regular shift work schedule.
  7. Minimize light exposure after your shift. For example, wear dark glasses on the way home from work at the end of your night shift.
  8. Reduce your commuting times and over time, if possible.
  9. Educate your family members and significant others about SWD. Enlist their support to help create a quiet sleep inducing environment.

Remember sleep disturbances are fairly common. And Shift Work Disorder is a real disorder. Often sleep disturbances are under recognized, ignored or not reported. Few people will visit there physician for trouble sleeping. Shift work disorder can create instability and impact the quality of your life. It may be time to identify your sleep problems with a mental health provider, your family doctor or a sleep disorder clinic.

Phillip Holman MD is the medical director for psychiatric services for Community Physician Group at Community Medical Center.