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Developing a light-based intervention to reduce fatigue and improve sleep in rapidly rotating shift workers

ABSTRACT Over a quarter of employees in North America and a fifth of those in the European Union do shift work. Working these schedules increases fatigue, sleepiness, and errors at work. In the long term, it may also increase the risk of cardiovascular disease, gastrointestinal problems, and cancer. Some of these consequences may be partly due to circadian misalignment, in which sleep and activity patterns no longer align with one’s circadian rhythms. Previous research has found that controlling light exposure can improve circadian alignment in individuals who work permanent night shifts. However, light-based interventions are rarely tested with rapidly rotating shift schedules, which include more than one type of shift within the same week (e.g., day shifts followed by night shifts). Further, many of the available interventions are seldom used in the workplace and may be less feasible in healthcare environments. In hospitals, the health and safety of both workers and patients can be compromised by increases in fatigue. We thus developed a practical intervention based on circadian and sleep hygiene principles to reduce some of the negative consequences associated with shift work. We then tested this intervention in a feasibility study of 33 nurses working rapidly rotating shifts. The study took place over two separate periods: the control (observation) period and the intervention period. Each period included two to four consecutive night shifts as well as the two days before and after those shifts. Nurses completed daily self-report questionnaires during both periods. During the intervention period, the nurses additionally followed a fatigue reduction plan. The plan involved 40 min of bright light exposure from a portable light box before night shifts, light avoidance using sunglasses after those shifts, and suggestions regarding the ideal times to sleep and nap. Results showed that nurses complied with the large majority of these recommendations. During the intervention period, nurses reported less fatigue, fewer work errors, better and longer sleep, and a more positive mood. Moreover, nurses with a preference for evenings (i.e., later chronotypes) reported the strongest benefits. Though more controlled studies are needed to assess causal mechanisms and long-term effectiveness, these promising results suggest that light-based interventions are feasible and may be effective at reducing fatigue in rapidly rotating shift workers.