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A Pill to Stretch Your Day

A new drug keeps people awake with no apparent ill effects. But is prescribing it the right thing to do?

April 15, 2002|TIMOTHY GOWER | SPECIAL TO THE TIMES

It has become a modern cliche: There aren't enough hours in the day. Americans are struggling to balance work and family commitments while trying to find time for a social life and recreation. A growing number of supermarkets, restaurants, gyms and other businesses are accommodating today's 24/7 culture by staying open all night. Not to mention, of course, that the Internet never shuts down. But what if you could do the same?

What if you could take a pill and stretch your day--by skipping sleep?

That sounds like the stuff of science fiction, but a drug called Provigil could make it possible. Studies have shown that this new medication allows people to remain awake and attentive when their bodies normally crave shut-eye, without suffering the unpleasant side effects and risk of addiction associated with caffeine, amphetamines and other stimulants.

Researchers caution that the long-term health consequences of avoiding slumber by taking Provigil, or any drug, aren't well understood.

And the makers of Provigil go out of their way to state that the drug is strictly for patients who feel sleepy during the day due to diagnosed medical disorders. Yet as its reputation grows, doctors may soon find themselves faced with a difficult question: When is sleepiness a sickness?

"This drug is going to bring up some very interesting ethical dilemmas," says Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorders Center in Minneapolis and an expert on the causes of daytime sleepiness. "Do you prescribe a stimulant medication for someone who is intentionally sleep deprived?"

Currently the U.S. Food and Drug Administration has approved Provigil only for the treatment of one condition, narcolepsy, which causes a sudden and uncontrollable urge to sleep. But Cephalon, the West Chester, Pa.-based company that sells Provigil, hopes to win FDA approval within a few years to market the drug as a pick-me-up for people plagued by sleepiness associated with any medical condition. Many doctors in this country already prescribe Provigil "off-label," that is, for conditions not approved by the FDA (which is a common and perfectly legal practice). Those conditions include depression, sleep apnea, Parkinson's disease and multiple sclerosis.

What's more, scientists at sleep clinics across the United States are studying whether Provigil can help those working the swing or graveyard shift, who are sometimes diagnosed with a condition known as "shift work disorder." Symptoms can include insomnia, headaches and an all-around blah feeling, in addition to problems staying focused on the job.

For 20 years, Jane Jaegers has worked the overnight shift as a 911 dispatcher for Santa Clara County--four days a week, 9 p.m. to 7 a.m. The San Jose resident loves the job, but her body has never adjusted to the odd schedule. In the wee hours of the morning, Jaegers says, her attention occasionally drifts during nonemergency calls. If she takes them in time, caffeine pills such as Vivarin and No-Doz help, but they leave Jaegers staring at the ceiling when she goes home and crawls into bed. Constantly exhausted, she has seen her social life suffer. Go to a movie? "As soon as the theater gets dark, I'm gone," says Jaegers, 55.

In December, Jaegers heard that scientists at the Sleep Disorders Clinic at Stanford University were studying Provigil, whose name is shorthand for "promotes vigilance." She signed up right away.

Every night before leaving for work, Jaegers takes two small tablets--she calls them "magic pills." Because half the people participating in the study are receiving placebo tablets, Jaegers can't be sure she's popping Provigil. But she thinks her pills are the real deal. "I just feel more alert," says Jaegers, who adds that she sleeps soundly these days too. "I'm tickled with the stuff."

Drug Is Not Classified as a Stimulant

Provigil was developed in France in the 1970s. Although no one is sure how it works, animal studies show that the medication--unlike other drugs that induce wakefulness--doesn't seem to dramatically increase levels of dopamine, a neurotransmitter associated with arousal and alertness.

Caffeine and older prescription stimulants buzz the entire central nervous system, causing jitteriness, insomnia and other unwanted effects. When people who use coffee or amphetamines to stay awake finally doze off, they often remain in bed for much longer than usual, their bodies paralyzed by the need for "rebound sleep." Provigil, meanwhile, seems to target only the part of the brain that keeps us awake. When its effects wear off, the user resumes a normal sleep pattern.

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