Sleep Disorders Current Topics in Sleep Disorders

Overtime Pill: The Rest is History?

In a busy work day where there never seems to be enough time, a drug like Provigil is a powerful draw. Just take this FDA approved pill and zip though your day on a couple hours of sleep—no coffee, no soda, no naps necessary. You'll feel more productive and less tired even several hours later. The best part: Provigil wears off after 7 hours, so when you finally want to turn in for the night, you'll be able to quickly fall asleep.

It all sounds too good to be true, so some are concerned by the promise Provigil brings of adding hours to the day by shaving time off sleep.

Keeping Alert and Productive
Provigil (modafinil) is the first drug in a class of medications called central nervous stimulants and is the only one approved to treat "excessive sleepiness." While scientists are not totally sure how it works, the drug seems to alter chemicals in the small region of the brain that controls sleep and wakefulness.

Provigil was first prescribed for patients with narcolepsy and sleepiness associated with sleep apnea, but, in 2004, the FDA broadened its use to include sleepiness associated with shift work sleep disorder (SWSD).

This latest indication is for a newly-described disorder of people who work overnight or rotating shifts, defined by excessive sleepiness on the job, insomnia, lack of energy, headaches and difficulty concentrating. While this diagnosis seems like it could apply to just about anyone who is overworked, estimates of those who suffer from shift work sleep disorder vary widely from 8 percent to 25 percent of the six million U.S. shift workers.

"Patients with this under-recognized condition are just as sleepy at night as patients with narcolepsy or obstructive sleep apnea are during the day," said lead study author Dr. Charles A. Czeisler, professor of sleep medicine at Harvard Medical School.

In the first study to look at SWSD, published August 3 in the New England Journal of Medicine, 204 patients with the condition said they had modestly increased alertness and less sleepiness after taking Provigil, and during a 20 minute computerized test, the subjects had fewer lapses in attention. After taking the drug for three months, they reported only minimal side effects, including headache, nausea and nervousness.

In an editorial accompanying the study, Dr. Robert C. Basner, of the Duke University Medical Center, was less than convinced with the study's conclusion. "It is simplistic to consider that a pill alone could sufficiently modify the effects of this disorder," he wrote.

Even though Provigil is meant to provide a gentle boost for those who cannot adjust to an odd sleep and work schedule, some worry that it may be taken as crutch to overcome long work hours

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