To treat shift work disorder, doctors usually start with improving sleep hygiene with the nine tips covered at the beginning of this article. Using blackout curtains and keeping a regular sleep-wake schedule can help your body adjust to sleeping during the day. Stimulant medications such as Nuvigil and Provigil can relieve sleepiness when people need to be awake.
These drugs are approved for the treatment of excessive sleepiness related to shift work disorder, among other conditions. Sleep aids such as Ambien , Lunesta , and Sonata may be prescribed to help with falling asleep. Certain antidepressants and benzodiazepines may also be used to help with sleep. Doctors such as Fleming recommend that shift workers try proper sleep hygiene first. Sleep Disorders Feature Stories. These tips can help you get good sleep: Try not to work a number of night shifts in a row. You may become increasingly more sleep-deprived over several nights on the job.
You're more likely to recover if you can limit night shifts and schedule days off in between. Avoid frequently rotating shifts. If you can't, it's easier to adjust to a schedule that rotates from day shift to evening to night rather than the reverse order.
Try to avoid long commutes that take time away from sleeping. Keep your workplace brightly lighted to promote alertness. If you're working the night shift, expose yourself to bright light, such as that from special light boxes, lamps, and visors designed for people with circadian-related sleep problems, when you wake up.
Circadian rhythms are the body's internal clock that tells us when to be awake and when to sleep. These rhythms are controlled by a part of the brain that is influenced by light. Fleming says that being exposed to bright light when you start your "day" can help train your body's internal clock to adjust. Drinking a cup of coffee at the beginning of your shift will help promote alertness. But don't consume caffeine later in the shift or you may have trouble falling asleep when you get home. Avoid bright light on the way home from work, which will make it easier for you to fall asleep once you hit the pillow.
Wear dark, wraparound sunglasses and a hat to shield yourself from sunlight. Don't stop to run errands, tempting as that may be. Stick to a regular sleep-wake schedule as much as you can. Ask your family to limit phone calls and visitors during your sleep hours. This pattern of cause and effect has been reported for many groups of shift workers. A dip after lunch has also been described for lowered efficiency of performance and this is only partially dependent on the meal itself.
The shortening of the sleep period caused by an early start at work has also been shown to be associated with an increase in errors and accidents in transport workers. Workers who engage in shift work or who work long hours can experience considerable disruption of family and social activities as many of these rhythms of the general population are oriented around the day.
Saturday and Sunday work, for example, can preclude involvement in sporting events or religious activities. Shift work can thus lead to social marginalisation. Family and marital responsibilities can be severely disrupted by shift work or long hours. Childcare, housework, shopping, and leaving a partner alone at night can all lead to marital strain and family dysfunction.
On the positive side, for those shift workers who like relatively solitary leisure pursuits or who abhor the crowds often find that shift scheduling provides them with greater opportunities to do what they want to do in their non-working time.
Summary of health effects of shift work Reduction in quality and quantity of sleep. There is general agreement in publications that the effects of long hours of work or shift work has a deleterious effect on sleep. Perhaps the most authoritative review concludes that despite considerable variation between people, sleep loss is a major effect of shift work. The quantity of sleep may be reduced by up to 2 hours a day but there is also an effect on the quality of sleep.
Rapid eye movement REM sleep and stage 2 sleep have been shown to be reduced. Such sleep deficits can lead to sleepiness at work, with some data showing that inadvertent napping at work can result. Overall, the effect of shift work has been likened to a long distance traveller working in San Francisco and returning to London for any rest days. Fatigue is a common complaint among those working abnormal hours. It is particularly noticeable after the night shift, less so on the morning shift, and least on the afternoon shift. Fatigue, however, is a complaint that is exceedingly difficult to measure.
Some published evidence exists to suggest that there is a reduction in complaints of fatigue after objective improvement in physical fitness. Nevertheless, it remains an important, if vague, symptom which is often cited as a major reason for intolerance to shift work. Shift working can be a potential psychosocial stressor. Stress is, however, a difficult concept to define, let alone measure. Many published reports on working hours cite stress as a problem but such reports all too commonly lack scientific rigour, acquiring these data from self administered questionnaires and case reports.
The increasing use of validated questionnaires such as the general health questionnaire GHQ and, more specifically, the standard shift work index SSI developed by Barton and Folkard8 has improved the researchers' ability to characterise and measure the effects of shift work on mental health. Anxiety and depression indices also point to the likelihood of an adverse effect on mental health from shift work and long working hours. Nevertheless it must be remembered that, by and large, shift workers are a self selected population.
Thus the question of whether shift work causes psychiatric mortality or shift workers have pre-existent psychiatric problems is not entirely resolved. There seems to be increased neuroticism with increasing years of shift work, but neuroticism in itself does not predict health related shift problems. In , the general consensus was that there was no firm evidence that cardiovascular disease was more prevalent in shift workers than other groups.
The health outcomes are mainly angina pectoris, hypertension, and myocardial infarction.
The effect of overtime or long hours of work has been less extensively investigated. One mortality study from California showed increased rates of arteriosclerotic heart disease for male occupational groups in increasing proportions of the population who worked more than 48 hours a week. The publicity surrounding the Japanese phenomenon of Karoshi sudden vascular death and overwork is relevant here but the published studies are little more than case series and thus lack epidemiological rigor. Many shift workers complain of digestive disorders, which may be a reflection on the poor quality of catering on some shifts.
