*Nothing in this article constitutes medical advice. Seek the guidance of a physician if you have any questions.*
Every morning, about 80% of the American workforce wakes up to begin their morning routine before beginning work for the day. Whether that work is at home on a computer, at a construction site, a school, a fast-food restaurant, or a military base, this is a routine observed by roughly 126 million Americans. In contrast, about 20% of the United States working population participates in off-hours “shift work.” Some of these individuals are at risk of developing “shift work sleep disorder (SWSD).” Today, let’s better understand the mechanisms, symptoms, and management strategies of SWSD.
What Is Shift Work Sleep Disorder?
Before we can define SWSD, we will first need to understand what “shift work” is. In the world of SWSD, “shift work” is defined as “any work schedule that falls outside the hours of 7 am and 6 pm.” Generally, this means that the entirety, or at least the majority, of a person’s work falls outside of those hours. Many different professions commonly require individuals to participate in shift work.
- Healthcare: Individuals such as doctors, nurses, or physician’s assistants may regularly work outside of 7-6
- Overnight store employees: Whether at a grocery store, hardware store, warehouse, or factory, many stores require individuals to work “the night shift.”
- Food-service workers: Many individuals who work as waiters, waitresses, hosts, or hostesses may not start work until the early afternoon, and they may not finish work until the early morning hours.
- “Third shift”: In many industries - transportation, reception, security - the “third shift” employee is the individual who works overnight to relieve the day shift employees.
Generally, individuals who are at risk to develop, or do develop, SWSD participate in shift work for a length of time. In other words, someone who works a shift outside of 7-6 occasionally would not be an individual with a high risk of developing SWSD.
Like many other sleep disorders, SWSD can have overlapping symptoms with related conditions. With that in mind, here is a list of common symptoms according to the Cleveland Clinic.
- Difficulty sleeping and excessive sleepiness
- Difficulty concentrating,
- Lack of energy
- Lack of motivation
These symptoms likely look somewhat similar to individuals who experience insomnia, night terrors, night sweats, or sleep apnea.
As implied by the name, shift work sleep disorder is primarily caused by the routine of shift work. But what does this mean?
As discussed previously, people who participate in shift work for extended periods of time are the most likely to develop SWSD. Biologically, the underlying issue revolves around the body’s internal “circadian rhythm.” The circadian rhythm is essentially the body’s “internal clock.” It controls the sleep-wake cycle. This is why we start to feel sleepy at night and begin to feel alert in the morning. While every person has their own, unique circadian rhythm, practically all humans’ rhythms are tied to the 24-hour cycle of the earth’s rotation.
When a shift worker begins to “break” this cycle by working during the night time and sleeping during the day time, this is the core cause of SWSD. The problem is usually two-fold.
- Length: The average SWSD patient sleeps “1 to 4 hours less than non-shift workers” according to the Cleveland Clinic. Obviously, this decrease in sleep amount can lead to many of the indicated SWSD symptoms like fatigue and lack of energy.
- Quality: Due to the “breaking” of the circadian rhythm, shift workers are also susceptible to decreased sleep quality. This generally arises from a decrease in REM sleep, a particularly restorative and necessary stage of sleep.
Akin to other sleep-related disorders, SWSD can cause a variety of complications aside from the indicated symptoms. These may include:
- Accidents or work-related errors
- Mood problems
- Poor coping skills or impaired social functioning
- Health-related complaints — gastrointestinal, cardiovascular, and metabolic problems can be common
- Drug and alcohol dependency can develop
Managing Shift Work Sleep Disorder
Now that we understand how to recognize SWSD, what are some strategies to combat the disorder? Here are a few key strategies to minimizing the effects.
Make Sleep a Priority
This may sound simple - but it’s easier said than done! Shift workers need to make every effort to make sleep a top priority. There are many ways to accomplish this.
- Set boundaries: Tell your friends and family when “your” sleeping hours are. If the people in your life know when you should be sleeping, it can help limit distractions.
- Keep a schedule: This point is true for all people who want a higher level of sleep quality, but it is especially important for individuals at risk of developing SWSD. Maintaining the same sleep-wake schedule, even on weekends and holidays, is vitally important to “teaching” your circadian rhythm when you want to fall asleep and when you want to be awake.
Sleep Your “Best Sleep”
- Create a conducive sleep environment: Most of us have the luxury of darkness when sleeping. This is not true for many shift workers. You may have to fall asleep at noon, right when the sun is at its brightest. Eye masks or blackout curtains can be very useful here. Also, if you live in a noisy environment, earplugs can be a lifesaver.
- Limit shift work nights: A good rule of thumb is to ensure that you’re not working more than 5 nights in a row of a specific night shift. For workers who are on the clock for 12-hour shifts, they should limit the number of consecutive nights to four.
If any of the above symptoms, complications, or conditions sound familiar to you or a loved one, contact your physician. Sleep is extremely important for a litany of different health reasons, so make sure to make good, quality sleep a top priority in your life.