Efficacy of bright light and sleep/darkness scheduling in alleviating circadian maladaptation to night work

We tested the hypothesis that circadian adaptation to night work is best achieved by combining bright light during the night shift and scheduled sleep in darkness. Fifty-four subjects participated in a shift work simulation of 4 day and 3 night shifts followed by a 38-h constant routine (CR). Subjects received 2,500 lux (Bright Light) or 150 lux (Room Light) during night shifts and were scheduled to sleep (at home in darkened bedrooms) from 0800 to 1600 (Fixed Sleep) or ad libitum (Free Sleep). Dim light melatonin onset (DLMO) was measured before and after the night shifts. Both Fixed Sleep and Bright Light conditions significantly phase delayed DLMO. Treatments combined additively, with light leading to larger phase shifts. Free Sleep subjects who spontaneously adopted consistent sleep schedules adapted better than those who did not. Neither properly timed bright light nor fixed sleep schedules were consistently sufficient to shift the melatonin rhythm completely into the sleep episode. Scheduling of sleep/darkness should play a major role in prescriptions for overcoming shift work-related phase misalignment.