Posted on 01/16/2005 3:03:17 AM PST by The Raven
PATRICIA PRATTIS JENNINGS, 63, FIRST TOOK PROVIGIL during a 2003 trip to Europe. Her doctor thought the drug—meant to help users suffering from a lack of sleep stay awake without jittery side effects—might counteract the jet lag that had plagued her throughout four globe-hopping decades as a pianist with the Pittsburgh Symphony Orchestra. Her first morning in Switzerland, she popped half a pill. Her usual fatigue disappeared almost instantly.
"I felt great all day and for a number of days after that," she says. The drug worked so well that she gave her husband some when he complained of feeling groggy.
Matt Parsons couldn't get through the day without drifting into an exhausted stupor. Barely 30, the Midlothian, Virginia, office manager always woke up feeling like he hadn't slept at all. He started calling in sick to work. When he did show up, he didn't accomplish much.
Eventually, he was diagnosed with a disorder that caused his limbs to jerk uncontrollably, disrupting his sleep. Anti-seizure medicine was ruled out because of the side effects. Instead, his doctor prescribed Provigil. An hour after taking his first pill, he remembered that his living room needed painting: "I looked over at the paint cans," he says, "got up, did all the prep, and painted the wall that evening."
A California lawyer had no medical reason to take the drug, but he did have a common complaint: "I work 10 to 14 hours a day, so I would have no personal life if I didn't sacrifice some sleep," he told an online support group. He now takes Provigil four times a day. "At the right dosage," he reported online, "this wonder drug is really great."
These aren't the only people enthusiastic about Provigil. Some sleep scientists have been impressed by its potential since the FDA approved modafinil (Provigil's generic name) in 1998. Sold by drugmaker Cephalon, the drug induces wakefulness without stimulating virtually the entire nervous system—an impossibility for its pharmaceutical predecessors, Ritalin and amphetamines. "Provigil works in a much more localized part of the brain, the hypothalamus, which controls the sleep-wake cycle," says Cephalon senior vice president Paul Blake.
Americans are chronically sleep-deprived. We now sleep one-fifth less than we did a century ago: the National Sleep Foundation reports that adults under 55 average just 6.7 hours of shuteye per weeknight. In part, that's because the 9 to 5 workday has become a relic of the past for many Americans. Somehow we also need to fit in time for ourselves, or for family and friends.
So the appeal of Provigil and of similar drugs that are sure to follow is obvious. Their development will mean that we've entered a new world in which we may be able to realize an impossible dream (If only there were more hours in the day). But are we just trading one problem for another?
Though considered safer and less likely to be addictive than the previous generation of stimulants, Provigil can be habit-forming. And because the drug is new, there are few long-term studies on its effects.
WHILE THE FDA INITIALLY APPROVED Provigil only for people with narcolepsy, a disease of excessive daytime sleepiness, doctors soon were prescribing it for other conditions, such as the fatigue linked to depression and multiple sclerosis. Sales have soared since its introduction. In 2000, physicians wrote 350,000 new and refill prescriptions; by last year the number had risen to 1.7 million. Military researchers have used it, too, keeping pilots awake for 40 straight hours during simulated helicopter flights.
But Provigil is just the tip of the iceberg. Dale Edgar thinks he can top it.
Edgar, a neurobiologist, spent much of his career at Stanford University's sleep research center. He left in 2000 to co-found the biotech firm Hypnion. At Stanford, Edgar, 48, gained fame when he discovered the functional role of the clock structure in the brain that keeps us awake. Known as the suprachiasmatic nucleus, this structure rings like an alarm throughout the day, growing quietest in the predawn hours. At the same time, another system called "sleep homeostasis" tracks how long we've been up and makes us grow sleepy when we've been out of bed for too long. The balance of these two systems, Edgar realized, regulates our daily sleep-wake rhythms.
Now, at Hypnion, Edgar hopes to find the exact location within the brain's complex chemistry where these two mechanisms mesh—to home in even more precisely than Provigil does—and then to find a medicine that stimulates that chemistry but not the rest of the nervous system. His goal: a drug even stronger and safer than Provigil. Such a pill could keep pilots alert during round-the-world flights. It could allow rescue workers to pull all-nighters at disaster sites. And it would surely appeal to college students, young professionals and working parents who want a quick fix for sleeplessness.
BUT IS SEEKING SUCH A FIX WISE? There's growing evidence that doing without sleep can boost the risk of developing various diseases. "At night, our biology is organized to repair tissues that have been assaulted—by pollution, by stress, by the workplace," says Michael Smolensky, a University of Texas environmental physiology professor. "If we take this away, we could be playing with danger."
Consider: University of Chicago researchers have discovered that when someone tries to survive on four hours of sleep a night, certain biochemical systems go awry, triggering symptoms of type-2 diabetes, memory loss and premature aging. And a recent Harvard study showed that female nurses working rotating night shifts for 30 years or more, never falling into regular sleep rhythms, have a 36 percent higher rate of breast cancer than those who never worked rotating shifts.
Given all that, some see the stay-alert pills as Band-Aids that cover up a short-term ill while ignoring—even exacerbating—long-term risks. What's good for one's lifestyle, these critics claim, isn't always good for one's life.
