Shift Work Disorder

This content was created by the National Sleep Foundation

Non-Medical Treatments

In addition to behavioral changes and good sleep habits, there are some other non-medical options for improving symptoms of Shift Work Disorder. One of these options may help regulate your sleep or improve your alertness on the job.

Melatonin

Melatonin is a drowsy-making chemical naturally produced by the body. In people not working night shifts, melatonin levels increase a few hours before bedtime when the body is preparing for sleep. Melatonin levels remain high at night, decrease in the morning, and remain very low during the rest of the day. If you work on a shift schedule and you’re exposed to light during the evening or night, your body’s natural production of melatonin can become suppressed. In addition, light at night can cause a change in the timing of this melatonin profile (which is normally high at night and low during the day). In most shift workers, the melatonin profile does not realign properly with night work and sleep during the daytime. This lack of proper alignment of the melatonin profile—and the rest of the circadian system—contributes to disturbed daytime sleep, decreased alertness during night shifts, and presumably to many other health problems associated with shift work.

Taking melatonin may help to “reset” your internal clock if you need to adjust to an irregular schedule. Melatonin is sold as a dietary supplement like vitamins and minerals and is not regulated by the Food and Drug Administration. If you’re considering taking melatonin, discuss it with your doctor and make sure you use it properly—in the correct dose and at the proper time. Inappropriate use of melatonin can backfire and increase sleep problems.

Light therapy

Light is a powerful signal for your internal clock. Light therapy may help shift workers adjust to irregular schedules. Light has two primary effects on your sleep/wake pattern. It has an alerting effect, and it also has the ability to gradually shift sleeping patterns earlier or later, depending on the timing of light exposure. During light therapy, you sit near a light box for a prescribed amount of time. The time of day is very important to achieve the desired effect. Exposure to bright light early in a person’s wake period (and dim light at the end of the wake period) has the effect of moving the internal clock earlier. Exposure to light late in the day delays the timing of the internal clock. The timing of exposure to light can help you establish a better sleep/wake pattern, based on your work schedule and needs.

Your doctor may advise light therapy as a way to help you alter your sleep patterns and become more alert and productive for shift work. Your doctor will need detailed information about your work schedule and sleep patterns before prescribing the timing and amount of light therapy that is best for you. Light boxes are available in stores and online, and are sometimes covered by insurance.

Caffeine

Caffeine can make you more alert and productive during your shift. As low as 200 mg of caffeine (a cup of coffee has 100-200mg of caffeine, a can of soda has 30-40mg) has been found to improve alertness for those who wish to be awake at night. A nap followed by caffeine may be especially effective. Caffeine remains in your body for many hours, so make sure to taper off your caffeine intake as your shift winds down, ideally limiting your caffeine to the beginning half of your shift.

Medical Treatments

Non-medical options, like following good sleep hygiene, making adjustments to your schedule and sleep environment, and practicing relaxation techniques are usually the first step in treating shift work sleep disorder. If you’ve tried these and you still have symptoms that interfere with work or family life, your doctor may suggest medication. This might be medication to help you stay alert at work, or to help you sleep during your off-hours.

Helping you feel alert: There are medications, such as modafinil (brand name Provigil) and armodafinil (brand name Nuvigil) that increase wakefulness and can help make people alert and productive on the job. If you’ve made changes to your sleep behaviors and schedule, but still feel very sleepy or have many bouts of falling asleep when you’re supposed to be awake, your doctor may suggest a medication as an option.

These medications work by turning on the systems that normally keep your brain awake during the day. These medications are not amphetamines and are not habit forming.

Helping you sleep: Sleep aids to help you fall asleep and stay asleep might be suggested to temporarily help a shift worker who needs to sleep during irregular hours. Examples of sleep aids include benzodiazepines, non-benzodiazepine hypnotics, and certain antidepressants.

You should ask your doctor which of these may be the best match for your symptoms and your health history.

Medication Safety

If your doctor has prescribed medications for your shift work disorder to help you stay alert on the job (a wakefulness-promoting medication) or sleep when you’re off duty (a sleep aid), it’s important to follow your doctor’s instructions.

Take the proper dosage exactly as prescribed by your doctor. Medications can have side effects and need to be taken the proper way, or they can be ineffective and even worsen your sleep problem.

Before prescribing one of these medications, your doctor will review your health history, your current symptoms, and learn about any medications you’re currently taking. This is an important step because there are certain health conditions and drug interactions to consider. Medications for treating excessive sleepiness and insomnia as well as other medications for other ailments can have side effects, so it’s very important to learn about these side effects first, and take note of any changes or symptoms you notice when taking them.

It’s important to know that medications that help you stay alert do not make up for the lack of sleep; your body still needs the proper amount of sleep to function well whether or not you take these medications.

Even if you do take medications for shift work disorder, make sure to also implement behavioral changes as well. Medications for excessive sleepiness or insomnia shouldn’t be thought of as a long-term solution, but rather as a temporary way to help alleviate your symptoms. Behavioral changes are important for long-term healthy sleep.