Skip to main content

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.

This is a preview of subscription content, access via your institution.

Figure 1

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    American Academy of Sleep Medicine: The International Classification of Sleep Disorders: Diagnostic & Coding Manual, edn 2. Westchester: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  2. 2.

    Reid KJ, Zee PC: Circadian rhythm disorders. Semin Neurol 2009, 29(4):393–405.

    Article  PubMed  Google Scholar 

  3. 3.

    Presser HB: Job, family, and gender: determinants of nonstandard work schedules among employed Americans in 1991. Demography 1995, 32:577–598.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Costa G: Shift work and occupational medicine: an overview. Occup Med (Lond) 2003, 53(2):83–88.

    Article  Google Scholar 

  5. 5.

    Kwon JS, Zee PC: Disorders of circadian rhythm. In Acute and Emergent Events in Sleep Disorders. Edited by Chokroverty S and Sahota P. New York: Oxford University Press; in press.

  6. 6.

    Gold DR, Rogacz S, Bock N, et al.: Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. Am J Public Health 1992, 82(7):1011–1014.

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Waterhouse J, Reilly T, Atkinson G, Edwards B: Jet lag: trends and coping strategies. Lancet 2007, 369(9567):1117–1129.

    Article  PubMed  Google Scholar 

  8. 8.••

    Sack RL, Auckley D, Auge RR, et al.: Circadian rhythm sleep disorders: Part I, basic principles, shift work and jet lag disorders. Sleep 2007, 30(11):1460–1483.

    PubMed  Google Scholar 

  9. 9.

    Aschoff J, Hoffmann K, Pohl H, Wever R: Re-entrainment of circadian rhythms after phase-shifts of the zeitgeber. Chronobiologia 1975, 2:23–78.

    CAS  PubMed  Google Scholar 

  10. 10.

    Sack RL: Jet lag. N Engl J Med 2010, 362(5):440–446.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Morgenthaler TI, Lee-Chiong T, Alessi C, et al.: Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders: an American Academy of Sleep Medicine report. Sleep 2007, 30(11):1445–1458.

    PubMed  Google Scholar 

  12. 12.

    Monthly departures to international destinations. Office of Travel & Tourism Industries Web Site. Accessed 31 May 2010.

  13. 13.

    Gabarino S, Mascialino B, Penco MA, et al.: Professional shift-work drivers who adopt prophylactic naps can reduce the risk of car accidents during night work. Sleep 2004, 27:1295–1302.

    Google Scholar 

  14. 14.

    Schweitzer PK, Randazzo AC, Stone K, et al.: Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. Sleep 2006, 29:39–50.

    PubMed  Google Scholar 

  15. 15.

    Sallinen M, Harma M, Akerstedt T, et al.: Promoting alertness with a short nap during a night shift. J Sleep Res 1998, 7:240–247.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Purnell MT, Feyer AM, Herbison GP: The impact of a nap opportunity during the night shift on the performance and alertness of 21-h shift workers. J Sleep Res 2002, 11:219–227.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Bonnefond A, Muzet A, Winter-Dill AS, et al.: Innovative working schedule: introducing one short nap during the night shift. Ergonomics 2001, 44:937–945.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Sharkey KM, Eastman CI: Melatonin phase shifts human circadian rhythms in a placebo-controlled simulated night-work study. Am J Physiol Regul Integr Comp Physiol 2002, 282:R454–R463.

    CAS  PubMed  Google Scholar 

  19. 19.

    Sack RL, Lewy AJ: Melatonin as a chronobiotic: treatment of circadian desynchrony in night workers and the blind. J Biol Rhythms 1997, 12:595–603.

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Crowley SJ, Lee C, Tseng CY, et al.: Combinations of bright light, scheduled dark, sunglasses, and melatonin to facilitate circadian entrainment to night shift work. J Biol Rhythms 2003, 18(6):513–523.

    Article  PubMed  Google Scholar 

  21. 21.

    Sharkey KM, Fogg LF, Eastman CI: Effects of melatonin administration on daytime sleep after simulated night shift work. J Sleep Res 2001, 10:181–192.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Folkard S, Arendt J, Clark M: Can melatonin improve shift workers’ tolerance for the night shift? Some preliminary findings. Chronobiol Int 1993, 10:315–320.

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Yoon IY, Song BG: Role of morning melatonin administration and attenuation of sunlight exposure in improving adaptation of night-shift workers. Chronobiol Int 2002, 19:903–913.

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    James M, Tremea MO, Jones JS, Krohmer JR: Can melatonin improve adaptation to night shift? Am J Emerg Med 1998, 16(4):367–370.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Jorgensen KM, Witting MD: Does exogenous melatonin improve day sleep or night alertness in emergency physicians working night shifts? Ann Emerg Med 1998, 31:699–704.

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Muehlbach MJ, Walsh JK: The effects of caffeine on simulated night-shift work and subsequent daytime sleep. Sleep 1995, 18(1):22–29.

