Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder that can affect people who work nontraditional hours. It causes issues with falling asleep, staying asleep and sleepiness at unwanted times. It’s treatable with lifestyle changes, light therapy and/or medication.
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder that commonly affects people who work nontraditional hours outside the “regular” 9 a.m. to 5 p.m. workday. This could involve overnight, early morning or rotating shifts.
Circadian rhythms are physical, mental and behavioral changes that follow a 24-hour cycle. These natural processes respond primarily to light and dark. Shift work schedules go against most people’s internal body clocks or circadian rhythms.
SWSD causes difficulties adjusting to a different sleep/wake schedule, which results in significant issues with:
About 20% of the full-time workforce in the United States participates in some form of shift work. Not everyone who does shift work experiences SWSD.
Shift work sleep disorder is common. It affects 10% to 40% of people who work nontraditional shifts for their job.
The two main symptoms of SWSD are:
Other symptoms of SWSD include:
If you’re a shift worker experiencing any of these symptoms, talk to a healthcare provider.
Shift work sleep disorder (SWSD) results from a mismatch between your “internal body clock” and the external environment, which affects the timing and duration of sleep.
Normally, the visual cue of light — specifically, sunlight — triggers your internal clock during a 24-hour day. Light is transmitted through your eyes and into a “control center” of your brain. This leads to a chain reaction of bodily processes and hormones that signal to your body that it’s time to wake up and start your “active” day.
Other cues that significantly contribute to your internal clock include:
For people who work nontraditional shifts, these cues don’t align with their “day” — their waking hours and sleeping hours. This can negatively affect both sleep and wakefulness.
For example, night shift workers frequently sleep during the daylight, precisely when your body’s signals to wake up and stay awake are strongest. As a result, daytime sleep can be short and frequently disrupted. People who work overnight are often sleepy and drowsy while working, as their melatonin levels are usually highest at this time.
A key part of diagnosing SWSD is keeping a sleep journal. Your healthcare provider will likely ask you to keep detailed notes for at least two weeks on:
Providers typically diagnose SWSD if you experience symptoms for at least three months. Your provider may have you do a sleep study or other tests to make sure your symptoms aren’t due to another condition, such as sleep apnea, or medication side effects.
Although there’s no cure for shift work sleep disorder, several treatments target the core features of SWSD, including:
The main forms of treatment for SWSD include:
One aspect of treating SWSD is making changes to your routines and schedule at work. If possible, discuss schedule changes or work adaptations with your employer that can help decrease the effects of SWSD.
Your provider will recommend specific strategies related to the shift you work and your work setting.
Some general tips include:
Most shift workers sleep one to four hours fewer than non-shift workers. It’s important to get at least seven to nine hours of sleep every day.
If you’re a shift worker, you must make sleep a priority. The following tips can help:
Bright light therapy involves exposure to a specific type of light to help your body adjust to your new schedule. You’ll use this light at a specific time, usually at the beginning of your shift. Your provider will tell you when and for how long you should use light therapy.
The light is available as a lightbox, desk lamp or light goggles. They’re similar to the lights that help treat seasonal depression (seasonal affective disorder). Light therapy is especially helpful for night shift workers.
Melatonin supplements may help you adapt better to a shift work schedule. Talk to your provider before taking a melatonin supplement.
Your provider may prescribe a sleeping pill to help you sleep at appropriate times. Sleeping pills may help you sleep better in the short term, but long-term use can lead to dependency. Sleeping pills can also have unpleasant or dangerous side effects.
Wake-promoting agents are medications that improve your alertness and your ability to maintain wakefulness. The U.S. Food and Drug Administration (FDA) currently approves two of these medications for SWSD:
While these medications may help improve performance issues associated with sleepiness, they aren’t a replacement for adequate sleep. These medications also have side effects and may be habit-forming. Talk to your healthcare provider to see if wake-promoting agents are right for you.
You may not be able to prevent shift work sleep disorder outside of working traditional working hours consistently. There are steps you can take to manage your symptoms and create a routine that results in better quality of sleep and improved alertness during your waking hours.
If left untreated, shift work sleep disorder (SWSD) can lead to complications, including:
Quality sleep is essential to good health. SWSD and a lack of sleep can worsen underlying health conditions or lead to new issues. Increased long-term health risks of SWSD include:
The symptoms of shift work sleep disorder usually last as long as you work nontraditional hours. It tends to go away once you begin sleeping and being awake at more conventional times again. You may have sleep issues even after your shift work schedule ends.
If you’re experiencing symptoms of shift work sleep disorder, talk to a healthcare provider about finding a solution that’s right for you.
If you’ve been diagnosed with SWSD and your treatment plan isn’t working after a few weeks, see your healthcare provider.
A note from Cleveland Clinic
Not everyone who does shift work has shift work sleep disorder (SWSD). Many people have difficulty first adjusting to a new shift. If after several weeks you continue to have issues falling asleep or staying asleep, or if you feel tired even after sleeping seven to eight hours, you may have SWSD. The good news is that several strategies can help decrease the symptoms of SWSD. A healthcare provider can determine a diagnosis and provide a treatment plan to manage SWSD.
Last reviewed by a Cleveland Clinic medical professional on 04/27/2023.
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