Excessive Sleepiness and Shift Work

It's estimated that 15 percent of the U.S. work force are shift workers—such as nurses, doctors and other medical professionals, drivers, and police officers—who do not keep a regular 9 to 5 schedule. Shift workers are at significantly increased risk for sleepiness, as well as the common health risks that come with insufficient sleep, such as high blood pressure and heart problems. More

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Excessive Sleepiness and Shift Work

It's estimated that 15 percent of the U.S. work force are shift workers—such as nurses, doctors and other medical professionals, drivers, and police officers—who do not keep a regular 9 to 5 schedule. Shift workers are at significantly increased risk for sleepiness, as well as the common health risks that come with insufficient sleep, such as high blood pressure and heart problems.

Shift work is challenging because it requires people to wake and sleep in a pattern that is out of sync with the body's biological clock. Our internal clock or "circadian rhythm," influences many chemical changes in the body on a 24 hour cycle, naturally telling our bodies to become drowsy in the evening and more alert in the morning, as well as influencing things like appetite and mood. When you have to sleep on an irregular schedule, you're working against your body's clock and you may find it difficult to sleep a full 7-9 hours. You also might find it difficult to be alert and productive if you're working at night, because this is when your circadian rhythm produces sleep-promoting chemicals like melatonin.

Despite the challenges, shift workers need just as much sleep as people who work traditional hours, and even a small amount of sleep loss over time can damage your health or make you unsafe to drive or to carry out work or family responsibilities. If you experience sleepiness on the job due to shift work, try these strategies to help you stay alert:

  • Avoid long commutes and extended hours.
  • Take short nap breaks throughout the shift.
  • Work with others to help keep you alert.
  • Try to be active during breaks (e.g., take a walk, shoot hoops in the parking lot, or even exercise).
  • Drink a caffeinated beverage (coffee, tea, colas) to help maintain alertness during the shift.
  • Don't leave the most tedious or boring tasks to the end of your shift when you are apt to feel the worst. Night shift workers are most sleepy around 4-5 a.m.
  • Exchange ideas with your colleagues on ways to cope with the problems of shift work. Set up a support group at work so that you can discuss these issues and learn from one another.

When your shift is over and you have to sleep, here are some tips for sleeping during the day:

  • Wear dark glasses to block out the sunlight on your way home.
  • Keep to the same bedtime and wake time schedule, even on weekends.
  • Eliminate light and noise from your sleep environment (use eye masks and ear plugs).
  • Avoid caffeinated beverages and foods close to bedtime.
  • Avoid alcohol; although it may seem to improve sleep initially, tolerance develops quickly and it will soon disturb sleep. Close

SUPPORTING RESEARCH

Sleepiness, Medications and Drugs

Sleepiness is one of the most commonly reported side effects of medications and drugs, and it's an important one to note and discuss with your doctor. Excessive sleepiness can be caused by the sedating effects of nonprescription and prescription medications, and it can also stem from the use of illicit substances.

Sleep is a complex biological process, so sometimes it's difficult to say exactly which chemicals in a drug are responsible for causing a person to feel tired. But often a sedating medication affects neurotransmitters such as dopamine, epinephrine, norepinephrine, serotonin, histamine, glutamate, or acetylcholine—all of which play a role in regulating sleep and alertness.

This is a partial list of medications that can cause sleepiness: More

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Sleepiness, Medications and Drugs

Sleepiness is one of the most commonly reported side effects of medications and drugs, and it's an important one to note and discuss with your doctor. Excessive sleepiness can be caused by the sedating effects of nonprescription and prescription medications, and it can also stem from the use of illicit substances.

Sleep is a complex biological process, so sometimes it's difficult to say exactly which chemicals in a drug are responsible for causing a person to feel tired. But often a sedating medication affects neurotransmitters such as dopamine, epinephrine, norepinephrine, serotonin, histamine, glutamate, or acetylcholine—all of which play a role in regulating sleep and alertness.

This is a partial list of medications that can cause sleepiness:

  • Alpha-adrenergic blocking agents—used to treat conditions such as high blood pressure
  • Antidepressants
  • Antihistamines—found in nonprescription sleeping pills and other medications like Benadryl
  • Antiemetics—used to control nausea and vomiting
  • Antipsychotics and anticonvulsants
  • Benzodiazepines and sedative-hypnotics—commonly prescribed for anxiety or insomnia
  • Beta-adrenergic blocking agents—for high blood pressure or anxiety
  • Medications for Parkinson's disease
  • Muscle relaxants

If you experience excessive sleepiness and you are currently using a medication, it's important to take this side effect seriously. Just as insufficient sleep and sleep disorders can make you less productive and even less safe during the day, so can the sedating effects of certain medications. In fact, drugs like antihistamines can affect your ability to drive, and are associated with an increased risk of next-day driving accidents.

