Lifestyle Medicine and Shift Work in Viet Nam: Circadian Health, Fatigue-Related Safety, and Workplace Responsibility

Lifestyle Medicine and Shift Work in Viet Nam: Circadian Health, Fatigue-Related Safety, and Workplace Responsibility

Primary category: Lifestyle Medicine in Viet Nam
Secondary category: Evidence & Clinical Practice
Article type: VLMA Perspective
Last reviewed: October 30, 2026

A nurse finishes an overnight shift after several hours of demanding clinical work. By the time the shift ends, the nurse may be exhausted but still needs to travel home and find an opportunity to sleep. Daylight, household noise, or family responsibilities may interrupt that rest. The next shift may begin before the nurse feels adequately recovered.

A factory worker on a rotating schedule faces a different challenge. Just as the body begins adjusting to nighttime work, the schedule changes again. Sleep becomes difficult to organize, meal times vary, and fatigue may accumulate over successive shifts.

Both workers may be advised to sleep regularly, exercise, eat well, and manage stress. These recommendations are reasonable, but they do not fully address the problem. Their working hours may repeatedly conflict with the body's biological rhythms, while the time and conditions needed for recovery are not always within their control.

This raises an important question for Lifestyle Medicine: how useful is advice about healthy behavior when working conditions make that behavior difficult to maintain?

Shift work also has implications beyond individual health. Fatigue can affect attention, reaction time, judgment, and the safe performance of tasks, particularly in healthcare, transportation, manufacturing, and other safety-sensitive settings. The consequences may involve workers, patients, colleagues, and members of the public.

Supporting shift workers therefore requires more than promoting healthy habits. It involves understanding circadian biology, recognizing when clinical assessment is needed, and examining how work schedules and organizational arrangements influence health and safety.

For the Vietnam Lifestyle Medicine Alliance (VLMA), this provides an opportunity to explore how evidence-based Lifestyle Medicine can contribute to occupational health while recognizing the responsibilities of healthcare professionals, workers, employers, and other relevant organizations.

Why Biological Rhythms Matter in Shift Work

Human physiology follows biological rhythms that influence sleep, alertness, body temperature, hormone secretion, metabolism, and other functions. The circadian system coordinates many of these processes across approximately 24 hours, with light and darkness providing important signals that help synchronize the internal biological clock with the external environment.

Sleep is also influenced by how long a person has been awake. As wakefulness continues, the pressure to sleep generally increases. Together, circadian timing and sleep pressure help explain why most people become sleepy at night and more alert during the day.

Night work can place these processes in conflict. A worker may need to remain attentive when the circadian system promotes sleep, then attempt to sleep during daylight hours when the body is more inclined toward wakefulness. Daytime sleep may consequently be shorter, more fragmented, or less restorative.

Some workers on permanent night schedules achieve a degree of circadian adaptation, but this varies considerably. Daylight exposure, social activities, family obligations, and changes in sleep timing on days off can make sustained adaptation difficult. Rotating schedules create additional challenges because workers may begin adjusting to one pattern only to be required to follow another.

Individual responses also differ. Circadian preference, age, existing health conditions, family responsibilities, and working arrangements may influence how someone tolerates nonstandard hours. Some workers experience relatively few difficulties, while others develop persistent sleep disturbance or excessive sleepiness.

The difficulty is not necessarily a lack of motivation or discipline. Biological rhythms cannot always be reorganized simply because employment requires a different timetable.

Lifestyle-related advice should acknowledge this limitation. Recommendations that work well for someone with regular daytime hours may be impractical or insufficient for someone who regularly works overnight.

Working Shifts Does Not Necessarily Mean Having a Sleep Disorder

An important clinical distinction is the difference between working nonstandard hours and having shift work disorder.

Shift work may involve fixed overnight duties, early morning work, rotating schedules, or irregular working hours that overlap with usual sleeping periods. Such arrangements can create difficulties without necessarily resulting in a recognized medical disorder.

Shift work disorder is a circadian rhythm sleep-wake disorder associated with work schedules that repeatedly conflict with a person's usual sleep period. It generally involves insomnia, excessive sleepiness, or both, with symptoms linked to the work schedule and associated with impaired functioning.

The diagnostic framework considers symptoms occurring in relation to such schedules for at least three months. Clinical assessment should examine the timing and persistence of symptoms, opportunities for sleep, working hours, and effects on everyday functioning. Sleep diaries and other appropriate assessments may help clarify the relationship between work and sleep.

