Effective Interventions for Reducing the Negative Effects of Night Shifts on Doctors’ and Nurses’ Health: A Systematic Review

R.E. Hengsterman
Oct 2
5 min read

Updated: 1 day ago

Source: Shakhloul, M., Amer, A., Zekry, M., Elgewely, M., Saleeb, A., Ghobrial, S., Shehata, M. Z. A., Abouelkhir, I., Kamal, M. O., Manqaryos, B., Abdulfattah, M., Syed, A., Shakhloul, D., & Kamel, M. (2025). Effective Interventions for Reducing the Negative Effects of Night Shifts on Doctors' and Nurses' Health and Well-Being: A Systematic Review. Cureus, 17(5), e83385. https://doi.org/10.7759/cureus.83385

Night shifts, a necessary component of healthcare work, often lead to sleep disruptions, fatigue, and long-term health risks for doctors and nurses. This systematic review explores various interventions, including light therapy, melatonin, naps, and pharmacological treatments, that can improve shift workers' sleep quality, alertness, and overall well-being. While some approaches show promise, a personalized, multimodal strategy is recommended for optimal outcomes.

Introduction: The Health Toll of Night Shifts on Healthcare Workers

Night shifts are an unavoidable aspect of healthcare, especially for doctors and nurses who are essential to patient care around the clock. However, working outside regular daylight hours disrupts the circadian rhythm, leading to a host of health issues like sleep disturbances, fatigue, and cognitive impairment. Over time, night shift work has been linked to increased risks of cardiovascular disease, type 2 diabetes, gastrointestinal issues, and even neurodegenerative diseases.

Given the vital role of healthcare professionals and the health risks of night shifts, it's critical to identify interventions that can improve their well-being and performance. This review examines a range of interventions tested to counteract the effects of night shift work on doctors’ and nurses’ health.

Key Findings: Most Effective Interventions for Night Shift Workers

This systematic review covered 74 studies exploring a variety of interventions designed to alleviate the negative impacts of night shifts. The results show that light therapy, melatonin, napping, and modafinil are among the most effective strategies. Here's a breakdown of the key interventions and their benefits.

1. Light Therapy: A Game-Changer for Circadian Alignment

Light therapy is one of the most well-studied interventions for night shift workers. A variety of studies highlighted the positive impact of bright light exposure, particularly blue-enriched light, on improving alertness and circadian alignment. Most studies reported that light exposure during the early part of the shift or just before driving home enhanced reaction times, alertness, and sleep quality.

Key Findings: 10 studies found light therapy helped reduce subjective sleepiness, while improving performance and circadian rhythms.
Challenges: There was some inconsistency in results, likely due to variations in light intensity, duration, and timing of exposure.

2. Melatonin: Restoring Daytime Sleep and Circadian Rhythm

Melatonin, a hormone that regulates the sleep-wake cycle, was another key intervention. The majority of studies on melatonin showed improvements in sleep quality and sleep efficiency for night shift workers, especially when melatonin was taken at the right time.

Key Findings: 9 studies reported significant benefits, including better daytime sleep and improved circadian alignment.
Challenges: Some studies showed no significant effects, likely due to inconsistent dosing, timing, and individual variations in response.

3. Naps: Boosting Alertness and Reducing Fatigue

Scheduled naps during or after night shifts were shown to significantly reduce sleepiness and improve cognitive performance. Short naps (20-30 minutes) were particularly effective in combatting sleep inertia and enhancing alertness during the shift.

Key Findings: Several studies supported the use of naps, especially longer naps (90 minutes) after a night shift for improved sleep quality.
Challenges: Nap opportunities can be limited, and the ideal nap duration and timing may vary based on individual chronotype.

4. Pharmacological Interventions: Modafinil and Caffeine

Medications like modafinil (a wakefulness-promoting drug) and caffeine are commonly used by healthcare professionals to stay alert during night shifts.

Modafinil has shown consistent improvements in alertness, reaction time, and cognitive function, especially during the night shift's peak fatigue hours.
Caffeine is widely used to boost vigilance and performance during night shifts, with significant improvements noted across multiple studies.
Key Findings: Both pharmacological agents effectively enhance alertness and cognitive performance.
Challenges: Long-term reliance on stimulants should be avoided due to potential side effects, such as sleep disruptions and dependency.

Other Promising Interventions for Night Shift Workers

5. Aromatherapy: A Relaxing and Non-Invasive Approach

While more research is needed, aromatherapy (using essential oils like lavender) has shown promise in reducing sleepiness and improving sleep quality for night-shift workers. Aromatherapy is a low-risk, non-pharmacological option that may complement other interventions.

6. Physical Exercise: Enhancing Physical and Mental Resilience

Physical activity, including restorative yoga, aerobic exercise, and high-intensity interval training (HIIT), has been studied for its benefits in reducing stress, fatigue, and improving cardiovascular health. However, the optimal type, timing, and duration of exercise for night shift workers remain unclear.

Key Findings: Mind-body exercises like yoga showed consistent benefits for stress reduction, while aerobic exercise improved cardiovascular health.
Challenges: The impact of physical exercise on sleep quality and cognitive performance needs further research, especially for varying shift types.

7. Acupuncture: Restoring Autonomic Balance

Acupuncture has been explored as a way to restore autonomic nervous system balance, which is often disrupted in night-shift workers. Though limited in scope, studies suggest acupuncture can reduce sympathetic activity and improve parasympathetic tone, helping shift workers recover from physiological stress.

A Personalized, Multimodal Approach: The Key to Effective Night Shift Recovery

The evidence suggests that a one-size-fits-all solution does not exist for mitigating the negative effects of night shifts. Instead, a personalized approach combining multiple strategies tailored to the individual’s circadian rhythm, chronotype, and work schedule is most effective.

Healthcare organizations should provide flexibility in scheduling, offer opportunities for napping, encourage light exposure, and incorporate healthy lifestyle practices like exercise and nutrition. Additionally, pharmacological interventions like melatonin or modafinil should be used cautiously and under professional guidance.

The Need for More Long-Term, Real-World Studies

Despite promising results, the majority of the studies reviewed were of short duration and focused on immediate or short-term effects. Future research should focus on long-term, real-world studies that examine the cumulative impact of these interventions over months or even years. This will help identify the most sustainable strategies for night shift workers and ensure their health and safety in the long run.

Conclusion: Supporting the Health and Well-Being of Night Shift Workers

Healthcare professionals working night shifts face significant health risks due to circadian disruption and sleep deprivation. However, interventions like light therapy, melatonin, napping, and pharmacological aids like modafinil have shown promise in improving alertness, sleep quality, and overall health.

A personalized, multimodal approach that combines behavioral and pharmacological strategies will likely be the most effective way to combat the negative effects of night shift work. With further research and the integration of technology to monitor and guide shift workers' health, we can significantly improve their well-being and job performance.