HealthDay News — Evidence for the efficacy and safety of pharmacologic interventions to treat sleep disturbances and sleepiness caused by shift work is lacking, according to a review published online in The Cochrane Library.

Juha Liira, MD, PhD, of the Finnish Institute of Occupational Health in Helsinki, and colleagues conducted a systematic review of the literature and selected 15 randomized, placebo-controlled trials, involving 718 participants, who underwent pharmacologic treatment for sleep-wake disturbances related to shift work. The researchers performed selected meta-analyses of the data.

There was low-quality evidence that use of melatonin, compared with placebo, following a night shift may increase sleep length during daytime sleep (mean difference 24 minutes; 95% CI: 9.8-38.9 minutes) and night-time sleep (MD 17 minutes; 95% CI: 3.71-30.22 minutes), the researchers found.

Moderate-quality evidence showed that sleepiness, measured by points on the Karolinska Sleepiness Scale, may be reduced by armodafinil (MD −0.99; 95% CI: −1.32 to −0.67) or modafinil (MD −0.90; 95% CI: −1.45 to −0.35) taken before the night shift.

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Both drugs also showed effectiveness in increasing alertness in a psychomotor vigilance test, but their use was associated with adverse effects, including headache, nausea, rise in blood pressure, and, in post-marketing reports, severe skin reactions. One trial showed that caffeine intake combined with naps taken before the night shift reduced sleepiness (MD −0.63; 95% CI: −1.09 to −0.17).

“The evidence was of low quality and mostly from small trials,” the authors write. “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.”


  1. Liira J, et al. The Cochrane Library. DOI: 10.1002/14651858.CD009776.pub2