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Shift work sleep disorder

shift work sleep disorder, shift work sleep disorder icd 10
Shift work sleep disorder SWSD is a circadian rhythm sleep disorder characterized by insomnia and excessive sleepiness affecting people whose work hours overlap with the typical sleep period There are numerous shift work schedules, and they may be permanent, intermittent, or rotating; consequently, the manifestations of SWSD are quite variable


  • 1 Diagnosis
  • 2 Causes and comorbidities
  • 3 Health risks
  • 4 Suprachiasmatic nucleus SCN
  • 5 Treatment
    • 51 Prescribed sleep/wake scheduling
    • 52 Bright light treatment
    • 53 Melatonin treatment
    • 54 Medications that promote alertness
    • 55 Medications that promote daytime sleep
  • 6 See also
  • 7 References
  • 8 External links


The primary symptoms of shift work sleep disorder are insomnia and excessive sleepiness associated with working and sleeping at non-standard times Shift work sleep disorder is also associated with falling asleep at work Total daily sleep time is usually shortened and sleep quality is less in those who work night shifts compared to those who work day shifts1 Sleepiness is manifested as a desire to nap, unintended dozing, impaired mental acuity, irritability, reduced performance, and accident proneness Shift work is often combined with extended hours of duty, so fatigue can be a compounding factor2 The symptoms coincide with the duration of shift work and usually remit with the adoption of a conventional sleep-wake schedule2 The boundary between a "normal response" to the rigors of shift work and a diagnosable disorder is not sharp

Causes and comorbiditiesedit

Insomnia and wake-time sleepiness are related to misalignment between the timing of the non-standard wake–sleep schedule and the endogenous circadian propensity for sleep and wake In addition to circadian misalignment, attempted sleep at unusual times can be interrupted by noise, social obligations, and other factors Finally, there is an inevitable degree of sleep deprivation associated with sudden transitions in sleep schedule1

Health risksedit

There have been many studies suggesting health risks associated with shift work For example, a 2007 study led by the IARC International Agency for Research on Cancer showed that shiftwork has been associated with cancer13 Other studies have reported that night workers have an increased incidence of heart disease, digestive disorders and menstrual irregularities4 Because a formal diagnosis of SWSD was not typically made in these studies, it remains unclear whether the reported risks apply to the subset of shiftworkers who qualify for a diagnosis of SWSD or apply to all shiftworkers

Suprachiasmatic nucleus SCNedit

Brain arousal is stimulated by the circadian system during the day and sleep is usually stimulated at night5 The rhythms are maintained in the suprachiasmatic nucleus SCN, located in the anterior hypothalamus in the brain, and synchronized with the day/night cycle5 Gene-transcription feedback loops in individual SCN cells form the molecular basis of biological timekeeping5 Circadian phase shifts are dependent on the schedule of light exposure, the intensity, and previous exposure to light6 Variations in exposure can advance or delay these rhythms For example, the rhythms can be delayed due to light exposure at night6

Photoreceptors located in the retina of the eye send information about environmental light through the retinohypothalamic tract to the SCN56 The SCN regulates the pineal gland, which secretes the hormone melatonin6 Typically, the secretion of melatonin begins two hours before bedtime and ends two hours prior to waking up6 A decline in neuronal firing in the SCN is caused by the binding of melatonin to the MT1 and MT2 melatonin receptors It is believed that the reduction in firing in the SCN stimulates sleep5 While day-active individuals produce melatonin at night, night shift workers' production of melatonin is suppressed at night due to light exposure6


Prescribed sleep/wake schedulingedit

Experts agree that there is no such thing as an "ideal" night work schedule, but some schedules may be better than others For example, rotating shifts every two weeks in a forward delaying direction was found to be easier than rotation in a backward advancing direction7 Gradual delays “nudging” the circadian system about an hour per day has been shown in a laboratory setting to maintain synchrony between sleep and the endogenous circadian rhythms,8 but this schedule is impractical for most real world settings Some experts have advocated short runs 1 to 2 days of night work with time for recovery; however, in the traditional heavy industries, longer 5 to 7 day runs remain the rule In the end, scheduling decisions usually involve maximizing leisure time, fairness in labor relations, etc rather than chronobiological considerations Shift workers can benefit from adhering to sleep hygiene practices related to sleep/wake schedulingcitation needed Symptoms typically only fully resolve once a normal sleep schedule is resumed2

Many night workers take naps during their breaks, and in some industries, planned napping at work with facilities provided is beginning to be accepted A nap before starting a night shift is a logical prophylactic measure However, naps that are too long over 20–30 minutes may generate sleep inertia, a groggy feeling after awakening that can impair performance Therefore, brief naps 10 to 30 minutes are preferred to longer naps over 30 minutes Also, long naps may also interfere with the main sleep boutcitation needed

In the transportation industry, safety is a major concern, and mandated hours of service rules attempt to enforce rest times

Bright light treatmentedit

The light-dark cycle is the most important environmental time cue for entraining circadian rhythms of most species, including humans, and bright artificial light exposure has been developed as a method to improve circadian adaptation in night workers The timing of bright light exposure is critical for its phase shifting effects To maximize a delay of the body clock, bright light exposure should occur in the evening or first part of the night, and bright light should be avoided in the morning Wearing dark goggles9 avoiding bright light or blue-blocking goggles during the morning commute home from work can improve circadian adaptation For workers who want to use bright light therapy, appropriate fixtures of the type used to treat winter depression are readily available10 but patients need to be educated regarding their appropriate use, especially the issue of timing Bright light treatment is not recommended for patients with light sensitivity or ocular disease

