Shift workers: Evidence for sleep-inducing and alertness drugs is weak

Shift workers are taking drugs to help them stay awake or get to sleep despite weak evidence for their benefit, according to a new Cochrane review. The authors of the review found only small numbers of trials testing over-the-counter and prescription drugs used by shift workers, and the results suggest that for some people they might do more harm than good.

In most developed countries, at least 10% of the workforce is involved in some form of shift work. European statistics suggest that as many as three quarters of the population have 'non-standard' working hours. Disturbances to normal sleeping and waking patterns increase the risk of accidents and affect shift workers' health. It is therefore important to avoid shift work where possible and improve shift work schedules to help shift workers achieve more normal sleeping and waking patterns. In jobs where shift work cannot be avoided, such as health care, the police force or the military, drugs can potentially offer short-term benefits.

The review included 15 trials involving a total of 718 people. In nine trials, the over-the- counter hormone drug melatonin helped shift workers sleep for around 24 minutes longer during the night or day, compared to placebos. However, it did not help them get to sleep any quicker. Data from only one trial of the hypnotic drug zoplicone was available. The was no more effective than placebos for helping shift workers sleep during the day.

The remaining trials focused on caffeine and two drugs, modafinil and armodafinil, that are prescribed for sleepiness during night shifts. In one trial, caffeine reduced sleepiness during night shifts, when workers also napped before shifts. Modafinil and armodafinil, used by shift workers in one and two trials respectively, increased alertness and reduced sleepiness. However, they also caused headaches, nausea and a rise in blood pressure in a substantial number of people. Due to the limited benefits and frequent side effects, neither of these drugs is approved for in Europe.

"For lots of people who do shift work, it would be really useful if they could take a pill that would help them go to sleep or stay awake at the right time," said lead author of the review, Juha Liira, who is based at the Finnish Institute of Occupational Health in Helsinki, Finland. "But from what we have seen in our review, there isn't good evidence that these drugs can be considered for more than temporary use and some may have quite serious side effects."

Most of the data reported in the review was from small, low quality trials. In addition, trials tended to be carried out in specific settings, such as health care or oil rigs, so their results may be less relevant for workers in other types of roles.

"It's curious that there's such a clear gap in the research," said Liira. "It may well be that studying the effects of these drugs or others drugs in properly designed would be seen as unethical because workers should not need drugs to get along with their work. So the studies just haven't been done or if they have, our review has not been able to identify relevant data."

add to favorites email to friend print save as pdf

Related Stories

Sweet dreams in the North Sea

May 31, 2013

Some workers in Norway's North Sea Oil industry alternate between night and day shifts, the so-called swing shift. A recent study conducted by Postdoctoral fellow Siri Waage and colleagues at the University of Bergen's (UiB) ...

Caffeine reduces mistakes made by shift workers

May 11, 2010

Caffeine can help those working shifts or nights to make fewer errors, according to a new study by Cochrane researchers. The findings have implications for health workers and for any industry relying on shift or night work, ...

Shift work linked to heightened risk of type 2 diabetes

Jul 24, 2014

Shift work is linked to a heightened risk of developing type 2 diabetes, with the risk seemingly greatest among men and those working rotating shift patterns, indicates an analysis of the available evidence published online ...

Recommended for you

Evidence plays limited role in OTC decision making

58 minutes ago

(HealthDay)—For pharmacy graduates and tutors, evidence seems to play a limited role in over-the-counter decision making, according to a study published online Dec. 11 in the Journal of Evaluation in Cl ...

Shared medical appointments beneficial in geriatric care

1 hour ago

(HealthDay)—For older patients, a shared medical appointment (SMA) program facilitates early detection and referral for geriatric syndromes, according to an article published online Nov. 29 in the Journal of ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.