Interventions to prevent and treat sleep-wake disturbances in shift workers

The evidence for interventions to prevent and treat sleep–wake disturbances in shift workers is limited. Despite this, the behavioural interventions in Practices to prevent and treat nightshift-related sleep–wake disturbances are recommended because they may be effective and are unlikely to cause harm. These interventions aim to:
  • improve sleep quality and quantity
  • promote safety and cognitive ability
  • normalise sleep patterns once the cycle of shift work has finished.
Individualise the interventions in Practices to prevent and treat nightshift-related sleep–wake disturbances; consider the person’s sleep requirements, chronotype, nature of work (frequency and timing of shifts, opportunities to rest during or between shifts) and nonwork commitments.
Practices to prevent and treat nightshift-related sleep–wake disturbances can be printed as a handout.

To reduce the risk of harm associated with sleepiness and impaired cognition, also recommend strategies to improve safety (eg extra checks when performing critical tasks, avoid driving home if possible).

Figure 1. Practices to prevent and treat nightshift-related sleep–wake disturbances.

[NB1]

Before starting nightshift:

  • ensure you are well rested when beginning your night shift by getting adequate sleep in the preceding nights—consider sleeping for longer than usual (‘sleep banking’)
  • don’t set an alarm on the morning of your first night shift and sleep in
  • have a 60 to 90 minute nap before the shift starts
  • eat a large meal before the shift starts.

During nightshift:

  • consider drinking between 1 and 3 caffeinated beverages early in the shift; avoid drinking caffeinated beverages 3 to 6 hours before you plan to sleep
  • keep active during the shift
  • if possible, nap for up to 30 minutes—if the nap is longer, it is more likely that you will temporarily have reduced alertness and performance upon waking
  • maximise exposure to bright light
  • limit food intake.

Between shifts in a series of nightshifts:

  • sleep for at least 7 hours per 24 hours; strategies to help achieve this include:
    • minimising exposure to light (eg wear sunglasses before going to sleep)
    • avoiding caffeine, nicotine and other stimulants
    • avoiding alcohol
    • ensuring the bedroom is quiet and dark
    • avoiding distractions in the bedroom; do not have a TV, music player, laptop, mobile phone or clock in the room
    • avoiding sleeping with children and pets in the room
    • ensuring a comfortable temperature for sleep
    • using a suitable mattress and pillow for comfort and support
    • wearing earplugs or an eye mask
  • increase alertness for upcoming nightshift by:
    • exercising
    • seeking exposure to bright light
    • eating a large meal before starting night shift.

Recovering once the cycle of shift work is over:

  • have a 90 to 180 minute nap in the morning after the last nightshift then go to sleep at your usual (non–shift work) bedtime
  • avoid daytime napping
  • maximise exposure to bright (preferably natural) light in the middle of the day
  • engage in daytime activities
  • exercise regularly.
Note: NB1: These practices are general recommendations; tailor them to your needs, depending on your sleep requirements, nature of shift work (frequency and timing of shifts, opportunities to rest during or between shifts) and nonwork commitments.
The treatment of sleep–wake disturbances in shift workers is primarily behavioural; however, limited evidence suggests immediate-release melatonin may help:
  • adjust the sleep–wake cycle in a prolonged cycle of night shifts (eg 3 nights or more)
  • reduce time to sleep onset
  • increase total sleep time.

A reasonable regimen for shift work–related sleep–wake disturbance is:

melatonin immediate-release 0.5 to 5 mg orally, 1 hour before desired bedtime 1. shiftwork sleep disorder melatonin melatonin melatonin

Avoid internet-sourced melatonin formulations because the melatonin content in these preparations is unreliable.

If, despite the use of the interventions above, a person continues to experience daytime insomnia during the shift-work cycle, excessive sleepiness during shifts or significant distress, seek advice from a sleep physician—treatment options include drugs to promote alertness (eg modafinil and armodafinil). It may be preferable to avoid working nightshifts.

Although hypnotics are commonly used to treat daytime insomnia in shift-workers, there is a lack of evidence to support this practice and hypnotics have adverse effects including sedation (which may persist at work) and dependence—see Hypnotics for further detail.

For information about psychotropic use (including principles of use and advice on individual drugs) in females:

  • of childbearing potential, see here
  • who are pregnant, see here
  • who are breastfeeding, see here.
1 A low melatonin dose (eg 0.5 mg) closely resembles physiological release. Doses higher than 5 mg do not improve outcomes and can have hypnotic properties.Return