Shift Work Sleep Disorder

Medically reviewed by Alana Biggers, MD on January 11, 2018Written by Ana Gotter on January 11, 2018

What is shift work sleep disorder?

Shift work sleep disorder (SWSD) occurs in individuals who work nontraditional hours like split shift, graveyard shifts, early morning shifts, or rotating shifts. It’s characterized by excessive sleepiness, lack of refreshing sleep, and drowsiness. These symptoms can affect both work and leisure time.

The nontraditional work schedule can disrupt a person’s circadian rhythm, or “biological clock.” It regulates wakefulness and sleepiness at relatively set times throughout the 24-hour day. The circadian rhythm can have frustrating symptoms when it’s been thrown off, since it affects:

  • sleepiness
  • alertness
  • body temperature
  • hormone levels
  • hunger

The Cleveland Clinic estimates that between 10 to 40 percent of shift workers experience SWSD. Those who have regularly shifting schedules are most likely to be affected.

However, not everyone who works a nontraditional shift experiences SWSD. Many people who work these shifts have circadian rhythms that make them natural “night owls,” and they’re able to avoid the disorder.

What are the symptoms of shift work sleep disorder?

SWSD is a chronic, or long-term, condition. The symptoms often impact your everyday life. You may experience many of the following symptoms:

  • excessive sleepiness, both on and off the job
  • difficulty concentrating
  • lack of energy
  • insomnia that prevents you from getting adequate sleep
  • sleep that feels incomplete or not refreshing
  • depression or moodiness
  • trouble with relationships

Chronic sleep deprivation can be dangerous and can increase your risk for falling asleep at the wheel or making errors on the job. It can impact your health, including heart health and proper digestive function. It can also increase your risk of cancer. Older workers and female workers are at risk for higher levels of sleep deprivation with this condition.

Sleepiness can create dangerous work conditions. It’s believed to be partly responsible for the Chernobyl disaster, Pennsylvania’s nuclear power plant disaster in 1979, and the Exxon spill on the Alaskan coast in 1989. Therefore, the symptoms of SWSD shouldn’t be taken lightly. It can result in accidents both on and off the job when not managed properly.

How is shift work sleep disorder diagnosed?

Your doctor will use diagnostic criteria to determine whether you have SWSD. They may use the International Classification of Sleep Disorders, the newest edition of the Diagnostic and Statistical Manual of Mental Disorders, or both.

Your doctor will likely ask you a series of questions about your sleep patterns and disturbances as well as what sort of shift you currently work. They may ask you for a sleep diary that covers at least seven days. You’ll also likely be asked about your medical history and any current medications.

Since SWSD can mimic other sleep disorders, your doctor might first rule out conditions such as narcolepsy and obstructive sleep apnea. They might order a sleep study to rule out these, or other, sleep disorders.

During the sleep study, you’ll sleep in a clinic overnight with monitors that may be placed on your finger, chest, or face. These monitors will evaluate things like:

  • sleep quality
  • number of sleep disturbances
  • heart rate
  • breathing

Lifestyle changes that help manage shift work sleep disorder

While many employees aren’t able to change their work hours, there are ways to lessen the effects of SWSD.

There are many lifestyle changes you can make which may help relieve some of your sleep disorder symptoms:

  • Try to keep a regular sleep schedule, including on days off.
  • If possible, take 48 hours off after a series of shifts.
  • Wear sunglasses when leaving work to minimize sun exposure. Doing so can help prevent the “daytime” clock from activating.
  • Take naps when possible.
  • Limit caffeine intake four hours before bedtime.
  • Maintain a healthy diet rich in fruits and vegetables.
  • Use heavy shades for sleeping to create a dark environment.
  • Ask family and other live-in companions to reduce noise by using headphones to watch television or listen to music. Ask them to avoid household chores until you’re awake.
  • Avoid a long commute if you can. It can cut into your sleeping hours and cause further drowsiness.
  • Keep nightly rituals before bed, even during the daytime.
  • Wear earplugs or use white noise to drown out sound while you sleep.
  • Take over-the-counter melatonin.
  • Purchase a light box for light therapy to expose your eyes to extremely bright but safe light before work.
  • Take a 30- to 60-minute nap right before your shift.

If you work for a company that regularly employs nontraditional shift workers — such as 24-hour factories, hospitals, or police departments — your employer may wish to implement their own aids to keep their workers safe. This may include keeping the workplace cool and bright to increase alertness.

How is shift work sleep disorder treated?

While lifestyle changes are the most important component of healthy sleep, some may turn to sleep aids. Melatonin is considered safe, and some workers find that it greatly improves the quality of their sleep.

Hypnotics and sedatives, however, should be used sparingly and for short periods of time. These include zolpidem (Ambien) and eszopiclone (Lunesta), which can be prescribed by your doctor.

Modafinil (Provigil) is approved by the U.S. Food and Drug Administration as a wake-promoting drug with a low abuse potential. It’s shown to improve sleep and lessen morning-after sleepiness. In clinical trials, modafinil was also shown to reduce long-term memory impairment and improve memory acquisition.

To improve sleep quality as much as possible, try to block out disruptions. Try not to look at your phone or bright screens for an hour before bed. Use white noise machines, calming music, or ear plugs to drown out the background noise of the day.

Living with shift work sleep disorder

A growing percentage of the U.S. workforce works unconventional shift hours. With the current workforce and the advances in technology, nontraditional work schedules aren’t expected to decline.

Making lifestyle changes and taking sleep medications can help you get the best quality of sleep during your time off.

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