Late at night, as most of us sleep, there are millions of people working to keep us safe, provide medical care and create new products as we dream. These people are shift workers, and they fight a constant battle with their internal circadian rhythm.
Because these rhythms are very much controlled by light and dark, shift workers are constantly going against what their body naturally wants to do. The result is a condition called shift work disorder, which can cause excessive sleepiness, fatigue, changes in endocrine function, cardiovascular disorders, depression, weight gain and unrefreshing sleep.
When diagnosing shift work disorder, it is important to rule out any other sleep disorders, including obstructive sleep apnea, insomnia or narcolepsy, as these can compound the problem. Schedule a polysomnogram if needed, but request that it be performed during the patient’s regular sleep hours.
Also discuss sleep hygiene, but remember that once patients leave the office, many will forget parts of your conversation. Providing a sleep hygiene handout to reference at home can help with compliance. It is important that patients with shift work disorder keep a regular schedule, even on days off. This can be difficult due to family responsibilities, but advise patients to stick as close to their regular sleep schedule as possible.
When treating shift work disorder, consider using bright light therapy before medications. Bright light improves wakefulness, attention and concentration. General guidelines suggest using light sources that ranges between 2,500 lux and 10,000 lux. Recommending bright light therapy in the early part of a night shift will help promote sleep after patients complete their shift.
When leaving for home, patients should wear sunglasses to help protect against direct sunlight exposure. At home, their room should be kept dark. Room darkening shades or an eye mask can be helpful.
Sleep aids and stimulant therapy may be used if improved sleep hygiene and bright light therapy do not control symptoms.
Ultimately, working a regular shift is the most helpful treatment for shift work disorder. But this is not always possible. After all, where would we be if the medical community closed shop at 5:00 pm?
Last, but not least, be sure to thank those who stay awake at night for their hard work and dedication. It is because of them that we feel safe and sound in our beds.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
- Chokroverty S. “20 Questions and Answers About Shift Work Disorder.” Sudbury: Jones and Barlett Learning, 2012.