Millions of Americans who clock in before dawn may finally have help staying sharp on the job. A new clinical trial led by researchers at Mass General Brigham found that the wake-promoting drug solriamfetol, sold as Sunosi, can significantly improve alertness in early-morning shift workers dealing with shift work disorder. The results were published in NEJM Evidence.
About one in four workers operates outside a traditional 9-to-5 schedule, and many of those who start between 3 a.m. and 7 a.m. don't even think of themselves as shift workers. But waking during hours when the brain is biologically programmed to sleep takes a serious toll. "They are often dealing with a double burden — excessive sleepiness during work hours and difficulty sleeping enough when they have the chance to rest," said first author Kirsi-Marja Zitting, an investigator with the Division of Sleep and Circadian Medicine at Mass General Brigham.
Shift work disorder is associated with reduced mental sharpness, lower productivity, increased car accidents, and more workplace injuries. Existing medications like modafinil have mainly been studied in overnight workers and can disrupt sleep later in the day. Until now, no clinical trial had specifically tested a treatment for the disorder in early-morning workers — the most common type of shift schedule.
"People who start work between 3 a.m. and 7 a.m. are waking up at a time when the brain is biologically programmed to sleep," said senior author Charles A. Czeisler, chief of the Division of Sleep and Circadian Medicine. "This study addresses a major gap by focusing on the workers who start their day when most people are still asleep." Participants who took solriamfetol were able to function better throughout full shifts, with improvements in productivity, safety, and overall daily performance.
The trial represents an important step toward recognizing early-morning shift work as a legitimate medical concern rather than simply a lifestyle inconvenience. Researchers hope the findings will encourage both workers and healthcare providers to take the symptoms of shift work disorder more seriously.
