New guideline provides recommendations on managing shift work disorder
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A new clinical practice guideline from the American Academy of Sleep Medicine establishes evidence‑based recommendations for the management of shift work disorder in adults.
The guideline is published in the Journal of Clinical Sleep Medicine and is accompanied by a systematic review and meta‑analysis examining behavioral, pharmacologic and circadian‑based interventions for shift work disorder, with outcomes relevant to both patients and clinicians.
Previous AASM practice parameters addressed circadian rhythm sleep‑wake disorders broadly and provided recommendations for commonly used interventions. The new guideline builds on this earlier work by applying a systematic, evidence‑graded approach to evaluate the benefits and potential harms of treatments specifically for shift work disorder.
"There is no one‑size‑fits‑all solution for shift work disorder," said lead co-author Kenneth P. Wright Jr., who has a doctorate in behavioral neuroscience and psychology and is a professor of distinction in integrative physiology and director of the Sleep and Chronobiology Laboratory at the University of Colorado Boulder.
"Our recommendations reflect the reality that patients have different schedules, symptoms and constraints, and clinicians need flexible, evidence‑based strategies to help them function safely and sleep effectively."
Shift work disorder affects approximately 27% of adult shift workers and occurs when required work schedules overlap with an individual's usual sleep timing for at least three months. The disorder is characterized by excessive sleepiness, sleep disturbance/insomnia, or both, resulting from circadian misalignment and insufficient sleep. Shift work disorder is commonly encountered in both primary care and sleep medicine settings.
The guideline emphasizes individualized treatment based on symptom profile, work schedule and patient preferences. Key recommendations include:
- For excessive sleepiness: The guideline suggests the use of armodafinil or modafinil for adults with shift work disorder to improve alertness during night shifts, based on moderate certainty of evidence. It also suggests the consideration of caffeine, bright light plus caffeine, and strategic naps and caffeine, as well as select circadian‑based interventions such as scheduled bright light exposure or meal timing, recognizing that the certainty of evidence for these approaches is low, and benefits may vary across individuals.
- For insomnia symptoms: For patients with difficulty initiating or maintaining sleep, the guideline suggests the use of cognitive behavioral therapy for insomnia, melatonin or melatonin receptor agonists, and certain hypnotic agents to support sleep in relation to work schedules. The AASM suggests against the use of some hypnotic agents with unfavorable risk–benefit profiles, including some benzodiazepines.
- For circadian adaptation: To address circadian misalignment, the guideline suggests interventions such as timed bright light exposure, consistent sleep scheduling when feasible, and use of light‑filtering strategies during the commute home, with the goal of better aligning the endogenous circadian system with required work hours.
The guideline also highlights the limited quality of evidence for many interventions and underscores the need for shared decision‑making and further research.
To develop this guideline, the AASM commissioned a task force of experts in sleep and circadian medicine to systematically review the published literature and develop updated recommendations for the management of shift work disorder, taking into consideration the certainty of evidence, beneficial and harmful effects, patient values and preferences, and resource use.
The draft guideline was posted for public comment, and the AASM board of directors approved the final recommendations.
This guideline was endorsed by the Australasian Sleep Association, Society of Behavioral Sleep Medicine, the Nurse Practitioner Association of Canada, Sleep Charity, Project Sleep and the Sleep Health Foundation.
Publication details
Kenneth P. Wright et al., Management of shift work disorder: an American Academy of Sleep Medicine clinical practice guideline, Journal of Clinical Sleep Medicine (2026). DOI: 10.1007/s44470-026-00084-w
Kenneth P. Wright et al., Management of shift work disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment, Journal of Clinical Sleep Medicine (2026). DOI: 10.1007/s44470-026-00076-w
Journal information: Journal of Clinical Sleep Medicine
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