Source: Slate
Date: 7 March 2003

Wake Up, Little Susie Can we sleep less?

By David Plotz

picture of Provigil / modafinil

On most days, my accumulated sleep deficit and post-lunch stupor gang up on me around 2 p.m., and I begin my slow fade. My eyes droop. Saliva dribbles onto my sweater. If I were trying to write this sentence at 2 p.m. on a normal day, it would read something like: "If I were tryyyyyyyyyyyyyyy … "

But today, I am bright-eyed and bushy-tailed, a chatty Kathy with my officemates, eager to spend all afternoon banging on the keyboard. (I normally prefer chewing my fingers off to writing.) I am not exactly wired, but I'm more alert, more focused, more Plotz-like. Today I am my own Superman, dosed on 100 milligrams of modafinil.

Every year, we need the same amount of sleep, and every year we get less. Since the invention of artificial illumination, sleep has been a bear market. There are many reasons we catch fewer Z's: Round-the-clock workplaces, longer commutes, brighter lights, 24-hour Krispy Kreme stores, the Home Shopping Network - the list goes on. According to University of Pennsylvania professor of psychology David Dinges, Americans probably sleep about six and a half to seven hours per night, compared to the more than eight hours our bodies want.

We have learned to cope with a regular sleep deficit, but we pay a price (and not just $4.05 for the venti latte). Studies by Dinges and military scientists have proved that performance deteriorates when you sleep less than eight hours. People who rest seven or six or five hours a night may not feel tired, but their thinking and dexterity are suffering. We medicate ourselves with caffeine, a drug that raises alertness but at a cost of jitteriness, irregular heartbeat, and addiction. Folks who really need to stay awake dope themselves with amphetamines - stimulants that can ward off sleep for days but cause terrible crashes when they wear off. (And we don't know what long-term damage they cause.)

The military is enthralled with the possibility of doing away with shut-eye. The supersecret Defense Advanced Research Projects Agency is investigating drugs that would keep soldiers awake for a week. The Air Force prescribes "go pills" - small doses of the amphetamine Dexedrin - to pep up long-haul pilots. (But hopped-up pilots may be dangerous: The American pilots who accidentally bombed and killed Canadian soldiers last spring were taking go pills.)

Avoiding sleep for a week might be necessary in an extreme situation like war, but the run-of-the-mill, office-working, wannabe Superman requires something different. We don't want a pill that will keep us Exceling and Power Pointing for three days straight. We just want something that makes us feel alert through an entire normal day - a drug that makes us feel as lively for the 18-hour-day we have to live as for the 16-hour-day we ought to live.

Hence my rendezvous with modafinil. The drug, made by Cephalon, is marketed under the creepy, pharma-Orwellian name Provigil. The FDA approved it in 1998 to treat narcolepsy, but it is starting to have a underground life as a pick-me-up for the routinely sleep-deprived. The military has tested it heavily, particularly on pilots.

The way modafinil works is not understood. It seems to slow the release of GABA, a sleep promoter in the brain. It also may act on the histamine system, which is connected to sleep regulation. What is clear is that modafinil differs from most other pick-me-ups, which tend to be indiscriminate in their function. Amphetamines like Dexedrine, for example, promote wakefulness by interfering with uptake of the neurotransmitter dopamine, causing dopamine to flood the brain. Dopamine, says Joyce Walsleben, director of the NYU Sleep Disorders Center, is a "broad hitter" that sets the heart racing, causes twitchiness, and makes you feel high. When the effect of such stimulants wears off, the crash is nasty. Caffeine affects a different pathway, involving adenosine, but that, too, spills over the brain's flood wall, making coffee drinkers jittery.

But modafinil tiptoes around dopamine, confining its activity to the particular neurological processes connected to wakefulness. It doesn't seem to act as a broad stimulant. (This is one reason, Walsleben says, that modafinil has not become a street drug. Unlike cocaine or amphetamines, modafinil doesn't make you feel high, and it acts very slowly, taking a couple of hours or more to kick in.) Narcoleptics seem to love modafinil. (By boosting alertness throughout the day, modafinil reduces the narcoleptic's compulsion to nod off.) Now doctors are getting barraged by requests from regular folks who want to use it to cut down on sleep.

The seduction of modafinil is that you can feel as peppy after six hours sleep as you would after nine. (It may also have a more drastic effect.) Doctors see modafinil as an occasional pick-me-up. They doubt you could take the drug everyday without consequences: Most sleep researchers agree that the longer sleep is necessary for hormonal regulation, among other essential bodily functions. (Drugs aren't the only way we may steal less sleep. Click here to read about how we may enlist gene therapy to help us stay awake.)

