Shift Work Sleep Disorder

Defining shift work sleep Disorder

 Sleep disturbances are common among shift workers whose work hours are scheduled during the time that most people are normally sleeping. An estimated three-fourths of the shift-working population report sleep disturbances while working an alternate shift schedule.
The ability to adapt to shift work varies on an individual basis with some shift workers being more susceptible to the negative effects of an erratic sleep-wake schedule than others. A small subset of these shift workers experiences difficulty maintaining adequate sleep-wake function while working an alternate shift. These workers experience sleep deficits significant enough to impair their alertness, physical functioning, and work performance. Those individuals unable to tolerate the effects of a shift work schedule are diagnosed as having shift work sleep disorder (SWSD).

Evening shift

commonly referred to as the “second shift,” the evening shift generally starts at 2 PM and ends at (10 -12 AM. As a result of arriving home late, the bedtimes of these workers tend to be delayed. These workers spend more time in bed and report a greater total amount of sleep compared to individuals who work regular daytime shifts. In addition, napping is less common amongst this shift work population given that morning wake-up times occur later in the day.15 Previous research has shown that evening workers obtain approximately 7.6 hours of sleep per day compared to the 6.8 hours obtained by those on daytime work schedules. Workers on the evening shift obtain the most sleep of all alternate shift workers and are least likely to experience a sleep debt.

Rotating shift Workers

on rotating shift schedules sleep the least of all alternate shift workers. With shifts that are constantly changing, rotating shift workers never experience a set work schedule and often find it difficult to get adequate rest. Two crucial factors affect the ability of a worker to adapt to a rotating shift—the speed and the direction of the rotation. Speed refers to the number of day, evening, or night shifts that are worked consecutively before a scheduled shift change takes place. Fast rotations, in which shifts change every few days, result in a greater loss of sleep and prevent workers from acclimating to set work times.7 Rapid rotations are also associated with a reduction in total sleep time. Work hours on longer rotations that change every 3 to 4 weeks provide more time for workers to adapt to a particular work schedule.

forward or backward direction

 The direction of a rotation can be either forward or backward. Forward rotations operate in a clockwise  Changes in sleep architecture documented on electroencephalograms during daytime sleep have shown that most of the sleep loss involves a decrease in stage 2 and rapid eye movement (REM) sleep, with no effect on stage 3 or slow-wave sleep.
Night shift workers often take late afternoon or early evening naps to combat the effects of inadequate sleep. The end result is insufficient sleep during the daytime to overcome the nighttime sleepiness and fatigue endured on the next shift. The effects of sleep loss accumulate over time, and the impairments that are caused do not improve over a series of successive night shifts. The resulting sleep debt experienced by night workers is greater than that of daytime, evening, or rotating shift workers. Schedules such as the afternoon and evening shifts, generally allow more time for sleep than other schedules. Sleep disturbances are most apparent on review of the following 3 work schedules: night shift, evening shift, and rotating shifts.

A typical night shift

A typical night shift begins around 10 PM and ends at 8 AM. Night shift workers sleep during the day, at a time when most other people are awake. Daytime sleep tends to be shorter, about 5 to 6 hours in total duration, and lighter than nighttime sleep because of outside environmental noise that makes it difficult to initiate and maintain sleep. It has been estimated that permanent night shift workers sleep 1 to 4 hours less than daytime workers manner, with workers changing from day to evening to night shift. Backward rotations run counterclockwise, with shifts alternating from day to night to evening. In an effort to adapt to this counterclockwise schedule, workers try to go to bed earlier and earlier, which leave them very little free time to fulfil social and familial obligations. The timing of the shift changeover represents another area of concern, as a quick shift changeover may result in only 8 hours in between shifts, further curtailing the opportunity to sleep and the subsequent total duration of sleep.

Managements should consider SWSD

To achieve optimal performance at work, an individual must maintain a high level of alertness to function efficiently and productively. If workers perform poorly due to lack of sleep, the likelihood of making errors leading to injuries and accidents rises substantially. With many service and industrial occupations operating around the clock, it is unlikely that shift work schedules will disappear from the work place. Thus, efforts to minimize the short-term and long term adverse effects of shift work are of great importance. An individualized approach to the care of patients with SWSD is key to facilitating the realignment of the circadian clock with the worker’s sleep-wake schedule. This realignment is crucial to improving the symptoms of sleepiness and fatigue. With the use of alternate shifts being determined by the demands of the job industry, employers must assume responsibility for safeguarding the well-being of the employees assigned to shift work. Through a collaborative effort between employer and employee, a work schedule that incorporates several short breaks into the shift, fewer successive shift changes, and shorter shift lengths may be developed and implemented. Such changes could potentially minimize sleep deficits and preserve the sleep quality and sleep duration of shift workers. On the world now more positions in the job market will likely open for the hire of new shift workers. As additional occupations extend their hours to accommodate the schedules of evening, nighttime, and rotating shift workers, .The main challenge will be to recognize and treat this disorder in a society geared toward around-the clock production and services.

How can I deal with SWSD?

Shift workers must be willing to make sleep a priority. People who work shifts other than a 9:00 am to 5:00 pm routine might have to prepare for sleep even though it might be daylight outside. Minimize exposure to light on your way home from work if you are on the night shift to keep morning sunlight from activating your internal “daytime clock.” Follow bedtime rituals and try to keep a regular sleep schedule – even on weekends.
Go to sleep as soon as possible after work. It is important to get at least 7 to 8 hours of sleep every day. At home, ask family and friends to help create a quiet and peaceful setting during your sleep time.
Have family members wear headphones to listen to music or watch TV. Encourage people in the household to avoid vacuuming, dish washing, and other noisy activities during your sleep time. Put a “Do Not Disturb” sign on the front door so that delivery people and friends will not knock or ring the doorbell. Some general guidelines for decreasing the effects of SWSD
Decrease the number of night shifts worked in a row. Shift workers working the night shift sleep less than day workers and become progressively more sleep deprived over several days. You are more likely to recover from sleep deprivation if you can limit your number of 8-hour third shifts to five or less in a week, with days off in between. If you work a 12-hour shift, you should limit work to no more than four shifts in a row. After a string of night shifts, you should have more than 48 hours off. 
Avoid extended work hours. Avoid working prolonged shifts and putting in excessive overtime. Make sure you have time to sleep and participate in family and social activities.

Avoid long commutes which can take time away from sleeping.
Avoid frequently rotating shifts. It is more difficult to deal with rotating shifts than it is to work the same shift for a longer period of time.
Get enough sleep on your days off. Practice good sleep hygiene by planning and arranging a sleep schedule and avoiding caffeine, alcohol, and nicotine. Do not start a night shift sleep deprived.
Caffeine and a prescription wake promoting drug such as modafinil (Provigil®) are effective in promoting wakefulness during work hours in select cases. But the best strategy is to get adequate sleep.

How to deal with shift work .

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