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According to 2004 data from the Bureau of Labor Statistics, almost 15 million Americans work full-time on evening shift, night shift, rotating shifts, or other employer-arranged irregular schedules. Shift work has been shown to have a number of negative effects on sleep, quality of life, and health, including a rating as a "probable carcinogen" by the World Health Organization. What's the connection with cancer? A leading theory is that exposure to blue light during inappropriate times of the day may disrupt our bodies' natural cancer-fighting abilities.
Shift work disorder is defined by the International Classification of Sleep Disorders, Third Edition (the diagnostic bible of sleep medicine) as necessarily having all of the following criteria:
There is a report of insomnia and/or excessive sleepiness, accompanied by a reduction of total sleep time, which is associated with a recurring work schedule that overlaps the usual time for sleep.
The symptoms have been present and associated with the shift work schedule for at least three months.
Sleep log and actigraphy monitoring (whenever possible and preferably with concurrent light exposure measurement) for at least 14 days (work and free days) demonstrate a disturbed sleep and wake pattern.
The sleep and/or wake disturbance are not better explained by another current sleep disorder, medical or neurological disorder, mental disorder, medication use, poor sleep hygiene, or substance use disorder.
Unfortunately, with our 24/7 economy, shift work is here to stay. Here are some tips to help you manage the situation and protect your sleep and health:
(1) Go to the Cave
Superman had his Fortress of Solitude, you need your cave when sleeping during the day after a night shift. Our retinas contain intrinsically photosensitive ganglion cells which send messages to our brains to "wake up" when exposed to even minute amounts of light. Cover all of your bedroom's windows with black trash bags or blackout window treatments. Remove or cover all bedroom electronics that emit visible light. Alternatively you can invest in a quality eye mask to shield you from light while sleeping.
(2) Sleep Is Sacred
Everyone in the household must respect the importance of your sleep. I remember treating a patient who had a side e-commerce business with his wife and was unfortunately tasked with accepting packages from UPS during his "protected sleep time." Have a family meeting to discuss why sleep is important to your health and formulate a plan to minimize noise and other disturbances while you are getting your 7-8 hours. Use white noise machines to combat ambient noise, which usually increases during daytime hours.
If you can't get the recommended 7-8 hours in one block, making up the deficit with naps is the next best thing. Night shift workers are at increased risk of motor vehicle accidents while driving home from work, due to their circadian rhythms being disrupted. If you think you might have a problem with sleepiness on your drive home, take a brief nap at work or in your car prior to departing.
(4) Anchor Sleep
With a natural desire to be a part of society, the majority of night shift workers "flip" their sleep/wake schedule on their days off, meaning that they transition to staying awake during the day and sleeping at night. This can wreak havoc on your circadian rhythms, resulting in sleep deprivation, daytime sleepiness and fatigue. "Anchor sleep" is a concept that refers to overlapping at least 4 hours of sleep during the same timeframe on your work days and your off days. So, as an example, if you normally sleep from 9 a.m. to 5 p.m. when you're on duty, try to maintain a schedule on your days off where you sleep from 5 a.m. to 1 p.m. your body will thank you.
Stimulating medications play an important role in managing shift work disorder. These medications should only be tried if you're still suffering even after all of the above actions have been attempted. Provigil (generic name modafinil) is a "wakefulness promoting medication" (mechanism of action officially "unkown") that is FDA-approved for shift work disorder. It is a prescription drug and a Schedule IV controlled substance, so you'll have to speak with your doctor about it. Provigil is generally well-tolerated, but common side effects include headaches and anxiety. There is a theoretical risk of the medication increasing blood pressure, but it is generally felt to be safer from a cardiovascular risk standpoint than stimulants such as Ritalin and Adderall. Importantly, women need to be aware that Provigil can reduce the efficacy of oral contraceptives and may need to employ a second method of contraception.
Shift work disorder is a significant problem for the American workforce, and economic trends suggest that it will likely be a growing problem. Thankfully, you can take steps to be proactive in minimizing the negative effects of shift work on your health.
Author: Joseph Krainin, M.D. FAASM is a board-certified sleep medicine physician and the founder of Singular Sleep, the world's first virtual sleep center. Singular Sleep specializes in online sleep doctor consultations and home sleep apnea tests.
The primary goal of the American Sleep Association is to increase public awareness about the importance of sleep health and the dangers of sleep disorders. ASA was founded in 2002 by sleep professionals as a member-driven public awareness effort.