How Antinarcoleptic Drugs Can Help Shift Workers

Shift work is a type of work schedule that involves working outside the typical 9 a.m. to 5 p.m. hours. Shift workers may work overnight, early morning, or rotating shifts that change periodically. Some examples of jobs that require shift work are nurses, doctors, firefighters, police officers, factory workers, and airport staff.

Shift work can have many benefits, such as higher pay, less traffic, more flexibility, and more opportunities for career advancement. However, shift work can also pose some challenges for the health and well-being of workers. One of the main challenges is coping with the disruption of the natural sleep-wake cycle, also known as the circadian rhythm.

The circadian rhythm is a biological clock that regulates various bodily functions, such as hormone levels, body temperature, metabolism, and immune system. The circadian rhythm is influenced by environmental cues, such as light and darkness, and helps us feel alert during the day and sleepy at night. When we work at night and sleep during the day, we go against our natural circadian rhythm and may experience difficulties falling asleep, staying asleep, or feeling refreshed after waking up. This can lead to chronic sleep deprivation and excessive daytime sleepiness (EDS).

EDS is a condition characterized by a persistent or recurrent need to sleep during the day, even after getting enough sleep at night. EDS can impair the cognitive, emotional, and physical performance of workers and increase the risk of errors, accidents, injuries, and illnesses. EDS can also affect the quality of life and mental health of workers and their families.

One way to manage EDS and improve alertness in shift workers is to use antinarcoleptic drugs. Antinarcoleptics are medications that stimulate the central nervous system (CNS) and promote wakefulness. They are commonly used to treat narcolepsy, a sleep disorder that causes excessive daytime sleepiness and sudden attacks of sleep. However, antinarcoleptics can also be prescribed off-label for shift work disorder (SWD), a condition that affects people who have difficulty adjusting to a non-traditional work schedule.

Some examples of antinarcoleptic drugs are:

•  Modafinil (Provigil) This is a prescription stimulant that can help keep you awake and reduce EDS associated with SWD. It works by increasing the levels of certain neurotransmitters in the brain that are involved in alertness and attention. Modafinil is usually taken once a day before the start of the work shift. Some common side effects are headache, nausea, anxiety, insomnia, and dry mouth.

•  Armodafinil (Nuvigil) This is a newer version of modafinil that has a longer duration of action and may be more effective for some people. It works in a similar way as modafinil but has a different chemical structure. Armodafinil is also taken once a day before the start of the work shift. Some common side effects are headache, nausea, dizziness, insomnia, and dry mouth.

•  Solriamfetol (Sunosi) This is a newer antinarcoleptic drug that was approved by the FDA in 2019 for SWD. It works by increasing the levels of dopamine and norepinephrine in the brain, which are neurotransmitters that regulate wakefulness and motivation. Solriamfetol is taken once a day in the morning or before the start of the work shift. Some common side effects are headache, nausea, decreased appetite, anxiety, and insomnia.

Antinarcoleptic drugs can be effective in improving alertness and reducing EDS in shift workers. However, they are not a substitute for good sleep hygiene and lifestyle habits.

Shift workers should also try to:

- Maintain a regular sleep schedule as much as possible;

- Avoid caffeine, alcohol, nicotine, and other stimulants or depressants before bedtime;

- Create a dark, quiet, comfortable sleeping environment;

- Use earplugs, eye masks, blackout curtains, or white noise machines to block out noise and light;

- Avoid exposure to bright light during the night shift and use sunglasses or blue-light blocking glasses when going outside;

- Get exposure to natural light during the day or use light therapy devices to reset the circadian rhythm;

- Take short naps before or during the work shift if possible;

- Eat healthy meals and snacks at regular intervals;

- Stay hydrated and avoid dehydration;

- Exercise regularly but avoid vigorous activity close to bedtime;

- Seek social support from family, friends, co-workers, or support groups;

- Consult a doctor or a sleep specialist if EDS persists or interferes with daily functioning.

Shift work can be rewarding and fulfilling for many people, but it can also pose some challenges for the health and well-being of workers. Antinarcoleptic drugs can help shift workers cope with EDS and improve their alertness and performance. However, they should also be used in conjunction with good sleep hygiene and lifestyle habits to optimize their health and quality of life.