Chronic circadian disturbance is thought to cause many of the health and social problems reported by shift workers. In recent years, appropriately timed exposure to bright light and exogenous melatonin have been used to accelerate adaptation to phase shifts of the circadian system. In this study we compared adaptation to night shift in three groups of subjects. The first treatment group received timed exposure to bright light (4-7,000 lux between 2400 and 0400 hours on each of three night shifts). The second treatment group received exogenous melatonin by capsule (2 mg at 0800 hours then 1 mg at 1100 and 1400 hours). The placebo control groups received either dim red light at less than 50 lux or placebo (sucrose) in identical capsules at the same time. Results indicated that all groups shifted significantly from baseline. Using the dim-light melatonin onset as a circadian marker, the bright-light group shifted the furthest, whereas there was no significant difference between the melatonin and placebo groups. Sleep quality as determined by wrist actigraphy was most improved in the light-treatment group, although the melatonin group also showed significant improvements. Cognitive psychomotor performance was most improved in the light-treatment group and the melatonin group again showed little difference from the control group. Although melatonin was unable to increase the amount of the phase shift following transition to night shift, it is likely that the intermediate levels of improvement in sleep reflect the hypothermic effects of melatonin. By lowering core temperature across the sleep period, sleep may be enhanced. This improvement in sleep quality did not produce concomitant improvements in shift performance for the melatonin group. This suggests that the enhanced performance in the light-treatment group may reflect more direct "energizing" effects. On the basis of these results, bright light is clearly superior in its ability ot phase shift the circadian system and thereby improve sleep and performance. However, melatonin may permit shift workers to override the circadian system for short periods and avoid the potential toxicity due to overzealous manipulations of the circadian pacemaker. In rapidly rotating shift schedules, melatonin may be preferable because it would not require workers to reverse the large phase shift induced by light.
