Def: insomnia and excessive sleepiness from work hours that overlap usual sleep time
More common with night, early or rotating shifts than late or split shifts
Prevalence up to 38% in rotating shift workers
Health and safety concerns
Safety risk: occupational accidents, professional drivers
Higher rates of mental and physical health problems
Epidemiological links to metabolic and CV dz
Reports of higher rates of certain cancers
Risk factors
- Age
- Mental and physical health problems
- Social pressures after shifts, incl childcare
- Chronotype: early chronotypes sleep less in the daytime
- Individual flexibility of circadian timing and sleep homeostasis
Assessment
Actigraphy with sleep diary to quantify TST across multiple days
Treatment
Stopping shift work is ideal but often not practical
1. Scheduling
Clockwise shift rotation (day, late, night, off)
Avoid many consecutive night shifts
Regular scheduled breaks
2-hr nap before night shift is better than 2-hr nap during shift
2. Sleep education
Encourage good sleep behavior, undo bad habits
Blackout, quiet sleep environment
Limit interruptions
Standard stimulus control and scheduling advice
Recognize critical times of vulnerability
If naps needed, keep to 10-20 min
3. Medications
Caffeine before sleepiness starts, not after
Modafinil (200 mg) and armodafinil (150 mg) FDA approved for SWD, take ~1 hr before shift
Low-dose melatonin (0.5 mg) can help daytime sleep
4. Light therapy
Nocturnal bright light sometimes used, caution esp with short runs of night shifts
- Oxford Handbook of Sleep Medicine 2022