Pills seldom solve health problems related to shift work. ^{© Colourbox}

If you meet a shift worker with health problems, and you suspect their problems are related to their work schedule, you should interview the worker and ask for instance questions on:

A. The shift work

• Type of shift; how long are the shifts, type of schedule, how many shifts before a day off, regularity in the organization of shifts, about working overtime
• Sleep habits
• Meals

B. Symptomatology that may be related to work:

• Sleep problems
• Indigestion
• Issues related to family
• Mental symptoms
• Lifestyle, including consumption of alcohol and drugs

Treatment

“Treatment” of for instance sleep problems related to shift work is primarily to give the same advice as for preventing health problems related to shift work. However, you may experience that some shift workers have major problems and they will ask you for instance if any medication can help them. Here is some information, which might be useful:

Medication

Sleep medication is not recommended to solve sleep problems related to shift work. ^{© Colourbox}

Sleep medication

Use of sleep medications is not recommended, because of the risk of development of drug addiction. Due to the fact that day-time sleep following night shifts often are shorter than preferred some night workers use hypnotics in order to obtain sleep of longer duration. We must consider that the shift workers preferably should be able to work for long periods and years in their work and then sleeping drugs are no good solution. Sometimes one might advise a person with major sleep problems when working night shifts, to stop this type of work. Night shift work is not a good solution for everyone, our genetic predisposition has importance. Some persons cannot adapt to such working life without serious problems.

Tablet treatment in the form of melatonin is not yet commonly used. Melatonin is the “sleep hormone” of the body, and is reduced when working nights. Intake of melatonin may reduce sleeping problems related to night shift work. However, we have so far insufficient knowledge about long-term effects of the drug, and cannot recommend it yet.

Think about when you drink coffee during night shifts. ^{© Colourbox}

Stimulants

Several central nervous system stimulants have been shown to counteract sleepiness and to improve performance caused by sleep loss. The by far most commonly used stimulant is caffeine. Several studies have confirmed that caffeine can prevent impairment in functioning due to sleep loss on night shifts. Normally a dose of 2-4 mg/kg in the beginning of the night shift is recommended. Large doses of caffeine near the end of the night shift should be avoided as it has been shown that caffeine disrupts daytime sleep more than nocturnal sleep Modafinil is a relatively new wake-promoting agent. It probably interacts with many wake- and sleep promoting neuro-chemicals in the brain. The use of modafinil for sleeping problems related to shift work is controversial and modafinil is not recommended for use in most countries. We know very little about possible side effects from modafinil use.

In sum, although several psychostimulants exists which may improve alertness during night work there is still not enough evidence to recommend routinely using psychostimulants, except for caffeine (may be), as means of counteracting sleepiness and impaired performance associated with night work.

Naps

Naps can be useful during night shifts. ^{© Colourbox}

Naps during the night shift counteract many of the performance impairments caused by sleep deprivation and long working hours. Therefore naps have been suggested as a means for sustaining performance when working at night. Studies on the effects of naps during night work have also shown improvement on measures of subjective sleepiness. However, the practice of napping on the night shift may represent some problems as there is not always an opportunity to nap.

Light therapy

Some person with sleep problems from shift work may benefit from light therapy. In countries with much sun during daytime, it is important for night shift workers to be outdoors in the light/sun during leisure hours during day time. In countries with less sun, light therapy can be given using an artificial source, such as a lamp. This requires specific knowledge concerning when the exposure should be and for how long, and this type of advice should be given by sleep experts. Normally, interventions based on bright light exposure use light in the visible part of the spectre with light intensity up till 10 000 lux.