Herbie Murray
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterised by insomnia, excessive sleepiness, or both, affecting people whose work hours overlap with the typical sleep period. Shift work means having a schedule that deviates from the traditional 9-5 day shift, including overnight shifts, very early morning shifts, or shifts that start in the late afternoon or evening. SWSD can cause various physical and psychological effects, including increased risk of chronic health conditions, accidents, irritability, lower work performance, safety concerns, and substance abuse issues.
| Characteristics | Values |
|---|---|
| Definition | Sleep disorder caused by working non-traditional hours |
| Affected Individuals | Anyone working outside the normal workday of 8:00 am – 6:00 pm, including manufacturing workers, healthcare workers, law enforcement, 24-hour retail workers, security, truck drivers, pilots, and childcare providers |
| Prevalence | 10-40% of shift workers |
| Symptoms | Insomnia, excessive sleepiness, or both; difficulty falling asleep or waking up before sleeping enough; decreased cognitive performance, including trouble concentrating and slowed reaction times |
| Health Risks | Increased risk of hypertension, cancer, decreased bone mineral density, wrist and hip fractures, low fertility, issues during pregnancy, obesity, diabetes, insulin resistance, elevated body fat, dyslipidemia, mental disorders, depression, anxiety, alcohol use disorder, and heart attacks |
| Treatment | Light therapy, improved sleep hygiene, chronotherapy, lifestyle changes, medication, caffeine, melatonin, blocking light, regular sleep schedule, control of light, sound, and temperature, use of blackout drapes or sleep mask |
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What You'll Learn
Shift work sleep disorder (SWSD)
The development of SWSD is closely tied to the misalignment of the body's internal circadian clock with the external work schedule. The human body operates on a natural 24-hour cycle known as the circadian rhythm, which is regulated by a master internal clock located in the hypothalamus of the brain. This clock tells us when to be alert and awake and when to be less alert and awake by taking cues from patterns of light and darkness exposure coming through receptors in the eyes. When it is light outside, the master clock will promote wakeful alertness, and when it is dark, the master clock will promote reduced alertness. In shift workers, the timing of light exposure and the 24-hour sleep-wake schedule is disrupted, causing a desynchronization of the internal circadian rhythm.
The symptoms of SWSD are a natural response of the body to external circumstances that go against our biological rhythms. Humans are a diurnal species, which means that we are biologically designed to be active during the day and sleep at night. However, for some shift workers, work overlaps with this natural sleep period. This can cause insomnia, which can manifest as difficulty falling asleep or waking up before one has slept enough. People with SWSD tend to get less sleep, take longer to fall asleep, and have a harder time staying asleep compared to non-shift workers.
The risk of developing SWSD is more pronounced in long-term shift workers, and age may also play a role, with older people who work shift work often having more difficulties with sleep disruption, daytime sleepiness, and fatigue. Research has found that shift workers are at an increased risk of developing chronic health conditions, including obesity, insulin resistance, heart disease, gastrointestinal disorders, and metabolic and hormonal imbalances. They are also at greater risk of experiencing anxiety, depression, and elevated stress, which may further contribute to sleep problems.
There are several treatments available for SWSD, including light therapy, improved sleep hygiene, chronotherapy, and lifestyle changes. Caffeine and light therapy can help keep shift workers alert during their shifts, while blocking light, taking melatonin, and having a wind-down routine can help with sleep after shifts.
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Health risks of shift work
Shift work is associated with a wide range of health risks and problems. The human body follows a 24-hour cycle known as the circadian rhythm, which is influenced by light and darkness. Shift work, especially at night, often disrupts the body's systems regulated by this rhythm, including the sleep/wake cycle. The more years a person works a shift schedule, the higher their risk of chronic health issues.
Some of the health risks associated with shift work are outlined below:
Sleep Disorders
Shift work can lead to sleep disorders, with night shift workers frequently sleeping during the day when the body's signals to stay awake are strongest. As a result, daytime sleep can be short and disrupted, leading to excessive sleepiness at work, impaired work performance, and decreased alertness. This can also cause difficulty concentrating, a lack of energy, and poor mood or irritability.
