Why Shift Work Disorder Is More Than Just Feeling Tired on the Job

Today´s conversation focused on the realities of shift work disorder, a condition often misunderstood or dismissed as just part of working odd hours. A key theme that emerged was the significant impact of misaligned circadian rhythms on both sleep quality and overall health, especially for those working night, early morning, or rotating shifts. The discussion explored the biological mechanisms that make it challenging for shift workers to get restorative sleep, highlighting symptoms like insomnia, excessive sleepiness, and decreased productivity. Several points were raised, including the long-term risks of untreated shift work disorder, its effects on relationships and family life, and practical management strategies for those unable to change their schedules. Listeners are encouraged to recognize the difference between normal adjustment struggles and a true sleep disorder, and to seek specialist help if symptoms persist.

Timestamps:

00:00 Understanding shift work disorder

04:55 Impact of Circadian Rhythm Disruption

08:53 Understanding circadian rhythm misalignment

10:14 The sleep struggles of shift workers

16:43 Adjusting to night shift work

17:57 Creating a sleep-friendly environment

22:00 Managing light for optimal alertness

24:38 Diagnosing Sleep Disorders Basics

29:33 Recognizing and managing shift work disorder

Dr. Vishal Saini - https://www.mwcsd.com/dr-vishal-saini/

Show Website - https://the-hidden-sleep-disorders-sho.beam.ly/

Podcast Producer - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_01 0:00

Shift work disorder falls into a category of sleep disorders. We call them circadian rhythm sleep disorders. Before the invention of light bulb, there wasn't any night shifts, so to speak, because everyone goes to sleep. That is what creates a misalignment and then individuals who are prone to see more consequences, they tend to feel the consequences more in the sense they feel very tired, they feel very sleepy when they are supposed to be awake and working. So it messes up with their productivity, their focus. A lot of these folks will say, Oh my gosh, maybe I have ADHD. And you can see how all these other things can get mislabeled, even though it's only a problem between their circadian alignment. It is the real problem. It's not just in your head, it will impact and put you in the harm's way if you don't manage it properly.

SPEAKER_00 1:22

This episode is for you. Dr. Sandy's here joining us today to talk about shift work disorder, a real medical condition and not just an occupational hazard. So we were chatting before we started to record, and I had never heard about this. I did not know that this was a thing. So it was like, I don't know if this was general knowledge that I didn't know about or if it's common that people don't know. So I'm excited for this episode.

SPEAKER_01 1:48

You know, you said it right. Let's dedicate this to all the shift workers in the world. And I was reading a few facts about it. Almost 20 to 30% of people in the industrialized world actually work these different shifts. You know, so there's plenty of people out there who work all different kinds of shifts, evening shifts, early morning shifts, rotating shifts, you know. So let's dedicate this to all our shift workers and uh let's dive in.

SPEAKER_00 2:20

Absolutely. So I'm so curious about this. So a lot of shift workers assume or feel that, you know, feeling off might just be part of the job. But what exactly is shift work disorder and how is it different from just let's say being tired from working an odd or not typical schedule?

