Shift Work Sleep Disorder (SWSD): Treatments and Diagnosis

Shift work sleep disorder or SWSD is a sleep issue that primarily affects people who work abnormal hours outside of the body’s internal clock, such as:

• Graveyard (night shift)
• Early morning shifts
• Rotating shift workers
• Other abnormal hour schedules

Such irregular work shifts upset the body’s circadian rhythm, disrupting proper sleep. Shift work sleep disorder can cause many problems with your daily activities.

Shift work sleep disorder can be devastating to your life and activities. It can be difficult to adjust to a different work schedule, and many never fully adjust. How well a person adjusts depends on how long their abnormal schedule lasts and how swift the schedule changes are.

“As a result, people with SWSD will have trouble sleeping,  staying alert when awake and suffer from depression, anxiety, cognitive impairment and overall life management issues,” noted Dr. Nayantara Santhi.

Almost 25% of the workforce is assigned abnormal and on-call shifts for work, and this number is still likely low. Since the pandemic, more people are working from home and able to choose their own schedules, with many choosing to work late nights or early mornings so as not to not disrupt family members.

Difference Between Insomnia and Shift Work Sleep Disorder

The two primary symptoms of SWSD are insomnia and excessive daytime sleepiness. Here is some more information on each.

Insomnia

Insomnia is when you have “persistent difficulty” with falling and staying asleep. When a person has insomniaVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source, they will often have plenty of time allotted for sleeping but have trouble getting proper sleep in that time.

Someone with insomnia can haveVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source various sleep problems, including falling asleep, staying asleep, or even reaching deep sleep during their sleep time. Insomnia can significantly diminish performance and cognition.

People who suffer from insomnia do not necessarily suffer from shift work sleep disorder. This is because insomnia can result from many different health conditions. However, studies show that insomniaVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source is a common occurrence in those with SWSD.

SEE ALSO: Best Mattresses for Insomnia

Excessive Daytime Sleepiness

As the term suggests,excessive daytime sleepinessVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View sourceis when a person is overtired when they should be feeling awake, often to the point that they’re at risk of nodding off. SWSD can cause a reduction in alertness while at work or carrying out daily activities, especially during the day.

Some impairments from insomnia and excessive sleepiness can include difficulty concentrating, memory problems, irritability, heightened aggression and anxiety, and frequent mistakes while working, which can even cause accidents while operating heavy equipment.

Symptoms of Shift Work Sleep Disorder

As a long-term condition, shift work sleep disorderVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source can have devastating effects on a person’s life. There are many signs of SWSD, including:

• Disturbed sleep
• Lack of energy
• Nodding off while active
• Difficulty concentrating
• DepressionVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source
• AnxietyVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source
• Oversleeping after several days of little sleep
• Waking up exhausted
• Having trouble staying awake at work
• Irritability
• Losing track of time and even days

SWSD can potentially even be dangerous and even life-threatening if you operate heavy machinery or fall asleep at the wheel. SWSD can lead to:

• Heart problemsVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source
• High blood pressureVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source
• Weight gainVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source
• Muscle weakness and spasms
• Memory problems

Shift work sleep disorder can also lead to an increased risk for cancerVerified Source Centers for Disease Control and Prevention (CDC)The United States’ health protection agency that defends against dangers to health and safety.View source. Researchers at the University of Missouri discovered that people with SWSD are up to 300 percent more likely to be in a car accident.

How Does Shift Work Disorder Impact Everyday Life?

Shift work sleep disorder can lead to many other dangerous behaviors, further complicating an already demanding lifestyle.

Shift work sleep disorder leads to other behaviors that can make sleep and daily health worse, such as:

• Use caffeine to excess: People with SWSD tend to drink more caffeine on the job, making it more difficult to fall asleep at home.
• Lack of a healthy diet: Tired people will cook healthy food less, opting for fast food and junk food, leading to poor nutrition and obesity, making their situation worse.
• Short-term use of medication: Taking Nyquil to fall asleep can lead to dependency, making sleep harder.
• Dangerous behavior: The stress from lack of sleep can cause violent reactions to minor situations.
• Poor decision making: With lack of sleep, people tend to be more impulsive, making more dangerous decisions without thinking them through.
• Medical conditions: SWSD can lead to obesity, less exercise, high blood pressure, and many other disorders.

