Shift work sleep disorder (SWSD) is a sleep disorder that commonly affects those who work non-traditional hours, outside the typical 9 a.m. Shift work schedules go against most peoples’ internal body clocks or circadian rhythms.

1. Shifting Methods
2. Shift Work Calendar

Not everyone has a work schedule that resembles the traditional nine-to-five day. In fact, more than 22 million Americans work evening, rotating, or on-call shifts. You face many challenges when working non-traditional hours. It can be hard to keep up with family and friends. You may feel disconnected from the people you care about the most. You may have trouble organizing your time and activities. You may be frustrated to realize that most things are planned around the schedule of the typical day worker. It may seem like no one has your needs in mind.

Your physical health may also suffer from shift work. It can be very hard to get the sleep you need to stay well rested. This can make you more likely to get sick. It also makes it hard for you to stay alert on the job. While this can hurt your performance, it can also put you in danger. Being tired increases the chance that you could suffer a work-related injury. Even driving home from work is a risk when you are sleepy.

Third shift positions are also called grave, midnight, or night shifts. Employees who work third shift start work at night and leave work in the morning. An employee working third shift might start work around 11:00 p.m. Or midnight and work until seven or eight in the morning. Take a look at some third shift position examples: Firefighter. Shift work involves scheduling employees to perform their job duties during all 24 hours of the day and usually the entire week. Shiftworks offers a trick kit that will convert a stock Camaro, Chevelle, or Nova two- or three-speed floor shifter into a four-speed auto shifter complete with a new indicator bezel. By Terry McGean in May, 2008 'The Nova shifter, outfitted with the Shiftworks conversion pieces, fits into the console just like the original'.

Studies show that sleepiness can have a negative effect on any of the following:

• Attention
• Concentration
• Reaction time
• Memory
• Mood

The following are all examples of major accidents involving human errors that were blamed at least in part on sleepiness:

• Three Mile Islandnuclear power plant accident in Pennsylvania in 1979
• Chernobyl nuclear power plant disaster in the former USSR in 1986
• Exxon Valdez oil spill off the coast of Alaska in 1989

The sleep problems that result from shift work can put a strain on every area of your life. But there are steps you can take to improve your sleep. Following them can help shift your sleep in the right direction.

Sleeping Against The Clock

A main challenge of shift work is that it forces you to sleep against the clock. You have an internal body clock in your brain that produces circadian rhythms. The word 'circadian' means to occur in a cycle of about 24 hours. These rhythms act like 'messages' that regulate various body functions. They influence such things as the following:

• Body temperature
• Alertness
• Sleepiness
• Hunger
• Hormone Levels

Your body clock uses these rhythms to signal to you when it is time to go to sleep or to wake up. This tends to occur at regular times every day. Among other factors, your clock is 'set' by your exposure to sunlight. This keeps the clock's timing close to the night/day cycle. In most adults, circadian rhythms cause your level of sleepiness to peak from aboutmidnight to 7 am. They can also make you mildly sleepy in the mid-afternoon between 1 pm and 4 pm. If you work at night, you must fight your body's natural rhythms to try and stay awake. Then you have to try to sleep during the day when your body expects to be alert.

Overall, shift workers tend to be continually sleep-deprived. It is very hard for night shift workers to get enough sleep during the day. They get a daily average of two to four hours less sleep than normal. It is hard for them to get their bodies to fall asleep during the day. Over time, this can develop into a case of insomnia. They are also much more likely to be awakened by noises or people. As a result, their sleep is very light. They are less likely to feel well rested when they wake up.

Other factors can add to the problem of having an unusual sleep schedule. People who work extremely long shifts can have even more severe sleep loss. This includes such people as doctors, nurses, soldiers, firefighters and police officers. You may also have a schedule that does not allow you to get enough sleep each day. Perhaps you work two jobs, one during the day and one at night. Maybe you go to school during the day and work at night. In either case, it can be hard to find the time to sleep. A sleep disorder can also make your sleep problems worse. Two examples are sleep apnea and narcolepsy. They can keep you from sleeping well and feeling alert. You should see a sleep specialist if you think that you may have a sleep disorder.