Not everyone who works at night develops shift work disorder. Similarly, feeling exhausted after an unusually demanding shift does not automatically establish the diagnosis.

Other conditions may coexist with shift work or produce similar symptoms. Obstructive sleep apnea, chronic insomnia, insufficient sleep, restless legs syndrome, medication effects, and mental health conditions should be considered when clinically relevant.

A worker experiencing temporary fatigue after several demanding shifts may primarily need adequate recovery. Another who experiences persistent excessive sleepiness despite reasonable sleep opportunities may require more detailed clinical evaluation.

This distinction matters because treatment recommendations developed for adults with diagnosed shift work disorder should not automatically be applied to everyone working outside conventional daytime hours.

What the October 2026 Sleep Medicine Guideline Tells Us

On October 24, 2026, the American Academy of Sleep Medicine published an updated clinical practice guideline for managing shift work disorder, accompanied by a systematic review and meta-analysis.

The guideline evaluates interventions intended to address excessive sleepiness, sleep disturbance or insomnia, and circadian adaptation in adults with shift work disorder. Its recommendations were developed using the Grading of Recommendations Assessment, Development and Evaluation approach, which considers the certainty of evidence alongside benefits, harms, patient preferences, and other relevant factors.

The guideline contains 19 conditional recommendations. These include recommendations supporting selected interventions, a recommendation against benzodiazepines for the specified sleep disturbance or insomnia symptoms, and a recommendation that does not favor either eight-hour or twelve-hour night shifts for the outcomes evaluated.

The certainty of supporting evidence varies considerably. Many interventions are supported by low- or very-low-certainty evidence, while the recommendation concerning modafinil and armodafinil for excessive sleepiness is supported by moderate-certainty evidence.

Much of the underlying research involved simulated night shifts among healthy volunteers or studies of shift workers without a formal diagnosis of shift work disorder. Relatively few trials directly examined patients with the disorder. This limits how confidently some findings can be generalized to clinical practice or different occupational settings.

For excessive sleepiness, the guideline conditionally supports selected approaches involving bright light during night shifts, caffeine, planned naps before night shifts, and certain combinations of these measures. It also conditionally suggests modafinil or armodafinil for appropriately selected adults with shift work disorder and excessive sleepiness.

For sleep disturbance or insomnia, the guideline includes conditional recommendations concerning cognitive behavioral therapy for insomnia, melatonin, selected melatonin receptor agonists, and dual orexin receptor antagonists. These treatments differ in their intended effects, clinical indications, and potential risks.

Timing is particularly important. An intervention intended to increase alertness during a shift may interfere with subsequent sleep if used at an inappropriate time. Similarly, a treatment that promotes sleep may create safety concerns if its effects persist when someone needs to drive or perform demanding work.

The guideline also examines scheduling arrangements. For adults with shift work disorder and excessive sleepiness, it conditionally favors clockwise, or forward, shift rotation over counterclockwise rotation. However, the recommendation is based on very-low-certainty evidence.

The evidence was insufficient to favor eight-hour night shifts over twelve-hour shifts, or the reverse, for the outcomes evaluated. This does not establish that both schedules are equally safe in all circumstances. The guideline did not assess every relevant factor, including all rotation patterns, cumulative working hours, staffing conditions, consecutive shifts, and the full range of occupational safety outcomes.

The guideline also identifies interventions for which no recommendation could be made because the evidence was insufficient or inconclusive. These include planned naps during shifts, split sleep arrangements, and certain standalone light-filtering strategies. Some light-reduction measures were nevertheless included in conditionally suggested multi-component approaches intended to support circadian adaptation.

A lack of recommendation should not automatically be interpreted as evidence that an intervention is ineffective. It may indicate that research has not yet provided a sufficiently reliable basis for recommending its routine use.

For healthcare professionals, the guideline offers an updated framework for considering clinical interventions. It does not establish a universal scheduling standard or a comprehensive occupational fatigue-management program for every workplace.

Protecting Sleep When Working Hours Are Unconventional

Adequate sleep remains essential for people working nonstandard hours. However, protecting sleep is not simply a matter of choosing the same bedtime every day.

Someone finishing an overnight shift may need to commute, attend to family responsibilities, or sleep in an environment with daylight, noise, heat, and frequent interruptions. A worker on rotating shifts may have little opportunity to maintain consistent sleep timing across different workdays.

Practical support should begin with understanding these circumstances. A quieter, darker, and more comfortable sleeping environment may help some workers. Others may benefit from arranging protected sleep opportunities around their schedules or reducing avoidable interruptions where possible.