In addition, lack of sleep can create dangerous work conditions. Lack of sleep is linked to 274000 workplace accidents per year, according to a 2012 study.

Diagnosing Shift Work Sleep Disorder

There are methods of diagnosing SWSD. If someone thinks they may have shift work sleep disorder, it is best to speak to your doctor or sleep specialist.

It may even be necessary to participate in a sleep study in a sleep labVerified Source Medline PlusOnline resource offered by the National Library of Medicine and part of the National Institutes of Health.View source during the day or off-work hours. In addition, most professionals will also ask about medical history. They may even ask you to complete a sleep diary.

One problem with diagnosing shift work sleep disorder is that many other conditions behave similarly to SWSD, including insomnia, sleep apneaVerified Source Medline PlusOnline resource offered by the National Library of Medicine and part of the National Institutes of Health.View source, or medication side effects.

Lifestyle Changes to Manage Shift Work Sleep disorder

Most shift workers have little choice in their work hours, so they need to be creative with finding ways to overcome SWSD.

Here are some things you can do to help fight shift work sleep disorder:

• Maintain a regular sleep schedule, even on days off
• Stop drinking caffeine four hours before bedtime
• Eat healthily! Maintain a diet with wholesome meats, fruits, and vegetables. If you’re tired and hungry, try making a protein shake before bed for something quick and filling
• Install blackout shades in the room you sleep in to limit light exposure during daylight hours
• Wear blue blocker sunglasses on your way home to limit sunlight exposure
• Try to have two days off in a row to lower stress per week
• Take naps whenever possible, even if just for a short time
• Avoid bright digital devices when you get off of work
• Wear earplugs when sleeping to avoid outside noise
• Maintain good sleep hygiene by creating a bedtime routine and sticking to it, even on days off
• Use a white noise machine to drown out sound while you sleep
• Add a dietary supplement such as melatonin to take before bed
• Use a lightbox to expose yourself to safe, bright light before work—the effect of light helps improve alertness
• Wear an eye mask to block out bright light when sleeping
• Set up your bedroom for better sleep, such as removing a bedroom TV to minimize distractions
• Talk to your employer about how they can help improve your sleep hygiene to help maintain a safe workplace

How to Treat Shift Work Sleep Disorder

Light Altering

Light is one of the strongest time signals for the body clock. So making changes to your daily light exposure can help stabilize circadian rhythms including sleep. Increased levels of melatonin in the evening is a signal for the brain to prepare for sleep.

But evening light at home suppresses melatonin, so having low levels of light and avoiding electronic devices before bedtime can facilitate sleep. Equally, light has an alerting effect, so having bright light can help you stay awake when you need to, for example during night shifts.

A light therapy lamp or extra bright bulbs and even a lot of sunlight before work during later shifts can make you feel more awake if you have more trouble staying awake than night owls. If you work alternating shifts, you can use bright light therapy to help shift your circadian rhythm to one that better fits your new schedule, helping you wake up and fall asleep more by your work shift.

Alternatively, if you need to sleep after an early morning shift that ends in the middle of the day, wear dark blue blocker sunglasses when you get off of work to minimize melatonin inhibiting rays. Light can even affect your sleep cycle while you sleep, so try to make the area you sleep as dark as possible by:

• Blocking out windows
• Turning off lights
• Wearing a sleep mask or even just a simple towel over your eyes when you sleep

Studies show the most effective light managementVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source combines light therapy with light avoidance for the best results.

SEE ALSO: Circadian Rhythm Sleep Disorders

Sleep Improvement Supplements

Supplements to improve sleep can include melatonin and magnesium, along with herbs such as lavender and chamomile.

