Although shift work disorder (SWD) affects a major part of the shift working population, little is known about its manifestation in real life. This observational field study aimed to provide a detailed picture of sleep and alertness among shift workers with a questionnaire-based SWD, by comparing them to shift workers without SWD during work shifts and free time.
Participants filled in a sleep diary twice a day, at bedtime and awakening times, and kept a record of bed, wake-up, shift start, and shift end times. The sleep latency of main sleep, bedtime stress scale from 1 (very calm and relaxed) to 9 (extremely stressed and tense), quality of sleep from 1 (good) to 5 (poor), number of awakenings, and the greatest KSS were evaluated daily (Ingre et al. 2004) (Fig. 1).
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Subjective sleepiness was assessed using the nine-point KSS: Participants evaluated their sleepiness (in the last 5 min) prior to each PVT on a mobile phone and their greatest sleepiness each day in their sleep diary (Fig. 1).
We studied the characteristics of sleep and alertness in SWD in various shifts and during free time utilizing information on sleep quantity and quality, sleepiness, and alertness. To our knowledge, this is the first study to investigate SWD in naturalistic morning, evening, and night shifts using both actigraphy and sleep diaries, or to verify disturbed sleep and wake patterns typical to the disorder, as required by the ICSD-3. To ensure that SWD symptoms were related to the shift work schedule, we only qualified as SWD cases those individuals whose questionnaire-based symptoms related to shifts and did not occur in relation to holidays. The results of the field data showed that morning and night shifts induced SWD-related symptoms, and that symptoms during morning shifts in particular seemed to differentiate shift workers with and without SWD. In addition, our results point to poorer recovery from shift work in SWD. This was indicated by greater sleepiness during free time and less compensatory and light sleep on days off.
In a previous study we found prospective associations between high information and communications technology (ICT) use, including high frequency of mobile phone use, and reported mental health symptoms among young adult college and university students [11], but concluded that the causal mechanisms are unclear. The study was followed by a qualitative interview study with 32 subjects with high computer or mobile phone use, who had reported mental health symptoms at 1-year follow-up. Based on the young adults' own perceptions and ideas of associations, a model of possible paths for associations between ICT use and mental health symptoms was proposed [12], with pathways to stress, depression, and sleep disorders via the consequences of high quantitative ICT use, negative quality of use, and user problems. Central factors appearing to explain high quantitative use were personal dependency, and demands for achievement and availability originating from domains of work, study, the social network, and the individual's own aspirations. These factors were also perceived as direct sources of stress and mental health symptoms. Consequences of high quantitative mobile phone exposure included mental overload, disturbed sleep, the feeling of never being free, role conflicts, and feelings of guilt due to inability to return all calls and messages. Furthermore, addiction or dependency was an area of concern, as was worry about possible hazards associated with exposure to electromagnetic fields. For several participants in the study, however, a major stressor was to not be available. The study concluded that there are many factors in different domains that should be taken into consideration in epidemiological studies concerning associations between ICT use and mental health symptoms [12].
The women reported stress almost twice as often as the men (29% compared to 16%) at baseline. Twenty-three percent of the men and 34% of the women indicated sleep disturbances. Of the men, 27% reported one and 24% two symptoms of depression, and of the women, 30% reported one and 34% two symptoms of depression. Among participants who were symptom-free at baseline (in outcome variable concerned), the prevalence at 1-year follow-up was as follows for the men and women, respectively; current stress: 10% and 19%, sleep disturbances: 15% and 20%, symptoms of depression (one item): 24% and 28%, and symptoms of depression (two items): 12% and 18%.
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