Melatonin treatmentedit

Melatonin is a hormone secreted by the pineal gland in darkness, normally at night Its production is suppressed by light exposure,11 principally blue light around 460 to 480 nm Light restriction, or dark therapy, in the hours before bedtime allows its production Dark therapy does not require total darkness Amber or orange colored goggles eliminate blue light to the eyes while allowing vision

Melatonin is also available as an oral supplement In the US and Canada, the hormone melatonin is not classified as a drug; it is sold as a dietary supplement In other countries it requires a prescription or is unavailable Although it is not licensed by the FDA as a treatment for any disorder, there have been no serious side effects or complications reported to date

Melatonin has been shown to accelerate the adaptation of the circadian system to a nighttime work schedule12 Melatonin may benefit daytime sleep in night workers by an additional direct sleep promoting mechanism Melatonin treatment may increase sleep length during both daytime and nighttime sleep in night shift workers1

Medications that promote alertnessedit

Caffeine is the most widely used alerting drug in the world and has been shown to improve alertness in simulated night work13 Caffeine and naps before a night shift reduces sleepiness during the shift1 Modafinil and armodafinil are non-amphetamine alerting drugs originally developed for the treatment of narcolepsy that have been approved by the FDA the US Food and Drug Administration for excessive sleepiness associated with SWSD14

Medications that promote daytime sleepedit

Obtaining enough sleep during the day is a major problem for many night workers Hypnotics given in the morning can lengthen daytime sleep; however, some studies have shown that nighttime sleepiness may be unaffected15 Zopiclone has been shown to be ineffective in increasing sleep in shift workers1

See alsoedit

  • Shift work
  • Jet lag
  • Human factors
  • Human reliability


  1. ^ a b c d e f Liira, Juha; Verbeek, Jos H; Costa, Giovanni; Driscoll, Tim R; Sallinen, Mikael; Isotalo, Leena K; Ruotsalainen, Jani H 2014 "Pharmacological interventions for sleepiness and sleep disturbances caused by shift work" The Cochrane Database of Systematic Reviews 8: CD009776 doi:101002/14651858CD009776pub2 ISSN 1469-493X PMID 25113164 
  2. ^ a b c Ker, Katharine; Edwards, Philip James; Felix, Lambert M; Blackhall, Karen; Roberts, Ian 2010 "Caffeine for the prevention of injuries and errors in shift workers" The Cochrane Database of Systematic Reviews 5: CD008508 doi:101002/14651858CD008508 ISSN 1469-493X PMC 4160007  PMID 20464765 
  3. ^ Kurt, Straif December 2007 "IARC Monographs Programme finds cancer hazards associated with shiftwork, painting and firefighting" Press release International Agency for Research on Cancer Retrieved 2010-06-08 
  4. ^ Nicholson PJ, D'Auria DA April 1999 "Shift work, health, the working time regulations and health assessments" Occup Med Lond 49 3: 127–37 doi:101093/occmed/493127 PMID 10451593 
  5. ^ a b c d e Wright, K, Bogan, R, & Wyatt, J 2012 Shift work and the assessment and management of shift work disorder SWD Sleep Medicine Reviews, 41-54 Retrieved December 8, 2014
  6. ^ a b c d e f Boivin, D, & Boudreau, P 2014 Impacts of shift work on sleep and circadian rhythms Pathologie Biologie, 292-301 Retrieved December 8, 2014
  7. ^ Czeisler CA, Moore-Ede MC, Coleman RH July 1982 "Rotating shift work schedules that disrupt sleep are improved by applying circadian principles" Science 217 4558: 460–3 doi:101126/science7089576 PMID 7089576 
  8. ^ Gallo LC, Eastman CI January 1993 "Circadian rhythms during gradually delaying and advancing sleep and light schedules" Physiol Behav 53 1: 119–26 doi:101016/0031-93849390019-C PMID 8434051 
  9. ^ Eastman CI, Stewart KT, Mahoney MP, Liu L, Fogg LF September 1994 "Dark goggles and bright light improve circadian rhythm adaptation to night-shift work" Sleep 17 6: 535–43 PMID 7809567 
  10. ^ "Seasonal affective disorder treatment: Choosing a light box" MayoCliniccom Retrieved 2010-12-30 
  11. ^ deHaro D, Kines KJ, Sokolowski M, Dauchy RT, Streva VA, Hill SM, Hanifin JP, Brainard GC, Blask DE, Belancio VP 2014 "Regulation of L1 expression and retrotransposition by melatonin and its receptor: implications for cancer risk associated with light exposure at night" Nucleic Acids Research 42 12: 7694–7707 doi:101093/nar/gku503 PMC 4081101  PMID 24914052 
  12. ^ Sack RL, Lewy AJ December 1997 "Melatonin as a chronobiotic: treatment of circadian desynchrony in night workers and the blind" J Biol Rhythms 12 6: 595–603 doi:101177/074873049701200615 PMID 9406035 
  13. ^ Muehlbach MJ, Walsh JK January 1995 "The effects of caffeine on simulated night-shift work and subsequent daytime sleep" Sleep 18 1: 22–9 PMID 7761739 
  14. ^ Czeisler CA, Walsh JK, Roth T, et al August 2005 "Modafinil for excessive sleepiness associated with shift-work sleep disorder" N Engl J Med 353 5: 476–86 doi:101056/NEJMoa041292 PMID 16079371 
  15. ^ Walsh JK, Schweitzer PK, Anch AM, Muehlbach MJ, Jenkins NA, Dickins QS April 1991 "Sleepiness/alertness on a simulated night shift following sleep at home with triazolam" Sleep 14 2: 140–6 PMID 1866527 

External linksedit

  • Shift Work Sleep Disorder uni-marburgde
  • IARC/usnews

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