For workers with relatively stable schedules, greater consistency in sleep and wake times may be achievable. For those whose shifts change frequently, complete consistency may be unrealistic.

The American Academy of Sleep Medicine's 2026 guideline recognizes that full circadian adaptation is not a realistic treatment goal for many people working rotating or frequently changing shifts. Strategies designed for permanent night work should therefore not automatically be applied to workers whose duties alternate between day and night.

Light exposure illustrates why timing matters. Appropriately timed bright light during a night shift may improve alertness or support circadian adaptation in selected circumstances, but these are different treatment objectives. The guideline's recommendations concerning bright light are conditional and supported by very-low-certainty evidence.

Some individuals may experience headache, eye discomfort, or other adverse effects, while certain medical conditions require additional caution. Similarly, reducing light exposure after night work may be considered within particular circadian strategies, but this should not compromise safety during commuting.

For example, eyewear designed to reduce light transmission may be relevant to certain circadian interventions, but it should not impair visibility when someone is driving or traveling in conditions requiring clear vision.

The objective is to protect realistic opportunities for sleep rather than impose a routine that the person cannot follow.

Persistent sleep difficulties or significant impairment should prompt appropriate clinical assessment instead of repeated general advice about sleep hygiene.

Caffeine, Planned Naps, and the Limits of Short-Term Alertness

Caffeine can temporarily improve alertness and cognitive performance, but its effects depend on dose, timing, individual sensitivity, and other circumstances.

The 2026 guideline conditionally supports caffeine for excessive sleepiness in adults with shift work disorder. However, caffeine consumed too close to an intended sleep period may interfere with sleep onset and reduce subsequent sleep quality.

A worker who repeatedly uses caffeine to remain alert may therefore experience temporary improvement during the shift while making recovery sleep more difficult. Caffeine does not replace adequate sleep, and its use should not be regarded as a solution to persistently insufficient recovery time.

Planned naps may also help in selected circumstances. The guideline conditionally suggests taking a nap before a night shift for adults with shift work disorder and excessive sleepiness, although the supporting evidence is of very low certainty.

One important consideration is sleep inertia. Immediately after waking, a person may experience temporary grogginess, slower reactions, or reduced cognitive performance. This can be particularly important when the person must drive, operate machinery, administer medication, or perform another safety-sensitive task.

Allowing sufficient time for alertness to recover after a nap may therefore be necessary before returning to demanding activities.

The guideline did not establish a recommendation for planned naps during shifts because the available evidence was insufficient or inconclusive. This does not mean rest opportunities are unimportant. It means the evidence reviewed was not sufficient to establish the effectiveness of particular nap arrangements as a clinical intervention for shift work disorder.

Neither caffeine nor planned naps should be presented as eliminating fatigue-related risk. An intervention that improves alertness over a short period does not necessarily prevent workplace accidents, improve long-term health, or compensate for every demanding schedule.

Healthcare professionals should therefore distinguish evidence about short-term sleepiness and cognitive performance from evidence about occupational safety and longer-term health outcomes.

Medication Requires Appropriate Clinical Assessment

Workers experiencing persistent sleepiness or difficulty sleeping after shifts may seek medication to remain awake or obtain better sleep. Such decisions require professional assessment rather than self-treatment.

The American Academy of Sleep Medicine's 2026 guideline conditionally suggests modafinil or armodafinil for adults with shift work disorder and excessive sleepiness. The recommendation is supported by moderate-certainty evidence, but this does not mean these medicines are suitable for everyone who works at night.

They have potential adverse effects, contraindications, interactions, and prescribing requirements. Their approved indications and availability also depend on the regulatory framework of the country in which they are used.

The guideline includes conditional recommendations for melatonin in selected circumstances, including daytime sleep after night work and transitions between sleep schedules. It also conditionally suggests certain melatonin receptor agonists and dual orexin receptor antagonists for specified sleep disturbance or insomnia presentations.

These treatments require attention to timing, residual sleepiness, other medications, and individual clinical circumstances. A medicine that helps someone sleep may create additional risks if its effects persist when the person needs to drive or undertake safety-sensitive duties.

The guideline conditionally suggests against triazolam and other benzodiazepines for daytime sleep disturbance or insomnia associated with shift work disorder. The potential harms, including dependence, withdrawal, falls, and impairment, were considered in relation to the limited evidence of benefit.

