Shift work sleep disorder

Shift work sleep disorder
Classification and external resources
Specialty	neurology
ICD-10	G47.26
ICD-9-CM	307.45
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Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia and excessive sleepiness affecting people whose work hours overlap with the typical sleep period. There are numerous shift work schedules, and they may be permanent, intermittent, or rotating; consequently, the manifestations of SWSD are quite variable.

The primary symptoms of shift work sleep disorder are insomnia and excessive sleepiness associated with working (and sleeping) at non-standard times. Shift work sleep disorder is also associated with falling asleep at work. Total daily sleep time is usually shortened and sleep quality is less in those who work night shifts compared to those who work day shifts. Sleepiness is manifested as a desire to nap, unintended dozing, impaired mental acuity, irritability, reduced performance, and accident proneness. Shift work is often combined with extended hours of duty, so fatigue can be a compounding factor. The symptoms coincide with the duration of shift work and usually remit with the adoption of a conventional sleep-wake schedule. The boundary between a "normal response" to the rigors of shift work and a diagnosable disorder is not sharp.

Insomnia and wake-time sleepiness are related to misalignment between the timing of the non-standard wake–sleep schedule and the endogenous circadian propensity for sleep and wake. In addition to circadian misalignment, attempted sleep at unusual times can be interrupted by noise, social obligations, and other factors. Finally, there is an inevitable degree of sleep deprivation associated with sudden transitions in sleep schedule.

There have been many studies suggesting health risks associated with shift work. For example, a 2007 study led by the IARC (International Agency for Research on Cancer) showed that shiftwork has been associated with cancer. Other studies have reported that night workers have an increased incidence of heart disease, digestive disorders and menstrual irregularities. Because a formal diagnosis of SWSD was not typically made in these studies, it remains unclear whether the reported risks apply to the subset of shiftworkers who qualify for a diagnosis of SWSD or apply to all shiftworkers.

Brain arousal is stimulated by the circadian system during the day and sleep is usually stimulated at night. The rhythms are maintained in the suprachiasmatic nucleus (SCN), located in the anterior hypothalamus in the brain, and synchronized with the day/night cycle. Gene-transcription feedback loops in individual SCN cells form the molecular basis of biological timekeeping. Circadian phase shifts are dependent on the schedule of light exposure, the intensity, and previous exposure to light. Variations in exposure can advance or delay these rhythms. For example, the rhythms can be delayed due to light exposure at night.

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