title: Managing the patient with shift-work disorder.
abstract: Behavioral measures, eg, exercise and improved sleep hygiene, can enhance sleep quality and combat insomnia and excessive sleepiness (ES) in shift workers and individuals with shift-work disorder (SWD). Napping before a shift followed by consumption of a caffeinated drink and, if appropriate, scheduled naps at work, may improve ES in patients with SWD. Use of bright light therapy to partially re-entrain the circadian clock should be explored for all night-shift workers-particularly those with SWD. The wakefulness-promoting agents armodafinil and modafinil are FDA approved for the treatment of ES in patients with SWD. Alongside nonpharmacologic interventions, they can be included in a comprehensive management plan for SWD. Melatonin or other sleep-promoting agents may help shift workers achieve sleep during required rest periods and when adjusting to night-shift work; studies are needed in patients with SWD to better evaluate the utility of these agents in this population.
authors.affiliation: Sleep-Wake Disorders Center, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thorpy
mesh_terms: D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004032:Diet; D004777:Environment; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008550:Melatonin / Q000627:therapeutic use; D000077408:Modafinil; D018696:Neuroprotective Agents / Q000627:therapeutic use; D011379:Prognosis; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014940:Work Schedule Tolerance / Q000502:physiology* / Q000523:psychology
chemical_list: D001559:Benzhydryl Compounds; D018696:Neuroprotective Agents; D008550:Melatonin; D000077408:Modafinil