In a 24-7 world, tens of thousands of Americans fall victim to shift-work sleep disorder _ they’re terribly sleepy during their night of work, but suffer from insomnia when they try to sleep in the daytime.
A study published Thursday shows that a drug first prescribed for narcolepsy sufferers also offers some relief to night workers trying to stay awake on the job.
The drug, called modafinil and sold under the brand name Provigil, extended the length of time it took shift workers between the ages of 18 and 60 to nod off at night from an average of about two minutes to nearly four minutes.
And it improved the workers’ self-reported wakefulness and their vigilance in tests.
Researchers say nearly 6 million Americans work at night on a permanent or rotating basis, and some 5 percent to 10 percent suffer from the shift-work disorder.
“Shift-work sleep disorder adversely affects many working Americans,” said Dr. Charles Czeisler, chief of the sleep-medicine division at Brigham and Women’s Hospital in Boston and leader of the study presented in The New England Journal of Medicine.
“It can compromise personal safety and significantly impact quality of life. This study demonstrates that while modafinil can significantly improve symptoms and reduce sleep tendency during night-work hours, patients remain excessively sleepy even after treatment for this sleep-wake disturbance.”
Originally intended to treat narcoleptics _ people with a rare brain disorder that causes them to uncontrollably fall asleep _ the drug is now approved for people with the shift-work disorder as well as those suffering from sleep apnea. The drug’s manufacturer, Cephalon, sponsored the new research, and Czeisler is a paid consultant to the firm.
The pills generally keep people awake with less of the jitteriness and other side effects seen from using caffeine or amphetamines. In previous trials by the U.S. military and others, the drug has allowed healthy people to stay up safely while remaining almost as focused, alert and capable of dealing with problems as people who are well-rested.
People with shift-work sleep disorder tend to miss family and social activities more frequently and have higher rates of ulcers, sleep-related accidents, depression and absenteeism than other night-shift workers who don’t suffer from the disorder.
In the three-month trial, the researchers randomly assigned 209 patients to take either 200 milligrams of modafinil or a placebo at the start of each shift. Neither the researchers nor the patients knew who got the actual drug.
Night-shift workers were defined as those who worked at least five night shifts for 12 hours or less, with six hours or more between 10 p.m. and 8 a.m., and at least three shifts that they worked on consecutive nights.
Nodding-off time, or sleep latency, was measured through various physical changes detected during sleep, while alertness was measured with a performance test. The patients also kept electronic diaries of how sleepy they felt during the tests.
The researchers found that clinical symptoms of the disorder, which include excessive sleepiness during night work and insomnia when trying to sleep during the day, improved among 74 percent of the patients taking Provigil, vs. 36 percent among those in the placebo group.
Accidents or near-accidents were reduced by 25 percent, and lapses of attention were also significantly reduced in the group getting active treatment. But those taking the drug reported increased problems with insomnia compared with those who took the dummy pills.
Sleep experts say that no matter what drug a person uses to stay alert, skipping sleep creates a deficit in rest that eventually takes a toll on the body, both with the accumulated need for rest and with problems of digestion, the immune system and other functions.
“It is simplistic to consider that a pill alone could sufficiently modify the effects of this disorder,” Dr. Robert Basner, a sleep specialist at Columbia University who did not take part in the study, observed in a Journal editorial.
While modafinil so far seems to be relatively safe and may prove to be part of comprehensive treatment strategies for shift-work disorders, the study “does not justify writing more prescriptions for modafinil,” Basner added.
On the Net: www.nejm.org
BREAKOUT BOX
Shift-work sleep disorder
While it’s tough, most of the country’s nearly 6 million shift workers manage to reset their natural clocks to sleep at least part of the day and remain awake overnight. But about 10 percent get terribly sleepy and nod off on the job, yet suffer from insomnia when they try to sleep during the day. Researchers find that a wakefulness pill helps such patients stay alert on the job, but doesn’t make them sleep better or feel less tired overall.
(Contact Lee Bowman at BowmanL(at)SHNS.com. Distributed by Scripps Howard News Service, http://www.shns.com)
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