Title: Managing the patient with shift-work disorder
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Practice recommendations * 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 shiftwork disorder (SWD) (SOR: B). * 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 (SOR: C). * Use of bright light therapy to partially re-entrain the circadian clock should be explored for all night-shift workers-particularly those with SWD (SOR: B). * 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 (SOR: A). * 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 (SOR: C). The goals of treatment for individuals with shift-work disorder (SWD) are to ensure sustained wakefulness when wakefulness is required and to facilitate restorative sleep when sleep is required. Several nonpharmacologic interventions are available for the treatment of SWD, such as the improvement of sleep hygiene, exercise, and timed exposure to light. Although these treatments are recommended as part of the Practice Parameter Guidelines for the Evaluation and Treatment of Circadian Rhythm Sleep Disorders from the American Academy of Sleep Medicine, (1,2) most have been evaluated in shift workers generally, rather than specifically in those with SWD. However, the current definition of SWD requires further validation, and while the delineation between workers who do not thrive under shift-work conditions and individuals who develop SWD remains indistinct, it is likely that literature specific to SWD will remain sparse. (2) Regardless, such nonpharmacologic interventions should be introduced for all individuals presenting with SWD. Pharmacotherapy may also be required. Two pharmacologic agents-modafinil and its R-enantiomer armodafinil--have been evaluated specifically in patients with excessive sleepiness (ES) associated with SWD and are approved as wakefulness-promoting agents for this indication by the US Food and Drug Administration (FDA). This article reviews appropriate management strategies and specific interventions--both nonpharmacologic and pharmacologic--that primary care physicians can offer to individuals diagnosed with SWD. Addressing comorbid conditions For the individual presenting with SWD, it is essential to identify and address any comorbid conditions that might contribute to poor sleep hygiene and/or cause ES or fatigue during required periods of wakefulness. Perhaps the most relevant comorbidities are other sleep disorders, such as obstructive sleep apnea (OSA), and mood disorders, such as depression. Referral to a sleep specialist may be necessary for individuals with a suspected or confirmed comorbid sleep disorder (see "Recognition of shiftwork disorder in primary care" on page S18 of this supplement). An algorithm for the management of SWD in the primary care setting, including steps to evaluate comorbid disorders, appears in FIGURE 1. Nonpharmacologic interventions A range of nonpharmacologic options have been evaluated to relieve the ES often...
Source Citation (MLA 8 th Edition)
Thorpy, Michael J. "Managing the patient with shift-work disorder." Journal of Family Practice, Jan. 2010, p. S24+. Academic OneFile, Accessed 22 Nov. 2018.

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