What treatments are available for shift work sleep disorder (SWSD) in night shift workers?

From the Guidelines

Night shift workers often experience sleep disturbances due to circadian rhythm disruption, and sleep medicine may be necessary to improve sleep quality.

Available Treatments

• Melatonin receptor agonists, such as ramelteon 8mg or tasimelteon 20mg, taken 30-60 minutes before bedtime, can help regulate sleep-wake cycles 1.
• Short-acting hypnotics like zolpidem 5-10mg or eszopiclone 1-3mg, taken as needed, can be used to promote sleep, but should be limited to 3-5 days per week to minimize dependence and side effects 1.
• Wakefulness-promoting medications, such as modafinil, may also be considered for treating excessive daytime sleepiness associated with shift work sleep disorder 1.

Additional Considerations

• Light therapy and strategic avoidance of light can also be used to help regulate sleep-wake cycles, with light timed in the evening and before the core body temperature minimum leading to phase delays, and light timed after the core body temperature minimum in the morning leading to phase advances 1.
• Cognitive behavioral therapy and sleep hygiene practices may also be beneficial in managing sleep disturbances in night shift workers 1.

From the Research

Treatments for Shift Work Sleep Disorder (SWSD)

• Pharmacological interventions:
  • Melatonin (1 to 10 mg) after the night shift may increase sleep length during daytime sleep and night-time sleep compared to placebo 2
  • Armodafinil taken before the night shift probably reduces sleepiness and increases alertness in shift work sleep disorder patients 2
  • Modafinil probably has similar effects on sleepiness and alertness in the same patient group 2
  • Caffeine plus pre-shift naps taken before the night shift decreased sleepiness 2
• Non-pharmacological interventions:
  • Appropriate scheduling of shift work 3
  • Proper consideration of the speed of shift rotation 3
  • Strategies for sleep and napping 3
  • Installing appropriate lighting at the workplace 3
• Lifestyle modifications:
  • Sleep hygiene practices 4
  • Napping 4
  • Physical exercise 5
• Light therapy:
  • Bright light exposure has been demonstrated as an effective treatment for circadian rhythm sleep disorders 5

Sleep Quality and Duration

• Shift workers may experience reduced sleep length and quality due to circadian disruptions 2, 3, 4
• Night-shift workers may have higher odds of lifetime use of sleep medication and melatonin 6
• Sleep quality and duration can be improved with appropriate treatments and lifestyle modifications 2, 3, 4, 5

Adverse Effects

• Pharmacological interventions may have adverse effects, such as headache, nausea, and a rise in blood pressure 2
• Severe skin reactions have been reported with the use of certain medications 2