Cognitive behavioral therapy for insomnia, appropriately adapted to the person's work schedule, is another treatment option. It may help address persistent insomnia, although access to qualified practitioners and the practical challenges of treatment around irregular working hours should be considered.

For healthcare professionals in Viet Nam, international recommendations must be interpreted alongside applicable Vietnamese clinical requirements, the regulatory status and authorized indications of medicines, and the professional scope of the treating practitioner.

Medication should not become the only response to a work schedule that repeatedly restricts opportunities for adequate sleep. Clinical treatment and organizational risk management address different aspects of the problem, and both may be necessary.

Nutrition and Physical Activity Need to Reflect Working Conditions

Working at night can change when and how people eat. A worker may have a substantial meal before beginning a shift, rely on snacks during the night, or return home hungry in the morning. Suitable food may also be less readily available outside conventional daytime hours.

Meal timing interacts with circadian physiology and metabolic regulation. However, the evidence should not be simplified into a rule that all night workers must avoid eating.

The 2026 American Academy of Sleep Medicine guideline conditionally suggests avoiding a full meal during a night shift or choosing a snack instead for adults with shift work disorder and excessive sleepiness. This recommendation is supported by low-certainty evidence and concerns a particular clinical population and outcome.

It does not establish that prolonged nighttime fasting improves long-term metabolic health or is appropriate for every worker.

Someone with diabetes who uses insulin or other glucose-lowering medication may have particular nutritional requirements. Pregnancy, physically demanding work, certain medical conditions, and other circumstances may also affect the safety of dietary recommendations.

Nutrition counseling should therefore consider working hours, metabolic health, medication, food availability, and the nature of the work. Maintaining nutritional adequacy remains important, and workplaces operating continuously may need to consider whether staff have reasonable access to suitable food and drinking water.

Physical activity presents similar challenges. Regular movement has established cardiovascular, metabolic, musculoskeletal, and mental health benefits, but recommending exercise immediately after a demanding night shift may be unrealistic when the worker needs an adequate opportunity to sleep.

Exercise should not routinely take priority over essential recovery. Its timing, intensity, and type should reflect the person's health, schedule, preferences, and available time.

For some workers, shorter periods of activity during suitable breaks or on nonworking days may be more achievable than a rigid exercise routine.

The aim is not to lower the importance of healthy behaviors. It is to make recommendations appropriate to the circumstances in which people are expected to follow them.

Fatigue-Related Safety Extends Beyond the Individual Worker

Fatigue can affect a person's ability to perform tasks requiring sustained attention, coordination, and judgment.

The United States National Institute for Occupational Safety and Health, in material updated on July 14, 2026, identifies slower reaction times, reduced concentration, impaired short-term memory, and poorer judgment among the potential consequences of work-related fatigue.

These effects are relevant across different industries. In healthcare, fatigue may influence clinical communication, decision-making, and complex tasks. In transportation, it may affect driving performance. In manufacturing and other industrial settings, it may influence the safe operation of equipment and machinery.

However, evidence that fatigue can impair performance does not mean every workplace error involving a shift worker was caused by insufficient sleep.

Safety incidents often result from several interacting factors, including workload, staffing, communication, equipment, supervision, training, environmental conditions, and organizational processes. A meaningful investigation should consider these factors rather than assigning a single explanation without evidence.

The journey home after a night shift also deserves attention. A worker may finish the shift without an incident but experience dangerous sleepiness while commuting. In Viet Nam, this concern may include travel by motorcycle or car after an extended overnight duty period.

Fatigue-related risk does not necessarily disappear when someone leaves the workplace.

Organizations can influence these risks through scheduling, staffing, workload distribution, rest opportunities, and procedures for responding when a worker appears unable to perform safety-sensitive tasks safely.

Reporting systems are also important. Workers should have appropriate ways to communicate fatigue concerns without unnecessary stigma or discouragement.

A low number of reported fatigue-related incidents does not necessarily mean the workplace is safer. Reporting patterns may reflect awareness, organizational culture, and whether employees believe their concerns will be taken seriously.

The objective should be identifying and reducing risk rather than simply producing favorable safety statistics.

Long-Term Health Risks Need Careful Interpretation

Researchers have also examined relationships between shift work and longer-term health outcomes, including cardiometabolic conditions, sleep disorders, and certain cancers.

Observational studies have reported associations between nonstandard work schedules and several health problems, but findings vary. Researchers use different definitions of shift work, assess different exposure durations, and study populations with different occupational, socioeconomic, and health characteristics.