Some researchers think that it may take as long as three years to adjust to a shift work schedule. Others believe that you will never fully adjust to an unusual sleep/wake pattern. Even if this is the case, you can make the best of a bad situation to sleep better.

Strategies For Sleeping Better

There are a variety of ways to cope with the sleep problems caused by rotating work shifts and ongoing night work. The approach that will help you the most depends on the following three factors:

• Your individual needs
• The requirements of your job
• Your environment at home

Some methods will apply to your situation more than others. For example, working rotating shifts in a hospital may require a different approach than working the night shift on an assembly line. Also, some people respond to shift work better than others. In general, older people find it harder to work nights or to rotate shifts. Your personality may also suit you better for one kind of shift. Some people are 'evening types.' They like to go to bed late and sleep late in the morning. They feel most alert and energetic in the evening. They may adjust to the night shift better than 'morning types.' Morning types wake up early and work best in the morning. They get tired and go to bed early in the evening.

From the options below, find what will work best for you in your situation. The most important thing you can do at first is to make sleep a high priority in your life.

Work schedules

Employers can plan rotating shifts in ways that will help their workers. A schedule that rotates clockwise can be adjusted to more easily. This is a more natural change for your body. This schedule keeps to the following kind of pattern:

Day shift? Evening shift? Night shift? Morning shift? Day shift

A schedule that is much harder to adjust to rotates in a counterclockwise direction. This is a difficult change for your body to make. This schedule stays on the following kind of pattern:

Day shift? Morning shift? Night shift? Evening shift? Day shift

Shifting Methods

Shifts that rotate in a random pattern are also very hard on your body. Rotating shifts every two or three days is also better than changing every five to seven days. Studies show that workers are more satisfied when shifts are rotated in the proper ways. They are also more productive and have fewer accidents. Talk to your manager about how the right kind of schedule is better for everyone involved.

Napping

It is a good idea to take a nap just before reporting for a night shift. This makes you more alert on the job. A nap of about 90 minutes seems to be best. Naps during work hours may also help you stay awake and alert. You may also want to take a nap during the night shift 'lunch hour.' This can make you more productive and more satisfied. But this is not a good idea for all types of jobs. This may not work well on a high-pressure job that demands instant reactions. You will need a little bit of time to shake the sleepy feeling that you may have right after a nap. About 15 to 20 minutes should be enough time for you to be fully alert again. See if your employer will allow you to take nap breaks during a night shift. This can make you more alert and improve your job performance.

Driving home from a night shift can be dangerous. It can be very hard to stay alert on the road. Drowsy driving is a cause of at least 100,000 auto crashes each year. You may want to take a 20-45 minute nap before starting out. This will make you much more alert for the drive home. You also may want to begin a car pool with other workers. The most alert worker at the end of the shift can be the one to drive most of the distance.

Eating well

Stomach problems are common in shift workers. Many shift workers eat poorly and at odd times. Try to eat three regular meals spaced evenly over the course of the day. Regular meal times are important for your body. They serve as time cues for your body clock. These cues help your body know when to make you sleepy. You may want to have a hot meal while on the job. Do not eat your largest meal of the day within three hours of bedtime. You should also avoid drinking any alcohol within three hours of bedtime. At first, alcohol may help you fall asleep quicker. But over time, it can make your sleep worse. It causes you to wake up more often during your sleep period. Avoid eating a lot of snacks and fast foods. Eat a balanced, low-fat diet with plenty of fruits, vegetables, and cereals. This helps to prevent stomach problems in shift workers.

Sleep schedules

Night shift workers should try to stay on the same sleep schedule every day of the week. This means that you don't change your sleep time on days off. Keeping a regular schedule will help align your body clock with your sleep pattern. This will increase the quality of your sleep. Sleeping at night during days off disrupts your body clock. This will make it harder to sleep during the day when you return to work.

