AASM updates shift work guidance: What to prescribe—and avoid

Clinical takeaway: Match treatment to the patient’s symptoms and work schedule: Consider modafinil or armodafinil for excessive sleepiness and cognitive behavioral therapy for insomnia (CBT-I), melatonin, or selected sleep medications for daytime insomnia. Counsel patients about residual sedation and driving safety, and avoid choosing benzodiazepines for shift work–related insomnia.

The American Academy of Sleep Medicine’s guideline updates its 2007 guidance with 19 conditional recommendations. Most interventions have low- or very-low-certainty evidence, making shared decision-making central to treatment.

For excessive sleepiness, AASM suggests armodafinil or modafinil 30–60 minutes before the night shift; these have moderate-certainty evidence, the highest among the recommended interventions. Caffeine before or during the shift, bright light during work, and a preshift nap are additional options, including caffeine combined with light or a nap.

Keep caffeine away from planned bedtime, and allow postnap grogginess to resolve before driving or safety-sensitive work. Eating a snack or avoiding food during the night shift is suggested over eating a full meal, with individual consideration when fasting could be unsafe.

For daytime insomnia, options include CBT-I, melatonin, ramelteon or other melatonin receptor agonists, and suvorexant or other dual orexin receptor antagonists. Evidence supporting the latter two drug classes is low certainty and comes from one randomized trial each of ramelteon and suvorexant.

Melatonin is also suggested when transitioning back to nighttime sleep or facilitating a nap before the first night shift. Allow adequate sleep time after sleep-promoting medications and counsel about lingering impairment.

AASM suggests against triazolam and other benzodiazepines because potential harms, including falls, misuse, dependence, and withdrawal, outweigh benefits.

For patients seeking circadian adaptation, options include night-shift bright light, alone or with fixed daytime sleep timing and morning light-filtering glasses. Adaptation is generally unrealistic for rotating or frequently changing shifts; glasses also require attention to driving safety.

“There is no one-size-fits-all solution for shift work disorder,” lead co-author Kenneth P. Wright Jr., PhD, said in an AASM press release.

What’s changed

• A dedicated, GRADE-based update organizes treatment around sleepiness, insomnia, and circadian adaptation; all recommendations are conditional.
• Earlier guidance permitted hypnotics for daytime sleep; the update specifically suggests against triazolam and other benzodiazepines.
• New recommendations address CBT-I, ramelteon and related agents, and suvorexant and related agents.
• Guidance now explicitly addresses overnight meals, clockwise shift rotation, and combined interventions; evidence does not favor 8-hour over 12-hour night shifts.

Source: Wright KP Jr, et al. (2026 Oct 24) J Clin Sleep Med. Management of shift work disorder: an American Academy of Sleep Medicine clinical practice guideline