These differences complicate causal interpretation. An association between shift work and a health outcome does not necessarily establish that the working schedule was the sole or direct cause.

An important example comes from the International Agency for Research on Cancer.

In its 2020 monograph, the agency classified night shift work as probably carcinogenic to humans, Group 2A. The classification was based on limited evidence of cancer in humans, sufficient evidence from experimental animals, and strong mechanistic evidence in experimental systems.

The human evidence considered included studies involving breast, prostate, colon, and rectal cancers.

However, this classification identifies a potential carcinogenic hazard. It does not quantify the cancer risk faced by an individual worker or establish that all night workers will develop cancer. It also does not demonstrate that every type of night shift or rotation pattern creates the same level of risk.

The distinction between hazard identification and individual risk assessment is important. Healthcare professionals should explain the available evidence without unnecessarily alarming workers or minimizing legitimate concerns.

Long-term health risks reinforce the importance of occupational prevention and appropriate clinical assessment, but individual decisions require consideration of actual exposures, medical history, and other relevant risk factors.

Workplace Scheduling Is an Organizational Responsibility

A worker may make reasonable efforts to protect sleep, eat well, and maintain physical activity while still struggling because of how working hours are organized.

Frequent changes between day and night shifts, limited recovery opportunities, unpredictable schedules, and demanding workloads may make healthy routines difficult to sustain. In such circumstances, providing further advice about sleep hygiene may have limited value if the underlying work arrangement remains unchanged.

Organizations influence fatigue-related risks through staffing, scheduling, shift rotation, opportunities for rest, workload distribution, and the predictability of working hours.

These decisions require consideration of operational requirements alongside occupational health, employee experience, and safety. There is no single schedule that has been demonstrated to be optimal for every worker or every industry.

The American Academy of Sleep Medicine's 2026 guideline illustrates this uncertainty. Although it conditionally favors forward shift rotation for certain adults with shift work disorder, the evidence is of very low certainty.

The guideline also does not establish that eight-hour night shifts are universally safer than twelve-hour shifts, or vice versa. Scheduling decisions require a broader assessment of consecutive shifts, cumulative working hours, opportunities for recovery, workload, commuting, and the physical and cognitive demands of the work.

Workers themselves may provide information that is not apparent from staffing records. A schedule that appears practical from an operational perspective may create unexpected difficulties with sleep, transportation, childcare, or other responsibilities.

Providing appropriate opportunities to communicate these concerns can help identify risks that might otherwise remain unnoticed.

Workplace fatigue management should not become a process that records tiredness while leaving preventable contributing conditions unchanged. Nor should it assume that workers experiencing repeated circadian disruption simply lack resilience.

The broader goal is to balance operational continuity with the health and safety of the people required to maintain it.

The Vietnamese Labor and Occupational Safety Framework

Shift work in Viet Nam must be considered within the applicable labor and occupational safety framework.

The Labor Code No. 45/2019/QH14 establishes requirements concerning working hours, night work, rest periods, overtime, and the responsibilities of employers and employees.

On February 12, 2026, the National Assembly Office issued Consolidated Document No. 18/VBHN-VPQH, incorporating relevant amendments into the Labor Code. This provides an updated reference to the legislative text but is not a newly enacted Labor Code replacing the original statute.

Article 106 defines night working hours as the period from 10:00 p.m. to 6:00 a.m. the following day.

Article 109 establishes requirements concerning rest breaks during working hours. Under the relevant provisions, employees working for at least six hours in a day are generally entitled to a break of at least 30 consecutive minutes, while qualifying night work requires a break of at least 45 consecutive minutes.

Article 64 of Decree No. 145/2020/NĐ-CP further clarifies the conditions for the 45-minute requirement. It applies where an employee works for at least six hours in a day, including at least three hours within the legally defined nighttime period.

Whether a rest break is counted as working time depends on the applicable provisions and working arrangements. For qualifying continuous shift work under the decree, the relevant break is counted as working time. The decree also regulates the placement of breaks within working hours.

Article 110 of the Labor Code provides that employees working in shifts must receive at least 12 hours of rest before changing to another shift.

Other provisions regulate normal working hours, overtime, weekly rest, and additional pay for night work. Certain occupations or special working arrangements may also be subject to specific requirements.

These provisions establish important legal protections. However, compliance with minimum working-time and rest requirements does not necessarily guarantee that an employee has obtained adequate sleep or is free from fatigue-related risk.

A legally compliant interval between shifts may still include commuting, family responsibilities, and other demands that reduce actual sleep opportunities.

