Shift Work Disorder FAQ: Rotating Shifts

by Eli Hendel, M.D. Medical Reviewer

In my first sharepost on shift work, we discussed shift work disorder, focusing on the causes and symptoms of the condition. Then, we looked at strategies to help avoid or minimize symptoms associated with shift work and strategies to limit daytime sleepiness. But what happens in some work circumstances, where you may have a schedule that consistently has you working different shifts? Here, we’ll answer some FAQ’s on the topic.

What do I do if I have a rotating shift?

One of the most difficult schedules to deal with is rotating shifts. A rotating shift is a work schedule where people move through a cycle of day, swing (day into night), and night shifts. This is very common in the healthcare industry and the police force. The goal is to distribute the stress of the least-desirable shift across the workforce, so no one person is dealing with it on a regular basis.

In some cases, rotations occur every three months, for others, it can be required every three days. It’s probably obvious that the disadvantage of the shorter schedules is that adjustment becomes difficult and more stressful. On this type of schedule, you’ll tend to get less sleep and suffer the consequences associated with sleep deprivation. However, the advantage is that it allows opportunities to do errands, spend time with friends, and engage in other activities.

But it’s important to realize that you may not be the best judge when it comes to symptoms, since many may be subtle. Senior management should be informed about the effects of rotating shifts on employees, and should weigh the employee preferences and work needs, with health concerns.

What is the preferred way to adapt to rotating shift changes?

The change process should take two weeks. Ideally, the person should shift forward by delaying the sleep time by 2 hours every third day, for total of three times This approach is the easiest way for your internal clock to adjust to the rotating shift.

What medications are available for shift work disorder?

The preferred sleep aide should be melatonin. It should not, however, be used to help you to fall asleep. Melatonin should be used as an aide in helping you to shift the schedule. For this, you’d take the dose two hours before the ideal time of sleep. This will help you to make the shift to the new sleep time. A 3mg dose is a good starting dose.

If you are struggling to stay awake during the shift you can use caffeine. Its effect typically lasts 3 to 5 hours, so refrain from using it close to the time you plan to go to sleep. Caffeine io source of energy. It works by blocking adenosine which is a marker of brain fatigue.

The FDA has also approved a drug called Modaafanil (brand name Provigyl) for shift work disorder. The drug is effective and has surprisingly few side effects as well as no potential for addiction or habituation. But contrary to popular belief, it does not enhance attention. It also doesn’t work like amphetamines, although the mechanism of action in the brain is similar.

What can I do if I have diabetes to make sure that shift work does not affect my blood sugar levels?

If you have certain health conditions such such as diabetes and/or high blood pressure, remember that they may have a circadian pattern as well. It’s a good idea to check with your doctor and see if you need to adjust any medication or testing schedules. Treating diabetes and controlling blood sugar levels can involve many different medications that have different lengths of action and have to be coordinated with meals, so you do need to evaluate the impact of shift work.

It’s also important to consider medications you may be taking that influence sleep patterns. For example, arthritis medications affect the internal body core temperature, which sets the sleep schedule. If you switch shifts, do review your current medications with your doctor to assess if they could potentially contribute to sleep issues

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Eli Hendel, M.D.
Meet Our Writer
Eli Hendel, M.D.

Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music.