Intended for healthcare professionals

Practice Essentials

Optimising sleep for night shifts

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5637 (Published 01 March 2018) Cite this as: BMJ 2018;360:j5637
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A suggested sleep strategy covering before, during, and after night shifts

Re: Optimising sleep for night shifts

Thank you for your much needed work on optimising sleep for night shifts. The article highlights some important areas which need more research and investigation in order to address some very critical issues around doctor - and by extension - patient safety. Regarding the evidence, you state that 'Two recent Cochrane reviews of strategies for shift workers highlighted a paucity of adequately powered, well designed, randomised control trials, and yielded mostly low quality evidence'. While randomised control trials are seen as the gold standard in drug trials, we need to move away from holding them as the gold standard for each and every field of study. It is unnecessary and near impossible to have randomised control trial evidence to support strategies for optimising sleep during night work - this topic simply does not lend itself to a randomised control trial design. Instead, we need to come up with other ways to build an evidence base and your article is an excellent starting point. If more people invest their time and effort into researching safe working during night shifts I am sure we will come up with ways to design meaningful studies that will lead to safer working at night.

Competing interests: No competing interests

30 May 2018
Hasan Shamsi
F2 Doctor
East Midlands, UK