Substances such as alcohol and marijuana can cause drowsiness as well. Other drugs that make people stay awake for long periods of time, such as cocaine or amphetamines, will also likely cause sleepiness after their effects wear off and a person has been deprived of sleep.

This is why if you experience excessive sleepiness, it's important to report all substances and medications you are taking to your doctor to give him or her the full picture of your health. From there, you can work to find the cause of your sleepiness and the right treatment course to get you back to feeling alert and productive. Close

SUPPORTING RESEARCH

Sleepiness in Women

Women are more likely to suffer sleep problems like insomnia and to experience excessive sleepiness. In one large study of adult women, roughly 20 percent reported having excessive sleepiness, fatigue, or both, and younger women were especially likely to have sleep troubles. A 2002 National Sleep Foundation poll found that women were more likely than men to experience insomnia at least a few nights per week (63 versus 54 percent), and an earlier poll found that women ages 30-60 slept an average of six hours and 41 minutes on weeknights, even though almost all adults need 7-9 hours of nightly sleep.

Why are women sleepier on average than men? More

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Sleepiness in Women>

Women are more likely to suffer sleep problems like insomnia and to experience excessive sleepiness. In one large study of adult women, roughly 20 percent reported having excessive sleepiness, fatigue, or both, and younger women were especially likely to have sleep troubles. A 2002 National Sleep Foundation poll found that women were more likely than men to experience insomnia at least a few nights per week (63 versus 54 percent), and an earlier poll found that women ages 30-60 slept an average of six hours and 41 minutes on weeknights, even though almost all adults need 7-9 hours of nightly sleep.

Why are women sleepier on average than men?

For one, various parts of the reproductive cycle present challenges to healthy sleep. Some women find it harder to sleep during certain phases of their menstrual cycle; pregnancy brings hormonal and temperature changes, as well as discomfort that makes sleep difficult; and the dropping estrogen levels associated with menopause can lead to hot flashes that disrupt sleep as well.

Not to mention that for many women, family and work responsibilities can make a full night's sleep difficult. Feeding an infant or responding to young children at night, or working in the evenings to accommodate a busy daytime family schedule—many women find themselves stretched between work and home life, and healthy sleep often takes a back seat.

If this sounds familiar, don't let sleepiness become the norm. Women who experience excessive sleepiness should bring this to their doctor's attention (See "How to Talk to Your Doctor") at their regular well visit, or make a special appointment with their doctor to discuss it. There are many changes in behavior and sleep environment that can help, such as addressing sleep temperature, managing light, avoiding caffeine in the afternoons, eating lightly and avoiding alcohol before bed, and learning ways to cope with anxiety and stress that can lead to insomnia. Women face unique sleep challenges, whether biological or lifestyle related, and it's important to ask for help in addressing this. Especially with busy lives, work, and family responsibilities, good sleep is vital to keeping us happy, healthy, and productive. Close

Excessive Sleepiness and Sleep Disorders

There are many causes of excessive sleepiness, and sometimes an underlying sleep disorder is responsible. Most sleep disorders disrupt a person's slumber—usually by shortening the length of time asleep or reducing the quality of sleep—making the person drowsy during the day as a result. More

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Excessive Sleepiness and Sleep Disorders

There are many causes of excessive sleepiness, and sometimes an underlying sleep disorder is responsible. Most sleep disorders disrupt a person's slumber—usually by shortening the length of time asleep or reducing the quality of sleep—making the person drowsy during the day as a result.

One fairly common reason for excessive sleepiness is obstructive sleep apnea. People with OSA struggle to breathe during the night and wake up many times per hour as a result. These wake ups continually interrupt the natural cycles of sleep, with all its lighter and deeper stages. As a result, the person doesn't have sufficient and healthy sleep and feels drowsy the next day. Many people with OSA don't realize they have it, because they wake up so briefly they believe they have slept continuously through the night (in fact they may have woken up a hundred times or more). If you are excessively sleepy during the day and especially if you snore, have high blood pressure, or are overweight (factors associated with OSA), it's a good idea to have your doctor investigate the possibility of this sleep disorder.

Insomnia is another common cause of excessive sleepiness, in which a person has difficulty falling asleep or staying asleep for the 7-9 hours the body requires. People with insomnia are aware of their sleep struggles, but often don't consult with a doctor to receive proper treatment.

Another less common sleep disorder that causes excessive sleepiness is narcolepsy. A person with narcolepsy unwillingly and briefly falls asleep during the day—while talking, eating a meal, or even driving. In addition to feeling drowsy during the day, people with narcolepsy often have disturbed sleep at night, which compounds the problem of daytime sleepiness. Most cases of narcolepsy are caused by the dysfunction of a certain area in the brain that promotes wakefulness.