SPEAKER_01 2:39

So shift work disorder falls into a category of sleep disorders. We call them circadian rhythm sleep disorders. And there are quite a few, and shift work is one of them. So, for example, there is a circadian rhythm sleep disorder, delayed sleep phase. There is a circadian rhythm sleep disorder, advanced sleep phase. What's the difference between those two? Meaning, hey, I cannot fall asleep. You know, you've heard of the term night owl. So those are the folks who have delayed circadian rhythm sleep disorder, especially if they're feeling somehow limited by their sleep timing. So they go to bed super late. You know, they can't fall asleep at regular nighttime. On the other hand, the other spectrum is the advanced sleep phase circadian rhythm disorder, where I'm going to sleep way too early, you know, at 5, 6 p.m., 7 p.m. I can't stay awake, you know, past 4 or 5 p.m. And you know, and a lot of this I see in my elderly population. Then the third one is where there's an irregular sleep wake pattern, where it's just all over the place. It's not, it's delayed some weeks, it's advanced some weeks, and so it's a mix of those two, and it's called irregular. And then the fourth one is where the shift work disorder comes into play, which is the circadian rhythm sleep disorder shift work type, meaning I have to be working an atypical shift. For example, I'm working in the evenings, or I'm working nights, or I have an early morning shift. And then there is what we hear in real life. Some people call it, hey, I'm on swing shift, meaning some days I'm working days, some days I'm working nights, some days I'm working early mornings. So that's a swing shift, so to speak. So very taxing on our bodies. So that's what this shift work disorder is part of that group, where there is a misalignment between my circadian cycle in my body. So our body has its inherent intrinsic sleep rhythm or circadian rhythm. And every single cell has it in our body. Where and it's a little bit longer than 24 hours, but it's safe to assume it's set by the light and dark cycle in our, you know, so sunrise to sunset. That's basically determining what our circadian cycle is set at. And you have to reset it every day. So that's why the early morning exposure to light is very important to keep that uh alignment in place. And once that alignment disrupts, that is what causes a lot of these problems. And shift work is a prime example, because that's sort of a man-made thing, right? Before we the invention of light bulb, there wasn't any night shifts, so to speak, right? Because everyone go to sleep, or at least most people would. So that is what creates a misalignment, and then individuals who are prone to see more consequences, they tend to feel the consequences more in the sense they feel very tired, they feel very sleepy when they are supposed to be awake and working. So it messes up with their productivity, their focus. A lot of these folks will say, Oh my gosh, maybe I have ADHD. And you can see how all these other things can get mislabeled, even though it's only a problem between their circadian alignment and what shift they're working. As far as its toll on the sleep, it messes up my sleep because a lot of these shift workers, they lose a lot of sleep. So it's sort of a double whammy. I'm dealing with the impact of sleep loss, where I don't have enough sleep hours, and then I'm dealing with the impact of misalignment between my intrinsic circadian cycle and my actual hours when I'm being awake or when I'm being asked to sleep, which may not be nothing that I would naturally do if I wasn't doing that shift work.

SPEAKER_00 6:54

Yeah, that's so interesting. I had so many different thoughts while you were saying that because I always that's why I didn't think it was a disorder. I just thought if you're, you know, you work at night, you're not seeing the sun, you're gonna feel off or you're gonna feel tired. So I'm sure people who do have those shifts. Exactly.

SPEAKER_01 7:09

So let me dive in a little bit deeper. So when does it become a disorder from just a regular shift work, right? So here are a few sort of clinical criteria that we have to look for. One, is it impacting my quality of work? Is it impacting my work life in the sense that, hey, let's say I'm a I'm a nurse in the ER or in the ICU and I work nights. But is it messing up with how much I can focus or I'm able to, you know, take care of things? If that's the case, then it's already turned into a disorder. Okay? If it's one off thing, then not really. And so there is a timeline criteria here as well. So it has these symptoms have to last for at least three months. If you had one off day, you know, all of us have one off day where we don't really are on top of our game. But if it's a consistent thing and it's been happening to me for more than 90 days, more than three months, that's when it sort of becomes a problem. So that's another thing to remember that if it's only like, hey, I had it for two days, five days, that's not shift work disorder, has to be minimum of 90 days criteria. So that's how you would differentiate whether I'm am I dealing with a real problem that's not going away, or was it just something that happened at work that night and meshed me up for a short term?

SPEAKER_00 8:37

So three months is about that time frame if people are experiencing it for three months. So then it seems like the body is kind of working against these schedules almost from the very beginning. So can you explain what's happening biologically when someone actually works against their natural circadian rhythm this way?

