Behavioral therapy improves insomnia severity in patients with shift work disorder

1. In healthcare workers experiencing shift work disorder, behavioral therapy was effective in improving insomnia severity after 2 weeks.

2. Patients receiving behavioral therapy for treatment had greater improvements in daytime sleep than the control group.

Evidence Rating Level: 1 (Excellent)

A common consequence of shift work is insomnia and sleepiness which is known as shift work disorder (SWD). Most treatments for SWD are focused on pharmacotherapy such as hypnotics to extend daytime sleep and stimulants to alleviate sleepiness. However, cognitive behavioral therapy has recently been shown to improve sleep outcomes. This study evaluates the effectiveness of behavioral therapy for SWD (BT-SWD).

This randomized control trial tested the effectiveness of BT-SWD on insomnia severity in shift workers working in the province of Quebec’s health network. 43-night shifters workers experiencing SWD randomized to either behavioral therapy or wait-listing control group were included if they worked at least 5 nights out of 14 days between 24:00 hours and 08:00 hours (+/-1 hr) for at least 3 months and were diagnosed with SWD. Participants with symptoms of sleep disorder other than SWD, major depression with suicidal ideation, psychotic disorder or any disorder resulting from substance abuse, having consumed hypnotics more than 3 times per week in the last month, and consuming more than 10 cups of coffee (or other stimulants) per day were excluded. BT-SWD involves sleep restriction therapy, stimulus control, and fixed sleep periods in the dark. Therapy involved face-to-face sessions at a sleep laboratory including psychoeducation on sleep, circadian rhythms, and adaptation of sleep restriction and stimulus control for shift workers. Total sleep time, total wake time, and sleep onset latency were derived from participants through sleep diaries. Insomnia symptoms were evaluated with the Insomnia Severity Index (ISI). The primary outcome measured was insomnia severity for daytime and nighttime sleep.

BT-SWD participants had a significantly greater decrease in daytime insomnia severity and an increase in daytime total sleep time post-treatment than the control group. Those who received behavioral therapy also reported improved sleepiness, anxiety, and depression levels that were maintained at 5 months follow-up. However, this study had limitations such as a high attrition rate. Nonetheless, this study shows that BT-SWD can be used to improve the sleep and mental health of healthcare workers.

Click here to read this study in Journal of Sleep Research.

Image: PD

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