Metabolic Disorders
Shift work has been linked to metabolic disorders such as metabolic syndrome, which includes health problems like high blood pressure, high blood sugar, obesity, and unhealthy cholesterol levels. These disorders increase the risk of diabetes, heart attacks, and stroke. Shift workers are more likely to snack at night and consume fewer healthy foods, contributing to these metabolic issues.
Cardiovascular Disease
Research has shown a strong association between shift work and the risk of cardiovascular disease, with one study indicating a 40% increased risk. Shift work has also been linked to high blood pressure and increased metabolic risk factors, further elevating the chances of developing cardiovascular disease.
Cancer
There is growing evidence that shift work increases the risk of certain cancers, including breast, colorectal, and prostate cancer. The disruption of the circadian rhythm and exposure to artificial light at night may contribute to this increased risk. The longer a person works night shifts, the higher their cancer risk appears to be.
Digestive Issues
Shift work can cause digestive upsets and gut dysfunction due to the disruption of the body's natural circadian rhythm, which influences digestion and other body functions.
Mental Health Issues
Shift work has been associated with higher rates of depression, emotional fatigue, and mood disturbances. It can also lead to feelings of isolation, as shift workers may feel cut off from their friends and families due to their unconventional work hours.
Accidents and Workplace Injuries
Excessive daytime sleepiness resulting from shift work can increase the risk of accidents and workplace injuries, especially for night shift workers.
While these health risks are concerning, it's important to note that not everyone who does shift work will experience all or any of these issues. Maintaining healthy lifestyle habits, adopting sleep strategies designed for shift workers, and seeking support from organizations that cater to shift workers can help reduce these risks.
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Light therapy
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterised by insomnia, excessive sleepiness, or both, affecting people whose work hours overlap with the typical sleep period. Light therapy is a non-invasive, non-pharmacological treatment that has been proven effective in mitigating sleepiness and regulating the circadian phase shift in people with SWSD.
Nocturnal light exposure has been demonstrated to modulate circadian rhythms, postpone sleep onset, and augment daytime sleepiness. For individuals engaged in rotating shift work, exposure to morning light has been shown to reset circadian rhythms, enhance sleep quality during non-working days, and subsequently improve cognitive functioning during the next shift.
Moderator analyses revealed that medium-intensity light therapy for a shorter duration more effectively reduced sleepiness at night, whereas higher-intensity light therapy more effectively induced phase shifting. However, the required treatment duration remains inconclusive. The success of light therapy might depend on the type of shifts worked and how many days in a row the same schedule is kept.
It is important to note that light therapy is just one of several strategies that can be employed to improve sleep quality for shift workers. Other strategies include taking naps, drinking caffeine, blocking light, taking melatonin, and improving sleep hygiene and overall lifestyle.
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Sleep studies
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder that affects people who work outside the typical 9 am–5 pm workday. This includes those who work overnight, early morning, or rotating shifts. SWSD is characterised by insomnia, excessive sleepiness, or both, with symptoms manifesting during work hours and/or when one wants to be asleep.
The disorder can lead to several issues, including accidents, irritability, lower work performance, safety concerns, health problems, and substance abuse issues. Studies have associated SWSD with an increased risk of various health issues, including hypertension, cancer, low fertility, issues during pregnancy, obesity, diabetes, and mental disorders such as depression and anxiety.
To diagnose SWSD, healthcare providers may ask patients to keep a sleep journal for at least two weeks, recording sleep patterns, caffeine use, noise disturbances, and how rested they feel. A sleep study or other tests may also be recommended to rule out other conditions.
Treatment options for SWSD include light therapy, improved sleep hygiene, chronotherapy, and lifestyle changes. For example, blocking light and using a light therapy lamp during shifts can help with sleep after shifts and staying alert during them, respectively. Additionally, maintaining a consistent shift work schedule, minimising consecutive challenging shifts, and making time for sleep on days off can help manage the disorder.
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Lifestyle changes
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder that affects people who work outside the traditional 9 a.m. to 5 p.m. workday. This condition causes difficulties with falling and staying asleep, as well as unwanted sleepiness during working hours. It can lead to accidents, irritability, lower work performance, safety concerns, health problems, and substance abuse issues.
