Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work

Abstract

Analysis 2.1. Comparison 2 Bright light alone at night versus normal light (300 lux) plus placebo capsule, Outcome 1 Sleepiness during the night shift (5-min. Reaction Time Test -milliseconds). . . . . . . . . . . . . Analysis 2.2. Comparison 2 Bright light alone at night versus normal light (300 lux) plus placebo capsule, Outcome 2 Total sleep time, next day

Person‐directed, nonpharmacological interventions for sleepiness at work and sleep disturbances caused by shift work

“…Using a search strategy combining the term “shift” with other terms to describe aspects of shift work, Slanger et al () searched various electronic databases, trial registers, reference lists, conference proceedings, and laboratory trials until August 2015, to locate individually randomized and cluster‐randomized controlled trials (RCTs) (including cross‐over designs) and reviews that investigated the effect of any person‐directed, nonpharmacological intervention on sleepiness on‐shift, sleep length off‐shift, or sleep quality off‐shift in shift workers who also work nights. These included effects of bright light exposure via light box, fluorescent ceiling bulbs or tubes in break rooms, or a portable lamp; napping during shift work; and other (neither light nor nap, ie, physical exercise, sleep hygiene education, etc). …”

“…Pharmacological and nonpharmacological interventions can be found in the evidence. According to Slanger et al (), over the past several years, the number of systematic reviews on pharmacological interventions has been increasing. It appears that many drugs show promise but may have adverse effects.…”

Optimising sleep for night shifts

“…Two recent Cochrane reviews of strategies for shift workers highlighted a paucity of adequately powered, well designed, randomised control trials, and yielded mostly low quality evidence 78. Sleep and performance are complex phenomena, difficult to control and measure in practice, and it is unlikely that a single intervention will act as a panacea.…”

“…A meta-analysis of randomised controlled trials, yielded only low quality evidence, however 8. We advise keeping shift naps to less than 30 minutes, to avoid slow wave sleep followed by grogginess on waking, known as “sleep inertia.”16 A systematic review of 12 randomised controlled trials showed that caffeine improved several aspects of cognitive performance, such as orientation, attention, and reasoning, during shift work or jet lag, when compared with placebo 17.…”

“…However, both drugs have been associated with severe skin reactions, and their long term consequences have not been well established. Theoretically, exposure to bright light during the shift might reduce sleepiness by inhibiting the secretion of the sleep-promoting circadian hormone melatonin, but problems with trial designs have led to inconclusive results 82122. Furthermore, diminished night time levels of melatonin, which also functions as an antioxidant, have been suggested as a cause for increased cancer rates in shift workers 23.…”