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Shift-work disorderthe other potentially causative conditions. (Examplesof how mood disorders and other sleep/wake disorderscan be differentiated from SWD appear below.)Mood disorders and sleep/wake disorders oftenpresent in the primary care setting and can at first seemindistinguishable. For example, patients with ES as a resultof a sleep/wake disorder may superficially appearto have depression, as a lack of energy, poor memory,reduced concentration, and a loss of interest in lifeare common features of both ES and mood disorders.In such instances, asking the patient about his or hersleep habits and the use of simple depression questionnairessuch as the Patient Health Questionnaire-9(www.patient.co.uk/showdoc/40025272/) are vital toavoid misdiagnosis and prescription of inappropriatemedication.ES is also a symptom of the sleep/wake disordersobstructive sleep apnea (OSA) and restless legs syndrome(RLS), which are commonly reported in shiftworkers. 26,27 Patients with OSA have poor quality sleep,as they experience repeated full or partial blockages oftheir airway, resulting in snoring and episodes of chokingor gasping during sleep. 28 Recurrent partial or completeobstruction of the upper airway leads to repeatedarousals and disturbed sleep, which can cause ES. 29,30Night-shift work has been shown to aggravate OSA, 31possibly due to the increased potential for weight gainand metabolic disturbance in this population 24 ; overweightand metabolic syndrome are risk factors for andcomorbidities associated with OSA. 28 It is imperativethat patients with suspected OSA are referred to a sleepspecialist as well as counseled about appropriate therapiesand lifestyle changes. 32RLS may develop in shift workers due to low serumiron levels induced by chronic sleep deprivation. 33 Patientswith symptoms of RLS should have their serumferritin levels checked and, if found to be
References1. American Academy of Sleep Medicine. Internationalclassification of sleep disorders and codingmanual. 2nd ed. Westchester, IL: AmericanAcademy of Sleep Medicine; 2005.2. Marquié JC, Foret J. Sleep, age, and shiftwork experience.J Sleep Res. 1999;8:297-304.3. Marquié JC, Foret J, Queinnec Y. Effects of age,working hours, and job content on sleep: a pilotstudy. Exp Aging Res. 1999;25:421-427.4. Schwartz JR, Roth T. Shift work sleep disorder:burden of illness and approaches to management.Drugs. 2006;66:2357-2370.5. Shen J, Botly LC, Chung SA, et al. Fatigue andshift work. J Sleep Res. 2006;15:1-5.6. Drake CL, Roehrs T, Richardson G, et al. Shiftwork sleep disorder: prevalence and consequencesbeyond that of symptomatic day workers.Sleep. 2004;27:1453-1462.7. Waage S, Moen BE, Pallesen S, et al. Shift workdisorder among oil rig workers in the North Sea.Sleep. 2009;32:558-565.8. Ohayon MM, Lemoine P, Arnaud-Briant V, et al.Prevalence and consequences of sleep disordersin a shift worker population. J Psychosom Res.2002;53:577-583.9. Czeisler CA, Moore-Ede MC, Coleman RH. Rotatingshift work schedules that disrupt sleep areimproved by applying circadian principles. Science.1982;217:460-463.10. Härmä M, Tarja H, Irja K, et al. A controlled interventionstudy on the effects of a very rapidly forwardrotating shift system on sleep-wakefulnessand well-being among young and elderly shiftworkers. Int J Psychophysiol. 2006;59:70-79.11. Dumont M, Benhaberou-Brun D, Paquet J. Profileof 24-h light exposure and circadian phaseof melatonin secretion in night workers. J BiolRhythms. 2001;16:502-511.12. Koller M, Kundi M, Stidl HG, et al. Personal lightdosimetry in permanent night and day workers.Chronobiol Int. 1993;10:143-155.13. Crowley SJ, Lee C, Tseng CY, et al. Complete orpartial circadian re-entrainment improves performance,alertness, and mood during nightshiftwork. 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Sleep.2007;30:1460-1483.20. Oginska H, Pokorski J, Oginski A. Gender, ageing,and shiftwork intolerance. Ergonomics.1993;36:161-168.21. Ostberg O. Interindividual differences in circadianfatigue patterns of shift workers. Br J IndMed. 1973;30:341-351.22. Hilliker NA, Muehlbach MJ, Schweitzer PK, et al.Sleepiness/alertness on a simulated night shiftschedule and morningness-eveningness tendency.Sleep. 