Current Knowledge/Study Rationale: A nap is often recommended before working a night shift to improve alertness and performance, but naps in the evening may be difficult to achieve secondary to circadian alerting mechanisms. Modulation of the melatonin receptor system can improve sleep in the early evening, perhaps by attenuating circadian arousal mechanisms, and may potentially improve performance during the following night shift. Study Impact: While prior studies suggested that ramelteon lacks cognitive side effects, we demonstrate neurobehavioral impairments for up to 12 hours after administration. We caution that conditions of high homeostatic sleep pressure coinciding with the circadian performance nadir during a night shift may increase the sensitivity for residual hypnoticinduced deficits on subsequent waking performance.
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