The Law on Occupational Safety and Health No. 84/2015/QH13, as amended, also establishes responsibilities concerning workplace safety, occupational health, risk prevention, and worker protection.

Employers must address occupational risks applicable to their activities in accordance with relevant legal requirements. However, general occupational safety obligations should not be interpreted as requiring every employer in Viet Nam to adopt one particular international fatigue-management program or scheduling model.

International clinical and occupational health recommendations may inform professional understanding and organizational decisions, but they do not automatically create binding legal requirements for Vietnamese employers.

Legal compliance and effective fatigue-risk management are related responsibilities, but they are not identical.

Protecting Workers' Health Information

Workplace fatigue initiatives may involve collecting information about sleep, symptoms, medical conditions, working hours, and the ability to perform particular duties safely.

Some organizations may consider questionnaires, wearable devices, digital monitoring systems, or other technologies to better understand fatigue-related risks.

These approaches may provide useful information, but they also raise questions about privacy, confidentiality, and the appropriate use of personal data.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 took effect on January 1, 2026. Decree No. 356/2025/NĐ-CP, effective from the same date, provides implementing provisions.

The legal framework includes requirements relevant to personal data collected during recruitment, employment, and worker management, as well as specific protections concerning health information.

Article 25 of the Law on Personal Data Protection addresses the handling of employee data, including information collected through technological or technical measures. Such measures must comply with applicable law, protect the rights and interests of individuals, and be implemented on a basis that ensures employees are aware of them.

Article 26 provides additional protections for personal health information. It generally requires the individual's consent for collecting and processing such information, subject to the statutory exceptions provided by the law.

Organizations considering sleep or fatigue monitoring must therefore assess the lawful purpose and basis of processing, the information genuinely needed, transparency, security measures, access restrictions, retention obligations, and the applicable rights of employees.

The use of wearable devices does not provide unrestricted authority to collect, share, or retain health information.

Clinical information and occupational safety information may also require different handling arrangements. An employer may need an appropriately limited assessment of whether a worker can safely perform particular duties, but this does not automatically provide unrestricted access to detailed medical records.

These distinctions require suitable professional procedures, confidentiality protections, and compliance with applicable data protection requirements.

For VLMA, discussing workplace health does not mean endorsing unnecessary employee surveillance or the use of sensitive personal information outside lawful and professionally appropriate arrangements.

What Research From Viet Nam Tells Us

Research conducted in Viet Nam provides relevant context for occupational sleep health, although its findings should be interpreted carefully.

A study titled Prevalence of Insomnia in Healthcare Profession – PIHEP Study: A Large-Scale National Study in Vietnam was published in Nature and Science of Sleep on June 25, 2026.

The researchers analyzed questionnaire data from 1,655 healthcare professionals recruited across multiple regions of Viet Nam.

Using the study's criteria for chronic insomnia, 24.2% of participants met the defined threshold, with a 95% confidence interval of 22.2% to 26.3%.

The study also reported sleep-related symptoms and daytime difficulties, including nighttime awakenings, difficulty initiating sleep, daytime sleepiness, memory complaints, and mood-related concerns.

These findings are relevant to occupational sleep health, particularly because healthcare work may involve night duties, long shifts, emotional demands, and irregular schedules.

However, the study did not establish the prevalence of shift work disorder in Viet Nam. The 24.2% figure concerns chronic insomnia as defined by the research protocol, not the proportion of Vietnamese shift workers affected by circadian rhythm sleep-wake disorders.

The research also used a cross-sectional design and questionnaire-based measures. It cannot establish that shift scheduling caused the insomnia observed or determine the effectiveness of particular workplace interventions.

Although participants were recruited from multiple regions, the study should not be interpreted as a nationally representative prevalence survey of all healthcare workers. Its findings also cannot be generalized directly to factory workers, drivers, hospitality employees, or other occupational groups.

Nevertheless, the research raises questions deserving further investigation.

Future Vietnamese studies could distinguish chronic insomnia, shift work disorder, insufficient sleep, and work-related fatigue more clearly. Detailed information about actual schedules, consecutive shifts, commuting time, sleep opportunities, and workplace conditions would help researchers understand the relationships involved.

Prospective studies and carefully evaluated interventions could also provide stronger evidence about which approaches improve health, functioning, and safety in different occupational settings.

International evidence provides an important foundation, but local research remains necessary to understand how findings apply within Viet Nam.