Melatonin

One of the best sleep-promoting hormones to take, as melatonin is the body’s natural sleep hormone. When working abnormal shifts for work, melatonin supplements help prep the body for sleep. While melatonin is beneficial for helping you fall asleep at night, it may not necessarily help you stay awake during work.

SEE ALSO: Can You Overdose on Melatonin?

Magnesium

Magnesium is a vital mineral to the human body with hundreds of benefits. Primarily, magnesium is known to have a relaxing effect and helps the body produce melatonin. One studyVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source showed that magnesium in combination with vitamin B and melatonin treated a variety of causes of insomnia.

Lavender

Lavender is a wonderful scent used worldwide as an odor blocker and mood enhancer. Several studies have shown that smelling lavender before bed can improve sleep quality, particularly in those who suffer insomnia or other sleep disorder.

Our guide on natural herbs for sleep has other suggestions if lavender isn’t quite to your liking.

SEE ALSO: Best Essential Oils for Sleep

Chamomile

Chamomile is an herb often brewed into a tea known for its calming effects. Chamomile tea before bed has shown to be effective in reducing depression and aiding in falling asleep.

Sleep Medicine

Medication can be used to help with more extreme insomnia or other sleep disorder. While medication is typically not ideal, in extreme situations, it may be necessary. Be sure to consult with a doctor before beginning any sleep medication or altering the dosage of sleeping pills.

• Lunesta: Lunesta can help you fall asleep faster and stay asleep longer. Lunesta is known as a sedative-hypnotic. These drugs produce a calming effect and are generally not recommended for daily, long-term use.
• Ambien: Ambien is another sedative-hypnotic. Ambien releases quickly to help you fall asleep fast. However, one known side effect is if woken up, many people report being awake but in a walking-sleep state, causing abnormal behavior until they return to sleep, sometimes with no recollection of what happened in the morning.
• Zolpidem: Zolpidem is another sedative-hypnotic used to slow brain activity before bed, allowing people to fall asleep more easily.

Wakefulness Medication

Currently, the FDA approves of two wakefulness medications for shift work sleep disorder.

• Modafinil: Modafinil is considered a quality wakefulness medication with little known side effects known to many stimulants. Also prescribed for narcolepsy, Modafinil is also known to increase alertness while working.
• Armodafinil: A similar medication, also prescribed to people with sleep apnea to aid in daytime alertness, Armodafinil is a common prescription for people with abnormal work schedules.

Lifestyle Changes

Severe shift work sleep disorder should be diagnosed and managed by a professional. Still, whether your case is severe or minor, lifestyle changes can greatly help you manage symptoms and avoid sleep deprivation.

Stay Active

Regular exercise is one of the best things you can do for your body in terms of better sleep and overall quality of life.  However, if you work a highly physical job already, adding exercise can tax your body too much leading to even more fatigue during work hours.

See our guide on the link between exercise and better sleep for more information.

Healthy Diet

Avoid high sugar and highly processed foods. Eat a diet rich in fruits and vegetables for better sleep and avoid overeating before going to sleep.

See our guide on the top superfoods in every U.S state for some suggestions.

Minimize Disturbances

Sleeping during the day when everyone else is awake can be difficult. Try to encourage the household to limit noisy activities when you are sleeping, sleep in a room furthest from where the most activity is, disconnect your doorbell and do anything else to limit outside disturbances.

Catch up on Sleep

While there is little you can do to ‘catch up on sleep’, resting until you feel rested on your days off can improve your quality of life during the week. Do not feel guilty about ‘oversleeping’.

Establish a Routine

Proper sleep hygiene includes setting up a bedtime routine. Go to bed at the same time every night, avoid bright lights and screens, have a cup of chamomile tea, and read a book or similar routine before going to sleep.

See our guide on fixing your sleep schedule for more details on setting up a bedtime routine.

