There’s a particular cruelty to waking up at 4 a.m. Your brain is screaming at you to stay asleep. Your body feels like it’s moving through molasses. And you’ve got eight hours of work ahead. Welcome to the world of early morning shift workers, a group that makes up roughly one in four workers in the U.S., yet remains mostly invisible in conversations about workplace wellness.
According to research from Mass General Brigham, a new clinical trial published in NEJM Evidence has found that a wake-promoting drug called solriamfetol can genuinely help these workers stay alert during their shifts. It’s the first time anyone has actually tested a treatment specifically designed for early morning shift workers, which tells you something about how overlooked this problem has been.
The Invisible Shift Work Crisis
Here’s the thing about early morning shifts: many people don’t even consider themselves shift workers. They just think they’re “morning people” or that they have an early schedule. But biologically, starting work between 3 a.m. and 7 a.m. puts your brain in direct conflict with its own programming. You’re being asked to perform complex tasks during hours when evolution designed you to be unconscious.
The consequences are real. Shift work disorder, as it’s clinically called, isn’t just about feeling groggy. It tangibly reduces mental sharpness, tanks productivity, and dramatically increases the risk of car accidents and workplace injuries. Night shift workers have gotten most of the attention in medical literature, but early morning workers face what Kirsi-Marja Zitting, PhD, from the study team, describes as a “double burden: excessive sleepiness during work hours and difficulty sleeping enough when they have the chance to rest.”
Medications like modafinil have been around for years to combat shift-related fatigue, but they were mainly studied in overnight workers and can disrupt sleep later in the day. That’s a trade-off that doesn’t really solve the problem.
What the Trial Actually Found
The research involved 78 early morning shift workers diagnosed with shift work disorder. Over four weeks, some took solriamfetol on workdays while others took a placebo. Researchers watched them in controlled, low-stimulation settings that mimicked their work environment during their actual work hours.
The results weren’t subtle. Workers on solriamfetol stayed awake longer, reported less sleepiness, and showed clear improvements in job performance and daily functioning. Charles Czeisler, the senior researcher, noted that “these workers were able to stay awake and alert throughout a full eight-hour shift, which has real implications for performance, safety, and quality of life.”
That matters. A lot. These aren’t marginal improvements on some academic metric. We’re talking about people actually being able to function during hours their bodies naturally reject.
Solriamfetol itself isn’t new to medicine. It’s already approved for treating excessive sleepiness in people with obstructive sleep apnea and narcolepsy. The drug has a proven track record of promoting alertness for extended periods without derailing sleep later in the day, which made it a logical candidate for this trial.
The Realistic Caveats
There’s always a “but” in science, and this research has some legitimate ones. The trial lasted only four weeks. The participants were otherwise healthy adults. The sample size was small. We don’t actually know yet what happens if someone takes this drug for months or years, or how it works in people with other health conditions.
The research team is now enrolling participants for a follow-up trial with overnight shift workers, which could eventually expand approval for treating shift work disorder more broadly. That’s important, because right now we’re talking about a drug that works, but only in one specific context.
Also worth noting: this trial was funded by Jazz Pharmaceuticals, which manufactures solriamfetol, along with Axsome Therapeutics and Brigham and Women’s Hospital. That financial relationship doesn’t invalidate the research, but it’s worth keeping in mind when weighing how enthusiastically the results get promoted.
Why This Matters Beyond the Lab
Millions of people work early morning shifts. Many of them are essential workers: healthcare providers, factory workers, delivery drivers, first responders. They keep society running while the rest of us sleep. The hidden cost they pay is constant, biological exhaustion that affects not just their work but their health, safety, and quality of life.
For too long, the conversation around shift work has either ignored early morning workers entirely or lumped them in with overnight workers as if the challenges are identical. They’re not. An overnight shift worker is fighting against social isolation and cultural weirdness. An early morning shift worker is fighting against their own neurobiology.
Having a pharmaceutical option that actually works changes things. Not perfectly. Not comprehensively. But meaningfully.
The real test will be what happens next. Will regulatory bodies expand approval for solriamfetol to treat shift work disorder in early morning workers? Will insurance companies actually cover it? Or will this drug remain one more treatment that exists in theory but stays inaccessible to the people who need it most?
