UP TO 20% OF SHIFT WORKERS NEED HELP TO STAY UP AT NIGHT AND SLEEP DURING THE DAY. This is especially important in the hospital where many professionals work varying shifts. Follow these steps...
Nondrug measures are first-line. Suggest sleep hygiene, pre-shift naps, staying active during breaks, keeping the work area bright and the bedroom dark, wearing sunglasses on the way home, etc. Caffeine is the next choice to increase alertness at work. Recommend limiting caffeine to 400 mg/day, about three 8-ounce cups of coffee. Advise avoiding caffeine within 4 hours of bedtime.
Modafinil (Modasomil, Bravamax, etc) or armodafinil (Armodacure, Armovigil) modestly improves nighttime alertness and decreases sleepiness. Consider either one if nondrug measures and caffeine aren't enough, but caution about headaches, nausea, and daytime insomnia. Let your female colleagues know that modafinil or armodafinil may reduce the efficacy of hormonal contraceptives. Other stimulants like methylphenidate (Concerta) may increase alertness, but there's not much evidence that they're beneficial for shift work disorder and abuse is a concern. Recommend trying to avoid them.
Melatonin (Now Melatonin, Viva-Max) can add about 25 minutes to daytime sleep. Suggest 3 mg before bed for those who want to try it. Hypnotics like zolpidem (Zodium, Stilnox) might increase daytime sleep duration, but aren't proven to reduce nighttime sleepiness. Warn about next day grogginess and the risk of sleep-walking, sleep-eating, and sleep-driving with these meds. Advise shift workers to get 8 hours of sleep per 24 hrs.
REFERENCES
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