Shift Work Sleep Disorder: Management and Treatment

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

Most shift workers sleep 1 to 4 hours less than non-shift workers. It is important to get at least 7 to 8 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.
• 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 5 or less, with days off in between. Shift workers working 12-hour shifts, should limit work to 4 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 is 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.
• 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.