Sleepiness shift work

There are also some cases when a doctor s prescription is needed to obtain a stimulant in order to keep the person awake. Such cases include people with narcolepsy, who are extremely sleepy much of the day, and people who have jobs that require prolonged periods of wakefulness, such as soldiers in the military, long-haul truck drivers, and people who work night shifts or rotating shift-work schedules. 

Sleepiness in the elderly Slow eyelid closures of the kind experienced by drowsy drivers Simulated night shift work in laboratory... 

Akerstedt T. Sleepiness as a consequence of shift work. Sleep 1988 ll(l) 17-34. 

In 1988, the total cost of work-related accidents of 47.1 billion was based on 10,600 deaths and 1,800,000 disabling injuries. Included in the estimate of work-related accidents attributable to sleepiness were (a) motor-vehicle accidents due to shift work and on-the-job motor vehicle accidents (35.0% of total work-related accidents), (b) falls during work caused by sleepiness or inattention (12.6%), and (c) water and transportation accidents (4.8%). Therefore, of all work-related accidents, about 52.5% might potentially be related to sleepiness and then, accounting for 5565 fatalities and 945,000 disabling injuries, resulted in a cost of 24.7 billion. 

Harma M, Tenkanen L, Sjoblom T, Alikoski T, Heinsalmi P. Combined effects of shift work and life-style on the prevalence of insomnia, sleep deprivation and daytime sleepiness. Scand J Work Environ Health 1998 24 300-307. 

Perhaps the most common type of verbal report used in sleep deprivation studies is a measure of subjective sleepiness. Subjective sleepiness is generally assessed by self-report scales (see also Chap. 1), such as the Stanford Sleepiness Scale (19), the Epworth Sleepiness Scale (20), visual analog scales (21), and the vigor and fatigue subscales on the Profile of Mood States (POMS Educational and Industrial Testing Service, San Diego, CA). These measures have been used in studies on the effects of sleep deprivation (22-25), shift work (26-28), and sleep disorders (29,30). 

Evidence suggests that moderate to severe sleepiness is virtually omnipresent for night shift workers. A recent assessment of 363 shift workers with symptoms of shift work sleep disorder (23) found their nocturnal sleepiness level, studied the night after 3-5 consecutive night shifts, to approximate sleepiness levels after a night of total sleep deprivation (24). The shift workers mean score on the Multiple Sleep Latency Test (MSLT) at night was 2.75 min. Further, the MSLT score for 90.1% of the shift workers was < 6 min, a level most experts believe to be associated with behavioral impairment and increased accident risk. 

Within the last few years, the role of wake-promoting medication has received renewed and increasing attention with development of modafinil. Although the mechanism through which modafinil works remains to be determined, the low abuse potential (51) and absence of cardiovascular effects (52,53), combined with its clear wake-promoting properties, increase the potential uses for this drug. Studies have shown consistent increases in alertness for narcolepsy (54), in sleep apnea patients (treated with CPAP) with residual sleepiness (55), for shift work sleep disorder (56), and for sleep deprivation (57). 

Walsh JK, Hughes R, Czeisler C, Dinges DF, Niebler G, Roth T. Sleepiness on the night shift in shift work sleep disorder. Sleep 2003 26(suppl) A110. 

The armodafinil development program was very similar to the development program previously undertaken for modafinil (or racemic API). Four double-blind and two opened-label clinical trials (1090 patients enrolled with 645 receiving active treatment with armodafinil and 445 receiving placebo) have evaluated the efficacy and safety of armodafinil for the treatment of excessive sleepiness (ES) associated with obstructive sleep apnea (OSA), shift-work disorder (SWD), and narcolepsy.24... 

Only agent approved for treating sleepiness associated with obstructive sleep apnea/hypopnea syndrome (OSAHS) Only agent approved for treating sleepiness associated with shift work sleep disorder... 

Gold, D. R., et al.. Rotating Shift Work, Sleep, and Accidents Related to Sleepiness in Hospital Nurses, American Journal of Public Health, Vol. 82, No. 7, 1992, pp. 1011-1014. 

Check and review your shift-work arrangements regularly. Includes suggested performance measures such as the HSE Fatigue and Risk Index Tool and Epworth sleepiness scale. 

Shift workers have a similar difficulty in trying to stay awake at a time when they would normally be asleep. Nurses working an evening shift may start to get sleepy while they are still at work, while those on the morning shift may have a great deal of difficulty getting up well before dawn. 

Assessing subjective sleepiness is an important issue in our 24/7 society. For instance, workers frequently have to rely on their internal assessment of sleepiness when making decisions about whether they are alert enough to work an extra shift or drive a little further before stopping. Often the subjective feeling of sleepiness may be one of the first cues that a worker has that he or she can no longer function on the job in a safe manner. Obviously this type of self-assessment can have profound safety implications in real-world settings. 

The findings in the subjective sleepiness assessments are supported by results obtained from night nurses (Folkard et al., 1978). Like night nurses that work on different shifts as opposed to permanent night workers, pilots experience two consecutive night flights as an unusual schedule and are less prone to cope with the situation than permanent night workers. 

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