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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Clockwise rotation of shifts is generally better tolerated. With modern diabetic control most diabetics can manage shift work. Fatigue, sleep disruption, mood disorder and gastrointestinal effects are the most common health issues for shift workers. Shift work sleep disorder typically occurs in 10–40% of shift workers.
Practical Multiple Testing Methods in Clinical Trials
Published in Mark Chang, John Balser, Jim Roach, Robin Bliss, Innovative Strategies, Statistical Solutions and Simulations for Modern Clinical Trials, 2019
Mark Chang, John Balser, Jim Roach, Robin Bliss
This randomized, placebo-controlled study was conducted to compare the overnight efficacy and plasma concentration-time profiles of armodafinil (250, 200, and 150 mg) in patients with chronic shift work sleep disorder (SWSD). The primary endpoint was the change in multiple sleep latency test (MSLT) from the baseline to the last visit. MSLT is an objective assessment of sleepiness that measures the likelihood of falling asleep. The details of this trial can be found at https://clinicaltrials.gov. The three individual hypotheses might be of interest:
The Role of Pharmacological Interventions for Sleep Deprivation
Published in Clete A. Kushida, Sleep Deprivation, 2004
Evidence suggests that moderate to severe sleepiness is virtually omnipresent for night shift workers. A recent assessment of 363 shift workers with symptoms of shift work sleep disorder (23) found their nocturnal sleepiness level, studied the night after 3–5 consecutive night shifts, to approximate sleepiness levels after a night of total sleep deprivation (24). The shift workers’ mean score on the Multiple Sleep Latency Test (MSLT) at night was 2.75 min. Further, the MSLT score for 90.1% of the shift workers was ≤ 6 min, a level most experts believe to be associated with behavioral impairment and increased accident risk.
Night today, day tomorrow: how irregular work shifts interfere with our psychological health
Published in Chronobiology International, 2021
Brigitte Holzinger, Lucille Mayer, Gerhard Klösch
Unfortunately, the around-the-clock availability has its downsides and working in shifts has a number of negative consequences on our health. In case of shift work, work schedules are no longer in line with the natural light-dark-cycles of the sun, and this desynchronization of biological rhythms may cause difficulties falling asleep, an increase in daytime sleepiness, impaired cognitive abilities, a higher risk for accidents, and persistent malfunctions of the biological clock (Kantermann et al. 2007). Shift workers are less likely to report a good fit between working hours and family and social commitments (work-life balance) and more likely to report working extremely fast, feeling exhausted at the end of the work day and not feeling they are paid appropriately (Parent-Thirion et al. 2017). The continuous disruption of sleep-wake rhythms peak in the diagnosis of shift work sleep disorder (SWSD). SWSD is characterized by insomnia and/or excessive daytime sleepiness and the loss of normal sleep-wake patterns, associated with a wide range of complaints, including reduced alertness, negative social consequences and increased irritability (American Academy of Sleep Medicine 2014).
Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects
Published in Substance Abuse, 2020
Ana Sousa, Ricardo Jorge Dinis-Oliveira
Due of its wake-promoting and psychotropic effects, modafinil is prescribed to improve wakefulness in adults who have excessive day sleepiness due to one of the following diagnosed sleep disorders:96–98 i) narcolepsy, as first-line treatment; ii) obstructive sleep apnea (OSA), as an adjunct to continuous positive airway pressure (CPAP); and iii) shift work disorder sleep (SWSD), as first-line treatment. The usual starting dose is 200 mg per day (100 mg twice daily). Nonetheless, it can be gradually increased to 400 mg per day (200 mg twice daily) in case of insufficient response.99 Modafinil is also approved for Air Force missions in the U.S. as an alternative to amphetamines for military usage and has also been shown to reduce jet lag symptomatology.24 In 2007, the longer-acting form of modafinil, armodafinil, was also approved for the treatment of excessive sleepiness associated with narcolepsy, OSA and SWSD,100,101 taken in a single dose (varying from 100 to 250 mg) in the morning.99,102 In narcoleptic patients previously treated unsatisfactorily with psychostimulants like d-amphetamine, methylphenidate, or pemoline, modafinil seems to be an effective and well-tolerated treatment for improving daytime wakefulness, regardless of which psychostimulant was taken formerly.103
Effectiveness of bright light exposure, modafinil and armodafinil for improving alertness during working time among nurses on the night shift: A systematic review
Published in International Journal of Healthcare Management, 2022
Chidiebere Emmanuel Okechukwu, Chidubem Ekpereamaka Okechukwu, Giuseppe La Torre
Night shift work upsets circadian sleep and alertness cycles, resulting in a lack of sleep during the day and increased drowsiness during the work shift. The misalignment of the needed sleep and wakefulness schedule with the endogenous circadian rhythm is the primary cause underlying shift work sleep disorder. As a result, circadian phase shifting is a reasonable management strategy. However, entraining a shift worker to a permanent night-work/day-sleep pattern, is often difficult because most workers want to engage in social and family activities on their days off. The combination of intermittent bright light exposure with the use of modafinil and armodafinil may be more effective in improving alertness during working hours and quality of life among nurses with shift work sleep disorder. Furthermore, hospital management and nurse managers can use e-learning and video platforms to train nurses on how to adapt to the night shift in this era of Omicron surge, and on how to become more aware of the potential negative physical and mental impacts of working night shifts, rotating shifts, and extended work hours, as well as how these consequences may affect their job performance [41]. Nurses can consider various ways to improve their sleep quantity and quality. They can be counseled on feeling more vigilant on the work and having fewer on-the-job accidents or injuries. The e-learning platforms can be used to teach strategies for preventing drowsy driving on the way to and from work, as well as how to improve one's well-being and health by engaging in regular physical activity, nutritional enhancements, and improving personal relationships and quality of life [42].