Figure 6. Treatment Options for the Management of Shift Work Disorder (SWD).

This example illustrates the timing of light exposure and the use of pharmacologic agents, either alone or in combination for the management of SWD. The habitual pre-shift sleep time of this 42 year old male is 11pm-7am. The new work shift requires that he work from 10pm to 6am for 4-5 days per week. Circadian alignment can be achieved by manipulating light and dark exposure. In order to delay his circadian rhythm, bright light exposure (continuous or intermittent) should start early in the shift and stop about 1-2 hours before the shift, and wear sunglasses to avoid advancing circadian rhythms in the morning. If needed, melatonin taken before bedtime may help improve sleep quality. To address the issue of excessive sleepiness, scheduled 1-2 hour nap prior to the shift work, if possible a short 30 minute nap in the middle of the shift, and/or caffeine can help decrease sleepiness at work. If sleepiness persists, modafinil 200 mg and armodafinil 150 mg have been shown to improve alertness during work and is approved by the FDA for the treatment of excessive sleepiness in patients with SWD.