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Sleep-wake disturbances in shift workers

Philip Cheng, PhD
Christopher L Drake, PhD
Section Editor
Cathy A Goldstein, MD
Deputy Editor
April F Eichler, MD, MPH


Individuals who work night shifts commonly experience difficulties with both sleep and alertness at desired times, and shift work is increasingly recognized as a risk factor for a variety of adverse health outcomes. While some shift workers show circadian adjustment to their work schedule, many others do not. Those who do not adjust commonly experience excessive sleepiness during work and significant sleep disturbance.

It is estimated that one-third or more of shift workers experience impairments of sufficient severity to meet criteria for shift work disorder.

The pathophysiology, clinical features, evaluation, and treatment of sleep-wake disturbances associated with shift work and shift work disorder will be discussed here. Other circadian rhythm disorders, such as jet lag and delayed sleep-wake phase disorder, are discussed elsewhere. (See "Jet lag" and "Delayed sleep-wake phase disorder".)


Disturbances to sleep and impaired alertness in shift workers can be explained by disruptions to two biological processes, referred to as Process S and Process C (figure 1) [1].

Process S – The drive for sleep is dependent on time since the last sleep episode. As such, sleep drive builds throughout wakefulness and dissipates with sleep.

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Literature review current through: Sep 2017. | This topic last updated: Aug 29, 2017.
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