Modafinil for excessive sleepiness associated with shift work sleep disorder
Open accessAbstract
BACKGROUND: Patients with shift-work sleep disorder chronically have excessive sleepiness during night work and insomnia when attempting to sleep during the day. We evaluated the use of modafinil for treating sleepiness in patients with this disorder. METHODS: In a three-month, double-blind trial, we randomly assigned 209 patients with shift-work sleep disorder to receive either 200 mg of modafinil or placebo before the start of each shift. Assessments were performed with the use of the nighttime Multiple Sleep Latency Test, the Clinical Global Impression of Change, the Psychomotor Vigilance Test, diaries of patients, and daytime polysomnography. After randomization, we conducted monthly assessments. RESULTS: Treatment with modafinil, as compared with placebo, resulted in a modest improvement from baseline in mean (+/-SEM) nighttime sleep latency (the interval between the time a person attempts to fall asleep and the onset of sleep) (1.7+/-0.4 vs. 0.3+/-0.3 minutes, respectively; P=0.002), and more patients had improvement in their clinical symptoms (74 percent vs. 36 percent, respectively; P<0.001). Patients who were receiving modafinil also had a reduction in the frequency and duration of lapses of attention during nighttime testing of their performance on the Psychomotor Vigilance Test (change from baseline, a reduction in lapse frequency of 2.6 vs. an increase of 3.8, respectively; P<0.001), and proportionally fewer patients reported having had accidents or near accidents while commuting home (29 percent vs. 54 percent, respectively; P<0.001). Despite these benefits, patients treated with modafinil continued to have excessive sleepiness and impaired performance at night. Modafinil did not adversely affect daytime sleep as compared with placebo. Headache was the most common adverse event. CONCLUSIONS: Treatment with 200 mg of modafinil reduced the extreme sleepiness that we observed in patients with shift-work sleep disorder and resulted in a small but significant improvement in performance as compared with placebo. However, the residual sleepiness that was observed in the treated patients underscores the need for the development of interventions that are even more effective.
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Modafinil ameliorates the adverse effects of sleep deprivation on alertness and performance.
“ameliorates the adverse effects of sleep deprivation on alertness and performance (27–29)”
From Sleep Restriction for 1 Week Reduces Insulin Sensitivity in Healthy Men (2010) · cites this paper as [29]
The efficacy measures and discussion (page not provided) report improved nighttime alertness and sustained-attention performance with modafinil versus placebo. The trial studied patients with shift-work sleep disorder, not sleep deprivation generally, and found that sleepiness and impaired performance persisted despite treatment. (LLM, conf=0.85)
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- Authors
- Czeisler, C. A., Walsh, J. K., Roth, T., Hughes, R. J., Wright, K. P., Kingsbury, L., Arora, S., Schwartz, J. R. L., Niebler, G. E., & Dinges, D. F.
- Affiliations
- Brigham and Women's Hospital (US)
- Henry Ford Hospital (US)
- INTEGRIS Baptist Medical Center (US)
- University of Pennsylvania (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2005-08-04
- Volume
- 353
- Issue
- 5
- Pages
- 476-486
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2107728601
- Cited by
- 413
- References
- 31
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 7 · 2023: 13 · 2022: 12 · 2021: 15 · 2020: 28 · 2019: 9 · 2018: 10 · 2017: 9 · 2016: 13 · 2015: 16 · 2014: 22 · 2013: 25 · 2012: 25
- FWCI
- 40.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- modafinil, shift work disorder, excessive sleepiness, sleep latency, daytime sleep, attentional lapses, psychomotor vigilance, traffic accidents, headache adverse effect
- MeSH terms
- Modafinil, Adult, Central Nervous System Stimulants, Attention, Benzhydryl Compounds, Double-Blind Method, Female, Headache, Humans, Disorders of Excessive Somnolence, Male, Middle Aged, Psychomotor Performance, Work Schedule Tolerance, Sleep Disorders, Circadian Rhythm
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