Sleep Deprivation – Most Night Shift Workers Don’t Adapt To The Hours

 

Most Night Shift Workers Don’t Adapt To The Hours Says Sleep Experts and Studies By NASA

NPR recently featured a in depth report on the topic of Night Shift Workers Don’t Adapt To The Hours Says Sleep. According to the report, numerous air traffic controllers who work the overnight shift have been caught sleeping on the job. Mary Louise Kelly talks to Dr. Charles Czeisler about the effects of sleep deprivation. Czeisler is the director of the Division of Sleep Medicine at Harvard Medical School and has studied the problem of fatigue on the job.

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MARY LOUISE KELLY, host:

We’ve been following the numerous reports about air traffic controllers caught sleeping on the job. Controllers often work overnight shifts or rotate among many different shifts. The Federal Aviation Administration is now changing staff scheduling practices to address fatigue among controllers.

Charles Czeisler is the director of the Division of Sleep Medicine at Harvard Medical School, and he told me why workers like air traffic controllers have a hard time adjusting to night shifts.

Dr. CHARLES?CZEISLER (Harvard Medical School): People can become completely adapted to overnight work, but most do not, even if they work permanent night shifts. And the reason for that is that on their days off they typically flip back into trying to function during the daytime and sleeping at night. And…

KELLY: On the weekends and that type thing.

Dr. CZEISLER: Exactly. Moreover, they’re living in a world in which the sun is up during the daytime and it’s dark at night. And the light/dark cycle is the most powerful synchronizer of our internal biological clock. Now, it’s possible to increase light intensity during nightshift work and use shorter wavelengths of light to help facilitate adaptation to working at night.

But nonetheless, most nightshift workers never fully adapt to their schedules, and hence it is more difficult for them to sustain alertness and performance when they’re working at night.

KELLY: You know, it’s curious, because people in all kinds of professions face sleep deprivation, many of the people working essential jobs: police, firefighters, overnight doctors and nurses in the ER. Have other professions figured out a better way to do this, a better way to schedule people to work the night shift?

Dr. CZEISLER: Well, that varies by profession. Certainly, the medical profession has not done so. They currently still schedule resident physicians to work 30-hour shifts twice a week. But change comes slowly in these areas, mainly because the environment has changed dramatically over the last 50 years, requiring people to stay continuously awake in jobs that they often were able to sleep at in times gone by, but the scheduling practices have not kept pace.

In addition, we are a sleep-deprived nation. Every week, nearly two million Americans nod off or fall asleep while driving their cars on the highways. And, you know, it’s part of our 24/7 culture that we think that we should be able to burn the candle at both ends without suffering any consequences, and at some point, the brain seizes control and we involuntarily make the transition from wakefulness to sleep, even at very inappropriate circumstances.

KELLY: One of the things that appears to have been ruled out in trying to tackle this is naps. Transportation Secretary Ray LaHood said this week, and I’m quoting him: “On my watch, controllers will not be paid to take naps.” Is that a good approach? Could naps be helpful, in your view?

Dr. CZEISLER: It’s a very common approach, although it’s kind of ironic. Controllers are allowed to eat while they’re being paid. They are allowed to smoke cigarettes while they’re being paid, during a break. But they’re not allowed to do the one thing that would help prepare them for work when they’re on break, which would be to take a brief nap.

KELLY: And in your view, would that help?

Dr. CZEISLER: Studies done by NASA for the FAA in relationship to pilots have shown that a brief, 20-minute nap greatly increases the ability to sustain alertness during the remainder of a flight. And yet, FAA regulations do not allow pilots to nap in the cockpit. So on one out of 10 trans-Atlantic flights, the pilots are nodding off in the cockpit, but it’s not scheduled or controlled in any way. It would be far better to recognize that it’s going to happen, to schedule it and to ensure that it doesn’t happen at unscheduled times than to simply ban it and pretend that it’s going to go away.

KELLY: Charles Czeisler is director of the Division of Sleep Medicine at Harvard Medical School.

Dr. Czeisler, thanks very much.

Dr. CZEISLER: Thank you.

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Shift Work Disorder News

 

Cephalon Presents Positive Results with NUVIGIL in Largest Shift Work Disorder Trial Ever Conducted

Study Shows Efficacy of NUVIGIL Late in Shift, Including Commute Home

At the Society of General Internal Medicine’s 34th Annual Meeting in Phoenix, Ariz. today, Cephalon, Inc. (Nasdaq:CEPH – News) presented positive results from a phase IV trial of nearly 400 people with excessive sleepiness associated with shift work disorder. In the trial, NUVIGIL® (armodafinil) Tablets [C-IV] improved shift-workers’ overall clinical condition late in their shifts (i.e., 4:00 a.m. to 8:00 a.m.), including the commute home, compared to placebo. The key secondary endpoint of the study was to assess global function, as measured by the Global Assessment of Functioning (GAF), and patients taking NUVIGIL experienced a greater improvement in GAF score compared to those patients taking placebo. Shift work disorder occurs when the body’s internal sleep-wake clock is out of sync with the individual’s work schedule – their bodies tell them to go to sleep when their work schedule needs them to stay awake. The primary symptoms of shift work disorder are excessive sleepiness and insomnia.

