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Review: Benefits of sleep-inducing and alertness drugs questionable

Wednesday August 13, 2014
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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 results of trials suggest for some they might do more harm than good.

Disturbances to normal sleeping and waking patterns increase the risk of accidents and affect shift workers’ health, making it important to avoid shift work when possible and improve schedules to help workers achieve more normal sleeping and waking patterns, according to a news release. In jobs where shift work cannot be avoided, such as healthcare, the police force or the military, drugs can potentially offer short-term benefits, according to the Cochrane review.

Due to the limited benefits and frequent side effects, neither of these drugs is approved for shift workers in Europe.

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 roughly 24 minutes longer during the night or day, compared with placebos. However, the drug did not help them get to sleep quicker. Data on one trial of the hypnotic drug zoplicone showed it was no more effective than placebos for helping workers sleep during the day.

The remaining trials focused on caffeine and two drugs, modafinil and armodafinil, prescribed for sleepiness. In one trial, caffeine reduced sleepiness during night shifts, when workers napped before shifts. Modafinil and armodafinil increased alertness and reduced sleepiness but caused headaches, nausea and a rise in blood pressure in a substantial number of people.

“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,” lead author of the review, Juha Liira, who is based at the Finnish Institute of Occupational Health in Helsinki, said in the release. “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.” “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.

“It’s curious that there’s such a clear gap in the research,” Liira said. “It may well be that studying the effects of these drugs or others drugs in properly designed trials 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.”


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