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Shift work disrupts circadian and homeostatic sleep regulation and is probably the most common cause of sleepiness in society. This chapter talks about the shift work disorder, and presents survey studies of sleepiness, physiological sleepiness and momentary subjective sleepiness. EEG measures give some indication of the pattern of sleepiness in relation to shift work, that is, incidents of sleep intrusions are frequently seen during the second half of a night shift. If sleepiness is as pronounced as suggested in connection with night work, there should be a link with performance errors and accidents. Shift work that includes night shifts causes high levels of sleepiness that may constitute a major safety risk, particularly in transport work, but also in health care and industry. The chapter discusses the individual differences, the diagnosis shift work disorder, and possible ways of counteracting or treating intolerance to shift work.
Dopamine is the most abundant of monoamines in the central nervous system (CNS). It modulates diverse behaviors including movement, motivation/reward, cognition, and feeding that share one notable attribute in common: they all play out on a backdrop of wakefulness (Bjorklund and Lindvall 1984; Marin et al. 1998; Durstewitz et al. 1999; Williams and Goldman-Rakic 1998). Dopamine's influence(s) upon normal and pathologic wake–sleep has unfortunately only recently begun to receive more widespread attention. The rebirth of interest in dopamine's participation in wake–sleep behaviors comes straight from the clinical arena. Here, sleepiness has been noted to be a common and disabling feature attending midbrain dopamine cell loss in Parkinson's disease (PD), as well as with dopamine agonist treatment of PD and additional disorders that interfere with normal sleep such as restless legs syndrome, and periodic leg movement and rapid eye movement sleep disorders (Rye 2004a,b; Rye and Jankovic 2002). Although this clinical experience argues that dopamine signaling is integral to maintaining wakefulness, a complete understanding is only beginning to emerge from recent scientific inquiries. What follows is a comprehensive account of the current state of knowledge of the brain's dopamine pathways as it pertains to their modulation of normal and pathologic wake–sleep state(s).
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