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Sleep Disorders

Tired After Inadequate Sleep

08/25/2009

Question:

Dear doctor, I work on a rather unique shift case. I work for one day, one night and two offs (day-night-off-off) for eg. Monday(day), Tuesday (night), Wednesday, Thursday (off). My night shift may look bizarre. I start work at 1600hrs to end 2200hrs..and wake up following morning at 500am to end at 6.30am. When at home I go sleep at 10pm to 0630am. But I cannot say why I feel extremely drawn out after each n/s....with bodily pains, and excess perspiration...It`s only after I get a nights normal sleep (10pm to 630am) that I find myself normal again.

Thanks.

Answer:

That's a very interesting work schedule! If I understand you correctly, your night shift rotation allows you to sleep from 2200 to 0500, but at work and not at home. If this is correct, then you are able to sleep at night each night, but not in your own bed on your night shift night and for a shorter duration than normal (assuming you are sleeping 8-8.5 hours at home on a normal night). Shift work is quite common in modern society due to the 24/7 nature of world. As a result, about 20% of the population is involved in some form of shift work and about 15% of these individuals will have problems with sleep. I will address some general statements about shift work and then speak specifically to your problem.

For rotating shift work, it is better to shift forward. By this, I mean it is more compatible with the human biological (circadian) rhythm to start with a dayshift; followed the next rotation by an evening shift, and the third rotation should be a night shift. This assumes the worker is given enough time between the night shift day and the next morning shift. The other way around, shifting from night shift into evening shift into day shift is less tolerated. Rotating shifts probably work best when the rotations are over longer periods (i.e. several days to weeks) to allow the circadian cycle to synchronize with your work pattern. Your work rotation appears to go in the correct direction, though the timing of the changes is rather quick.

Shift workers tend to have a lot of sleep problems. Most commonly, they experience problems related to their internal clock being out of synch. Thus, they tend to have problems falling asleep when they should be sleeping and staying awake when they should be awake. This manifests as insomnia and excessive sleepiness. In general, shift workers tend to get less sleep than they should be getting on a regular basis.

However, when we encounter a patient who is complaining of extreme fatigue or sleepiness, we consider several problems, only one of which is the shift work. Other common causes of symptoms like you have are short sleep time, poor quality sleep (which may be related to a primary sleep disorder such as sleep apnea and periodic limb movement disorder) and nonsleep problems (such as liver, heart, or kidney disease, or anemia, or medication effects). A full history and examination are usually need to exclude these possibilities.

Body aches are a general problem that may be exacerbated by physical activity during the work shift. Arthritis or fibromyalgia are common causes of these aches and can cause sleepiness and fatigue. Excessive perspiration may be caused by sleep apnea, among other causes.

Based on the information you have provided, I suspect you may not be getting enough good quality sleep on the night of your night shift. If this is the case, then eliminating this shift may be the answer.

I suggest that you increase your sleep time on the night of your night shift and see if this eliminates the problems. If so, then no further evaluation is needed. However, if your symptoms persist, then you should see your regular doctor and review the symptoms you have. The perspiration, body aches and fatigue may require at least some preliminary blood work.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University