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Treatment of Shift Work Disorder and Jet Lag

Opinion statement

With the growth of the 24-hour global marketplace, a substantial proportion of workers are engaged in nontraditional work schedules and frequent jet travel across multiple time zones. Thus, shift work disorder and jet lag are prevalent in our 24/7 society and have been associated with significant health and safety repercussions. In both disorders, treatment strategies are based on promoting good sleep hygiene, improving circadian alignment, and targeting specific symptoms.

Treatment of shift work must be tailored to the type of shift. For a night worker, circadian alignment can be achieved with bright light exposure during the shift and avoidance of bright light (with dark or amber sunglasses) toward the latter portion of the work period and during the morning commute home. If insomnia and/or excessive sleepiness are prominent complaints despite behavioral approaches and adequate opportunity for sleep, melatonin may be administered prior to the day sleep period to improve sleep, and alertness during work can be augmented by caffeine and wake-promoting agents.

For jet lag, circadian adaptation is suggested only for travel greater than 48 h, with travel east more challenging than travel west. Although advancing sleep and wake times and circadian timing for eastward travel with evening melatonin and morning bright light several days prior to departure can help avoid jet lag at the new destination, this approach may be impractical for many people, Therefore, strategies for treatment at the destination, such as avoidance of early morning light and exposure to late-morning and afternoon light alone or in conjunction with bedtime melatonin, can accelerate re-entrainment following eastward travel. For westward travel, a circadian delay can be achieved after arrival with afternoon and early-evening light with bedtime melatonin.

Good sleep hygiene practices, together with the application of circadian principles, can improve sleep quality, alertness, performance, and safety in shift workers and jet travelers. However, definitive multicenter randomized controlled clinical trials are still needed, using traditional efficacy outcomes such as sleep and performance as well as novel biomarkers of health.

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Disclosure

Dr. Zee has received consulting fees from Takeda, Cephalon, Philips, Sanofi-aventis, and Merck; honoraria from Sanofi-aventis; and a sleep fellowship education grant from Takeda. She also has been paid to develop educational materials for Cephalon. No other potential conflicts of interest relevant to this article were reported.

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Correspondence to Cathy A. Goldstein MD.

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Zee, P.C., Goldstein, C.A. Treatment of Shift Work Disorder and Jet Lag. Curr Treat Options Neurol 12, 396–411 (2010). https://doi.org/10.1007/s11940-010-0090-9

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Keywords

  • Melatonin
  • Time Zone
  • Armodafinil
  • Excessive Sleepiness
  • Endogenous Circadian Rhythm