Shift Work and Problem Sleepiness

Daytime sleepiness

About 20 million Americans (20 to 25 percent of workers) perform shift work. Most shift workers get less sleep over 24 hours than conventionally-scheduled day workers. Additionally, sleep loss is greatest for night shift workers, those who work early morning shifts and female shift workers with children at home. As a result, roughly 60 to 70 percent of shift workers have difficulty sleeping and/or problem sleepiness.

Roughly 60 to 70 percent of shift workers have difficulty sleeping and/or problem sleepiness.

The human sleep-wake system is designed to prepare the body and mind for sleep at night and wakefulness during the day. These natural rhythms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested. It is possible that the human body completely adjusts to nighttime activity and daytime sleep, even in those who work permanent night shifts.

In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Because our society is strongly day-oriented, shift workers who try to sleep during the day are often interrupted by noise, light, telephones, family members and other distractions. In contrast, the nighttime sleep of day workers is largely protected by social customs that keep noises and interruptions to a minimum.

Problem sleepiness in shift workers may result in:

  • Increased risk for automobile crashes, especially while driving home after the night shift
  • Decreased quality of life
  • Decreased productivity (night work performance may be slower and less accurate than day performance
  • Increased risk of accidents  and injuries at work

What Can Help?

Sleep-there’s no substitute! Many people simply do not allow enough time for sleep on a regular basis. A first step may be to evaluate daily activities and sleep-wake patterns to determine how much sleep is obtained. If you are consistently getting less than 8 hours of sleep per night, more sleep may be needed. A good approach is to gradually move to an earlier bedtime. For example, if an extra hour is needed, try going to bed 15 minutes earlier each night for four nights and then keep the last bedtime. This method will increase the amount of time in bed without causing a sudden change in schedule. However, if work or family schedules do not permit the earlier bedtime, a 30-60 minute daily nap may help.

Medications/Drugs

In general, medications do not help problem sleepiness, and some make it worse. Caffeine can reduce sleepiness and increase alertness, but only temporarily. It can also cause problem sleepiness to become worse by interrupting sleep. While alcohol may shorten the time it takes to fall asleep, it can disrupt sleep later in the night, and therefore add to the problem sleepiness. Medications may be prescribed for patients in certain situations. For example, the short-term use of sleeping pills has been shown to be helpful in patients diagnosed with acute insomnia. Long-term use of sleep medication is recommended only for the treatment of specific sleep disorders.

If you think you are getting enough sleep but still feel sleepy during the day, contact us or schedule an appointment to be sure your sleepiness is not a symptom of an undiagnosed sleep disorder.

 

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Part 1: What Is Narcolepsy? (A Series On Sleep Difficulty)

Join us as we share a weekly blog post series from the National Institute of Health on the topic of sleep disorders and Narcolepsy

A Series On Sleep Difficulty

What Is Narcolepsy?

Narcolepsy is a chronic sleep disorder with no known cause. The main characteristic of Narcolepsy is excessive and overwhelming daytime sleepiness, even after adequate nighttime sleep. A person with Narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime sleep attacks may occur with or without warning and may be irresistible. These attacks can occur repeatedly in a single day. Drowsiness may persist for prolonged periods of time. In addition, nighttime sleep may be fragmented with frequent awakenings. Three other classic symptoms of narcolepsy, which may not occur in all patients, are:

  • Cateplexy: sudden episodes of loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Attacks may be triggered by sudden emotional reactions such as laughter, anger or fear and may last from a few seconds to several minutes. The person remains conscious throughout the episode.
  • Sleep paralysis: temporary inability to talk or move when falling asleep or waking up. It may last a few seconds to minutes.
  • Hypnagogic hallucinations: vivid, often frightening, dream-like experiences that occur while dozing or falling asleep.

Daytime sleepiness, sleep paralysis and hypnagogic hallucinations can also occur in people who do not have narcolepsy. In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime sleep attacks. There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious disruptions in a person’s social, personal and professional lives and severely limit activities.

When Should You Suspect Narcolepsy?

You should be checked for narcolepsy if:

  • you often feel excessively and overwhelmingly sleepy during the day, even after having had a full night’s sleep;
  • you fall asleep when you do not intend to, such as while having dinner, talking, driving or working;
  • you collapse suddenly or your neck muscles feel too weak to hold up your head when you laugh or become angry, surprised or shocked;
  • you find yourself briefly unable to talk or move while falling asleep or waking up.