SPEAKER_01 8:53

So yes. So our biological rhythm is completely dependent on sunrise and sunset, those cues, and that kind of cues my brain, my body cells, and not just the brain. Every single cell scientists have discovered is they have these circadian clock genes, and those genes determine the circadian cycle at a cellular level. So then if I'm somehow creating artificially a situation where I'm sleeping in a misaligned way. So basically my circadian clock says I should be sleeping, for example, and I'm just making this up. Let's say it's it's saying I I should sleep from 10 p.m. till six or seven in the morning. But then I'm supposed to be working because I gotta earn a livelihood or I gotta do a rotation or whatever. So then I'm artificially going against my biology, against my genetic circadian cycle. And that misalignment is the sort of underlying root cause of the problem. Now, some people, some cells, some bodies will be able to manage and tolerate that better, versus others who are genetically more predisposed or more vulnerable, they're gonna see bad outcomes, big consequences, because then when they're at work at nighttime, they're busy fighting sleepiness. When they come back home, they're busy fighting wakefulness, because then they can't sleep during the daytime. So then it turns into a big sleep loss. And so in fact, there are studies that show that shift workers they pretty much lose anywhere between one to four hours of sleep over a 24-hour cycle compared to a non-shift worker. So that's a big amount of chunk of sleep loss to be dealing with, and then of course I'm dealing with the consequences of sleep loss. So it's a double whammy. One, it's working against my biological uh circadian rhythm, and two, I'm dealing with the consequences of sleep loss. So then it sort of becomes hard to manage.

SPEAKER_00 11:15

We talked about how some of these symptoms kind of seem normal, especially with like atypical shifts. And I think it's common that some symptoms just get written off as normal for anyone kind of working rotating shifts or night shifts or anything like that. And you kind of touched on this, but what symptoms or specific symptoms kind of tell you that a shift worker has crossed the line from just adjusting poorly into an actual sleep disorder?

SPEAKER_01 11:38

So two main sort of symptoms that we see in this population. One is the complaint of insomnia, where hey, I can't fall asleep, I can't stay asleep when I'm wanting to. But that's not when your body, your cells, your genes, your brain is ready for sleep. Because to them, they're still in that wakefulness phase as far as their circadian rhythm is concerned. So insomnia becomes a big symptom. The second symptom becomes hypersomnia, which is excessive sleepiness. When I should be more wakeful, I should be able to drive without feeling drowsy, I should be able to work at top of my game without feeling drowsy. And so these folks are dealing with a lot of excessive sleepiness. So those two really either it's gonna be one or the other, but generally I see both in the same person. And then as a clinician, we're scratching our head. It's like, okay, which one is what? You know, but it's part of the same problem, and that's the underlying misalignment from my biological circadian rhythm to what I've artificially created as a shift work.

SPEAKER_00 12:52

Absolutely. And you kind of touch on this as well, but this condition seems to reach obviously beyond just feeling exhausted at work. So, what are some of the longer-term risks that are actually tied to shift work disorder if it does go unaddressed or undiagnosed?

SPEAKER_01 13:07

Quite a few, actually. I mentioned loss of productivity, that's a big one. I'm not gonna be as productive or as focused, or and I might make a lot of errors in whatever work I'm doing. There are a lot of, you know, I'm prone to accidents. In fact, there are studies that report there is higher history of substance abuse in this population. I remember actually someone did an experiment on resident physicians and they offered them, you know, during their night shifts just to see if it was impacting their decision making. And this is just on their diet, you know. So they so they placed healthy options versus high carb options. And every single time, all the nighttime shift workers they went for the high carb diet.

SPEAKER_00 14:00

Like, shout out to all the healthcare workers that work overnight because and I found this out, I guess, a few years ago, but like nurses will work, you know, these crazy, like long shifts, and then like four days in a row or like three days off or some kind of schedule like that. And I always wondered, it's such an important job. It's so, so important to be up for that many hours and just have to be mentally on it. I've always wondered how people do that because I know I would mentally be checked out.

