Many organizations rely upon shift workers to maintain round-the-clock services and operations, with shift workers estimated to comprise 20% of the global workforce (Torquati et al., 2019; Booker et al., 2022). While shift schedules may vary greatly, individuals engaged in shift work are often required to work irregular hours and nights, resulting in a changeable sleep-wake pattern at odds with their body-clocks (circadian rhythms) and the world around them (Rajaratnam et al., 2013; Walker et al., 2020). The resulting “circadian misalignment” can lead to excessive sleepiness and fatigue during the waking period, as well as sleep disturbances and insomnia during the sleeping period (Chatterjee and Ambekar, 2017; James et al., 2017; Walker et al., 2020). When accompanied by significant distress and impairment, and not attributable to other underlying causes, these symptoms may be indicative of Shift Work Disorder (SWD), which is estimated to impact 26.5% of shift workers (Pallesen et al., 2021).

In addition to having a negative impact on sleep, circadian misalignment can also have detrimental consequences for physical health and psychological functioning, and has been associated with increased risk of cancer, cardiovascular diseases, and mood disorders (James et al., 2017; Torquati et al., 2019; Sletten et al., 2020; Walker et al., 2020). The effects of circadian misalignment can also be problematic for the workplace, leading to reduced levels of alertness and productivity, higher rates of sickness absence and staff turnover, and increased risk of accident and injury (Wong et al., 2011; Hui and Grandner, 2015; Ryu et al., 2017). Thus, as well as having a significant impact on the individual, the health and safety consequences associated with shift work also present a substantial socioeconomic burden (Culpepper, 2010).

When it comes to tackling insomnia in the general population, Cognitive Behavioral Therapy (CBT-i) is recommended as the first line of treatment (Edinger et al., 2021); however, elements of CBT-i – such as maintaining a consistent sleep schedule and sleep restriction – may not be possible for shift workers who work irregular hours and already experience sleep loss (Reynolds et al., 2022). Night workers who need to sleep during the day may also have difficulty accessing in-person therapies delivered during standard clinical hours. As a result, alternative strategies, such as adjusting shift schedules, controlled light exposure, and sleep hygiene education have been employed to help manage sleep problems in this population (Bragge et al., 2023).

Here, it should be noted that attempts to modify CBT-i for shift workers have been made more recently (Järnefelt et al., 2020), with digital platforms also providing 24/7 access options (Wickwire, 2019). Nevertheless, interventions that consider both the individual and the workplace may be more appropriate for this population, given that cognitive-behavioral factors and the organizational environment are likely to contribute to sleep problems in tandem (Papantoniou et al., 2017; Wong et al., 2019). Indeed, as well as focusing on individual-level factors, CBT-i targets those who are already engaged in shift work and/or already suffer from sleep problems as a result, highlighting the need to provide employees with the skills and knowledge to manage sleep from the outset of employment as part of a preventative approach (Wong et al., 2019).

Despite the existence of multiple strategies, however, efforts to combine and administer them as part of a preventative, multicomponent programme remain scarce, and research evidence for the effectiveness of organizational-level interventions is lacking (Redeker et al., 2019; Bragge et al., 2023). Given the widespread impacts of shift work and the associated costs to the individual, the workplace, and society, a preventative, multicomponent approach may therefore hold promise for improving the health and wellbeing of this population (Papantoniou et al., 2017; Wong et al., 2019).

Accordingly, this mini review aims to provide a concise overview of non-pharmacological interventions for shift workers to inform the development of a preventative, multicomponent sleep management programme in line with Phase 1 of the Framework for the Development and Evaluation of Complex Interventions (Skivington et al., 2021). To direct the review phase, co-authors with expertise in the areas of shift work and sleep pooled insights and relevant articles. Systematic reviews of the literature were explored to identify interventions; discussion papers, narrative reviews, and guidelines were consulted to determine current practice recommendations; and original intervention studies were examined for methodological details.

