NIOSH Training for Nurses on Shift Work and Long Work Hours

Sleep Aids and Stimulants

People can be helped by using the good personal strategies and workplace management strategies discussed in this training program. It is best to use these non-pharmacologic strategies fully to achieve alertness and good sleep. Careful use of sleep medications and stimulants could be considered for short-term help until the non-pharmacologic strategies can be implemented or when occasional difficulties with sleep or alertness occur.

Be aware that a wide range of serious side effects have been reported with use of some stimulants and sleep medications. These include but are not limited to serious neurological, cardiovascular, gastrointestinal, and skin reactions as well as strange behavior, suicidal thoughts, and hallucinations. A few deaths from severe skin reactions have been reported that were linked to some prescription stimulants.¹⁰ Continued sleepiness can occur on awakening after using some sleep medications. Over time, these medications can lead to dependence or loss of effectiveness. In addition, these substances may not completely remedy the effects of sleep deprivation, and the effects of long-term use are not fully known. A 2014 Cochrane Review examined the evidence from 15 randomized placebo-controlled trials that tested sleep medications and stimulants in shift workers.¹⁰ The authors concluded that the evidence about effects on shift workers’ sleep and alertness is limited and low in quality, and more research is needed to determine their beneficial and harmful effects. Their conclusions were similar to the American Academy of Sleep Medicine practice guidelines for shift workers that were published in 2007.¹¹
If you follow the suggestions for creating a good sleep environment (preparing to sleep, timing your sleep according to your work schedule, and using light to maintain alertness) you may sleep well without any medication. Everyone has an occasional night when sleep does not come easily, and that is normal. However, if you develop a pattern of not sleeping, and this is of sufficient severity that you are sleepy at work or while driving, then you should see a health care provider. A consultation with a sleep medicine specialist is the best way to find out why you cannot get enough sleep and what to do about it. At the end of the training, the Other Resources section has a list of web sites that can help you find a sleep center and board-certified sleep specialists.