The world works on a 24-hour basis, and humans have to adapt. Unfortunately, the stress associated with night shift work has many negative consequences. These are poorly researched and therefore poorly understood.
To get through the night shift, workers might be tempted to resort to medications, whether over the counter or prescribed. Which ones work?
In medicine, to tell what works, the gold-standard approach these days is to do a systematic review of the evidence. The Cochrane Group does these in a standardized way, and is generally considered a reliable source of evidence for the practice of medicine.
The group did a review of the evidence on medications to help night shift workers. Keep in mind that the focus of the group here was only on high quality evidence. They want to know what we can know with some certainty. They are not so interested in smaller or poorer quality studies that include substantial uncertainty. Furthermore, many commonly used medications, like caffeine, have not been studied in high quality trials. That means that we can't really know the effects for sure, from a scientific perspective. There are a lot of holes in the data.
The results of the review showed:
- Melatonin, while commonly used as a sleep aide, doesn't seem to work very well. At best, it increases the duration of your sleep by 15 to 25 minutes, but that might not even be true, based on the possibility of bias in studies.
- Armodafinil (Nuvigil) probably works to decrease sleepiness during the night shift for people diagnosed with shift work disorder (see below).
- Modafinil (Provigil) also seems to work as well, though its effect tends not to last as long and it may have more side effects, like palpitations.
- It's not clear whether other sleep aids, like zolpidem (Ambien), help you deal with night shift fatigue by improving your sleep during the day.
So really, all we have evidence for are armodafinil and modafinil. These are prescription medications indicated for shift work disorder, which is basically a formal label for feeling really tired and night and having trouble sleeping during the day.
The safety of long-term use of these drugs is not entirely clear, but they don't appear to be too bad.
An interesting note is that these drugs are also being used by normal daytime types as ways to increase their cognitive function. Generally this is looked down upon by the medical community, though there are some prominent self-hackers who extol the practice. (Warning: punctuation error in the last linked page's headline.)