Management

The main aim of management is to mitigate the adverse health effects of shift work (1).

The following treatment methods may be beneficial in patients with shift work disorders:

• designing shift schedules according to some ergonomic criteria:
  • minimise night work as much as possible
  • try to avoid a large number of consecutive night shifts
  • provide quickly rotating (every 1-3 days) shift systems to slowly rotating (i.e. weekly or longer) ones and to permanent night work (also for social reasons)
  • prescribed sleep/wake scheduling - rotation of an individual shift clockwise (when the shift moves forward- morning/afternoon/night) rather than anticlockwise (when the shift moves backwards - afternoon/morning/night) since workers found that delaying sleep time was easier than moving it forward
  • lengths of shifts should be set according to psycho-physical demands
  • if possible avoid morning shifts that start too early
  • provide sufficient rest days between shifts, especially after night shift
    • a minimum of 11 hours between shifts
  • keep a regular schedule as much as possible (1)
• regularly screen for clinical sleep disorders among shift workers
• educate shift workers about individual strategies which can help minimise sleep and fatigue problems:
  • timed light exposure - appropriately timed exposure to bright light in the work environment may have beneficial effects in some patients
  • inform about sleep hygiene - how to prioritise sleep and recovery before, during, and after work, planned naps before or during shift which will prevent shift work sleepiness and increase alertness and performance of an individual
  • follow a healthy lifestyle - eat healthy, limit night time eating, sufficient physical activity, avoid smoking and excessive alcohol intake
  • promoting sleep using hypnotic medication - may help to promote duration and quality of daytime sleep in night shift workers
  • timed melatonin administration - for night shift workers, melatonin taken during the day may help daytime sleep (1,2)
• increasing alertness with stimulant medication
  • Modafinil - may improve night time alertness in shift workers
  • caffeine taken within the first two hours of the night shift may help to improve night time alertness (3)

Reference

• (1) Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210.
• (2) Giovanni Costa. Shift Work and Health: Current Problems and Preventive Actions. Saf Health Work. 2010; 1(2): 112–123.
• (3) Sack RL et al. Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders - An American Academy of Sleep Medicine Review. Sleep 2007;30(11)