Drugs, driving and traffic safety in shift workers

Abstract

Shift work and other irregular working schedules are common in modern society, but may also lead to disruptions in the regulation of sleep and wakefulness. Intolerance to shift work may lead to Shift Work Sleep Disorder (SWSD), primarily characterized by insomnia and excessive sleepiness. The effects of shift work on driving ability and traffic safety have been demonstrated in a number of epidemiological and driving simulator studies. The main consequences of shift work are fewer hours of sleep, higher levels of sleepiness, and falling asleep while driving. Consequently, increased traffic accident risk has been reported relative to daytime workers (odds ratio 1.14 to 2.3). Different strategies are available to combat driver fatigue and accidents in shift workers. Alertness can be improved by prophylactic napping or by using stimulant drugs such as modafinil, a compound specifically targeting SWSD. Another way to combat the negative effects of shift work is manipulating the circadian system by administering melatonin and bright light. Future research should identify the factors leading to SWSD and impaired driving, so that optimal strategies can be developed.