Article

Treatment of shift work disorder and jet lag.

, 710 North Lake Shore Drive, 5th Floor, Chicago, IL, 60611, USA.
Current Treatment Options in Neurology (Impact Factor: 2.18). 09/2010; 12(5):396-411. DOI: 10.1007/s11940-010-0090-9
Source: PubMed

ABSTRACT 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.

Download full-text

Full-text

Available from: Phyllis C Zee, Jun 21, 2015
2 Followers
 · 
149 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Circadian desynchrony occurs when individuals are exposed to abrupt phase shifts of the light-dark cycle, as in jet lag. For reducing symptoms and for speeding up resynchronization, several strategies have been suggested, including scheduled exercise, exposure to bright light, drugs, and especially exogenous melatonin administration. Restricted feeding schedules have shown to be powerful entraining signals for metabolic and hormonal daily cycles, as well as for clock genes in tissues and organs of the periphery. This study explored in a rat model of jet lag the contribution of exogenous melatonin or scheduled feeding on the re-entrainment speed of spontaneous general activity and core temperature after a 6-h phase advance of the light-dark cycle. In a first phase, the treatment was scheduled for 5 days prior to the phase shift, while in a second stage, the treatment was simultaneous with the phase advance of the light-dark cycle. Melatonin administration and especially scheduled feeding simultaneous with the phase shift improved significantly the re-entrainment speed. The evaluation of the free-running activity and temperature following the 5-day treatment proved that both exogenous melatonin and specially scheduled feeding accelerated re-entrainment of the SCN-driven general activity and core temperature, respectively, with 7, 5 days (p < 0.01) and 3, 3 days (p < 0.001). The present results show the relevance of feeding schedules as entraining signals for the circadian system and highlight the importance of using them as a strategy for preventing internal desynchrony.
    Journal of Biological Rhythms 08/2011; 26(4):324-34. DOI:10.1177/0748730411409715 · 3.32 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the physiological and psychological mechanisms involved in the development of sleep disorders remain similar throughout history, factors that potentiate these mechanisms are closely related to the "zeitgeist", ie, the sociocultural, technological and lifestyle trends which characterize an era. Technological advancements have afforded modern society with 24-hour work operations, transmeridian travel and exposure to a myriad of electronic devices such as televisions, computers and cellular phones. Growing evidence suggests that these advancements take their toll on human functioning and health via their damaging effects on sleep quality, quantity and timing. Additional behavioral lifestyle factors associated with poor sleep include weight gain, insufficient physical exercise and consumption of substances such as caffeine, alcohol and nicotine. Some of these factors have been implicated as self-help aids used to combat daytime sleepiness and impaired daytime functioning. This review aims to highlight current lifestyle trends that have been shown in scientific investigations to be associated with sleep patterns, sleep duration and sleep quality. Current understanding of the underlying mechanisms of these associations will be presented, as well as some of the reported consequences. Available therapies used to treat some lifestyle related sleep disorders will be discussed. Perspectives will be provided for further investigation of lifestyle factors that are associated with poor sleep, including developing theoretical frameworks, identifying underlying mechanisms, and establishing appropriate therapies and public health interventions aimed to improve sleep behaviors in order to enhance functioning and health in modern society.
    Nature and Science of Sleep 03/2012; 4:19-31. DOI:10.2147/NSS.S18891
  • [Show abstract] [Hide abstract]
    ABSTRACT: Adsorption of a typical sugar-based surfactant,n-dodecyl-β-d-maltoside (DM), on hydrophilic solids, silica, alumina, titania, and hematite, and a hydrophobic solid, graphite, was studied. Effects of salts and pH on the adsorption on alumina as well as the electrokinetic potential of the particles after surfactant adsorption were studied to determine the adsorption mechanisms. Hydrophobicity and settling rate were measured to explore the surfactant conformation on the particle surfaces. For hydrophilic solids, DM was found to adsorb strongly on alumina, titania, and hematite but weakly on silica. While hydrogen bonding is postulated to be the major driving force for the adsorption on hydrophilic solids, for hydrophobic solid, the adsorption is mainly due to the hydrophobic interactions. The different behaviors of surfactant on hydrophilic and hydrophobic solids were attributed to the different interactions between surfactant and solids. Also, the surfactant is estimated to form a bilayer on alumina while on graphite it forms a monolayer. The surface hydrophobicity and stability of the solids are discussed in terms of the adsorbed monolayer/bilayer formation on the particles.
    Journal of Colloid and Interface Science 07/1997; 191(1):202-208. DOI:10.1006/jcis.1997.4923 · 3.55 Impact Factor