Tossing and turning: Shift workers often have trouble sleeping

Friday, Jan. 4, 2002 | 4:59 a.m.

Applications The Clinical Research Center of Nevada is now accepting applicants for a study of shift-worker sleep disorder. Participants must be between 18 and 60 years of age and suffer from sleeping problems associated with their work schedules.

As part of the three-month study, participants will spend several nights sleeping in the research lab and completing a simulated night shift. Participants will also have to maintain daily journals and limit caffeine, cigarettes and alcohol. The participants will be divided into two groups, with one receiving the prescription drug modafinil and the other receiving a placebo. All participants will receive $1,000 compensation. The study is sponsored by Cephalon Inc., a pharmaceutical company and manufacturer of modafinil.

For more information about the study, call 877-NITEJOB (648-3562).

Alex Repp hasn't had a good night's sleep in 17 years.

As a pit boss at Harrah's, Repp works the casino floor from 8 p.m. to 4 a.m. and drives home through the near-empty streets, searching for rest.

At home, Repp pulls down the room-darkening shades in his bedroom, unplugs the phone and climbs under the covers. And then he waits for sleep to come.

"I'll close my eyes and nothing happens," said Repp, 42. "Sometimes it takes me three hours to fall asleep, and then I'm only sleeping for two hours. And when I wake up, I'm more tired than when I went to bed."

Repp's hope for rest lies in a new study at the Clinical Research Center of Nevada that is trying to uncover a solution for shift-work sleep disorder. The disorder affects Repp and thousands of other shift workers whose bodies can't adjust to the schedule of the work. If there's an answer, researchers figure, it will be in Las Vegas, where about a third of the work force pulls shifts outside the regular 9-to-5.

"When you think about shift workers, you think about Las Vegas," said Dr. John Pinto, lead researcher for the study. "We have a unique opportunity to define what happens to shift workers' sleep and how we can help."

Getting a good night's sleep is more than satisfying a mother's urging, researchers say, as sleep problems can lead to health problems as well as contribute to accidents caused by fatigue.

"A good night's sleep is a basic necessity, not a luxury," said Pinto. "When you don't get enough sleep it takes a toll on you physically and emotionally."

Nearly two-thirds of the shift workers surveyed reported difficulty sleeping, and 29 percent said at least a few days a week sleepiness interfered with work and daily activities, according to the National Sleep Foundation. That's compared to 17 percent of regular day workers who reported similar difficulties.

The study is trying to use a drug that will simulate the effects of sleep on the brain, giving shift-workers -- who struggle following an unnatural sleep cycle -- the ability to rest.

Until recently, most sleep studies have focused on the effects of stimulants to keep people awake. College students pulling all-nighters long ago discovered sugar and caffeine as a way to keep working, Pinto said.

There are also prescription stimulants, such as amphetamine, that can boost wakefulness for short periods. But amphetamine, sometimes in the form of speed or crank, has a high potential for addiction. People usually end up "crashing" when the drug wears off, and experience dangerous side effects such as irregular heartbeat.

The new study will focus on a drug called modafinil, currently used for the treatment of narcolepsy. Cephalon Inc., a pharmaceutical company and the manufacturer of modafinil, is sponsoring the Las Vegas sleep study. Modafinil is believed to replace orexin, a recently discovered brain protein that is believed to control sleep-wake cycles.

Unlike conventional stimulants, modafinil seems to have no effect on people who have enough orexin.

"There's no buzz like we see with amphetamine, which means the chances of someone abusing modafinil are reduced," Pinto said. "If you're already awake and you take it, nothing happens."

No drug should be viewed as a replacement for sleep, said Dr. Robert Ingham, an assistant professor at the University of Nevada School of Medicine.

The idea of replacing sleep and creating soldiers capable of fighting 24 hours a day or factory workers that never go home isn't realistic, he said.

Modafinil could be a promising "rescue drug," helping shift workers get through the night while they learn healthier sleep patterns, said Ingham, who is not part of the new study.

Ingham said most of his patients are insomniacs -- unable to fall asleep no matter how hard they try. Las Vegas offers special challenges to insomniacs because there's never a shortage of places to go or things to do besides sleep, Ingham said.

The first step toward helping people with sleep disorders is to figure out how their circadian clocks are set, Ingham said. Some people are drawn to night work because they naturally feel more alert after dark, Ingham said. Most people are sleepiest between midnight and 6 a.m.

"There are definitely night owls and early birds," Ingham said. "And early birds probably shouldn't be shift workers."

Repp said he would like to switch to day shifts, but pit bosses are needed mostly at night. Repp, who has six children ranging in age from 9 to 18, said his work and sleep schedule contributed to his divorce and hurt his relationships with friends and family.

"You're not around your family as much as you need to be, and when you're trying to sleep, they're walking on pins and needles trying not to wake you up," Repp said. "It's frustrating for them, and frustrating for me."

As a participant in the study, Repp will have to use a computerized organizer to record what he eats, how tired he feels and how successful he is at falling, and staying, asleep.

"I'll do anything they tell me to if it means my eyes won't feel so heavy all the time," Repp said. "If I could just get a few hours real sleep every day, I would be doing great."