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Shift Work Sleep Disorder

WooRN WooRN (New) New

Hi everyone,

I was diagnosed with shift work sleep disorder by my doctor today and prescribed Provigil (modafinil). I have been a nurse for almost a year now, and have worked night shift ever since. Everyone I worked with told me that "I would find my rhythm for sleeping" and get used to it, but I have a really hard time staying awake during my shift and then I'm wide awake when I get home. I tried melatonin, sleepy time tea, Benadryl, black out curtains, an eye mask, pretty much any suggestion I could find on the internet but nothing helps. I can usually sleep for 4 hours after I've worked overnight before going back again. I can't stop working nights for now, I would lose $700 a month from the differentials and with my husband being laid off I can't afford to stop working that shift right now. I'm really upset because now my manager has said something to people on night shift about closing our eyes at the nurse's station and I feel bad everyone is getting yelled at because of my sleep disorder. I know a lot of nurses on my floor do close their eyes for a couple of minutes... I feel responsible though. I'm hoping the medication works but I feel absolutely awful. I didn't know if anyone else is dealing with this, and if they have any advice. I feel awful. Thank you for reading.

meanmaryjean, DNP, RN

Has 40 years experience. Specializes in NICU, ICU, PICU, Academia.

One thing you didn't mention trying is sunglasses. Sunlight falling in the retina supresses melatonin secretion and drives wakefulness. So, you're exhausted and can barely stay awake at work, drive home with the sunlight hitting your retina and *BAM wide awake and unable to sleep when you get home.

Try this: Wear sunglasses, putting them on before you even step outside for the drive home, and keeping them on until your butt hits the bed. Every person I've suggested this to has commented on how much it helps! You know how much easier it is to fall asleep after driving home in the dark or on an overcast morning? Same principle at work.

I teach a class on adapting to shift work- this is the number one take away that people have previously not tried.

NICU Guy, BSN, RN

Has 5 years experience. Specializes in NICU.

What kind of sleep schedule do you have on your days off? If you are attempting to flip to sleeping during the night on your days off, then flip back to sleeping during the day during your work shift, your body will never get into a normal sleep schedule. In addition to the suggestions from Meanmaryjean, avoid watching TV or using the computer after you get home from your shift. It is the same effect as having sunlight hit your eyes. The bright lights from the screens cause the suppression of Melatonin.

ShantheRN, BSN, RN

Has 4 years experience. Specializes in Pediatric Hem/Onc.

This isn't a disorder, necessarily.....some people just can't adjust to working nights. I've been on nights for 6 years, and I only manage because I am very protective of my sleep. Unless I have at least 4 days off, I maintain my daytime sleeping schedule. On off days, I usually go to sleep around 0500 and wake up between 15-1700, depending on how well I slept. I have blackout curtains, my walls are painted a dark color, and I use a sound app. About once a year (usually when when day light savings kicks in) I may need to do Ambien for a week to get back on schedule. I don't get why your doc didn't start with something like that. You have the issues with staying awake because you aren't sleeping. Are you trying to stay awake all day, too? If so....you need to stop that or you will never adjust.

And I'm sorry, I know you're tired.....but you can't appear to be sleeping at the desk. Get up and walk around. Keep yourself hydrated - ice cold water is great for perking you up. You may need to do some caffeine around 2300 to get you through the night. Don't overdo it because caffeine itself is dehydrating. One cup of coffee should suffice. Make sure your diet is well balanced. Protein snacks are a good idea overnight. Tell your husband/family that you need to maintain a sleep schedule and establish firm rules about when it's okay to wake you up (nothing short of an emergency should be the answer!).

The shift differential is great, but it costs a lot in terms of life. If your health is being seriously affected by it - and it sounds like it is - you may need to try something else. A lot of places do shift diff for E shifts too. Granted, you'd be working five 8 hour shifts a week, but at least you could sleep at night.

dirtyhippiegirl, BSN, RN

Has 8 years experience. Specializes in PDN; Burn; Phone triage.

re. The provigil - I take this off label for depression PRN. If you decide to use it, definitely do a trial when you are not at work. Effects seem to vary a lot. It can also cause stomach upset.

I take 100 mg and would equate its effects to a really strong cup of coffee for me. I am up and moving for about 3 hours, but definitely get a post-provigil crash afterwards that makes me really sleepy. Other people seem to find it SUPER stimulating for longer periods of time.

I was prescribed vyvanse- it has a much longer lasting effect. Careful though- it can work TOO well and doses may need to be adjusted!

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