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 Use of these drugs for this purpose “has been studied to a very
limited extent and the studies that have been published mostly have
not been of sufficient quality to allow firm conclusions,” said Dr.
David Neubauer, associate director of the Johns Hopkins Sleep
Disorders Center in Baltimore, Maryland.
“Considering the large number of people who do shift work, it
certainly is unfortunate that minimal research has been performed to
offer clinical guidance to address the problems of inadequate
alertness or sleepiness,” Neubauer, who was not involved with the
new study, told Reuters Health by email.
For the study, Dr. Juha Liira of the Finnish Institute of
Occupational Health in Helsinki and colleagues gathered data from 15
trials involving 718 participants. The trials evaluated the effect
of melatonin and hypnotic drugs on sleep after the shift, and the
effect of modafinil, armodafinil and caffeine plus naps on
sleepiness during the shift.
They found that taking a nap and caffeine before a night shift may
improve alertness, and daytime melatonin may add around 24 minutes
of extra sleep during daylight hours, but the evidence is weak.
For some workers, modafinil improves alertness at work but carries
the risk of side effects like headache and nausea, and rarely a
serious skin rash syndrome.
In general, the authors cautioned, “The evidence was of low quality
and mostly from small trials. Both sleep and alertness promoting
agents have potentially serious adverse effects. Therefore, we need
more trials to determine the beneficial and harmful effects of these
drugs.”
They did not respond to a request by Reuters Health for comment.
Roughly 15 percent of the U.S. workforce usually worked the night
shift in 2004, according to a Bureau of Labor Statistics report
cited in the review.
For many workers, falling asleep isn’t a problem, since they tend to
be sleepy getting off the night shift, Neubauer said. The bigger
challenge is remaining asleep long enough.
“Anyone with significant problems associated with shift work -
whether excessive sleepiness at work or driving home, or with
getting sufficient sleep during the hours off work – should confer
with his or her primary care provider,” Neubauer added. “Some people
have much greater difficulty adapting to a shift work schedule and
may benefit from behavioral approaches or medications.”
Many workers use caffeine to stay awake at night, and fewer use
prescription medications, but they can have a place for some
patients, he said.
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Caffeine and melatonin can be purchased over the counter in various
formulations. Modafinil (Provigil) and armodafinil (Nuvigil) require
a prescription.
Claire C. Caruso told Reuters Health by email that shift work, and
long work hours, can put workers’ health and safety at risk “by
disturbing sleep and circadian rhythms and reducing time for family
and non-work responsibilities.”
Caruso, who was not a part of the new review, is a research health
scientist at the National Institute for Occupational Safety and
Health in Cincinnati.
There are non-pharmacologic ways to reduce the strain of shift work,
she said.
Aside from improving work schedules to allow for more time for
sleep, managers can institute policies and systems in the workplace
to reduce fatigue, she said.
Also, workers can try to allow enough time for getting to sleep and
use good sleep practices, like keeping the bedroom dark, maintain a
bedtime routine and avoiding screens for an hour before sleep.
Workers can also educate the important people in their lives about
their special needs to reduce conflicting demands from work and home
life, Caruso said.
“Stimulants and sleep medications can have side effects, can become
addictive, and generally have been tested for short-term use,” she
said. “In addition, they do not completely remedy the effects of
inadequate sleep, and questions remain about their long-term use.”
SOURCE: http://bit.ly/1yoq32d
The Cochrane Library, August 11, 2014.
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