Managing insomnia in shift workers

The human, environmental and financial implications of these disasters have been considerable, and have been long remembered.

What these disasters also have in common is that all have been attributed to fatigue. People working shifts will be able to relate to the excessive sleepiness than can occur either when working night shifts, or working double shifts. Jet lag presents similar feelings of excessive sleepiness. In a nutshell shift work throws out your body clock and is a well-known risk factor for insomnia.

Referred to as circadian rhythm sleep disorder, shift-work type, but more commonly known as shift-work disorder, this particular manifestation of insomnia can have serious implications: nurses, doctors, ambulance drivers - all are professions which rely on shift work, and their capacity to make life and death decisions on the spot. Sleep deprivation can lead to poor decisions being made. In fact, neurologist and sleep expert Dr Kevin Rosman says that people who have been awake for 17 hours straight function as if they have a blood alcohol level of 0.05%, the legal blood alcohol limit in South Africa. Stay awake for a further two hours, and you are functioning with the equivalent of a 0.08% blood alcohol level. “The most dangerous time to be on our roads is at 3am, as people are driving home incredibly tired after a long day at work followed by an evening out,” says Dr Rosman. “Traffic accidents in South Africa are all too common, and a huge number of these accidents are related to fatigue. When tired, people tend to respond rapidly, but the response isn't always the right one.”

Of particular concern for Dr Rosman are the long hours truck and bus drivers are expected to undertake here in South Africa. “People can fall asleep in three seconds without warning. You simply can't beat fatigue, you will succumb to it eventually. Winding down windows and putting up the music only delays the inevitable if you are suffering from extreme sleep fatigue.”

But there are ways to address the challenges inherent in shift-work disorder. The focus of most interventions is to optimise the natural sleep-wake cycle. “Shift-workers often don't have a problem falling asleep, their problem is staying asleep. They need to sleep better, and for longer, so that they wake up feeling refreshed - irrespective if it is day or night - and then to stay awake.”

First and foremost, shifts need to be properly structured, with speed of shift rotation, direction of rotation and even shift length and time playing a significant role in minimising the negative consequences of shift-work disorder. Short-acting sleeping agents such as sleeping pills can be hugely beneficial in facilitating a higher quality of sleep. People working longer shifts can benefit from a one hour nap - even a 10 minute power nap can be invigorating. Night shift workers should wear dark goggles when going home to avoid exposure to sunlight (the retinal cells of the eye will pick up the stimulus of the sun and suppress melatonin which encourages wakefulness). “Of equal importance is the understanding and compassion of family members and friends who must realise that, even though a shift worker is home during the day, it does not mean he or she can now do the shopping or look after the children. They need to sleep for their own safety, and for that of others.”

There are also people who are more suited - and less suited - to working shifts. People over 40 or who have pre-existing sleep problems, gastrointestinal disorders, need a rigid sleep schedule or conditions to sleep well, or are ‘morning' people, should generally avoid shift work. Conversely, ‘night owls' and people suffering from delayed sleep phase disorder may adapt to shift work very well.

Issued on behalf of sanofi aventis