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Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment

Authors Smith, Eastman C

Received 13 July 2012

Accepted for publication 21 August 2012

Published 27 September 2012 Volume 2012:4 Pages 111—132

DOI https://doi.org/10.2147/NSS.S10372

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Mark R Smith, Charmane I Eastman

Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, USA

Abstract: There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan.

Keywords: circadian rhythms, night work, bright light, phase-shifting, sleep, melatonin

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