II. Epidemiology
- Hypersomnolence occurs in 20% of Night Shift Workers
III. Adverse Effects
- Decreased productivity
- Safety and injury risk
- Limited sleep to 4-5 hours in prior 24 hours is equivalent to driving while intoxicated
- Green (2020) West J Emerg Med 21(6): 219-24 +PMID: 33207169 [PubMed]
- Decreased quality of life
- Adverse health effects including decreased Life Expectancy
IV. Diagnosis: Excessive night shift Sleepiness
- Uses Daytime Sleepiness tools validated for night shift work
- Epworth Sleepiness Scale
- Multiple Sleep Latency Test
V. Management: Daytime Insomnia (sleeping during the day)
- Non-medication management
- See Sleep Hygiene
- Minimize light exposure while traveling home to bed (e.g. dark sun glasses)
- Keep bedroom dark
- Medication management
- Melatonin
- Dose: 3 mg before bed
- Consider prior to mid-afternoon nap
- Sedative-Hypnotics (e.g. Zolpidem)
- Melatonin
VI. Management: Nighttime Hypersomnolence (staying awake overnight)
- Non-medication management
- Keep work area brightly lit
- Take a nap prior to overnight shift
- Maintain 8 hours sleep per 24 hours
- Exercise prior to work
-
Caffeine
- Limit to 400 mg/day (e.g. maximum of 24 ounces coffee per day)
- Avoid within 4 hours of bed time
- Stimulants
- Preparations
- Adverse effects
- Headaches, Nausea, daytime Insomnia
- Diminish efficacy of Oral Contraceptives
- Abuse potential (albeit lower than Methylphenidate and other stimulants)
VII. Resources
- Cochrane