SPEAKER_01 14:28

There's a lot of history on that. In fact, I I remember back in 2010 as a resident physician, that's when they strictly came about with an 80-hour work week rule for the incoming residents. Prior to that, there was no such rule. So you could be working 90, 110, 120 hours a week, and you're just constantly working tired. And then I think someone ended up getting into a car accident and dying, and so there was a lot of advocacy around that. So then, you know, all the powers to be, they they sort of come up with a way to reduce the hour. You know, 80 hours a week is still a lot of hours to be working, but you know, imagine life before that. So you're you're absolutely right. There are certain groups of occupations that have a very high burden of this.

SPEAKER_00 15:27

That's yeah, that's so interesting. And I know well, most shift workers can't really just, you know, go and quit their job or change their schedule overnight. But for someone who can't change their work hours, what treatment options or strategies do you recommend to manage this?

SPEAKER_01 15:41

So, yes, it can be quite challenging trying to fight against your own genetics, against your own biology. So, yes, managing is a good term because I don't think there's really any treatment for this. So all you can do is really manage it. And you know, I see a lot of cops and and police officers who are on these brutal shifts as well, you know, and that's another group that is, you know, they have swing shifts. And if you're new to the force, you just join, you don't have that level of seniority. So then guess what? You're getting all these, you know, late night, early morning shifts, and that it becomes extremely hard to manage those. So some of the things that a person needs to do or should be doing to manage is is to one, have a very consistent schedule. Because what ends up happening is we tend to revert back to our normal sort of cycle, so to speak. So let's say I work night shifts for three days, then I stay awake at night and sleep during the daytime. But as soon as I'm off, I'm trying to stay awake all day long and then trying to flip back and forth, flip back and forth, which actually is much harder to deal with versus keeping the schedule, even on your off days, to keep it consistent as if you were working night shifts, especially if you don't see you know any changes in your situation anytime soon. So what that allows is to sort of let the brain go into at least some rhythm so that it's not fighting back and forth into these swings, basically. So that's one important thing to remember. The second one is that especially for people who deal with more insomnia, you know, yes, I did great during my night shift, and then during the daytime I'm trying to sleep. So then they need to make sure they have a quiet and peaceful sleep environment, because you know the world around us doesn't stop. In fact, it just comes alive during the daytime. So a lot of these folks will need to create, you know, environment where kids are not around disturbing you or dogs are not, you know. So you you have to make sure that you treat that sleep time, that phase where you're planning to sleep with the same intensity as if you were trying to sleep at night. So you gotta keep your room dark, you gotta keep it cool, you know. So all those things will matter. And in fact, there are a lot of people, despite doing all that, it still doesn't really keep them asleep, and then we have to utilize sleep aids or sleeping medications to help them get more restful sleep. So it can become very, very challenging. Other thing that I usually tell some of these folks who have long commutes, you know, and if I'm going back from work and it's bright sun shining in my eyes, it's going to delay your sleep as you're trying to go to sleep. You know, you're already fighting your biology, and then on top of that, if you have a lot of light exposure happening to you early morning, it's going to make it harder for you to fall asleep. So generally we tell these folks to use dark glasses, tinted carb, you know, windshields and whatnot to minimize that light exposure that's happening to them.

SPEAKER_00 19:20

I just had a thought that's somewhat related. But for example, people that we've talked about before with narcolepsy that struggle sometimes with the driving, if they have it, you know, make make it darker and they struggle with narcolepsy, does that ever happen? They can overlap, I'm sure, right?

SPEAKER_01 19:36

Yeah, yeah, you you can have both, but narcolepsy patients are, you know, extremely sleepy no matter what. So they're sleeping, you know, 10, 12, 16 hours, and regardless of that, they're still complaining of excessive sleepiness. The shift work disorder, on the other hand, they're struggling at work, they're struggling to sleep during the daytime. And you're absolutely right. In a right person, it can become extremely, extremely challenging to pick them apart. And that's where all the tools of testing, you know, the actigraph, the sleep studies are gonna come into play to differentiate those for us.