    CAS  PubMed  Google Scholar 

  27. 27.

    Ker K, Edwards PJ, Felix LM, et al.: Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev 2010 May 12, CD008508.

  28. 28.

    Walsh JK, Sugerman JL, Muehlbach MJ, Schweitzer PK: Physiological sleep tendency on a simulated night shift: adaptation and effects of triazolam. Sleep 1988, 11:251–264.

    CAS  PubMed  Google Scholar 

  29. 29.

    Walsh JK, Schweitzer PK, Anch AM, et al.: Sleepiness/alertness on a simulated night shift following sleep at home with triazolam. Sleep 1991, 14:140–146.

    CAS  PubMed  Google Scholar 

  30. 30.

    Puca FM, Perrucci S, Prudenzano MP, et al.: Quality of life in shift work syndrome. Funct Neurol 1996, 11(5):261–268.

    CAS  PubMed  Google Scholar 

  31. 31.

    Porcù S, Bellatreccia A, Ferrara M, Casagrande M: Performance, ability to stay awake, and tendency to fall asleep during the night after a diurnal sleep with temazepam or placebo. Sleep 1997, 20(7):535–541.

    PubMed  Google Scholar 

  32. 32.

    Monchesky TC, Billings BJ, Phillips R, Bourgouin J: Zopiclone in insomniac shiftworkers. Evaluation of its hypnotic properties and its effects on mood and performance of shift workers. Int Arch Occupat. Environ Health 1989, 61:255–659.

    CAS  Google Scholar 

  33. 33.

    Moon CA, Hindmarch I, Holland RL: The effect of zopiclone 7.5 mg on sleep, mood and performance of shift workers. International Clin Psychopharmacol 1990, 5:79–83.

    Google Scholar 

  34. 34.

    Hart CL, Ward AS, Haney M, Foltin RW: Zolpidem-related effects on performance and mood during simulated night-shift work. Exp Clin Psychopharmacol 2003, 11(4):259–268.

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Temazepam. Clinical Pharmacology Web site. Accessed 06 June 2010.

  36. 36.

    Zolpidem. Clinical Pharmacology Web site. Accessed 06 June 2010.

  37. 37.

    Hart CL, Haney M, Nasser J, Foltin RW: Combined effects of methamphetamine and zolpidem on performance and mood during simulated night shift work. Pharmacol Biochem Behav 2005, 81:559–568.

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Czeisler CA, Walsh JK, Roth T, et al.: Modafinil for excessive sleepiness associated with shift-work sleep disorder. N Engl J Med 2005, 353:476–486.

    Article  CAS  PubMed  Google Scholar 

  39. 39.•

    Czeisler CA, Walsh JK, Wesnes KA, et al.: Armodafinil for treatment of excessive sleepiness associated with shift work disorder: a randomized controlled study. Mayo Clin Proc 2009, 84(11):958–972.

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Modafinil. Clinical Pharmacology Web site. Accessed 29 May 2010.

  41. 41.

    Armodafinil. Clinical Pharmacology Web site. Accessed 29 May 2010.

  42. 42.

    Campbell SS, Dijk DJ, Boulos Z, et al.: Light treatment for sleep disorders: consensus report. III. Alerting and activating effects. J Biol Rhythms 1995, 10(2):129–132.

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    Costa G, Ghirlanda G, Minors DS, Waterhouse JM: Effect of bright light on tolerance to night work. Scand J Work, Environ Health 1993, 19:414–420.

    CAS  Google Scholar 

  44. 44.

    Budnick LD, Lerman SE, Nicolich MJ: An evaluation of scheduled bright light and darkness on rotating shiftworkers: trial and limitations. Am J Industrial Med 1995, 27:771–778.

    Article  CAS  Google Scholar 

  45. 45.

    Lowden A, Akerstedt T, Wibom R: Suppression of sleepiness and melatonin by bright light exposure during breaks in night work. J Sleep Res 2004, 13:37–43.

    PubMed  Google Scholar 

  46. 46.

    Eastman CI, Stewart KT, Mahoney MP, et al.: Dark goggles and bright light improve circadian rhythm adaptation to night-shift work. Sleep 1994, 17(6):535–543.

    CAS  PubMed  Google Scholar 

  47. 47.•

    Smith MR, Fogg LF, Eastman CI: A compromise circadian phase position for permanent night work improves mood, fatigue, and performance. Sleep 2009, 32(11):1481–1489.

    PubMed  Google Scholar 

  48. 48.

    Terman M, Terman JS: Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 2005, 10(8):647–663.

    PubMed  Google Scholar 

  49. 49.

    Eastman CI, Gazda CJ, Burgess HJ, et al.: Advancing circadian rhythms before eastward flight: a strategy to prevent or reduce jet lag. Sleep 2005, 28:33–44.

    PubMed  Google Scholar 

  50. 50.

    Lowden A, Akerstedt T: Retaining home-base sleep hours to prevent jet lag in connection with a westward flight across nine time zones. Chronobiol Int 1998, 15(4):365–376.