Sleep Routine and Environment
- Make sleep a priority and aim for 7 or more hours of sleep per day, as recommended by the American Academy of Sleep Medicine.
- Maintain a consistent sleep schedule, even on days off. This helps your body establish a regular sleep-wake cycle.
- Adjust your sleep schedule gradually before transitioning to a new shift. For example, if you're moving from an evening shift to a night shift, delay your bedtime and wake-up time by one to two hours each day to ease the transition.
- Create a relaxing sleep environment by using blackout curtains or a sleep mask to block out daylight. Earplugs or a white noise machine can help block out noise disturbances.
- Keep your bedroom cool, as a slight decrease in temperature can promote sleep.
- Establish a bedtime routine to wind down before sleep. This could include taking a hot bath or shower, reading, journaling, listening to relaxing music, or light stretching.
- Avoid vigorous exercise close to bedtime, as it can be stimulating and raise your body temperature. Opt for a short walk or light activities instead.
Light Therapy
- Use light therapy to help regulate your body's circadian rhythm. Purchase a light box or lamp that emits bright light. Use it for 15 to 30 minutes each day, or as recommended by a sleep specialist.
- If you need to sleep during the day, avoid exposure to sunlight in the morning. Wear sunglasses when outdoors or driving.
- Use blue light-blocking amber or orange-tinted goggles or glasses when using electronic devices before bed to reduce blue light exposure.
Diet and Meal Timing
- Eat three regular meals spaced evenly throughout your day. Regular meal times act as time cues for your body clock and help regulate sleepiness.
- Avoid eating a large meal within three hours of bedtime.
- Maintain a balanced, low-fat diet rich in fruits, vegetables, and whole grains. This can help prevent digestive issues, which are common in shift workers.
- Avoid excessive alcohol consumption, especially within three hours of bedtime. While it may initially help you fall asleep, it can disrupt your sleep later in the night.
Work Environment and Social Activities
- Discuss with your employer to create a bright and cool work environment, especially for night shifts. This can help promote alertness and productivity.
- Invite colleagues who work similar shifts to join you in social activities when others are at work, as it can be challenging to socialize with a different schedule.
- Plan your domestic duties and errands around your shift schedule to ensure they don't interfere with your sleep.
Medication and Supplements
- Consult your healthcare provider about taking melatonin supplements. Melatonin is a hormone that can help regulate your sleep-wake cycle and is available as a dietary supplement in some countries.
- Be cautious when considering sleeping pills and sedatives, as they can lead to dependency and addiction. Always seek medical advice before taking any sleep medications.
Remember, these strategies may not work for everyone, and it's important to find what suits your individual needs. If you're concerned about the impact of shift work on your sleep, consider seeking advice from a healthcare professional or a sleep specialist.
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Frequently asked questions
It is a sleep disorder that affects people who work outside the normal workday of 8:00 am–6:00 pm or 9:00 am–5:00 pm. This includes manufacturing workers, healthcare workers, law enforcement, 24-hour retail workers, security, truck drivers, pilots, and childcare providers.
SWSD is caused by a misalignment between an individual's body clock and their sleep-wake schedule, which is imposed by external factors such as a work schedule. Our body's internal clock, or circadian rhythm, is guided by natural light and darkness. When it is light outside, our body promotes wakefulness, and when it is dark, our body promotes sleep.
People with SWSD tend to get less sleep, take longer to fall asleep, and have a harder time staying asleep compared to non-shift workers. They may experience insomnia, excessive sleepiness, or both. Other symptoms include irritability, lower work performance, safety concerns, health problems, and substance abuse issues.
Healthcare professionals may use various assessments and procedures to diagnose SWSD, including sleep questionnaires, sleep diaries, sleep logs, and sleep studies. An overnight sleep study is usually not required.
SWSD can be treated using a combination of lifestyle changes, good sleep hygiene practices, and medication when needed. Light therapy, improved sleep hygiene, chronotherapy, and melatonin supplements may also help.
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