What Is Shift Work Disorder? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Shift work disorder is a sleep disorder that specifically affects people working either night shifts or rotating shifts outside of a more common nine-to-five-type schedule. Working (or doing other activities) when the body would typically sleep goes against the body’s natural circadian rhythm, which may make it tougher for people with these schedules to sleep when they have the opportunity to.
When a work schedule conflicts with a sleep schedule, it can cause insomnia and extreme sleepiness during waking shift hours.
Shift work disorder can come from any work cycle if it disrupts your sleep, according to Debra Stultz, MD, a psychiatrist and sleep physician in Barboursville, West Virginia. For example, someone who has to get up extremely early for a long morning commute may also develop the disorder.
It’s considered a circadian rhythm sleep disorder because the sleep problems involve the body’s internal clock, which interacts with our external environment (different parts of the brain intake cues from things like the sun, our physical activity level, and our eating schedule) to establish a daily sleep-wake cycle.
Some people who work overnight (or other nonconventional schedules) are able to adapt to shift work, and might not experience symptoms of shift work disorder. Others may not be able to get enough consistent sleep when their sleep cycle is disrupted.
Shift work disorder can disrupt your daily life.
In addition to difficulty sleeping and feeling extremely tired on a regular basis, according to Cleveland Clinic, you may also experience:
People with shift work disorder have sleepiness that’s built up over time, so they just never feel rested, according to Dr. Stultz.
Shift work disorder, like other sleep disorders, is caused when the body doesn’t get enough uninterrupted quality sleep on a regular basis.
According to the Centers for Disease Control and Prevention, adults need seven or more hours of sleep per night.
With shift work disorder, the sleep problems are due to a sleep-wake schedule that doesn’t align with the body’s natural circadian rhythm. Our circadian rhythm is the (approximately) 24-hour cycle the body uses to set sleeping and waking times based on the light exposure you get during the day. Shift work disrupts it because you might be going to work when your body wants to sleep and trying to sleep when your body thinks it should be awake.
Working night shifts, having to wake up extremely early for a morning commute, or working swing shifts where hours can change from morning to evening can all put you at risk for shift work disorder.
Not everyone who works nontraditional hours gets shift work disorder; some people are able to adapt or compensate by taking naps.
Additionally, those who describe themselves as night owls might have an easier time adjusting to an evening shift than those who describe themselves as morning people, according to the American Academy of Sleep Medicine (AASM).
According to Cleveland Clinic, about 20 percent of full-time workers in the United States engage in shift work, and an estimated 10 to 40 percent of shift workers have shift work disorder.
In order to get a diagnosis, you’ll need to speak with a doctor. They’ll ask questions about your work and sleep patterns and may want to do a physical exam to rule out other conditions. You can start by talking to a primary care doctor, who will likely refer you to a doctor who specializes in sleep.
“Those with shift work disorder are usually diagnosed based on their sleep history,” says Holly Schiff, PsyD, a clinical psychologist in Greenwich, Connecticut. “Doctors review their sleep-wake patterns and activities using a sleep log.”
A sleep log or sleep diary is a daily record you keep of when you go to sleep and when you wake up.
Michael Breus, PhD, a clinical psychologist and clinical sleep specialist, says sleep data can now be gathered using a wrist monitoring device called an actigraph. This device might be paired with your log to get a better picture of your sleep patterns.
A doctor might also recommend a sleep study to rule out other sleep disorders, such as sleep apnea.
Shift work disorder is characterized as a circadian rhythm disorder that affects people because of a work schedule that interrupts the body’s ability to get quality sleep.
According to the National Heart, Lung, and Blood Institute, other circadian rhythm disorders that characterize sleep disruption due to other causes include:
If someone with shift work disorder isn’t able to change their work schedule, treatment focuses on improving sleep duration and quality. Changes in daily behaviors and routine can help someone with shift disorder get more rest. There are also a few medications used to help with alertness during waking hours, and to promote sleep.
Sometimes making lifestyle and behavior adjustments can help people sleep at times their circadian rhythms would not otherwise have them sleep.
If you can when you’re started a new work schedule (that will not align with typical working hours), Stultz recommends rotating shifts in a forward direction so you move from an earlier work schedule towards a later work schedule, limiting the number of consecutive days of shift work, limiting overtime work, and limiting commute times.
Try making these lifestyle and behavioral changes to help ease shift work disorder symptoms:
Medications prescribed for shift work disorder include those to keep workers alert during work hours and those to help promote sleep during desired sleep time.
Stultz says there are three medications used for the disorder:
These medications can help keep you alert during a shift if you’re extremely tired. However, they can have side effects and might become habit-forming if used over time.
Your doctor also may prescribe sleeping pills to help you sleep at the end of a shift.
But, prescription sleep aids come with risks of side effects, like building intolerance over time. Some people also become dependent on them once they start taking them, so it’s recommended to use them for a short period and discuss use with a doctor. You’ll also want to be careful not to take these too close to the beginning of your next shift.
Before taking any medications for shift work disorder, it’s important to discuss your options and potential side effects with your doctor. Your healthcare provider can help decide if medication is right for you and which one.
Some other therapeutic approaches include:
It can be challenging to prevent shift work disorder, especially if you don’t know how shift work will impact your sleep cycle.
“Usually, those with shift work disorder experience fewer symptoms after changing to a more traditional work schedule where they work during the day and sleep at night,” says Schiff.
You can minimize the negative effects by implementing lifestyle and behavior changes early on. Try to establish a regular sleep routine.
Schiff says keeping a regular schedule can help align your body clock with your sleep pattern and having this consistency can increase the quality of your sleep.
Since it involves sleep loss over a long period of time, shift work disorder can have several physical and mental complications.
It can put people at an increased risk of the following conditions, according to AASM and Cleveland Clinic:
Other complications include:
According to the U.S. Bureau of Labor Statistics, about 16 percent of workers have shift work schedules. Those who work in service occupations have a high rate of shift work, research suggests. Service jobs with high rates of shift work include:
Research suggests that more than 1 in 5 of these shift workers experience shift work disorder.
About 10 to 20 percent of the general population is affected by insomnia, but in shift workers that number is higher — ranging from 12 to 76 percent higher, per research.
There isn’t a lot of research that’s looked at if or how shift work disorder might affect Black, Indigenous, and People of Color (BIPOC) differently than people of other backgrounds — or if it is more or less common.
However, 2017–2018 data from the U.S. Bureau of Labor Statistics shows that Black and Hispanic or Latino workers work evening, night, and rotating shift schedules at a higher rate than white workers.
And one study found a link between long-term night-shift work and type 2 diabetes in African American women. While lack of sleep from shift work disorder can be a contributing factor in developing diabetes and other health conditions, it’s unclear from this study if sleep patterns were taken into account.
Shift work disorder is a circadian rhythm disorder. Circadian rhythm disorders are caused by disruptions in the body’s 24-hour sleep and wake schedule.
Related circadian rhythm disorders include:
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