Night workers seem to have the most complaints of dyspepsia, heartburn, abdominal pains, and flatulence. The data in these studies are not particularly robust. It is necessary to realise that psychosomatic disorders are common in the general population and to recognise the influence of several other factors including Helicobactor pylori, infection, family history, and lifestyle. There is increasing evidence to suggest that shift work and particularly night work, may present special risks to women of child bearing age.
Specific health outcomes linked to shift work include increased risk of spontaneous abortion, low birth weight, and prematurity. The evidence for subfertility is less convincing. Summary of safety effects of shift work Poorer performance especially at night.
This area has already been alluded to. Until relatively recently, much of the evidence for a performance decrement associated with long hours of work relates to some excellent studies undertaken by Vernon et al11 on munitions workers in the first world war. The studies are thorough, well designed, and clearly show that reducing hours of work by between 7 and 20 per week down to 50—55 hours per week resulted in an improvement in the quality and quantity of units produced.
Since these studies, much of the research effort has been concentrated on laboratory based work because comparability of working conditions between shifts is difficult to find in the work situation. Some well designed workplace studies, however, support the laboratory based research. In short, there is a persuasive body of evidence to suggest that performance output is poorer at night. However, performance of tasks with a high working memory component is less dependent on endogenous circadian rhythm and thus may have relatively rapid adjustment to night work.
This implies the need to view the task as well as the person in tailoring the shift system.
The cause of industrial accidents is exceedingly complex but the link between increased fatigue with lowered performance and subsequent high rates of accidents would seem logical. Publications on working hours do not support this very well, largely because many of the studies have inadequate analytical procedures, or failed to allow for the many confounding factors that can influence accident statistics.
However, some recent well designed studies have shown an increased risk of accidents on the night shift and with long working hours. Several studies have shown peak accident rates at around and and again between and but this probably reflects peaks in work activities as performance capabilities due to circadian rhythms should be relatively high at these times.
Finally, on an anecdotal note, it is interesting that some major catastrophes such as Three Mile Island, Chernobyl, Exxon Valdez, and the space shuttle Challenger all started in the early hours of the morning with errors by people who had been on duty for long hours.
This is an area that has received scant attention but clearly could be important in terms of long working hours or possible chemical variation in pharmokinetic handling of absorbed chemicals. What is clear is that occupational exposure limits are almost invariably calculated on the basis of an 8 hour day, 5 day week. Scaling down these limits to accommodate long working shifts such as 10 or 12 hours or making allowances for diurnal variation in metabolic processes is no easy task and no rules are available to accomodate these variations in working hours.
There is a potential toxicological problem here but no solutions at present. Many countries have long banned the employment of women on shift work.
The emergence of equal opportunity legislation has questioned the basis for such prohibition. It seems that women complain of more sleepiness on shift work 4 but the physiological basis for this is difficult to substantiate. Some of the increased difficulties that women have on shift work are related to their greater domestic obligations and to the broad based assertion that women tend to report health symptoms more often than men.
Also there does seem to be some evidence for an adverse reproductive effect already noted. Intuitively, it might be proposed that shift working would be better tolerated the older the worker becomes. They might have less domestic pressures from small children, more experience of coping in general, and older people seem to require less sleep than younger people. Furthermore, the shift worker who has been working such schedules for decades is, of course, part of a survivor population. In fact, the research findings support the opposite. The evidence all points in the direction of asserting that the aging worker tolerates shift work less well than younger colleagues.
With age, sleep becomes shorter and more fragmented. This does not necessarily reflect a need for less sleep but simply an inability to achieve so easily what is needed.
What is clear, therefore, is that whereas the aging shift worker may cope, it is inadvisable to begin shift work at an older age. It may be simplistic to view introvert-extrovert personality types in this way but there is some physiological support for the importance of personality if people are viewed as morning types and evening types. People who are at their best in the morning face more difficulties in adjusting their circadian rhythms to night work compared with those who feel better in the evening.
By contrast, evening types have greater problems with the early morning shift.
Physical factors may also play a part and are discussed later. Most of the work on minimising the deleterious effects of shift work has concentrated on the three 8 hour shift rotation. As the night shift seems to cause a disproportionate amount of the problems of shift work, night work should be reduced as much as possible, perhaps by increasing the number of crews involved.
Rapid rotation of shifts a change every few days is preferable to slow rotation as this schedule produces less interference with circadian rhythm. Clockwise rotation morning, afternoon, night is preferable to counter clockwise rotation as quick changeovers—for example, the morning and the night shift in the same 24 hour period—are avoided and this rotation allows longer rest periods between shifts. Finally, a later start for the morning shift which is traditionally reduces the truncation of the previous sleep period, particularly for REM sleep.
On balance, the duration of shift should not be extended to 10 or 12 hours as complaints of fatigue are greater on the long shifts. However, the evidence that this translates into poorer performance and increased accidents is lacking. Finally, there is some evidence that allowing the workers to design their own shift schedules encourages good work performance as they take responsibility for achieving the work output targets.