Shift work sleep disorder - The SHIFT-SLEEP programme of work

Thavapriya Sugavanam, Simon D. Kyle, Andrew Farmer, Ly-Mee Yu, Stavros Petrou, Ruth Travis, Peter Bower, David French, Ira Madan, Leah Holmes, Nicola Park, Forrest Tin Wai Cheung, Rachel Sharman, Rhiannon Hawkes, Vaughan Parsons, Annie Keane, Xiaoxiao Ling, Dimitri Gavriloff, Colin A. Espie, Amy C. Reynolds, Jack S. Benton, Xianqi Li, Charlotte Lee, Anne Stagg, David Ray

Abstract

Introduction: Prolonged sleep-wake difficulties due to shift work, lasting for more than three months, may meet criteria for shift work sleep disorder (SWD) and require intervention, especially if they engender significant functional impairment. SWD is common but there is unmet medical need, with a lack of proven interventions or guidelines.

Our aim is to develop and test a usable, acceptable, and cost-effective intervention to reduce the impact of SWD in shift workers in the UK National Health Service (NHS) through five work packages (WP) and an integrated research advisory group (RAG) of shift workers.

Materials and methods:

WP1: A systematic review of qualitative studies on shift workers’ experiences of sleep disturbance and its impacts and an overview of reviews on individually-directed non-pharmacological interventions to improve sleep or reduce sleepiness in shift workers.

WP2: A survey with NHS staff to determine prevalence and burden of SWD and a survey with NHS managers to understand current knowledge, training and implementation obstacles.

WP3: Examining existing large datasets (e.g. UK Biobank) to identify risk factors for sleep problems in UK shift workers and to characterise its burden.

WP4: Development of a complex intervention for SWD through a triangulation of evidence from the above WPs.

WP5: Testing the above intervention in a large-scale randomised controlled trial (RCT).

Results:

RAG: Ten shift workers contributed to the development of all WPs through online meetings, offline tasks and by sharing their shift working experiences.

WP1: 28 studies (1519 participants) were included in the qualitative review. Three analytical themes were generated: inevitability of fatigue and tiredness, balancing sleep needs with competing responsibilities, obstacles to engaging in healthy behaviours. 28 systematic reviews (69 RCTs, 4,947 participants) were included in the review of reviews. High-quality reviews suggested inconclusive evidence; lower quality reviews indicated light therapy, napping, physical activity, dietary supplements, mobile health apps and mindfulness may be effective in improving sleep quality and subjective sleepiness.

WP2: Of the 443 NHS staff who completed the survey, 71% (n=315) met the probable SWD criteria. Twenty-one managers participated in the survey of managerial experience. The majority (n=15, 71%) reported lack of training/information on impact of shift work.

WP3: Of the 285,175 participants in the UK Biobank who were employed, 48,975 (17.2%) were shift workers. Shift work was associated with higher odds of sleep disorders compared to non-shift work, with greatest odds observed among those always working night shifts (OR:1.21, 95%CI:1.16-1.27). The association was significantly modified by age (p<0.0001), ethnicity (p=0.0005) and smoking status (p=0.04).

WP4: A multi-component complex behavioural intervention for SWD has been developed (Oxford Behavioural Intervention for Shiftwork (OxBIS)) and is being tested in a feasibility study with 30 shift workers with SWD.

WP5: The intervention and study procedures will be refined based on the feasibility study findings. A RCT with 600 participants is planned to test the cost-effectiveness of the intervention in 2026.

Conclusions: Through a systematic, interdisciplinary programme of research, we aim to address the problem of SWD in NHS shift workers.

Acknowledgments: This project is funded by the NIHR Programme Grants for Applied Research programme (NIHR203667).

Recommended citation: Sugavanam, T., Kyle, S. D., Farmer, A., Yu, L.-M., Petrou, S., Travis, R., Bower, P., French, D., Madan, I., Holmes, L., Park, N., Cheung, F. T. W., Sharman, R., Hawkes, R., Parsons, V., Keane, A., Ling, X., Gavriloff, D., Espie, C. A., Reynolds, A., Benton, J., Li, X., Lee, C., Stagg, A., & Ray, D. (2026). Shift work sleep disorder - The SHIFT-SLEEP programme of work. Sleep Medicine, 138, 107152. https://doi.org/10.1016/j.sleep.2025.107152