Connecting Clinical Evidence With Safer Workplace Practice

Improving health and safety in shift work requires an understanding of both individual needs and organizational conditions.

A workplace may identify repeated complaints of excessive sleepiness during night shifts, near misses, limited rest opportunities, or employees reporting persistent sleep problems. These concerns may appear similar, but they can have different causes.

Some workers may require clinical assessment for a suspected sleep disorder. Others may benefit from information about sleep opportunities, caffeine timing, or strategies for managing alertness. Still others may face scheduling, workload, or staffing conditions that cannot be adequately addressed through individual counseling.

Clinical management and organizational risk management should therefore be distinguished.

Clinical examination, diagnosis, and treatment belong to appropriately authorized healthcare professionals and facilities. Staffing, scheduling, working conditions, and occupational safety measures remain the responsibilities of the relevant organizations and qualified professionals under applicable law.

Coordination may be helpful, but these responsibilities should not be treated as interchangeable.

Organizations also need to understand whether an intervention has achieved its intended outcome.

Providing education about fatigue does not necessarily demonstrate that employees are obtaining better sleep or that fatigue-related safety risks have decreased.

Evaluation may involve appropriately selected information about work schedules, sleep opportunities, reported fatigue, relevant safety events, and the practical experiences of workers. Such information should be interpreted carefully because reporting patterns can be influenced by awareness, workplace culture, and confidence in the reporting system.

An increase in reported concerns may sometimes reflect improved willingness to speak up rather than a deterioration in safety. Conversely, fewer reports do not necessarily prove that risks have been reduced.

The purpose of evaluation should be learning and prevention, supported by appropriate governance and protection of personal information.

Any formal workplace intervention requires suitable occupational health expertise, resources, organizational commitment, and careful consideration of applicable legal responsibilities.

What This Means for the Vietnam Lifestyle Medicine Alliance

Shift work illustrates why Lifestyle Medicine cannot focus exclusively on individual behavior.

A worker may understand the benefits of adequate sleep, nutritious food, regular physical activity, and stress management while having limited control over the conditions that make these behaviors possible.

This does not reduce the value of Lifestyle Medicine. It reinforces the importance of applying it within the social, occupational, and organizational circumstances that influence health.

The 2025 update of the Lifestyle Medicine Core Competencies places greater emphasis on social determinants of health and adapting interventions to real-world conditions. Shift work is a practical example of why this matters.

The American Academy of Sleep Medicine's October 2026 guideline also demonstrates the importance of scientific precision. It addresses the clinical management of shift work disorder, not every health concern experienced by shift workers. Its recommendations are conditional, and evidence for several interventions remains limited.

For VLMA, an appropriate contribution is to support healthcare professionals in understanding these distinctions and critically evaluating the available evidence.

Potential educational topics include circadian physiology, recognition of shift work disorder, sleep and recovery, fatigue-related safety, the limitations of lifestyle interventions, and the relationship between working conditions and health.

Such work may benefit from collaboration with appropriately qualified sleep medicine specialists, occupational health professionals, healthcare quality and patient safety experts, researchers, and other relevant practitioners.

These are possible directions for professional education, scientific knowledge exchange, and collaboration. They do not indicate that VLMA currently provides occupational health services, clinical sleep assessments, workplace scheduling advice, or fatigue-management certification.

VLMA does not independently diagnose sleep disorders, prescribe treatment for shift work disorder, assess fitness for duty, authorize workplace schedules, or certify occupational fatigue-management programs.

Its intended contribution is to strengthen professional understanding and support the responsible interpretation and communication of scientific evidence within Vietnamese healthcare and related fields.

Healthy Workers Need More Than Healthy Advice

Shift work is necessary in many parts of modern society. Hospitals must care for patients overnight, while transportation, manufacturing, emergency services, and other essential activities may require continuous operations.

Recognizing the health and safety challenges associated with shift work does not mean that such work can or should always be eliminated. It means the consequences of working outside normal biological rhythms deserve appropriate attention.

Lifestyle Medicine can help workers understand and support their health through suitable sleep strategies, nutrition, physical activity, and other relevant behaviors. Clinical care can identify and manage sleep disorders when indicated. Organizations can contribute through scheduling, recovery opportunities, workplace conditions, and fatigue-related risk management.

These approaches are complementary, but none is sufficient on its own.

Advice about sleep cannot replace adequate opportunities for rest. Medication cannot make every demanding schedule safe. Workplace policies cannot substitute for clinical assessment when a worker has a significant sleep disorder.

