Shift work sleep disorder is common among persons whose working hours fall between 6 PM and 7 AM. Some night or overnight shift workers cannot stay alert at work or sleep well when off duty, endangering others on the job or while driving.
When shift work sleep disorder is suspected, find out:
- Is the patient getting enough sleep? The average rotating shift worker sleeps 6 hours nightly1 while working the night shift.
- Is another sleep disorder present? Obstructive sleep apnea, restless legs syndrome, or other common comorbidities may also be disrupting sleep.
- Is an unrecognized comorbid psychiatric disorder present? Not surprisingly, major depression, chemical dependency, and other untreated psychiatric disorders impede adherence to a sleep schedule.
- Is caffeine being used appropriately? Shift workers can effectively use caffeine as an alerting agent but should only use it within 4 to 6 hours after arising. Advise patients against consuming beverages or foods containing caffeine within 8 to 10 hours of bedtime.
Promoting sleep
To help the patient get ample sleep, encourage him or her to:
- find time for uninterrupted sleep. Family time, social events, and errands must be scheduled so that they do not interfere.
- maintain a consistent sleep schedule when possible. Workers with long night shifts should try to stay awake all night and sleep during the day, even on days off.
- use bright lights during waking hours to promote alertness and prevent sleep disruption. Bright light has been shown to influence the human circadian clock.2
Some workplaces are installing artificial lights to increase light exposure during night work. Night shift workers traveling home in the morning should wear sunglasses to limit light exposure.
Also consider prescribing:
- a short-acting hypnotic. Although not specifically FDA-approved for shift work sleep disorder, medications such as zaleplon or zolpidem can reduce time to falling asleep and increase sleep without producing a hangover effect.
- a wakefulness-promoting agent. The FDA recently approved modafinil for reducing excessive daytime sleepiness in shift work sleep disorder. Patients take modafinil, 200 mg/d, shortly after arising to increase alertness at work. Be sure to advise patients that the medication is not a substitute for getting adequate sleep.