Take Naps

Naps can help make a tough schedule manageable. Taking a brief nap before work or during a break can help make it through a tiring work shift. While napping has its benefits, limit the nap to 15-20 minutes to avoid falling into a deep sleep.

SEE ALSO: How to Power Nap

Watch Your Caffeine

While it is not recommended to drink too much caffeine, a cup or two of coffee or tea at the beginning or middle of your shift can help make it through work. Try to avoid caffeine on the second half of your shift or at least 4-6 hours before going to sleep to avoid restlessness.

SEE ALSO: How Much Caffeine is in a Cup of Coffee?

Minimize Alternating Schedules

Talk to your supervisor to see if changes can be made to limit the stress of alternating schedules. Rather than a schedule that rotates every other day, for example, you can request three straight shifts at one time, followed by two shifts at another time.

SEE ALSO: Time Management and Sleep

Work From Home Time Management

Since COVID, more employees are working from home and having meetings with teams around the world. Try to schedule global meetings at a time, allowing you to maintain a normal sleep schedule. Also, try to avoid working too late or two early when working from home.

With more people working from home, managing family life with work, some workers show symptoms of shift work sleep disorder due to the issues related to working from home. Parents are working late at night or early in the morning when children are in bed. Others are working late at night only to return early in the morning.

Try to stick to a similar schedule while working from home to avoid the added stress of putting yourself into alternating shifts. Plan your work so that more things are done simultaneously every day, and take weekends off to avoid burnout. Not sticking to a schedule while working from home can greatly disrupt sleep patterns.

Frequently Asked Questions

What are the symptoms of shift work sleep disorder?

Shift work sleep disorder is often characterized by sleeping troubles and excessive daytime sleepiness. Shift workers may also feel the common side effects of chronic sleep deprivation, including headaches, trouble focusing, and a lack of energy. A shift worker with the disorder may also find themselves prone to irritability or impulsiveness.

How is shift work sleep disorder treated?

Establishing environmental cues for better sleep is one way to alleviate shift work sleep disorder. Light therapy tools, like a bright light box, can be used to help a worker feel more “awake” at night. Eating healthy and exercising regularly can also help them drift off to sleep better, as can minimizing disturbances and distractions in the bedroom.

Melatonin supplements may be recommended as a way for shift workers to swiftly fall asleep. There is also medication specifically approved for shift workers, such as prescription sleep aids and drugs that promote wakefulness. These are not meant to replace sleep and you should speak with a doctor about whether or not these medications are compatible with your lifestyle.

Does shift work sleep disorder go away?

Normally, yes, once a person stops working shifts at unusual hours, they should eventually break away from the effects of shift work sleep disorder. That said, the problems of shift work sleep disorder can linger, particularly if workers don’t take steps to get their sleep schedule back on track.

It’s best to use a bedtime or sleep calculator to figure out when you should be going to bed to get the full sleep needed. Simply enter your desired wake time, and the calculator will do the rest.

How does shift work affect mental health?

A 2020 study notedVerified Source National Library of Medicine (NIH)World’s largest medical library, making biomedical data and information more accessible.View source that shift work is associated with lower moods and greater anxiety, along with cognitive impairment. All of these are also symptoms of sleep deprivation. Another 2020 study noted that shift workers, particularly women workers, have a greater risk of reduced mental health, especially when it comes to depression.

Is it normal to feel sick after a night shift?

Feeling sick or nauseated can be a side effect of sleep deprivation, so night shift workers may experience nausea if they haven’t slept in a while. Stomach troubles can also result if workers eat during a night shift, when their bodies feel like they should be resting.

Lastly, dehydration as result of not drinking enough fluids during a shift can cause nausea.

Conclusion

A growing number of workers are working abnormal work hours for an increasing number of reasons. With advances in technology and a global workforce, issues are no longer constrained to hospitality and labor but white-collar jobs.

Learning to recognize the signs of shift work sleep disorder and taking steps to manage it before things get out of hand is essential to work-life balance and effectiveness at work and in life.