Health guide

Sleep, including shift work

Educational only: This page is for general education—not personal medical advice, diagnosis, or treatment. See a licensed clinician for your situation.

Sleep that does not hold, including shift work

Not everyone who works nights or rotating shifts has a sleep disorder. Shift work disorder, in the American Academy of Sleep Medicine’s classification, is insomnia or excessive sleepiness, with reduced sleep time, tied to a recurring work schedule that overlaps the usual time for sleep, present for at least three months, and not better explained by another sleep, medical, or mental disorder, or by a medicine or substance. 1 The classification asks for sleep logs, and actigraphy when possible, because the story has to match the schedule.

Shift work can also simply shorten sleep without meeting that disorder. A shorter night is not, by itself, shift work disorder, and it is not obstructive sleep apnea, which is diagnosed with a sleep study. 12 A visit separates those.

A visit is an evaluation, not a promise of a prescription. Medicines that promote wakefulness exist for sleepiness in some people with this disorder. Whether one is used is individualized. This page does not name a drug or a dose.

Apnea, snoring, and unrefreshing sleep

Obstructive sleep apnea is repeated blockage of the airway during sleep. The classification and the AASM testing guideline list, among typical symptoms, unrefreshing sleep, daytime sleepiness, fatigue or insomnia, waking with gasping or choking, loud snoring, and witnessed pauses in breathing. 2 Not every person has every symptom. Snoring alone is not the diagnosis, and the absence of a classic story does not rule the condition out.

Diagnosis is a sleep study interpreted with standard criteria, after a clinician has decided the test is appropriate. Home tests and laboratory studies are both used, under specific conditions the AASM guideline sets out. A consumer device is not that test. 2

Apnea fragments sleep and drops oxygen. The result people notice is often exhaustion or sleepiness after a full night in bed, which is why the exhaustion page points here. 2 The AASM testing guideline names obesity, hypertension, stroke, and heart failure among conditions associated with a higher risk of obstructive sleep apnea. 2 Those are associations, not a list of diseases a person has because they snore.

If testosterone therapy is being considered, the Endocrine Society recommends against starting it in men with untreated severe obstructive sleep apnea. 3 The rest of that discussion is on the hormonal health page.

When poor sleep looks like a focus problem

Daytime sleepiness, fatigue, and unrefreshing sleep impair attention. 2 An adult ADHD diagnosis requires that the symptoms not be better explained by another condition. 4 Poor sleep is one of those conditions. Someone can have both a sleep disorder and ADHD. Treating the sentence “I cannot focus” as automatically one or the other is the mistake.

Anxiety, burnout, and screening are explained on the mental-health page. Sleep belongs in the history before symptoms are called ADHD. Sleep problems can also be part of ADHD’s own presentation, not only a competing explanation. If the focus problem is lifelong and sleep is a second issue, both belong in the history. Iron and thyroid are on the exhaustion page.

References

  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014. Shift work disorder. The manual is the settled classification; the AASM’s public ICSD-3-TR circadian chapter is still a draft file and is not cited. Catalog: https://aasm.org/clinical-resources/international-classification-sleep-disorders/ Contents: https://aasm.org/wp-content/uploads/2019/05/ICSD3-TOC.pdf
  2. Kapur VK, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504. https://jcsm.aasm.org/doi/10.5664/jcsm.6506
  3. Bhasin S, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018. Recommendation against starting testosterone in untreated severe obstructive sleep apnea. https://academic.oup.com/jcem/article/103/5/1715/4939465
  4. American Psychiatric Association. DSM-5-TR. 2022. ADHD criterion that symptoms are not better explained by another disorder.