Shift work disorder case studies: applying management principles in clinical practice.

Shift work disorder (SWD) is a circadian rhythm sleep disorder characterized by insomnia and excessive sleepiness. SWD, which is estimated to affect 10% of people who work night or rotating shifts, can have serious consequences such as accidents, loss of productivity, and depression. By enlisting the support of family, identifying and treating comorbid sleep disorders, and appropriately timing light and dark exposure (supplemented by melatonin), clinicians can help many shift workers improve their ability to sleep, maintain wakefulness, and possibly decrease other adverse effects of shift work. More aggressive treatment strategies and referral to a sleep specialist should be considered for patients who do not respond to these simple measures.