Sleep

Shift Work Disorder

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Shift Work Disorder, Night Shift Worker

  • Epidemiology
  1. Hypersomnolence occurs in 20% of Night Shift Workers
  • Adverse Effects
  1. Decreased productivity
  2. Safety and injury risk
  3. Decreased quality of life
  4. Adverse health effects including decreased Life Expectancy
  1. Uses Daytime Sleepiness tools validated for night shift work
  2. Epworth Sleepiness Scale
  3. Multiple Sleep Latency Test
  • Management
  • Daytime Insomnia (sleeping during the day)
  1. Non-medication management
    1. See Sleep Hygiene
    2. Minimize light exposure while traveling home to bed (e.g. dark sun glasses)
    3. Keep bedroom dark
  2. Medication management
    1. Melatonin
      1. Dose: 3 mg before bed
      2. Consider prior to mid-afternoon nap
    2. Sedative-Hypnotics (e.g. Zolpidem)
  1. Non-medication management
    1. Keep work area brightly lit
    2. Take a nap prior to overnight shift
    3. Maintain 8 hours sleep per 24 hours
    4. Exercise prior to work
  2. Caffeine
    1. Limit to 400 mg/day (e.g. maximum of 24 ounces coffee per day)
    2. Avoid within 4 hours of bed time
  3. Stimulants
    1. Preparations
      1. Modafinil (Provigil)
      2. Armodafinil (Nuvigil)
    2. Adverse effects
      1. Headaches, Nausea, daytime Insomnia
      2. Diminish efficacy of Oral Contraceptives
      3. Abuse potential (albeit lower than Methylphenidate and other stimulants)