Nocturnal Workers Get Little Help From Popular Sleep and Alertness Pills

Photograph by Blaise Hayward/Getty Images

Almost one in five American workers have schedules that put them on the job at odd hours, according to government data, (PDF) and the proportion is much higher for hospital employees, restaurant staffers, and long-haul truckers. The pills favored by these off-hours workers—either to stay alert at night or to ease into sleep during the day—may not be all that effective.

The evidence in favor of using drug treatments to help those with so-called shift work sleep disorder is weak, according to an analysis by the Cochrane Library, which urged more research.  The market for helping people get their Zs has been pegged at more than $32 billion per year, a total that includes medication, fancy mattresses, and “sleep consultants” promising sweet dreams. So the implications of the new finding are potentially large.

Cochrane is a global effort by scientists to sort through voluminous and sometimes conflicting scientific papers on medical questions to get to the bottom of whether a treatment helps—and if its benefits outweigh potential harm. The group gathered published studies examining the sleep aid melatonin and two drugs, modafinil and armodafinil, intended to keep sleepy workers alert. Modafinil has caught on with traders, coders, and other type-A go-getters who put in long hours at computer screens.

Cochrane found 15 trials with 718 patients—not a huge base of evidence to guide decisions. Melatonin helped daytime sleepers extend their snoozes by less than half an hour, and there wasn’t much evidence showing that it helped them fall asleep faster.

Modafinil and armodafinil “probably have a small reduction in sleepiness and an increase in alertness during the night shift,” according to the review. The drugs also came with the risk of side effects—mild ones such as headaches and nausea and occasionally, more serious skin disorders. It’s not yet clear that the effects are worth the risks, the researchers say.

One trial in which people took caffeine and had a nap before starting the night shift showed they were more alert.

The scientific jury is still out on the best ways for workers to get adequate rest and stay sharp during the graveyard shift. “Both sleep and alertness promoting agents have potentially serious adverse effects,” the Cochrane researchers concluded. “Therefore, we need more trials to determine the beneficial and harmful effects of these drugs.”

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