From the Research
Shift work sleep disorder is diagnosed when a person experiences excessive sleepiness or insomnia due to working non-traditional hours that conflict with their natural sleep-wake cycle, and the primary recommendation for treatment is to switch to daytime work, although this may not be feasible for all workers. The diagnostic criteria include having a recurring work schedule that overlaps with the usual sleep period (such as night shifts, early morning shifts, or rotating shifts), experiencing sleep disturbance or excessive sleepiness for at least three months, and having these symptoms documented by sleep logs or actigraphy monitoring for at least 14 days 1. Additionally, the sleep problems must not be better explained by another sleep, medical, or psychiatric disorder, or by medication effects. The disorder causes significant distress or impairment in social, occupational, or other important areas of functioning.
Some key points to consider in the diagnosis and treatment of shift work sleep disorder include:
- The importance of maintaining a consistent sleep schedule, even on days off, to help regulate the body's circadian rhythm 2
- The use of behavioral approaches, such as using blackout curtains and practicing good sleep hygiene, to improve sleep quality 2
- The potential benefits of melatonin therapy in reducing sleep latency and improving sleep efficiency in shift workers with difficulty falling asleep 3
- The need to rule out other sleep, medical, or psychiatric disorders that may be contributing to the sleep problems 4
Treatment typically involves both behavioral approaches and sometimes medications like modafinil (200mg daily) or armodafinil (150mg daily) for excessive daytime sleepiness, or short-term use of sleep aids like zolpidem (5-10mg) or eszopiclone (1-3mg) for insomnia 5. These symptoms occur because shift work disrupts the body's circadian rhythm, which regulates the sleep-wake cycle through hormones like melatonin that are naturally synchronized with daylight and darkness.
It is essential to note that the primary goal of treatment for shift work sleep disorder is to reduce the rate of circadian misalignment by fostering better sleep when it is desired and improved alertness and functioning when appropriate 2. Nonpharmacologic strategies, such as melatonin and light therapy, should be tried before considering medications to promote sleep and/or alertness.