Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL, USA.
Nat Sci Sleep. 2012 Sep 27;4:111-32. doi: 10.2147/NSS.S10372. Print 2012.
There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan.
有三种机制可能导致夜班工作相关的健康、表现和安全问题：（1）内部生物钟与工作、睡眠和进食等活动之间的昼夜节律失调，（2）慢性、部分睡眠剥夺，以及（3）夜间光线对褪黑素的抑制。典型的对策，如咖啡因、小睡和褪黑素（因其促进睡眠的作用），以及关于睡眠和昼夜节律的教育，是大多数疲劳风险管理计划的组成部分。我们认为，虽然这些措施比没有好，但还不够，因为它们没有解决问题的根本原因，即昼夜节律失调。我们解释了如何重置（相位调整）生物钟，使其与夜班、白天睡觉的时间表部分对齐，从而减少昼夜节律失调，同时在休息日保持睡眠和正常工作。这涉及到通过户外光照、太阳镜、在黑暗中睡觉以及在夜间工作时使用少量亮光来控制明暗。我们展示了一个睡眠和光照时间表的图表，以减少永久性夜班或夜班和白班之间轮换中的昼夜节律失调，并提供了关于如何实施这种计划的实用建议。