This six-week, double-blind, placebo-controlled study of 383 patients with excessive sleepiness associated with shift work disorder was conducted at 45 sites across the United States. Participants in the study spanned a wide range of occupations associated with shifts or non-traditional work hours, including transportation and material moving, healthcare support, protective services, management roles and office and administrative support. For the primary endpoint, physicians used the Clinical Global Impression of Change (CGI-C) scale to evaluate the change from baseline (beginning of the study) in overall clinical condition late in the shift – from 4:00 a.m. to 8:00 a.m. The observation period also included the participant’s commute home from work. Using the CGI-C rating, at the final visit, 77 percent of patients taking the recommended NUVIGIL dose of 150 mg (n=177) improved, compared to 57 percent of patients taking placebo (n=182) – a significantly greater improvement (p<0.0001). These clinical data build upon the findings from the pivotal phase III study of NUVIGIL in patients with excessive sleepiness associated with shift work disorder. The key secondary endpoint in this trial was the Global Assessment of Functioning or GAF, a well-recognized assessment of patient functioning found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which evaluates an individual's social, occupational, and psychological functioning on a scale of 1 to 100. Scores above 70 on the Global Assessment of Functioning may be considered within the normal range of functioning. This study was the first to use the GAF to provide an assessment of functioning in patients with excessive sleepiness associated with shift work disorder. In this trial, physicians used the GAF to measure a patient's overall level of functioning at baseline and at the final visit. At baseline, patients in both the placebo and NUVIGIL groups were rated an average score of 63, which is indicative of functional impairment associated with shift work disorder. Patients treated with NUVIGIL experienced a 9.5 point improvement over baseline in the Global Assessment of Functioning, to mean scores of 72.6 at the final visit, compared to a 5.2 point improvement to means scores of 67.9 in those taking placebo at final visit (p< 0.0001). "This study is important because up to 25 percent of people who work nights, early mornings, or other nontraditional shifts may be affected by shift work disorder. This condition affects their ability to function at work and at home, but they still need to do their jobs. The results of this study show an improvement in condition as well as a reduction in the impairment of patients treated with NUVIGIL for excessive sleepiness associated with shift work disorder when compared to placebo," said Milton K. Erman, M.D., study lead investigator. Dr. Erman is a Clinical Professor of Psychiatry at the University of California San Diego and President, Pacific Sleep Medicine Services, San Diego, CA. "This study reinforces the need for healthcare professionals to learn more about this disorder and about how treatment options like NUVIGIL may be of help in managing excessive sleepiness due to shift work disorder." The most frequently reported adverse events in this study are similar to those described in the NUVIGIL prescribing information, and include headache, nausea, and insomnia. There were no serious adverse events observed in patients taking NUVIGIL in this study. This is the first presentation of these data at a medical meeting and additional results will be submitted for future publications and presentations. About Shift Work Disorder According to the U.S. Department of Labor, over 15 million Americans work odd hours or non-traditional shifts, and are "at risk" for shift work disorder. Approximately 10 – 25 percent of shift workers are estimated to have shift work disorder. People with shift work disorder often struggle to stay awake during their waking hours (excessive sleepiness), or have trouble sleeping during their sleeping hours (insomnia). About NUVIGIL NUVIGIL is indicated to improve wakefulness in patients with excessive sleepiness associated with shift work disorder (SWD), treated obstructive sleep apnea (OSA), or narcolepsy. In patients with OSA, NUVIGIL is used along with other medical treatments for this condition. The NUVIGIL (armodafinil) label includes a bolded warning for serious or life-threatening rash, including Stevens-Johnson Syndrome, requiring hospitalization and discontinuation of treatment, that has been reported in adults in association with the use of modafinil and armodafinil and in children in association with the use of modafinil, a racemic mixture of S and R modafinil (the latter is armodafinil, the active ingredient in NUVIGIL). NUVIGIL is not approved for use in pediatric patients for any indication. The most common adverse events in controlled clinical trials (five percent or greater) were headache, nausea, dizziness, and insomnia. Full prescribing information for NUVIGIL is available at www.nuvigil.com. About Cephalon, Inc. Cephalon is a global biopharmaceutical company dedicated to discovering, developing and bringing to market medications to improve the quality of life of individuals around the world. Since its inception in 1987, Cephalon has brought first-in-class and best-in-class medicines to patients in several therapeutic areas. Cephalon has the distinction of being one of the world's fastest-growing biopharmaceutical companies, now among the Fortune 1000 and a member of the S&P 500 Index, employing approximately 4,000 people worldwide. The company sells numerous branded and generic products around the world. In total, Cephalon sells more than 150 products in nearly 100 countries. More information on Cephalon and its products is available at www.cephalon.com. In addition to historical facts or statements of current condition, this press release may contain forward-looking statements. Forward-looking statements provide the Cephalon current expectations or forecasts of future events. These may include statements regarding anticipated scientific progress on its research programs; development of potential pharmaceutical products; interpretation of clinical results; prospects for regulatory approval; manufacturing development and capabilities; market prospects for its products; and other statements regarding matters that are not historical facts. You may identify some of these forward-looking statements by the use of words in the statements such as "anticipate," "estimate," "expect," "project," "intend," "plan," "believe" or other words and terms of similar meaning. Cephalon performance and financial results could differ materially from those reflected in these forward-looking statements due to general financial, economic, regulatory and political conditions affecting the biotechnology and pharmaceutical industries as well as more specific risks and uncertainties facing Cephalon such as those set forth in its reports on Form 8-K, 10-Q and 10-K filed with the U.S. Securities and Exchange Commission. Given these risks and uncertainties, any or all of these forward-looking statements may prove to be incorrect. Therefore, you should not rely on any such factors or forward-looking statements. Furthermore, Cephalon does not intend to update publicly any forward-looking statement, except as required by law. The Private Securities Litigation Reform Act of 1995 permits this discussion.