SPEAKER_00 20:15

That's what interesting. And so there's probably a point where this stops being something to really manage alone. So at what point should a shift worker stop trying to just push through and actually see a sleep specialist about this?

SPEAKER_01 20:27

So you're right. It is tough. Even with the help of a clinician, it's gonna be tough. So I can't imagine dealing with it all by yourself, you know. So you're absolutely right. So one, you know, the criteria that we talked about at the start, that if you've been struggling for more than three months, then it's not gonna go away by itself. And then you really need some professional on your side. So that's number one thing to remember. Number two, depending on how intense these symptoms are impacting my work day or my nighttime sleep, how distressed I am. So before, you know, it starts to mess up my mood, starts to mess up my relationships, starts to mess up my social obligations, that's really when you you need to take some action. And that's the hardest thing, that I'm so tired, I all I want is just to go and crawl in my bed and not really seek any help. Because you can just keep blaming, oh, I just need more sleep, I just need more sleep, but that sleep isn't coming. So then what do you do? So that's I think that's how one can determine how to seek help.

SPEAKER_00 21:42

Absolutely. And we just talked about this a little bit with light exposure with sleeping, and I think that there is probably a lot of conflicting advice out there about napping and light exposure for people, especially on odd schedules. So, how should shift workers be using naps and light exposure to work with their bodies instead of against them?

SPEAKER_01 22:00

So who hire these night shift workers, they may utilize or they should utilize a lot of bright lighting. And the more light exposure those workers have, it's better for their brain to feel more alert, less accidents, less workplace accidents. And the same logic for when I'm trying to sleep during, you know, everyone else's daytime, but my nighttime is to make sure my room is dark and I don't have a lot of light exposure happening. So light plays a crucial role. It helps us stay alert and awake, you know, if it's bright and the right intensity. And then it can also disrupt my sleep if I'm not managing light in my bedroom. So you have to manage light in the workplace, you have to manage light while you're driving from work to home or from home to work, and then you're you're having to manage light in my bedroom. And so does the temperature. Even temperature plays a role in this. If my bedroom is too hot, that's gonna mess up my sleep more. So it's generally a good idea to keep my room on the cooler side, you know, close to 65, 67 degrees. So that generally is optimal.

SPEAKER_00 23:14

It's an oh notice. I think I think mine is exactly at 63. But I yeah, I I've taken some tips from from these sleep shows for sure. But and it's interesting talking about the lighting, because if you're struggling with this and you don't even know that it's a disorder, you would never even really think about the different lights that you would need at all. Like that blackout curtains are common, things like that. But if you don't really know you need it, it's something that wouldn't really cross your mind.

SPEAKER_01 23:41

That's all that's yeah, and it's so easy, right? You can blame just everything on like, oh yeah, I just need more sleep, but then you're struggling to get more sleep, right? And then what about you know the other sleep disorders that still could be hidden or hiding? So you still gotta rule out everything else, you know. So for if I'm at risk for sleep apnea and I'm trying to sleep, no matter which shift I'm trying to sleep, it's still going to disrupt my sleep. So I gotta take care of that as well. So yes, I I think if you are experiencing what we just talked about and dealing with this, then there should not be any hesitation in seeking help.

SPEAKER_00 24:24

Absolutely. And so before you can go really treat this, you actually have to confirm what's going on, which is what we were talking about. So can you kind of walk us through how shift work disorder does get diagnosed? And are we talking sleep logs? Is it a form of sleep study or is it something else?

