New Drugs Promise More Alertness: Sleep in a Pill

Sleep in a Pill

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.