"If sleep were that unnecessary, it was a major evolutionary mistake," says Michael Wincor, associate professor of clinical pharmacy, psychiatry and behavioral sciences at the University of Southern California. "Why did we evolve to need seven or eight hours of sleep a night if all it takes is an external agent and then we don't need sleep? It's hard for me to conceive of that."
Physicians and ethicists also worry that these drugs are too tempting for many people to resist. "If people are under pressure to get ahead, and there's the possibility of working three, four, five, six days around the clock, they're going to try to get the drug, even illegally," says Audrey Chapman, an ethicist at the American Association for the Advancement of Science. Workers, she fears, will feel they must use such drugs to keep up with colleagues: "Once this starts, are we going to start a pharmacological arms race?"
That's just part of what troubles Harvard neurologist Thomas Scammel. "I've seen some truck drivers and, for reasons of lifestyle or economics or stubbornness, they refuse to get enough sleep," he says. "They say, 'I want this drug, and if I don't get it, I might get into an accident.'" Scammel says he won't prescribe modafinil under those circumstances—though he understands why others would.
Scammel sees few cases where drugs like Provigil should be used. "We really should be trying to work with people's biology," he says, "not using drugs to patch up unhealthy societal patterns."
To Dale Edgar, that's a pipe dream. He recognizes the health risks associated with not getting enough sleep, and he doesn't think drugs like Provigil or the one he's developing are appropriate for everyone. But he believes strongly that they provide real solutions to modern problems. "Are we going to shift away from a 24-hour society?" he says. "Not a chance. The train has left the station, and it's not coming back."
No one, Edgar says, needs these drugs all the time. Those who can benefit: people with a medical need and "individuals at risk for inappropriate sleepiness, or who have responsibilities for large numbers of people, where their impairment could affect others' lives." He cites long-haul truckers, pilots, rescue workers, soldiers, or night-shift workers who could doze off while driving home.
But how many of us will take these drugs to meet deadlines, dance until sunrise or just get through another drowsy day at work—regardless of what might be the health implications of fiddling with nature? Whatever the numbers, Edgar says, they don't undermine his primary justification for seeking a pharmaceutical wake-up call: "We can save lives."
Nothing doing! Sleep is good. More sleep is better.
Looks like a Yuppy drug. "...I can stay awake in meetings now without my boss nudging me to wake me up"
But is it addicitng?
Looks like it would be good for troops under certain circumstances.
Yep----see here
It's Sunday. I should be asleep. Old age and a steady body clock.
I fly on the back side of the clock continously. This sounds good but until the FAA approves it for commercial pilots we won't be seeing it. Too bad, we could sure use it!
>>I fly on the back side of the clock continously
I'm probably in the plane
Artificial energy. Used in moderation, to cut back sleep time by 2 hours, it might be benign.
If you don't get enough sleep, your brain is unable to run the equivalent of defragmenter, which means that your mind starts running slower and slower, taking more time to access data, system response suffers, and pretty soon you find that it takes all morning just to boot up.
Provigil?
Maybe for others, but not for me, thank you very much.
This is irresponsible and typical for today's medical and drug community. Anything to sell a drug and the doctors are willing accomplices.
LOL! Wouldn't you want the pilot wide awake?
Would this drug show up in testing? If a Marine were tested for drugs would this get him kicked out of the Corps?
Didn't they just find that the less sleep people get the fatter they are? The question becomes, "Sure you can dance all night, but who wants to dance with you, Fatso?" I can see these drugs being a big hit on the internet, though.
Sleeping....eating....I dunno which I like more.....
Oh, goodness.
No thanks.
I live on here as it is.
Thankfully, I sleep when I'm sleepy and FREEP between other duties--which, thankfully--means a LOT of FREEPING.
But I love my sleep. I just get it in 2-3 jumps.
Oh, goodness.
No thanks.
I live on here as it is.
Thankfully, I sleep when I'm sleepy and FREEP between other duties--which, thankfully--means a LOT of FREEPING.
But I love my sleep. I just get it in 2-3 jumps.
'A California lawyer had no medical reason to take the drug, but he did have a common complaint: "I work 10 to 14 hours a day, so I would have no personal life if I didn't sacrifice some sleep," he told an online support group. He now takes Provigil four times a day. "At the right dosage," he reported online, "this wonder drug is really great."'
In other words, he wasn't getting enough action. Pathetic; what other chemicals is he taking to "enhance" his lifestyle?
What the article conveniently doesn't say, is that there is a large variation in the requirement for sleep among individuals. A significant portion of the population does very well on four hours of sleep a night. A very small, but measurable number, do very well on one hour of sleep per day. Thomas Edison, for example needed very little sleep, generally getting only a couple of cat naps.
The point of all this is that since we *know* that some people live long and healthy lives with very little sleep, it is not inherent in human biology to require 8 hours of sleep for health. Perhaps only 4 hours is necessary, perhaps only 1 hour.
I am all for the technological advances that would allow me to safely regulate the amount of sleep that I want. In some circumstances I might wish to sleep for 20 hours a day, in some 1 hour. I would love to have that choice, and I see no reason why it could not be possible some day.
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