Tired of merely writing about enhancement (and tired, period), I decided to conduct my own unscientific trial of modafinil. As the father of a 2-year-old, I live in a constant haze of sleep deprivation. I vowed to take modafinil for a week and see what happened. Could it transform a lazy, exhausted hack into a brilliant Jeffrey Goldberg? Or recast a grouchy father into Superdad? I persuaded my doctor - and no, you can't have his number - to prescribe me a week's supply of Provigil, seven 200-milligram pills.

Here is the diary I kept.

Day 1, Monday
6:45 a.m.: Woken up by my daughter after the usual six and a half hours.

7 a.m.: I open the bottle. The pills are monstrous. I start to chicken out. I've never smoked pot, much less taken cocaine or amphetamines. I decide to halve the dosage. When I cut the first pill with my pocketknife, half of it shoots off my bureau, slides across the floor, and disappears under a dresser, no doubt to be discovered and eaten by my daughter someday in the near future. I pop the other 100-milligram half.

10 a.m.: At the office. I've felt no rush, but alertness has snuck up on me. I am incredibly attentive, but not on edge. I really, really feel like working, a rare sensation.

12 p.m.: I reach for my usual lunchtime Coca-Cola, then think better of it. Caffeine plus this sprightliness and I will be ping-ponging off the walls.

2 p.m.: This is when I usually fold. Today I am the picture of vivacity. I am working about twice as fast as usual. I have a desperate urge to write, to make reporting calls, to finish my expense account - activities I religiously avoid. I find myself talking very loudly and quickly. A colleague says I am grinning like a "feral chipmunk."

6 p.m.: Annoyed to have to leave the office when there is all this lovely work to do.

9 p.m.: Home. After dinner, I race upstairs to start working again. This is totally out of character, especially on a Monday Night Football evening.

12 a.m.: I want the day to keep going but force myself to go to bed. I fall asleep easily enough, but it's a weird night. I have lots of dreams, which is unusual. All are about Getting Things Done.

Day 2, Tuesday
6:30 a.m.: I wake up feeling good, cut another pill in two, and pop a half.

9 a.m.-7 p.m.: I work like a fiend again. These have been the two most productive days I've had in years. Idea for new Provigil ad slogan: "Bosses' Little Helper."

1 a.m.: Again I'm alert through the late evening—so alert that I infuriate my wife by chattering at her long past her bedtime. This time, when I do conk out, I sleep deeply. Day 3, Wednesday 7 a.m.: My one-man clinical trial starts to fall apart. Everyone says modafinil is not addictive, but I wake up worried about how long my supply will last. I count the pills and realize I have only five and a half left. That's just an 11-day supply. I remember that I offered a sample to a friend yesterday. I am annoyed - one day less for me. I start to cut up the remaining pills, wondering if I can divide them into thirds instead of halves.

I realize that maybe I can find a different supplier. I log onto the Internet to see if I can get modafinil on the sly. I find it cheap at the Discount Mexican Pharmacy. I feel delighted and relieved. Then I feel terrified that I am delighted and relieved. "Discount Mexican Pharmacy"?!

7:30 a.m.: I end my experiment after two days. I am acting like a lunatic. I stash the remaining pills in a distant corner of the medicine cabinet. I calm myself with the reminder that I have 11 more great days to look forward to.

So is modafinil a drug for future superpeople? Maybe. There are good reasons for doubt, though. The drug is approved only for treating narcolepsy, and doctors are not going to prescribe it like aspirin anytime soon. Though patients don't seem to get addicted to modafinil or to build a tolerance, according to Walsleben, the drug has been in use for only 10 years, and no one knows for certain that it's safe over the long term. (Cephalon and other drug companies, incidentally, are working on even more powerful wakefulness drugs, but none is on the market yet.)

I loved taking modafinil for two days. I worked supernaturally hard and well. But I'd be afraid to make it a habit. I'll use it again for a special occasion - when I am late for a deadline, perhaps. In the meantime, I'll just yawn my way through the midafternoon.
further reading

Product Info
Caphalon, Inc
BLTC Research
Quality Health Inc
The Good Drug Guide
Modafinil (Provigil) : structure
Modafinil: The Kelli White Affair
Modafinil (Provigil) and Beyond
Big Pharma and Madison Avenue
Narcolepsy and Sleep Disorders Hotlinks
Modafinil (Provigil): FDA endorses new uses