Rotating shift workers are unable to keep a regular sleep schedule. Instead, they should begin to adjust their sleep time before a schedule change. For example, you may be working an evening shift. Soon you are going to rotate to a night shift. On the last few days of the evening shift, delay the times you go to bed and wake up by one to two hours each day. Then when you begin the night shift, your body will already be getting ready for the new schedule. See the chart below for an example. This kind of gradual plan gives your body more time to adjust. You avoid the harsh disruption of a sudden schedule change. This will allow you to sleep better through the change.

Example: Adjusting Your Sleep Schedule to Prepare for a Change from an Evening Shift to a Night Shift.

Normal sleep time for shift:
Sleep time - Night 1 of Transition:
Sleep time - Night 2 of Transition:
Sleep time - Night 3 of Transition:
Slepe time - Night 1 of New Shift

Evening Shift (5 pm - 1 am)
3 am - 11am
5 am - 1 pm
7 am - 3pm
8 am - 4 pm

Night Shift (11 pm - 7 am)
9 am - 5 pm
9 am - 5 pm

Sleep aides

Shift workers often rely on sleeping pills to help them fall asleep during the day. These pills are also known as hypnotics or sedatives. These drugs can be useful in helping some people sleep better. But pills should not be seen as a long-term solution for better sleep. Doctors rarely prescribe them for more than three to four weeks. They become less effective when used for a long period of time. There can also be negative side effects involved. You don't want to become dependent on a drug to be able to sleep. They will also give you only a small boost in alertness and performance on the job. Sleeping pills may offer temporary relief. But they do not address the root cause of your sleep problems; sleeping pills cannot reset your body clock. Talk to your doctor if you think a sleeping pill might help you once in a while.

Store shelves are stocked with items that claim to help you sleep better. Antihistamines are the most common ingredient in these sleep aids. They may help you sleep better. But the side effect of drowsiness can be very severe. They may cause you to be sleepy while working or driving. These items should be used with extreme caution. There is very little evidence to show that using other herbs or vitamins will help you sleep better.

Stimulants

Studies show that using a stimulant may reduce sleepiness and increase alertness on a night shift. The most common stimulant used is caffeine. But you should avoid caffeine within four hours of your desired bedtime. Otherwise, it may keep you from being able to fall asleep after you get home.

Melatonin

Melatonin is a hormone that is released by the brain at night. It appears to have a strong link to the sleep/wake cycle. Its release is regulated by an area of the brain that serves as your body clock. Taking melatonin has been found to be most effective in helping people with jet lag. For other people, it may have a mild effect, if any at all. Studies have found melatonin to be fairly safe in healthy adults. There do not seem to be any serious side effects, but more tests need to be done. The fact that it is widely available in stores does not guarantee its safety. The long-term effects of taking it remain unknown.

Light therapy

Studies show that timed exposure to bright light can be used to adjust your body's sleep cycle. Artificial bright light can affect the body clock in the same way that sunlight does. Light therapy is used to expose your eyes to intense but safe amounts of light. This is done for a specific and regular length of time. In general, using light treatment in the evening should help someone who regularly works nights. In this case, you would also want to avoid daylight when you come off work and go to bed. Dark sunglasses or special goggles can help.

Light boxes can be purchased in a variety of makes and models. The box houses several tubes that produce extremely bright light. It sits on top of a table or desk and plugs into the wall. Sessions may take as little as 15 to 30 minutes. More than one session may be needed each day. It depends upon your body, your need, and the strength of light being used. The key is to use the light at the right time of day and for the right amount of time. A sleep specialist can help you develop a light therapy plan that will be both helpful and safe.

Workplace conditions

Your employer should strive to create a work environment that will promote safety. This is even more important for those working the night shift. The workplace should be bright and cool. This will help workers to be more alert on the job. Discuss with your employer any changes that need to be made in your workspace. Safety can be increased without losing any productivity.

The home front

Your family and living companions have a vital role in helping you to sleep better. They need to understand both your unique schedule and your sleep need. Post a shift work calendar to help them keep track of your schedule. Include your work hours and your sleep times. Educate them about the body clock and its effect on sleep. Get them to reduce the levels of noise and light in the home during your sleep hours. Darken and sound proof your room as best you can. Use 'white noise' (static on the radio or TV) to help cover up disturbing sounds. Ask others to help with daytime childcare and household tasks. Schedule home repairs and deliveries outside of your scheduled sleep hours.