There are behavioral, psychological, and medical treatment options for sleep disorders. If you feel excessively sleepy, it's important to talk to your doctor—if a sleep disorder is the root, you can get started working on a strategy to treat it, improve your night's sleep, and feel alert and productive the next day. Close

Excessive Sleepiness and Brain Problems

The most common causes of excessive sleepiness are insufficient sleep, changes to sleep schedule, and sleep disorders like sleep apnea. But if you experience sleepiness on a regular basis, it's important to work with your doctor to rule out some of the other less common causes of sleepiness. More

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Excessive Sleepiness and Brain Problems

The most common causes of excessive sleepiness are insufficient sleep, changes to sleep schedule, and sleep disorders like sleep apnea. But if you experience sleepiness on a regular basis, it's important to work with your doctor to rule out some of the other less common causes of sleepiness.

Certain brain and other medical conditions can make a person excessively sleepy. For example, a concussion can cause sleepiness or other disturbances in a person's sleep that result in daytime drowsiness. Neurological conditions such as Parkinson's disease can also cause sleepiness, and psychiatric disorders like anxiety and depression can often cause a person to sleep too little or too much.

Other medical conditions can affect a person's sleep directly, or simply cause enough discomfort to make a full night's sleep difficult. Medical conditions associated with excessive sleepiness include infections, asthma, gastrointestinal disorders, and metabolic abnormalities. In some cases, while people know they have one of these conditions, they don't realize drowsiness is a symptom. In other cases, a person may not be aware of the condition and drowsiness is the first sign.

This is why it's important to take symptoms of excessive sleepiness seriously. Good sleep is critical to your health and your ability to thrive in work, at school, and with your family and friends. Conversely, excessive sleepiness may signal an underlying condition that needs to be addressed and treated. Most of the time, sleepiness can be alleviated by making adjustments to the sleep environment and sleep habits. But sometimes the root of excessive sleepiness is a more serious condition that requires medical attention. If you feel sleepy on a regular basis, bring this to your doctor's attention at your regular well visit, or make an appointment to specifically talk about sleep. You can work together with your doctor to look at your symptoms, sleep and lifestyle habits, and health history to systematically go through all the potential causes of sleepiness and figure out how to help. Close

The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications.” James Pagel, MD, MS

Excessive Sleepiness and Sleep Habits

If you're experiencing excessive sleepiness, poor sleep habits are often the cause. It's important to review your routines, schedules, and the environment you're sleeping in so you can spot potential problems and make adjustments.

One of the main causes of sleepiness is insufficient sleep—or less sleep than your mind and body need to function optimally. Most adults need 7-9 hours of sleep per night, and even 30 minutes less can make you drowsy, underproductive, or moody, especially if this "sleep debt" accumulates over time. Avoiding caffeine in the afternoons, winding down in the evening, turning off computers and cell phones (the blue light from these devices may be alerting to the brain), and going to bed at an early and regular time are all important ways to carve out sufficient time and peace of mind for sleep. More

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Excessive Sleepiness and Sleep Habits

If you're experiencing excessive sleepiness, poor sleep habits are often the cause. It's important to review your routines, schedules, and the environment you're sleeping in so you can spot potential problems and make adjustments.

One of the main causes of sleepiness is insufficient sleep—or less sleep than your mind and body need to function optimally. Most adults need 7-9 hours of sleep per night, and even 30 minutes less can make you drowsy, underproductive, or moody, especially if this "sleep debt" accumulates over time. Avoiding caffeine in the afternoons, winding down in the evening, turning off computers and cell phones (the blue light from these devices may be alerting to the brain), and going to bed at an early and regular time are all important ways to carve out sufficient time and peace of mind for sleep.

What if you diligently craft your bedtime rituals and spend 7-9 hours in bed, but still feel sleepy the next day? In this case, the culprit might be poor sleep quality—or sleep that is interrupted or is not deep and restorative. In some cases, people are aware that they wake up during the night frequently, in which case it may help to practice relaxation, avoid electronic devices, not consume alcohol before bed, and make sure your bedroom is cool, comfortable, and dark. However, if you believe you sleep long enough at night but still feel tired, you could have a sleep disorder like sleep apnea, which drastically reduces the quality of your sleep.

Another reason for excessive sleepiness is a change in schedule, which could be caused by work or school responsibilities. In particular, shift workers, who keep nontraditional hours and often switch schedules, are at high risk for excessive sleepiness. This is because it's difficult to sleep 7-9 hours when those hours are not in line with traditional nightfall, but it's also because when your schedule changes, it takes your body a long time to adjust. Sometimes by the time the adjustment happens, your schedule has shifted yet again. Taking care of your sleep by making sure your bedroom is quiet and dark during your sleep time, exposing yourself to light when you wake up if possible, and trying to keep as regular and consistent a sleep pattern as possible will help. If you've tried to take care of your sleep habits and still find yourself drowsy during the day, it's important to talk to your doctor (See "How to Talk to Your Doctor") and ask for a referral to a sleep specialist. Close