    Article  CAS  PubMed  Google Scholar 

  51. 51.

    Arendt J: Managing jet lag: some of the problems and possible new solutions. Sleep Med Rev 2009, 13(4):249–256.

    Article  PubMed  Google Scholar 

  52. 52.

    Eastman CI, Burgess HJ: How to travel the world without jet lag. Sleep Med Clin 2009, 4:241–255.

    Article  PubMed  Google Scholar 

  53. 53.

    Paul MA, Gray G, Sardana TM, Pigeau RA: Melatonin and zopiclone as facilitators of early circadian sleep in operational air transport crews. Aviat Space Environ Med 2004, 75:439–443.

    CAS  PubMed  Google Scholar 

  54. 54.

    Pierard C, Beaumont M, Enslen M, et al.: Resynchronization of hormonal rhythms after an eastbound flight in humans: effects of slow-release caffeine and melatonin. Eur J Appl Physiol 2001, 85:144–150.

    Article  CAS  PubMed  Google Scholar 

  55. 55.

    Arendt J, Aldhous M, English J, et al.: Some effects of jet-lag and their alleviation by melatonin. Ergonomics 1987, 30:1379–1393.

    Article  Google Scholar 

  56. 56.

    Takahashi T, Sasaki M, Itoh H, et al.: Melatonin alleviates jet lag symptoms caused by an 11-hour eastward flight. Psychiatry Clin Neurosci 2002, 56:301–302.

    Article  CAS  PubMed  Google Scholar 

  57. 57.

    Beaumont M, Batejat D, Pierard C, et al.: Caffeine or melatonin effects on sleep and sleepiness after rapid eastward transmeridian travel. J Appl Physiol 2004, 96:50–58.

    Article  CAS  PubMed  Google Scholar 

  58. 58.

    Jamieson AO, Zammit GK, Rosenberg RS, et al.: Zolpidem reduces the sleep disturbance of jet lag. Sleep Med 2001, 2(5):423–430.

    Article  CAS  PubMed  Google Scholar 

  59. 59.

    Suhner A, Schlagenhauf P, Höfer I, et al.: Effectiveness and tolerability of melatonin and zolpidem for the alleviation of jet lag. Aviat Space Environ Med 2001, 72(7):638–646.

    CAS  PubMed  Google Scholar 

  60. 60.

    Daurat A, Benoit O, Buguet A: Effect of zopiclone on the rest/activity rhythm after a westward flight across five time zones. Psychopharmacology 2000, 149:241–245.

    Article  CAS  PubMed  Google Scholar 

  61. 61.

    Burgess HJ, Crowly SJ, Gazda CJ, et al.: Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. J Biol Rhythms 2003, 18(4):318–328.

    Article  PubMed  Google Scholar 

  62. 62.

    Boulos Z, Macchi MM, Sturcher MP, et al.: Light visor treatment for jet lag after westward travel across six time zones. Aviat Space Environ Med 2002, 73:953–963.

    PubMed  Google Scholar 

  63. 63.

    Aeschbach D, Lockyer BJ, Dijk DJ, et al.: Use of transdermal melatonin delivery to improve sleep maintenance during daytime. Clin Pharmacol Ther 2009, 86(4):378–382.

    Article  CAS  PubMed  Google Scholar 

  64. 64.

    Richardson GS, Zee PC, Wang-Weigand S, et al.: Circadian phase-shifting effects of repeated ramelteon administration in healthy adults. J Clin Sleep Med 2008, 4(5):456–461.

    PubMed  Google Scholar 

  65. 65.•

    Zee PC, Wang-Weigand S, Wright Jr KP, et al.: Effects of ramelteon on insomnia symptoms induced by rapid, eastward travel. Sleep Med 2010, 11(6):525–533.

    Article  PubMed  Google Scholar 

  66. 66.

    Rajaratnam SM, Polymeropoulos MH, Fisher DM, et al.: Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. Lancet 2009, 373(9662):482–491.

    Article  CAS  PubMed  Google Scholar 

  67. 67.

    Dubovsky SL, Warren C: Agomelatine. A melatonin agonist with antidepressant properties. Expert Opin Investig Drugs 2009, 18(10):1533–1540.

    Article  CAS  PubMed  Google Scholar 

  68. 68.•

    Rosenberg RP, Bogan RK, Tiller JM, et al.: A phase 3, double-blind, randomized, placebo-controlled study of armodafinil for excessive sleepiness associated with jet lag disorder. Mayo Clin Proc 2010 Jun 7 (Epub ahead of print). This large, randomized controlled field study evaluates the use of a wake-promoting agent in jet lag.

Download references


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.

Author information



Corresponding author

Correspondence to Cathy A. Goldstein MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zee, P.C., Goldstein, C.A. Treatment of Shift Work Disorder and Jet Lag. Curr Treat Options Neurol 12, 396–411 (2010).

Download citation


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