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july 2010
Shift Work Sleep Disorder

Dr. Avdhesh Bansal

 
27 feared dead as bus falls in river; driver fell asleep driving (Times of India, April 2009) Man falls asleep on lathe machine, cuts both hands (Hindustan Times, May 2009)

We’ve all seen these kinds of news reports, numerous times. But why do people sleep while driving or working? Well, it turns out that both the driver and the lathe worker were doing night shifts for the past few days! It had disturbed their circadian (pronounced sur’kay-dee-un) rhythm.

What is circadian rhythm?
The circadian rhythm is an internal body clock, which follows a regular cycle. This rhythm makes you feel sleepy at night and keeps you awake during the day. The circadian rhythm is controlled by factors inside one’s body (like the melatonin hormone) and outside it (like sunlight).

What is SWSD?
The circadian rhythm is an internal body clock, which follows a regular cycle. This rhythm makes you feel sleepy at night and keeps you awake during the day. The circadian rhythm is controlled by factors inside one’s body (like the melatonin hormone) and outside it (like sunlight).

What is SWSD?
Shift Work Sleep Disorder (SWSD) is a circadian rhythm sleep disorder that occurs due to a work schedule that takes place during the natural sleep period. This unnatural schedule requires you to work when your body wants to sleep – and sleep when your body is designed to be awake.

Is this disorder common?
It is fairly common: as many as 20 percent of workers in industrialised nations are shift workers, who work either at night or on rotating shifts (mostly in the health and transport industries). Almost 10 percent of shift workers may suffer sleep disorders. Both men and women are equally affected in all age groups, but women have worse daytime sleep than males.
Disclaimer: SWSD need not affect everyone. Some who work the nights are ‘night owls’ and manage to get plenty of restful sleep during the day.

Is SWSD dangerous?
  • SWSD can pose a significant hazard in the work environment - you tend to make more mistakes and can have accidents.
  • This disorder can affect you even in your after-work hours. Using major portions of your free time to catch up on sleep can negatively impact your social and family life.
  • You may also become more irritable, hurting your relationships.
  • It increases the risk of drowsy driving, leading to accidents as you drive home from work.
  • It also increases risk for peptic ulcer disease, coronary heart disease, insulin resistance, and metabolic syndromes.
  • Using drugs or alcohol to try to improve sleep can lead to substance abuse.
Diagnosis
  • The diagnosis can be easily made by a thorough sleep record (sleep diary) maintained over several days, including working and non-working days.
  • Usually tests such as Sleep Study (polysomnography) and Multiple Sleep Latency Time (MSLT) - a test of how fast you can sleep once you hit the bed - are not required.
  • Your doctor will try to exclude other causes of sleep disturbances such as medical condition (like hypothyroidism), medication use (like sedatives), mental health disorder or substance abuse.
7 Remedies
  1. The treatment of SWSD should be directed at improving night-time alertness, with the use of bright light in work areas to imitate sunlight.
  2. Eat a healthy diet. Some people who work night shifts gain weight because they eat high-calorie or high-fat meals.
  3. Abstinence from alcohol in the hours before bedtime.
  4. Daytime sleep duration and quality can be improved by using sleep hygiene methods, enhanced by intermittent use of hypnotic agents.
  5. Properly timed short naps before night shifts can give the workers regular rest periods.
  6. Option of exercise breaks during works hours and stimulant agents such as caffeine or Modafinil (use only as per your doctor’s advice) can also reduce tiredness and sleepiness.
  7. Employers need to help their shift workers stay better rested. The goal should be to lessen the effects of shift work on the workers’ body clocks, to keep them overall healthier as well as safer on the job.
3 SWSD Symptoms
These symptoms usually last as long as the work schedule is in shifts.
  1. Feeling very sleepy or very tired. May also have insomnia (inability to sleep).
  2. Unsatisfactory quality of sleep - typically sleep one to four hours less than the average.
  3. Difficulty in concentrating, headache and lack of energy.
Dr. Avdhesh Bansal is Sr. Consultant, Dept. of Respiratory, Critical Care & Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi


    
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