One Pill, Two Days, No Sleep

Sleep is just a waste of time. Let’s be honest. Hitting the sack for eight hours every night is just not an option this time of year. Unfortunately, the strongest stuff most students take to keep awake is caffeine, which makes you both wired and addicted, and has recently found to be a potent insecticide. (A report in Nature this summer showed that slugs placed in caffeine-sprayed soil soon die in a fit of “uncoordinated writhing.”)

Enter Provigil. It’s a small, white and slightly oblong pill that has fewer side effects than caffeine, is safe even in large doses, and has not yet been shown to be any more addictive than your bottomless cup of coffee from Toscanini’s. Army helicopter pilots who have taken the drug were able to stay up for 40 hours, sleep for eight hours, and then stay up for another 40 hours without losing the ability to perform complex tasks. Although the military often experiments with ways to keep soldiers awake, the rest of us need a prescription from a doctor to get Provigil. But getting that prescription may soon get much easier. The manufacturer of Provigil (which is also called modafinil) announced two weeks ago that it would try to get the drug approved for “circadian rhythm disorder,” a fancy name for being sleepy when not sleeping on a normal schedule. If approved for this use, Provigil will take one more step toward becoming a lifestyle drug like Viagra that completely changes the way we think about sleep.

The drug has already started making headlines—accompanied by much hand-wringing—on other Ivy League campuses as a substitute for sleep. This worry is misplaced, however. If current trends play out, sleep is just the latest human behavior that will pass from normal, to problematic to disease. One day, when sleep becomes a treatable condition like cavities in your teeth or ear infections, Provigil may be heralded as a forerunner of wonder-drugs that free us from the tyranny of the pillow.

So far, Provigil has not made a splash on the Harvard campus. Multiple inquiries to local dealers turned up no sign of the drug. Dexadrin (speed) and adderall (various amphetamines) are freely available, but the dealers have not even heard to Provigil. However, this lack of interest from the black market may be Provigil’s great advantage. Many people who take Provigil now do so not to treat narcolepsy (the only condition for which the drug has been approved) but for other, “off-label” conditions such as simple jet-lag. Doctors, not dealers, are currently the biggest source of this drug.

Moreover, there is precedent for normal behaviors such as sleep being transmogrified into disease. A good example is Attention Deficit and Hyperactivity Disorder (ADHD), which according to some psychiatrists, may affect 15 million Americans. This disease, which was originally called ADD, entered the American Psychiatric Association’s list of disorders only in 1980. Within in a decade, Ritalin became the favored drug to treat this disorder, and both the disease and the drug became wildly popular. But the enormous numbers of children taking the drug suggest that the normal exuberance of childhood has been declared treatable. Studies on the use of drugs such as Ritalin have proven their amazing popularity. A 1995 study of a Medicaid program in the Midwest, for example, showed that over 10 percent of children age two to four were taking Ritalin or another stimulant.

The best explanation for these results is that the drug and the disease have co-evolved and now exist in a harmonious, mutually beneficial relationship. Without the disease, the drug would be just another form of getting high. (Ritalin and cocaine are similarly preferable to laboratory animals when given a choice.) And without the drug, the disease could be written off as normal childhood boisterousness.

Thus, the border between drugs to support a lifestyle and drugs to treat a disease is constantly shifting. The mothers who demand Ritalin for their sons do so not only so their children can sit still through hours of boring class time; it’s just plain easier to deal with a pliable, narcotized child than a normal, energetic, rambunctious one. Doctors, who have been put in an increasingly difficult position in the last decade as pharmaceutical companies try to sell their drugs directly to patients, have a difficult time saying no if their colleagues are all saying yes when patients demand drugs.

Provigil is not a wonder drug that will do away with sleep. It has been shown to be similar to caffeine in effectiveness, with fewer side effects. It’s a stimulant and causes a mild euphoria. It has definite benefits, however, of not producing significant symptoms of withdrawal (something anyone who has been afflicted with caffeine headaches will appreciate). Even in extremely large doses, it has proven not to have life-threatening effects. Provigil is not the cure for sleep.

But when the cure for sleep does come, should we take it? That’s a tough question. I think I’ll sleep on it.

Jonathan H. Esensten ’04 is a biochemical sciences concentrator in Lowell House. His column appears on alternate Thursdays.