1992;15:430-433.23. Morgenthaler TI, Lee-Chiong T, Alessi C, et al.Practice parameters for the clinical evaluationand treatment of circadian rhythm sleep disorders.An American Academy of Sleep Medicinereport. Sleep. 2007;30:1445-1459.24. Härmä M, Tenkanen L, Sjöblom T, et al. Combinedeffects of shift work and life-style on theprevalence of insomnia, sleep deprivationand daytime sleepiness. Scand J Work EnvironHealth. 1998;24:300-307.25. Doghramji K. Assessment of excessive sleepinessand insomnia as they relate to circadianrhythm sleep disorders. J Clin Psychiatry. 2004;65(suppl 16):17-22.26. Ohayon MM, Roth T. Prevalence of restless legssyndrome and periodic limb movement disorderin the general population. J Psychosom Res.2002;53:547-554.27. Paim SL, Pires ML, Bittencourt LR, et al. Sleepcomplaints and polysomnographic findings:a study of nuclear power plant shift workers.Chronobiol Int. 2008;25:321-331.28. Pagel JF. The burden of obstructive sleep apneaand associated excessive sleepiness. J Fam Pract.2008;57(suppl 8):S3-S8.29. Pagel JF. Excessive daytime sleepiness. Am FamPhysician. 2009;79:391-396.30. Veasey SC, Davis CW, Fenik P, et al. Long-termintermittent hypoxia in mice: protracted hypersomnolencewith oxidative injury to sleep-wakebrain regions. Sleep. 2004;27:194-201.31. Laudencka A, Klawe JJ, Tafil-Klawe M, et al.Does night shift work induce apneic events inobstructive sleep apnea patients? J Physiol Pharmacol.2007;58(suppl 5):S345-S347.32. Doghramji PP. Recognition of obstructive sleepapnea and associated excessive sleepiness in primarycare. J Fam Pract. 2008;57:(suppl 8):S17-S23.33. Barton JC, Wooten VD, Acton RT. Hemochromatosisand iron therapy of restless legs syndrome.Sleep Med. 2001;2:249-251.34. Silber MH, Ehrenberg BL, Allen RP, et al. Analgorithm for the management of restless legssyndrome. Mayo Clin Proc. 2004;79:916-922.35. Johns MW. A new method for measuring daytimesleepiness: the Epworth sleepiness scale.Sleep. 1991;14:540-545.Supplement to The Journal of Family Practice • Vol 59, No 1 / January 2010 S23
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Practice Management Tips ForSHIFT W
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Patient QuestionnaireDo you often f
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Sleep/Wake LogIn bedOut of bedLight
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PHQ-9 QUICK DEPRESSION ASSESSMENTFo
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Insomnia Severity IndexPlease answe
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Take-Away PointsSHIFT WORK DISORDER
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CIRCADIAN RHYTHM SLEEP DISORDERSPra
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Table 2— AASM Levels of Recommend
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3.2.1.1 Both the Morningness-Evenin
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Five studies used one of the newer
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as an indicator of phase in sighted
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4.4 Advanced Sleep Phase DisorderBe
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45. Walsh, JK, Randazzo, AC, Stone,
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123. Van Someren, EJ, Kessler, A, M
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Table 1—Subject Demographicsn M:F
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Scale. 28 The simple reaction time
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Median RT (msec)1600A14001200100080
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Current Treatment Options in Neurol
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398 Sleep Disordersand sleep loss,
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400 Sleep DisordersTable 1. Treatme
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402 Sleep DisordersStandard dosageC
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404 Sleep DisordersStandard procedu
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406 Sleep DisordersCaffeineMelatoni
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408 Sleep DisordersWake-promoting a
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