Sleep hygiene

You can often sleep better by simply following the practices of good sleep hygiene. Sleep hygiene consists of basic habits and tips that help you develop a pattern of healthy sleep. Following these tips will give you a head start down the path to better sleep.

Shift Work Calendar

Overview

What is shift work sleep disorder (SWSD)?

Shift work sleep disorder (SWSD) is a sleep disorder that commonly affects those who work non-traditional hours, outside the typical 9 a.m. to 5 p.m. work day. Shift work schedules go against most peoples’ internal body clocks or circadian rhythms. SWSD causes difficulties adjusting to a different sleep/wake schedule, which results in significant issues with falling asleep, staying asleep, and sleeping when desired. About 20% of the fulltime workforce in the United States is involved in some form of shift work.

Symptoms and Causes

What are the symptoms of shift work sleep disorder (SWSD)?

The most common symptoms of SWSD are difficulty sleeping and excessive sleepiness. Other symptoms associated with SWSD can include difficulty concentrating, headaches or lack of energy.

Not every shift worker suffers from SWSD. It is estimated that 10% to 40% of shift workers have SWSD. If you're a shift worker experiencing any of these symptoms, talk to your doctor.

What are the consequences of shift work sleep disorder (SWSD)?

Increased likelihood of:

• Accidents and work-related errors.
• Irritability or mood problems.
• Poor coping skills and impaired social functioning.
• Health related complaints — including gastrointestinal, cardiovascular and metabolic problems.
• Drug and alcohol dependency.

Management and Treatment

How can I deal with shift work sleep disorder (SWSD)?

Most shift workers sleep one to four hours less than non-shift workers. It is important to get at least seven to nine hours of sleep every day.

Shift workers must be willing to make sleep a priority. People who work shifts other than a 9 a.m. to 5 p.m. routine might have to prepare for sleep even though it might be daylight outside. This can be done in the following ways:

• Minimize exposure to light on the way home from night shift work to keep morning sunlight from activating the internal “daytime clock.”
• Follow bedtime rituals and try to keep a regular sleep schedule, even on weekends and days off from work.
• At home, ask family and friends to help create a quiet, dark and peaceful setting during sleep time.
• Ask family members to wear headphones to listen to music or watch TV.
• Encourage people in the household to avoid vacuuming, dish washing and other noisy activities while you sleep.
• Put a 'Do Not Disturb' sign on the front door so that delivery people and friends will not knock or ring the doorbell.

What can I do to decrease the effects of SWSD?

• Maintain a sleep diary to help identify the problem and monitor its progression over time.
• Decrease the number of night shifts worked in a row. Shift workers working the night shift should limit the number of night shifts to five or less, with days off in between. Shift workers working 12-hour shifts, should limit work to four shifts in a row.
• After a string of night shifts, take more than 48 hours off, if possible.
• Avoid extended work hours. Avoid working prolonged shifts and putting in excessive overtime. Make sure to have time to sleep and participate in family and social activities.
• Avoid long commutes, which can take time away from sleeping.
• Avoid frequently rotating shifts. It’s more difficult to deal with rotating shifts than it is to work the same shift for a longer period of time.
• Get enough sleep on days off. Practice good sleep hygiene by planning and arranging a sleep schedule and by avoiding caffeine, alcohol and nicotine. Do not start a night shift with sleep deprivation.
• Plan a nap before or during the night shift. Naps can improve alertness in night shift workers.
• Avoid drowsy driving. If you’re too sleepy to drive home from your shift, take a power nap first, or find an alternative ride home.
• Caffeine and prescription wake-promoting drugs such as modafinil (Provigil®) or armodafinil (Nuvigil®) have some role in promoting wakefulness during work hours. But the best strategy is to get adequate sleep.
• Sleep aids at times can be prescribed if difficulty sleeping persists despite following the above measures.
• Appropriate light exposure during the early part of the shift can improve alertness during the shift.

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