What can we do?
As health-care providers treating sleep disorders, we commonly encounter shift workers and SWD. It is our responsibility to identify these at-risk patients and provide early intervention. Optimally, shift workers should attempt to sleep immediately after their night shift. Promoting good sleep hygiene is essential; restricting caffeine and alcohol consumption prior to bedtime, and turning off phones and other electronic devices during daytime sleep prevents disturbance. It is also important to educate family members regarding the need for protected sleep time for shift workers.
Administration of melatonin prior to daytime sleep may help to phase-shift the sleep period and provide a soporific effect. However, the data have not definitively supported improvements in sleep with morning (AM) melatonin use. Appropriately timed light exposure is critical to adaptation to a nocturnal schedule. Use of bright light during the first half of the night shift and increasing outside light exposure in the evening prior to starting one’s shift can phase delay the circadian pacemaker. Likewise, avoiding bright light on the ride home and in the morning is necessary to fully adapt to a night schedule. This can be done with use of dark sunglasses on the ride home. The scheduled daytime sleep period should be done in a dark room.
Ideally, those working night shifts should maintain their nocturnal schedule even on days off to allow them to stay in circadian phase. However, this is often not practical with family and personal responsibilities. Adjuncts to optimize workplace alertness and safety may be used. Caffeine use may enhance alertness during the night shift. Napping in the afternoon before starting a night shift and for brief periods throughout the night can be effective in improving alertness. More workplaces are providing sleep rooms to facilitate naps during work hours.
A final option to promote sleep and optimize alertness is with the aid of pharmaceuticals. Hypnotic medications may be used to promote daytime sleep among night shift workers with persistent difficulty initiating sleep and adjusting their circadian phase. However, carryover of sedation to the nighttime shift with potential adverse consequences for nighttime performance and safety must be considered. The nonamphetamine wakefulness promoting medications, including modafinil and armodafinil, can enhance alertness during the night shift for SWD. Their use in SWD is studied in clinical trials and is currently approved by the FDA for this indication.
Shift work is unavoidable in our present 24-hour society; therefore, a substantial proportion of the population is at risk for SWD. Cessation of shift work is curative but may not be an option. All shift workers will likely benefit from education about ways to promote circadian adaptation, increase wakefulness, improve sleep hygiene, increase sleep duration, and promote good health practices. Clinical practice guidelines for shift work and SWD are founded on evidence-based medicine.
Dr. Soriano and Dr. Das are with the Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine; The Ohio State University; Columbus, Ohio.