Shift Work Disorder: Diagnosis and Management

Diagnostic Criteria and Assessment

The American Geriatrics Society recommends obtaining a detailed sleep history focusing on frequency and timing of symptoms in relation to work schedule, and using the Epworth Sleepiness Scale (ESS) score to assess excessive sleepiness, with a score of ≥10 indicating symptomatic patients 1
The American Geriatrics Society suggests documenting sleep-wake patterns over 1-2 weeks using a sleep diary, and considering bed partner observations if available 2, 1
Screening for comorbid conditions such as obstructive sleep apnea, which affects 24% of adults and causes similar symptoms, is recommended 3, 4

The American College of Physicians recommends implementing sleep/circadian hygiene measures, including maintaining a consistent sleep-wake schedule even on days off, scheduling two brief 15-20 minute naps during or before shifts, and avoiding heavy meals and alcohol before sleep periods 1
The American Academy of Sleep Medicine suggests using bright light therapy during night shifts to partially re-entrain the circadian clock, and increasing daytime bright light exposure on days off 4
The National Sleep Foundation recommends avoiding caffeine 4-6 hours before planned sleep, and consuming caffeinated beverages before shifts and during scheduled breaks 1

The American Academy of Sleep Medicine advises against using benzodiazepines for sleep promotion in shift workers due to the risk of decreased cognitive performance, dependence, and next-morning impairment 4
The National Highway Traffic Safety Administration warns that drowsy driving causes 15-33% of fatal crashes, and that SWD increases the risk of work-related injuries and motor vehicle accidents 3

The American Heart Association notes that SWD is associated with an increased risk of obesity and insulin resistance, as well as cardiovascular disease and cancer 3