Section XXXII: Shift Work Sleep Disorder

Alternative Sleep Scheduling

Goals of the Exercise

1. Develop a sleep schedule to promote adequate sleep quantity and quality.

2. Develop a consistent sleep schedule that applies to work and non-work days.

3. Address cognitive, emotional, and physical symptoms of sleep deprivation.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Alternative Sleep Scheduling” activity addresses the challenge of alternating shift work, a common occurrence in both military and civilian settings. Frequent changes in work schedules can cause symptoms such as fatigue, sleepiness, and attention/ concentration deficits, which can increase the risk of accidents and damage moods, relationships, and quality of life. In this activity, the veteran/service member identifies behavioral techniques he/she can use to minimize the effects of shift work, plan healthy sleep hygiene and induction behaviors, and prepare for changes in work schedule. In processing this activity, it helps to emphasize the degree to which sleep problems can contribute to many problems in life. It is also necessary to recognize that for many veterans/service members, it may be more difficult to request changes in schedule due to their military specialty or civilian job title, operational tempo, and rank/seniority. Follow-up can include reporting back to the therapist on actions from this assignment and their outcomes, as well as bibliotherapy using books from Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner.

EXERCISE XXXII.A Alternative Sleep Scheduling

Frequent work schedule changes are often times a necessary part of one's job. If careful and thoughtful attention is not paid to the potential detrimental effects of work shift changes, the consequences can be dramatic and dire. In the following exercise, you will identify those behaviors that you can commit to engaging in that will minimize sleep disturbances related to schedule changes. You will then identify useful sleep hygiene behaviors and induction techniques that promote falling to sleep and learn how to prepare in advance for upcoming shift work schedule changes.

1. Please place a check by each behavioral technique that you will commit to using on a regular basis to minimize effects of shift work. For each technique you check, make a few notes on how you will accomplish the technique.

a. _____ Talk with your supervisor about reducing frequency of alternating shift schedules.

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b. _____ Minimize exposure to light on the way home from work.

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c. _____ Follow bedtime rituals.

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d. _____ Go to bed as soon as possible after work.

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e. _____ Maintain consistent sleep/wake schedule on days off.

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f. _____ Set consistent times to take care of errands and responsibilities (e.g., pay bills, shop for groceries).

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g. _____ Use modest amounts of caffeine at work to prevent drowsiness and sleep.

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2. Check the sleep induction techniques you are most likely to use when it is time to sleep.

a. _____ Avoid caffeine at least four hours prior to bedtime.

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b. _____ Avoid nicotine at least one hour before bedtime.

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c. _____ Avoid spicy or large meals prior to going to bed.

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d. _____ Avoid emotional conversations with loved ones prior to bedtime.

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e. _____ Take a hot bath/shower 30 minutes prior to bed.

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f. _____ Don't watch television or play video games in bed.

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g. _____ Write down disturbing thoughts to get them out of your mind.

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h. _____ Practice deep breathing 15 minutes before bedtime.

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i. _____ Close your eyes and imagine peaceful and relaxing images.

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3. Prepare for upcoming shift schedule change by shifting your sleep/wake schedule back one hour each day for the five days preceding the change.

Normal sleep schedule:
Sleep Time _____ Wake Time _____
Day 5 before starting new schedule:
Sleep Time _____ Wake Time _____
Day 4 before starting new schedule:
Sleep Time _____ Wake Time _____
Day 3 before starting new schedule:
Sleep Time _____ Wake Time _____
Day 2 before starting new schedule:
Sleep Time _____ Wake Time _____
Day 1 before starting new schedule:
Sleep Time _____ Wake Time _____

Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.

Establishing a Shift Work Sleep Environment

Goals of the Exercise

1. Practice healthy sleep hygiene behaviors.

2. Implement appropriate stimulus control techniques.

3. Create sleeping environment that is devoid of light.

4. Create a noise/disturbance-free sleeping environment

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Establishing a Shift Work Sleep Environment” activity, like “Alternative Sleep Scheduling,” is designed for veterans/service members whose work hours mean that they must sleep during the day. In general, people tend to underestimate the impact a noisy, bright, and uncomfortable bedroom can have on sleep. In this activity, you will help the veteran/service member create a sleeping environment that is conducive to receiving good quality and an appropriate quantity of sleep. You will help the veteran/service member identify those techniques he/she can engage in that will make his/her bedroom less noisy and bright and more comfortable. It is important for you to also emphasize the concept that creating and sticking to a regular bedtime routine allows greater opportunity to receive restful and restorative sleep. Follow-up for this exercise could include reporting back to the therapist on actions related to this assignment and their outcomes, as well as bibliotherapy using books suggested in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner.

EXERCISE XXXII.B Establishing a Shift Work Sleep Environment

Creating a noise, stress, and light free sleeping environment is a crucial step in battling the negative effects of alternating work schedules. In a sense, you have to “trick” your internal biological clock to make your body and mind believe it is nighttime. In this exercise, you will identify those techniques you will engage in that will make your sleeping environment as sleep friendly as possible.

1. Please place a check by each technique you can use to make your sleeping environ-ment as free of light as possible:

_____ Cover windows with dark material _____ Wear eye mask while sleeping
_____ Stuff towels in crack of door _____ Sleep in a room with least amount of sunlight
_____ Paint walls a dark, non-reflective color _____ Sleep under the covers
_____ Cover windows in adjacent rooms _____ Cover lights of the alarm clock

2. Please place a check by each technique you can use to make your sleeping environ-ment as free from noise as possible:

_____ Ask family members to wear headphones when listening to music or watching television.

_____ Ask family members to avoid vacuuming or washing dishes while you sleep.

_____ Put a “Do Not Disturb” sign on your front door so that friends or delivery people won't wake you up.

_____ Turn off the ringer to your phone or put it on low.

_____ Turn off pager or cell phone if you are not on-call.

_____ Sleep in a room of the house that has the greatest distance from the street and neighbors.

_____ Turn on a low and consistent source of noise that filters out background noise (e.g., ceiling fan).

_____ Wear soft and comfortable earplugs.

3. Please place a check by each technique you can use to make your sleeping environ-ment as comfortable and relaxing as possible:

_____ Make sure temperature in the room is not too hot or too cold.

_____ Experiment with different levels of firmness for your mattress and pillows.

_____ Invest in a sound/sleep machine.

_____ Wash/change bed linen weekly.

_____ Use scented fabric softeners that you find soothing.

_____ Sleep in comfortable and unrestrictive clothes.

_____ Turn off the television/radio before falling asleep.

Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.