There Are Ways to Get a Good Day’s Sleep

Night-shift workers--like day-shift workers--often fall asleep quickly and easily at the end of their workday. Staying asleep, however, is another matter. Within earshot of barking dogs and crying children, night-shift workers often tell doctors they’re not able to sleep long enough to wake up refreshed.

Intermittent use of a controversial sleeping pill can help, at least for middle-aged workers, says a St. Louis research team that studied this approach in 15 shift workers and published the findings in a recent issue of the journal Sleep.

In the study, subjects who had not worked a night shift or rotating shift during the last year put in two “tours” of duty, each for four consecutive nights, working on a simulated night shift. During one tour, they took the sleeping pill triazolam (Halcion) on the mornings after they worked nights. During the other tour, they took a placebo pill. The subjects, whose average age was 41, didn’t know which pill they were taking.

The workers became increasingly alert on the job, even on the shifts when they had not taken the active pill, says psychologist James Walsh of the Sleep Disorders and Research Center at Deaconness Hospital, who led the study. That’s because, he says, the body naturally and gradually adapts to a schedule change.

But when taking the drug, the workers described their daytime sleep as longer, deeper and of better quality. The sleeping pill stretched sleeping time by about half an hour--not as big an increase as Walsh expected. Workers taking the sleeping pill were “more alert and less prone to on-the-job errors” than those taking the placebo, says Walsh, whose study was funded by the drug’s manufacturer. But in another manufacturer-funded study published about two years ago, Walsh found the same sleeping pill did not improve job alertness in night shift workers in their 20s.

Halcion came under intense scrutiny several years ago after the Food and Drug Administration received numerous reports of amnesia and other side effects. In one of the most recent lawsuits, a Utah woman, charged with killing her mother, sued the manufacturer, claiming it failed to notify the public of its “severe” side effects. The case was settled out of court; charges against the woman were dropped.

A government panel recommended in September, 1989, that a label change reflect the incidence of side effects but saw no need for a ban. Many sleep experts contend that the sleeping pill is safe when prescribed and taken appropriately.

Judicious use of sleeping pills, especially for middle-aged night-shift workers, may be one answer, Walsh says.

He recommends:

* Take Halcion only on mornings after working a night shift.

* Use the lowest effective dose.

* Use for short periods of time--days or weeks, not months.

* Don’t combine with other sedating medicines or alcohol.

* Don’t take Halcion if you have sleep apnea (temporary cessation of breathing).

“It’s an interesting study . . . and sounds reasonable,” says Michael M. Stevenson, clinical director of the North Valley Sleep Disorders Center in Mission Hills.

Both Walsh and Stevenson caution that temporary night workers--such as doctors on call or other workers who might be summoned to the job during customary sleep hours--should not take sleeping pills because the pills would have adverse effects on their performance.

There are some nonmedical sleep remedies for night workers, too, adds Paula Schweitzer, co-author of the study. “When night-shift workers wake up during the day, they tend to give up too easily, and say, ‘Oh, I am awake, I might as well get up.’ ” Schweitzer tells them to lie in bed a while and give sleep a chance. “Keeping the sleep schedule the same, even on nights off, can help too,” Schweitzer says, “but I know that is not always practical.”