Treatment of Shift Work Disorder and Jet Lag

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Current Treatment Options in Neurology (Impact Factor: 1.94). 09/2010; 12(5):396-411. DOI: 10.1007/s11940-010-0090-9
Source: PubMed


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.

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    • "In recent years, more knowledge has become available about the influencing factors on disturbance of the circadian rhythm, and possible countermeasures of fatigue [12-14]. It has been shown that by correct timing of exposure to and avoidance of daylight, the most important biorhythm synchronizer (or zeitgeber) [2,12,13], jet lag symptoms can be reduced. "
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    ABSTRACT: A considerable percentage of flight crew reports to be fatigued regularly. This is partly caused by irregular and long working hours and the crossing of time zones. It has been shown that persistent fatigue can lead to health problems, impaired performance during work, and a decreased work-private life balance. It is hypothesized that an intervention consisting of tailored advice regarding exposure to daylight, optimising sleep, physical activity, and nutrition will lead to a reduction of fatigue in airline pilots compared to a control group, which receives a minimal intervention with standard available information.Methods/design: The study population will consist of pilots of a large airline company. All pilots who posses a smartphone or tablet, and who are not on sick leave for more than four weeks at the moment of recruitment, will be eligible for participation.In a two-armed randomised controlled trial, participants will be allocated to an intervention group that will receive the tailored advice to optimise exposure to daylight, sleep, physical activity and nutrition, and a control group that will receive standard available information. The intervention will be applied using a smartphone application and a website, and will be tailored on flight- and participant-specific characteristics. The primary outcome of the study is perceived fatigue. Secondary outcomes are need for recovery, duration and quality of sleep, dietary and physical activity behaviours, work-private life balance, general health, and sickness absence. A process evaluation will be conducted as well. Outcomes will be measured at baseline and at three and six months after baseline. This paper describes the development of an intervention for airline pilots, consisting of tailored advice (on exposure to daylight and sleep-, physical activity, and nutrition) applied into a smartphone application. Further, the paper describes the design of the randomised controlled trial evaluating the effect of the intervention on fatigue, health and sickness absence. If proven effective, the intervention can be applied as a new and practical tool in fatigue management. Results are expected at the end of 2013.Trial registration: Netherlands Trial Register: NTR2722.
    Full-text · Article · Aug 2013 · BMC Public Health
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    • "Avoidance of early morning bright light on the ride home from work has also been found to be beneficial to allow a smoother transition to the morning sleep period.140 For jet lag, appropriately timed light exposure at the destination of travel has also been found to be beneficial.141 Westward travelers may benefit from evening light exposure and avoiding morning light exposure at their destination; while eastward travelers should avoid evening light and be exposed to morning light, in order to achieve an advanced sleep phase. "
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    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.
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    • "Such data are in agreement with previous reports indicating that MEL accelerates re-entrainment of circadian rhythms of locomotor activity in rats subjected to a shift in the LD cycle (Redman et al., 1983); in addition, the present data suggest that it does not exert a significant effect on core temperature, suggesting a differential effect of MEL on the effectors. Altogether and according to the present results, MEL can be an efficient chronobiotic for general activity when administered at the right time and during the consecutive days after a phase shift (Zee and Goldstein, 2010). "
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    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.
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