For healthcare professionals in Viet Nam, responsible practice requires understanding emerging international evidence while respecting the country's clinical, labor, occupational safety, and data protection requirements.

Protecting the health of shift workers is not solely a matter of improving personal habits. It also requires recognizing biological limits and addressing the working conditions that influence health, recovery, and safety.

For VLMA, this is an important example of how evidence-based Lifestyle Medicine can contribute to occupational health discussions without overstating what individual lifestyle interventions can achieve.

Selected References

1. Wright KP Jr, Abbott SM, Ashbrook L, et al. Management of Shift Work Disorder: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. 2026;22 202. Published October 24, 2026. doi:10.1007/s44470-026-00084-w.

2. Wright KP Jr, Abbott SM, Ashbrook L, et al. Management of Shift Work Disorder: An American Academy of Sleep Medicine Systematic Review, Meta-analysis, and GRADE Assessment. Journal of Clinical Sleep Medicine. 2026;22 201. Published October 24, 2026. doi:10.1007/s44470-026-00076-w.

3. American Academy of Sleep Medicine. International Classification of Sleep Disorders. Third edition, text revision. Darien, Illinois: American Academy of Sleep Medicine; 2023.

4. National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Fatigue and Work. Updated July 14, 2026.

5. International Agency for Research on Cancer. Night Shift Work. IARC Monographs on the Identification of Carcinogenic Hazards to Humans. Volume 124. Lyon: International Agency for Research on Cancer; 2020.

6. Duong-Quy S, Nguyen-Thi-Thu D, Hoang-Thi-Xuan H, et al. Prevalence of Insomnia in Healthcare Profession – PIHEP Study: A Large-Scale National Study in Vietnam. Nature and Science of Sleep. 2026;18. Published June 25, 2026. doi:10.2147/NSS.S597038.

7. National Assembly of Viet Nam. Labor Code No. 45/2019/QH14. November 20, 2019. Effective January 1, 2021, as amended.

8. National Assembly Office of Viet Nam. Consolidated Document No. 18/VBHN-VPQH: Labor Code. February 12, 2026.

9. Government of Viet Nam. Decree No. 145/2020/NĐ-CP Detailing and Guiding the Implementation of Certain Articles of the Labor Code on Working Conditions and Labor Relations. December 14, 2020, as amended.

10. National Assembly of Viet Nam. Law on Occupational Safety and Health No. 84/2015/QH13. June 25, 2015. Effective July 1, 2016, as amended.

11. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. January 9, 2023. Effective January 1, 2024, as amended.

12. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

13. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Articles and Measures for Implementing the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

14. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. doi:10.1177/15598276251379821.

Editorial and Professional Scope Note

This article presents an educational and professional perspective of the Vietnam Lifestyle Medicine Alliance on the relationship between evidence-based Lifestyle Medicine, circadian health, shift work, fatigue-related safety, and workplace responsibility, based on information reviewed through October 30, 2026. It is intended for professional education, scientific knowledge exchange, and general information.

The article does not constitute a clinical practice guideline, individualized medical advice, a diagnosis or treatment protocol for shift work disorder, a medication prescription, an occupational health assessment, a workplace scheduling standard, a fatigue-risk management protocol, or an authoritative interpretation of Vietnamese law. The worker scenarios are illustrative and do not describe actual VLMA clinical services or identifiable individuals.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. It is not a licensed medical examination or treatment facility, occupational health service, sleep medicine clinic, labor inspection authority, or workplace safety certification organization. VLMA does not independently diagnose sleep disorders, prescribe sleep-related medications, assess fitness for duty, certify workplace schedules, or operate occupational fatigue-management programs.

Clinical assessment and treatment of sleep disorders must be provided by appropriately authorized healthcare professionals and facilities within their lawful scopes of practice. Occupational safety assessments, workplace scheduling decisions, and employment-related arrangements remain subject to the responsibilities of the relevant organizations, qualified professionals, and applicable Vietnamese law.

Lifestyle-related interventions should not delay or replace necessary medical assessment, treatment of clinically significant sleep disorders, or appropriate workplace safety measures. References to light exposure, caffeine, planned naps, meal timing, medications, and work schedules are intended to explain the available evidence and its limitations, not to provide instructions for self-treatment or organizational implementation.

International clinical guidelines and occupational health resources are included for educational purposes. Their discussion does not establish that they automatically have regulatory force in Viet Nam or that VLMA has formally adopted, clinically implemented, evaluated, validated, or certified any intervention or workplace program described in this article.