Systematic reviews have explored interventions for shift workers (e.g., Neil-Sztramko et al., 2014; Richter et al., 2016; Robbins et al., 2021; Bragge et al., 2023). The most-to-least frequently implemented strategies include: (1) Adjusting shift schedules; (2) Controlled light exposure; (3) Sleep hygiene education; (4) Planned napping; (5) Caffeine consumption;¹ (6) CBT-i; and (7) Mind-body interventions (see Figure 1). A summary of the literature is provided in Supplementary Table 1.

This mini review highlights various strategies that have been employed to help manage the impacts of shift work on sleep; however, research evidence for the effectiveness of preventative, multicomponent programmes is currently lacking (Redeker et al., 2019; Bragge et al., 2023). A summary of the evidence pertaining to each intervention category is presented below; future directions and limitations are also considered.

Adjustments to shift schedules and changes to workplace lighting have been shown to mitigate the effects of shift work-related circadian misalignment; however, balancing the needs of employees against what is feasible for the organization may be complex (Wong et al., 2019). For instance, while reducing shift duration and enhancing workplace lighting might benefit employees, such organizational-level changes have substantial costs for employers (e.g., recruiting additional staff to make-up for lost hours). Thus, as well as emphasizing organizational benefits, government regulation of research-backed recommendations may be required to encourage implementation.

Given the health and safety consequences of shift work-related circadian misalignment, intervention programmes should aim to educate employers and equip employees with the skills needed to manage sleep from the outset of employment. Collective ownership of employee sleep could be achieved by delivering tailored forms of SHE as part of staff inductions and training. As employers are legally required to protect staff from health and safety risks, night workers could also be provided with personal protective equipment to facilitate daytime sleeping (e.g., eye-masks and earplugs).

In addition to the above, employers could consider facilitating nap opportunities and providing access to caffeine on nights shifts to help manage alertness. Advice on timing and dosage could also be incorporated into SHE, although negative attitudes toward “sleeping on the job” may present a barrier to the implementation of napping. While educating employers and being selective with terminology – i.e., “controlled rest” vs. “naps” – could help to overcome such challenges, providing suitable rest conditions may still pose difficulties for sectors with noisy and/or outdoor working environments. Indeed, it should be noted that the implementation of any intervention component must be tailored to job role, setting and circumstances.

As shift work increases the risk of clinical sleep problems, organizations should be prepared to support employees with the relevant resources. Digital CBT-i platforms could offer an inexpensive and scalable option for employers, while providing an external access option for employees who may have anxieties about revealing sleep problems in the workplace. Despite this, further research is needed to identify modifications that could improve the acceptability and effectiveness of digital CBT-i for shift workers (Reynolds et al., 2022). Similarly, the effectiveness of mind-body interventions remains unclear, despite benefits being found in other working populations (Pérez-Fuentes et al., 2020). While these approaches may help to address sleep problems associated with shift work-related circadian misalignment, it is also important to acknowledge their limited application to sleep disorders with other causal underpinnings (i.e., obstructive sleep apnea), which should be addressed via additional and/or alternative treatments (i.e., continuous positive airway pressure).

Lastly, it should be noted that personal demands also constrain sleep time and increase sleepiness (Knauth and Hornberger, 2003; Gurubhagavatula et al., 2021). Despite this, factors such as family life, the commute, and eating behaviors appear to have been overlooked in current intervention efforts. In light of this, working with shift workers and employers to co-develop preventative, multicomponent approaches represents an essential step for future research, and may help to identify further intervention opportunities (Wong et al., 2019; Reynolds et al., 2022).

AT: Conceptualization, Investigation, Project administration, Visualization, Writing—original draft, Writing—review & editing. NT: Conceptualization, Funding acquisition, Writing—review & editing. TS: Conceptualization, Funding acquisition, Writing—review & editing. CT: Conceptualization, Funding acquisition, Writing—review & editing. CK: Conceptualization, Funding acquisition, Writing—review & editing. CM: Conceptualization, Funding acquisition, Writing—review & editing. SR: Conceptualization, Funding acquisition, Writing—review & editing. TM: Conceptualization, Funding acquisition, Supervision, Writing—original draft, Writing—review & editing.