Shift work disorder: clinical assessment and treatment strategies

Shift work disorder (SWD) occurs when individuals are unable to successfully synchronize their internal clocks with a work schedule that requires them to stay awake when it is dark and sleep when it is light. When assessing for SWD, clinicians should take a thorough sleep history and have the patient maintain a sleep diary. Clinicians should also be aware of conditions that commonly occur in conjunction with this illness, including sleep apnea, restless legs syndrome, depressive and anxiety disorders, and chronic fatigue. The primary goal of treatment for SWD is to reduce the rate of circadian misalignment by fostering better sleep when it is desired and improved alertness and functioning when appropriate. Nonpharmacologic strategies (eg, melatonin and light therapy) should be tried before considering medications to promote sleep and/or alertness.