Introduction
Night Shift Work has become increasingly prevalent globally, with the percentage of night shift workers as high as 18% in the US and at similar levels in other parts of Europe, Australia, Middle-eastern, and Asian Countries. Shift-Work covers any work shift between 7 am and 6 am and includes evening, night, and early-morning shifts along with rotating shifts that require workers to adjust their sleep cycles and subsequently interfere with their sleep patterns.
Impact of Shift-Work
Among the shift works, night shifts are considered to be among the most difficult, and they compromise several aspects of human health. On average, night shift workers sleep two to four hours less than an evening or rotating shift worker and have to sleep during the normal rising phase of the circadian rhythm, which prolongs their wakefulness. Lighting and noises add to the difficulty and result in them experiencing Stage-2 Rapid Eye Movement Sleep, regarded as the least Restful of sleep phases.
The problem is experienced more acutely during the Early Hours of the morning or the second half of the shift, leading to stressful working conditions and increased risk of errors and accidents. Epidemiological studies have shown psychiatric implications in the form of nervousness, irritability, and anxiety that impacts systemic health and leads to gastrointestinal troubles and metabolic disorders, namely Type II Diabetes and Cardiovascular Problems.
The problem is termed Shift Work Sleep Disorder as a blanket term encompassing all aspects of the shift-work-induced complications. Among all treatment options, psychostimulants like Armodafinil / Artvigil are considered one of the best treatment options for the problem. Artvigil 150mg has been shown to work in Chronic Shift Work Disorders of increased severity and work on reducing excessive sleepiness experienced by them. In addition, it improves long-term memory and attention that is impacted by chronic sleep deprivation or circadian rhythm fluctuations.
A word about Artvigil
Artvigil is the derivative of Armodafinil, an FDA-approved psychostimulant used to treat excessive daytime sleepiness problems. Armodafinil is the enantiopure version of another equally potent medicine Modafinil and because of its racemic purity has a longer half-life and better absorption. Artvigil, manufactured by HAB Pharmaceuticals, India, is the generic counterpart of Armodafinil and shares its pharmacodynamics, properties, and characteristic features. It is especially useful for Night Shift Workers and keeps them awake and attentive through its effects on Dopamine reuptake.
Artvigil vs. Modafinil in Shift Work Sleep Disorder Patients
To compare the efficacy and safety of Armodafinil ( the chief ingredient of Artvigil ), 211 patients with SWSD ( Shift Work Sleep Disorder ) were included in a 12-week, double-blind study. The participants were administered Armodafinil 150 mg or Modafinil an hour before their shift, and researchers assessed the medicine’s efficacy by evaluating their sleepiness scores.
Overall Armodafinil showed a slightly increased effectiveness than Modafinil in SWSD conditions and had a safer profile. Modafinil showed variable efficacy in patients, and its dose ranged from strengths of 200 mg to as high as 600 mg strength in chronic cases. But Armodafinil showed a constant strength profile, and its 200 mg strength maintained its wakefulness throughout the shift with the same effect. It even showed a 43% higher plasma concentration than Modafinil at 7-11 hours of dosing, with 28% less fluctuation than Modafinil over 24 hours.
Adverse reactions like headaches, nausea, Diarrhea, and Nervousness are less in Armodafinil than in Modafinil, which adds to its safety and effectiveness.
How does Artvigil exert its therapeutic effects in Shift Work Sleep Disorder Patients?
Understanding the biological impact of night shift work on the CNS and PNS is essential to comprehend Artvigils therapeutic effects better. Night shift impacts the circadian rhythms of biological functions and leads to changes in the activities in the Suprachiasmatic nucleus (SCN) of the human brain.
The SCN is a bilateral structure located in the anterior part of the hypothalamus that controls the timing of the sleep-wake cycles and coordinates it with circadian rhythms in the other brain areas and tissues to enhance behavioral adaptation. Besides circadian rhythms, SCN is also responsible for affecting the core body temperatures, the neuroendocrine systems, the memory, psychomotor and behavioral processes. Environmental factors like the light-dark cycle control it. As a result, people who work night shifts undergo a shift in SCN rhythm and suffer from sleepiness, insomnia, reduced work efficiency, altered cognitive function, and tiredness.
Animal studies on Armodafinil ( the chief ingredient on Artvigil ) have shown that the medicine inhibits the Ventrolateral Preoptic Nucleus that plays a vital role in inhibiting sleep to bring out its arousal-promoting effects. It even activates the dopaminergic pathways, stimulating wake-promoting centers and inhibiting sleep. While it does not directly bind to the dopamine receptors, it inhibits the dopamine transporter, a presynaptic monoamine transporter mediating Dopamine reuptake from the synapse to bring out its wake-promoting effects. Dopamine is a neurotransmitter vital in complex cognitive functions like working memory, language and thought, motor planning, and decision-making skills. It is at its highest levels in the afternoon and evening and peaks at night in anticipation of sleep, contributing to Dopamine synthesis and uptake.
Subsequently, chronically sleep-deprived night shift workers suffer from problematic dopamine transmission, reducing cognitive activity throughout the brain cells. Some studies have even hinted that Artvigil-induced inhibition of Dopamine reuptake restores SCN signaling in the hypothalamus and restores the circadian rhythm.
What do clinical trials suggest?
To evaluate the safety and efficacy of Armodafinil in SWSD patients, researchers conducted a six-week, multicenter, randomized, double-blind trial in 45 centers across the United States. Patients diagnosed with shift work disorder based on the International Classification of Sleep Disorders-DSM-IV were included in the trial. These patients had a Sleepiness Score > 6, experienced late-in shift sleepiness between 4 am-8 am, and were functionally impaired.
Using Artvigil significantly improved their Sleepiness scores, with statistically significant improvement observed within six weeks of treatment. Their productivity and activity levels improved, enhancing their quality of life.
Image Credit – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505139/
Other combined studies about Narcolepsy and Shift Disorder patients using Artvigil demonstrated that it was an effective and tolerated medicine.
Image credit- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952749/
Other Sleep Strategies that can be incorporated in people engaged in Night-shifts
- Going to bed later on the days off than usual but earlier than when working nights
- Waking up at the normal time and staying up through the first night shift.’
- Taking a nap of > 1 hour when you would generally sleep when working night shifts
- Sleeping in the daytime on workdays and off days
- Sleeping longer and later on the last night off to ease the wake time before starting the night shift
Conclusion
Artvigil is a safe and effective remedy for people working Night Shifts experiencing excessive sleepiness. Because of its wakeful promoting effects, it ensures that they maintain their work efficiency and can continue with their jobs without accidents or being written up because of increasing work-related mistakes. But it would be best if you used it as per the advice and guidance of your physician for its safe usage.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209035/
https://www.bmj.com/content/363/bmj.k4641
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464337/
https://www.news-medical.net/health/What-Are-the-Health-Effects-of-Working-Night-Shifts.aspx
https://psychscenehub.com/psychinsights/modafinil-and-armodafinil-mechanism-of-action/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505139/