SPEAKER_01 24:38

So the majority of the diagnosis is going to come from the clinical history, which is where we're chatting face to face and making sure there's nothing else going on. Everything else is secondary as far as shift work is concerned. So a good detailed history with a clinician is really the primary focus as to how the diagnosis is made. But there are some tools where we may ask you to keep a sleep log or sleep diary for a few weeks, activity, which a lot of people now have, all these smart watches that track your sleep, so you can even show that to your clinician. And it's keeping track of hey, what time you went to bed, what time you got out, how many times you woke up through your sleep phase. So that, or the clinician might do a more formal activity of their own as well. And then the other sleep studies, for example, either home sleep test or in-lapse sleep study, is to rule out underlying sleep disorders like sleep apnea and uh, you know, everything else that sleep studies could rule out. And that is to make sure, okay, because if I'm dealing with, let's say, sleep apnea or restless legs, you know, those kind of things, I can easily manage them and get them out of the way. Obviously, I can't do a whole lot about changing that person's shift work, but I can optimize everything else that's in my control. So, you know, for example, if let's say, hey, I did a home sleep test at home, but no one's really assessed my situation, then you're only gonna get partial answers from that. But so you have to kind of look at a whole picture in a holistic way.

SPEAKER_00 26:23

It's interesting too, because this didn't really come to mind, but now I I can't unsee it. Like this condition also doesn't just affect the person that's working the shift, it ripples out to everyone around them. So, how does shift work disorder tend to really affect relationships and family life? And what have you really seen help with those issues?

SPEAKER_01 26:42

So, not in a good way, obviously, right? Because my social connections are gonna suffer and I'm gonna be, you know, either very irritable or cranky because I'm dealing with the sleep deprivation or sleep loss. And then I'm not just available, right? I'm doing things when I'm at work when everyone else might be hanging out or sleeping, and I need to sleep when everyone else is doing their daytime duties. So, yes, that's the price that our shift workers pay, and it messes up with them. So how do you manage that? That's a tough question, because everyone's social situation is unique, depending on, hey, do I have kids to take care of? I've had a lot of shift workers who come after work, and even though as a clinician I'm telling them, hey, why can't you go right off, you know, as soon as you come back, go to sleep? And they're like, No, I can't. I have kids that I have to drop off to school or urgent things like that, just not gonna wait or don't care whether you're working shifts at night or days. So it it becomes harder depending on what sort of social situation you are in. For a single person who has more control over their schedule, it may be a little bit easier to manage those things. Versus if I'm a single mom raising two kids, it's like, hey, where is the time for all this, you know? So you have to customize the advice based on who's sitting in front of us and what are the challenges that they face in their social life.

SPEAKER_00 28:20

Absolutely. Yeah, this was such an interesting conversation because I'm curious to know how many people are are just existing and not knowing that this is a disorder, especially ones that are, you know, living this life and have these atypical schedules. So I'm curious.

SPEAKER_01 28:34

And we were talking about this data point, you know, about 20% of our population is doing shift work of some sort. And so we we believe out of that, at least 5% have shift work disorder. So you can imagine the numbers are quite massive for this.

SPEAKER_00 28:53

Absolutely. And before we wrap up this conversation, is there anything else that you want to touch on or mention to our listeners that you haven't had the opportunity to say yet today?

SPEAKER_01 29:02

I think we covered it pretty well, but I would say parting thoughts that it is a real problem. It's not just in your head. It will impact and put you in the harm's way if you don't manage it properly. And there are ways to manage it. There is no quick fix. It has to be managed through a multi-sort of prong approach. So talk to a clinician, talk to a sleep doctor, and make sure you're seeking help if you're dealing with any of this stuff that we just talked about.

SPEAKER_00 29:33

Absolutely. And if your schedule is fighting your body every single day, that exhaustion isn't something that you just have to accept. I think is a key takeaway from this episode. And shift work disorder, it is treatable, like you said, and it starts with recognizing it for what it is. And it is, like you said, something that is manageable. So if anyone is going through this, make sure that you do reach out to a specialist and really find a way to manage it and treat it. And for everyone listening, thank you for listening. It's been another great episode of the Hidden Sleep Disorder Show. Make sure you're following, subscribing, and sharing it with someone who can benefit from it. It was a pleasure speaking with you as always, and I can't wait to talk to you again soon.

SPEAKER_01 30:09

Thank you, Layla.