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Work Now, Sleep Later

Natalie Staats Reiss, Ph.D. Updated: Jun 4th 2007

Would you take a pill that decreased your need for sleep? What if I told you that the pill could allow you to stay awake for 40 hours (or more) at close to full mental capacity with very few side effects other than mild headache, dizziness or nausea? A physician friend recently told me that she has seen a recent jump in the number of people asking her to write prescriptions for this medication.

Manufactured since 1998, modafinil, sold under the brand name Provigil, was originally designed to treat narcolepsy (a neurological condition that causes overwhelming and excessive daytime sleepiness and a tendency to fall asleep at inappropriate times and places). Since then, the drug received Food and Drug Administration (FDA) approval for people with sleep apnea (narrowing of the breathing airways that interferes with sleep) and for problems with staying awake associated with shift work. However, the most frequent use of the drug is "off-label". Off-label prescribing is the practice of using a drug or medical device for purposes other than those which are approved by the FDA. Not surprisingly, modafinil has been used off-label by traveling executives, soldiers, truckers, athletes, and college students trying to combat the effects of sleep-deprived schedules or gain a competitive edge.

Modafinil is a central nervous stimulant whose mode of action is not entirely clear. It seems to affect the hypothalamus (part of the brain that controls the sleep-wake cycle). In addition, the drug impacts the neurotransmitters (brain chemical messengers) dopamine, adrenaline, glutamate, and GABA. Unlike traditional stimulants (e.g., caffeine, cocaine, Ritalin), modafinil does not cause jitteriness, anxiety or restlessness. In addition, the medication does not seem to create a dependency (users must continue to take higher and higher levels of the medication to produce the desired effects), or withdrawal symptoms (users must keep taking the medication to stave off undesirable effects that occur when the medicine is no longer in their bodies). Not surprisingly, a drug that allows people to skip sleep with little "penalty" is enormously appealing in our competitive, performance-driven culture.

As my friend the physician pointed out, the long-term ramifications of the drug are unknown. Just because modafinil masks the need for sleep in the short-term doesn't mean that it's not wreaking havoc on the body across time. A large body of research points to a host of problems that occur when animals and humans are sleep-deprived, including problems with physical and cognitive performance, blood pressure, heart rate, insulin, hormone secretions, and so on. Only time will tell us about the long-term effects of modafinil use. "Not to worry", my friend quipped, "people can always pop one of the new sleeping pills if they start to have problems."


Reader Comments
Discuss this issue below or in our forums.

Who needs sleep? - Remus Suciu - Jun 7th 2007

Coming from college I can attest to the fact that sleep is superfluous.  Since I'm going to grad school and based on the rumors that it's similar to the labor of Sisyphus, only more difficult...and hopefully less pointless I'd better get accustomed to the thought.

 I hope your article does not turn out to be an advertisement for the drug and the doing in of sleep.

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