Is the poor sleep of shift workers a disorder?

Article Abstract:

Many Americans work night shifts on a regular basis. Night workers tend to have poorer sleep and more sleep difficulties than day workers. This impairment of sleep quality can lead to psychological and physiological problems. One problem faced in addressing the issues regarding poor sleep is whether the poor sleep should be defined as a disorder or as a hazard of shift work. The Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, contains a diagnostic category for sleep-wake schedule disorder, yet many characteristics of the problem indicate it is not an abnormality, but is rather a consequence of the work scheduling that is to be expected. The way in which this problem is defined has important legal consequences. To further examine the problem of shift-related poor sleep, recent research in the area, including questionnaire studies, polygraphic measurement studies, and clinical sleep studies were reviewed. Questionnaire study results indicate that shift work can adversely affect sleep, with workers on night shifts having more sleep problems than those on day shifts. The shifts do not appear to affect all workers equally. Some workers have few, if any, sleep-related problems when working night shifts, while others have many problems. The problems appear to be worst right after a change in shift schedule to the night shift, and least when the night shift work is constant. Polygraphic studies also indicate that working night shifts affects sleep, inasmuch as people working night shifts sleep shorter periods of time than those working day shifts. Some studies have indicated shift workers have more social problems, such as drug and alcohol abuse, although health studies have not indicated that shift workers have more health-related problems than regular workers. The US is one of the few countries that does not place legal limitations of shift work. Overall, the studies performed in this area indicate that sleep problems resulting from shift work are common, but that they vary significantly by individual. Further research in this area is warranted, as is a reconsideration of whether to define the problem as a disorder or a job hazard. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Night work

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Panic disorder in children at high risk for depression

Article Abstract:

It has been thought that panic disorders do not exist in children, and therapeutic emphasis has been placed upon children with depression. However, no scientifically substantiated studies of panic disorders in children have been conducted, and current theories are based primarily upon retrospective analyses. A study examined 220 children ranging in ages from 6 to 23 years old who were part of a group determined to be at risk for depression. Of this group, seven children were diagnosed with panic disorder. The patterns that were observed in the seven patients were similar to those exhibited by adults with panic disorder, especially a greater tendency to develop major depression. Because this high-risk group consisted of children of depressed parents, results are probably not representative of the general population and the incidence of panic observed is probably inflated. The final diagnosis of panic disorder was a result of clinicians' best estimates based upon a variety of data that was compiled. Agreement in the reports on the identification of the children with panic disorder was very good between clinicians. However, reports of their own behaviors obtained from the children were not always consistent with those submitted by the parents. Retrospective reports by the children of the symptoms of panic attacks were not always consistent. Depending upon the reproducibility of these results, the authors recommend that panic disorder be considered in the general psychiatric evaluation of children, especially those at high risk for depression.

Case studies, Risk factors, Depression in children, Childhood depression

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Sleep panic attacks: new clinical findings and theoretical implications

Article Abstract:

Panic disorder is characterized by unpredictable episodes of panic attacks. The unpredictability of the attacks has caused some researchers to conduct studies which rely upon the administration of drugs known to induce panic. These drugs, which heighten arousal before the onset of panic, include sodium lactate, caffeine, yohimbine and carbon dioxide. A problem with such research is that the biological theories of panic disorder are based upon results of panic preceded by increased anxiety. A less well known characteristic of panic disorder is that attacks may be preceded by states of diminished arousal. The authors posit a relationship between this phenomenon and panic attacks during sleep. Forty-five panic disorder patients and 26 control subjects were questioned about sleep panic attacks, insomnia, and vulnerability to external panic-producing stimuli. Over two thirds of the patients reported they had experienced sleep panic at some point, and half of those acknowledged they had recurrent episodes. Patients with sleep panic had a greater degree of insomnia and depression than patients without such attacks. Results suggest that sleep panic attacks, insomnia, sleep deprivation and waking panic may be interrelated in a feedback loop (or "vicious circle"). Consequently, these phenomena should be assessed together when preparing the overall management of panic disorder patients.

Research, Insomnia

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