Question: What do firefighters, fishermen, musicians and casino workers have in common?

Answer: They all work in 24-hour industries that sometimes require them to work in the evening and overnight hours. As a result of this flip-flopped schedule, they may also share the condition known as shift work disorder.

Shift work disorder (also known as shift work sleep disorder and shift lag) is a disruption of the natural sleep-wake cycle that can lead to a chronic lack of energy, difficulty concentrating, increased irritability, increased work-related errors, and sometimes, serious accidents.

The 1989 Exxon Valdez disaster in Alaska has been blamed on sleep deprivation; when the tanker went aground, spilling 10 million gallons of oil into Prince William Sound, the on-duty officers had been deprived of mandatory time off before their shift. Fatigue also played a role in a 2009 commuter plane crash near Buffalo that killed 50 people. Both the pilot and first officer were seen catnapping in the crew room shortly before takeoff.
   
Eyes Wide Shut

While occupational catastrophes like these can’t befall casino workers, anyone who’s ever worked while the world sleeps knows there’s a price to be paid for going against the body’s circadian rhythms. Symptoms of shift work disorder, including insomnia, headaches and depression, take a big toll on security guards, long-haul truckers, wait staff, actors and anyone who works non-traditional hours (typically between 10 p.m. and 6 a.m.).

“Some people are able to adapt to some extent, but others, even when they get an adequate amount of sleep, simply cannot readjust their internal body clock,” says Dr. Ryan Dammerman, associate medical director with Cephalon, Inc., manufacturer of medications prescribed for sleep disorders. “I had to deal with it in medical school and during my residency, and it’s tough.” 

For one thing, Dammerman says, daytime sleep simply may not be as recuperative as nighttime sleep. “Think about it. If you nap on the beach on a sunny day, some sunlight will get through the eyelids and hit the retina, disrupting sleep, and that sort of situation is not as restorative. It’s the same thing if you sleep at home during the day. You’re hearing daytime noises—the kids playing, traffic in the streets—and your brain is getting mixed messages” that prevent quality sleep.

Unfortunately, human beings cannot really “catch up” on sleep on the weekends or on days off. In fact, trying to make up for a sleep deficit by spending your day off in bed may only confuse the body more.

And the problem is worse for those who work swing shifts. Each time a worker has to adjust to a new sleep-wake cycle, it can take up to a week for the body to fully adjust. Constant rotation of the cycle can lead to undersleeping, oversleeping or restless sleep, in which the body loses its sense of when to shut down and when to wake up. It’s much harder to deal with rotating shifts than to work the same shift over a prolonged period.

Day for Night

If you must work nights, there are ways to practice what doctors call “good sleep hygiene,” and your employer can help.

“Some workplaces allow you to take intermittent naps on the job,” says Dammerman. “Other places will allow you to have exercise breaks. Those regimens are helpful.”

Adequate indoor lighting, which simulates daylight after dark, helps fool the mind into believing it is on a normal, diurnal schedule. And for those who work rotating shifts, it is much better if work shifts move forward in time rather than backward (i.e., going from a 7-to-3 schedule to a 3-11 schedule, and then to an 11-to-7 time frame if necessary).

Tips For Surviving the Night Shift

• “The No. 1 thing is not adding the second problem of sleep deprivation,” says Dr. Dammerman. “Try to get seven to eight  hours of sleep.”

• Establish a sleep schedule and stick to it, even on weekends and days off.

• Use blackout shades in the bedroom or wear a sleep mask. The darker the environment, the better for restful sleep. Ear plugs or white noise tapes block out extraneous sound and promote healthy rest.

• Avoid caffeine and cigarettes for at least four hours before you plan to sleep, and stay away from alcohol. Though a drink or  two will seem to relax you at first, alcohol disrupts dreaming and can keep you from getting deep, restful sleep.

• Ask your family to be quiet when you’re sleeping. Have them wear headphones to listen to music or watch TV. Encourage them to avoid vacuuming and other noisy activities. Put a “Do Not Disturb” sign on the front door so that delivery people and friends won’t knock or ring the doorbell.

• If you must be up during the day, consider wearing dark, welder-style goggles or sunglasses; remember, sunlight cues your brain for wakefulness. If you wear goggles, be extra-careful while driving.

• Decrease the number of night shifts worked in a row. People on the night shift sleep less than day workers, and become progressively more sleep-deprived over several days. You’re more likely to recover from sleep deprivation if you limit your number of third shifts to five or less, with days off in between. If you work a 12-hour shift, limit work to four shifts in a row. After a string of night shifts, you should have more than 48 hours off, if possible.

• Avoid prolonged shifts and excessive overtime.

• Never drive sleep-deprived. Some studies indicate that drowsy driving is a factor in up to one-third of road accidents. Like drunk driving, fatigue reduces coordination and response time, which are critical to safety on the road, both for you and for other motorists.

• Take naps whenever you can, but remember, naps do not take the place of seven to eight hours of sustained sleep.

• Watch your diet. Have you ever found yourself wolfing down food or drinking too much cola when you’re tired? Researchers believe that sleep deprivation disrupts the hormones that regulate glucose metabolism and appetite. Get more sleep, and you could avoid an unwelcome weight gain.

• Ask your doctor if medications would help alleviate the symptoms of shift work disorder in your case. Provigil (modafinil) and Nuvigil (armodafinil) improve wakefulness and have also been prescribed for narcolepsy and sleep apnea. “But remember, the purpose of any of medication is not so you can stay up for 36 to 48 hours,” says Dr. Dammerman. “It’s an essential principle of good health to get eight full hours of sleep.”

For more information about shift work disorder, visit www.SWDaware.com or www.sleepfoundation.org.

By Marjorie Preston

Marjorie Preston is a contributing editor of Global Gaming Business magazine and managing editor of Casino Connection Atlantic City.