Shift Work Sleep Disorder

Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder characterized by insomnia and/or excessive sleepiness with a shortened total sleep time that occurs due to a recurring work schedule that overlaps with one’s habitual sleep period. Approximately 10–20% of the workforce of industrialized nations participates in shift work. SWD may occur in up to one-third of shift workers with higher rates in night shift workers. Circadian disruption in shift workers has been associated with increased rates of numerous adverse health consequences, including cardiovascular disease, diabetes, obesity, breast cancer, and gastrointestinal ulcers; these health problems may be most common in shift workers with SWD. In addition to adverse health consequences, shift workers with SWD may suffer from work-related injuries and accidents, occupational dysfunction, and social dysfunction. These potential negative consequences of shift work necessitate that clinicians maintain a high index of suspicion for the presence of SWD in shift workers, especially night shift workers. Once identified, SWD must be treated, and the definitive treatment is termination of the inciting shift work. If a shift change is not possible, a patient with SWD may benefit from prescribed sleep scheduling, circadian phase shifting interventions (such as timed melatonin or bright light therapy), hypnotic (sleep-promoting) medications, and/or stimulant (wake-promoting) medications. All shift workers should be educated about the possible negative effects of circadian misalignment, including the development of SWD. The care of shift workers with and without SWD is a global priority, requiring thoughtful cooperation between shift workers, employers, and healthcare providers.