By Alexandra Gill, Globe and Mail, April 1, 2006
Every morning, I wake up to a pounding wail of thunder, feeling shaken, spent and thoroughly unsatisfied. Then I roll over, hit the snooze button, and do it again.
This bleary-eyed ritual, which must be repeated several times to drag my weary body out of its deprived state of slumber, is the symptom of a widespread hunger.
"Sleep is the new sex." So says Arthur J. Spielman, a New York psychologist and co-author of The Insomnia Answer. "People want it, need it and can't get enough."
This weekend, as we spring forward to daylight time, and lose yet another precious hour of shut-eye, it's the same old story: We're getting less and less sleep.
The National Sleep Foundation (NSF) estimates that the average sleep time in the United States has dropped by more than 20 per cent in the past century. By last year, 71 per cent of people were getting by with less than the eight hours of sleep the body needs (up from 63 per cent in 1998). According to the latest numbers from Statistics Canada, one in seven Canadians -- 3.3 million people -- have trouble going to sleep and staying asleep.
Things are now so bad that the Monday after the annual switch to daylight time has been declared National Napping Day, and this year the goal is to have us catch 40 winks while on the job.
"We live in a time famine," says Harvey Moldofsky, director of the Centre for Sleep and Chronobiology at the University of Toronto. "There isn't enough time in our waking periods to accomplish all of the expectations industrialized society requires of us."
The 24/7, BlackBerry-buzzing, on-demand lifestyle is taking its toll. We pummel ourselves through a vicious cycle, jolting up on caffeine during the day and knocking ourselves out with hypnotics at night. Last year, 42 million sleeping-pill prescriptions were filled in the United States, up 60 per cent since 2000, according to a study by Forbes magazine.
This cranky, edgy, worn-out state of being leaves us vulnerable to anxiety, depression and weakened immunity. Studies have shown that a lack of sleep affects memory loss and dexterity and has contributed to rising rates of obesity. Not surprisingly, it also diminishes our sex drive. In last year's Sleep in America poll conducted by the NSF, nearly one-quarter of partnered adults said they have lost interest in sex, or have it less often because they are just too darn tired.
There has to be a better way. Perhaps there is.
What if you were offered a magic pill that made you feel alert throughout the entire day, without the jitter, buzz, euphoria, crash, addictive qualities or potential for paranoid delusion that come with amphetamines and caffeine? Would you be interested in a pill that lets you bounce back from a late night, bright-eyed and bushy-tailed, after just four hours of sleep?
Meet modafinil, "the first wave of new lifestyle drugs that promise to do for sleep what the contraceptive pill did for sex -- unshackle it from nature," New Scientist magazine trumpets in a recent cover story.
"Modafinil has made it possible to have 48 hours of continuous wakefulness with few, if any, ill effects," Graham Lawton writes, almost giddily, about the brave new world of 24-hour living.
"New classes of sleeping pills are on the horizon that promise to deliver sleep that is deeper and more refreshing than the real thing," he continues. "Further down the line are even more radical interventions -- wakefulness promoters that can safely abolish sleep for several days at a stretch, and sleeping pills that deliver what feels like eight hours of sleep in half the time."
Modafinil, a stimulant trademarked as Provigil in the United States and Alertec in Canada, was approved by the U.S. Federal Drug Administration in 1998 to treat narcolepsy, a chronic neurological disorder that causes excessive daytime sleepiness, loss of voluntary muscle tone, vivid hallucinations and brief episodes of total paralysis.
The way modafinil works is not clearly understood. It seems to target regions of the brain believed to regulate normal wakefulness and cognitive functions, perhaps by slowing the release of GABA (a sleep promoter in the brain) or acting on the histamine pathways (connected to sleep regulation). And unlike amphetamines, cocaine and most other pick-me-ups, it doesn't appear to fire up the neurotransmitters that cause dopamine to flood the brain, which then sets the heart racing, makes you feel high and causes twitchiness.
"It works," Dr. Moldofsky says. "It's not a panacea, but our studies have shown that, for narcolepsy, it can be very helpful. It literally can change the lives of these people overnight."
Although modafinil is still approved only for narcolepsy, there are many who would like to put it to other uses. The U.S. Defence Department has been testing it heavily as a replacement for dexedrine, the "go pill" taken by the two U.S. Air Force bomber pilots who accidentally killed four Canadian soldiers in Afghanistan.
Last winter, researchers at the University of Pennsylvania published the results of a small study, which found that modafinil may help recovering cocaine addicts fight their addiction. Some professional athletes were using it to enhance their performance, until the International Olympic Committee and World Anti-Doping Agency listed it as a banned substance in 2004. And increasingly, sleep-deprived professionals are using it to pursue a more active lifestyle.
In 2002, the FDA issued a warning to Cephalon, the Pennsylvania-based pharmaceutical company that licensed the drug from France's Laboratoire Lafon and conducted its clinical trials, about misleading promotional materials that encouraged off-label use for general sleepiness, lack of energy and fatigue.
As reported by The Washington Post, Americans bought $150-million (U.S.) worth of modafinil in 2001; three-quarters of the pills were swallowed by people who didn't have narcolepsy.
Cephalon amended its marketing, but modafinil's underground use shows no sign of slacking.
"If I take a dose just before I go to bed, I can wake up after four or five hours and feel refreshed," one user told the New Scientist reporter. "The alarm goes off and I'm like, 'Let's go!' "
The 31-year-old old software developer from Seattle, who has been popping the pills for three years and buys them on-line, says the drug doesn't make him any more alert or less sleepy.
"It's just that thoughts of tiredness don't occur to me. I find I can be very productive at work. I'm more organized and more motivated. And it means I can go out partying on a Friday night and still go skiing early on Saturday morning."
Hmm, that sounds awfully seductive. I must try to get some -- after I take a nap.
"I've never heard of it," says the doctor on duty at my neighbourhood walk-in clinic.
"They say it's quite safe," I implore, pushing the article into his hands, after explaining the travails of my restless nights and daytime exhaustion.
Frowning, he skims through the piece, then picks up the hefty 2005 edition of the Canadian Pharmacists Association's Compendium of Pharmaceuticals and Specialties, and starts flipping.
"Oh, it's here," he says, mildly surprised. "Can cause headaches, nausea, dizziness, overconfidence and psychosis. Do you have any problems with your liver? Well, there are no big red flags."
Psychosis isn't a big red flag?
"Lots of drugs cause psychosis," he says, peering sternly over the book. "Pot makes some people psychotic, but we seem to think that's okay."
Jonathan Fleming, co-director of the Sleep Disorder Clinic at the University of British Columbia Hospital, warns that doctors must be cautious in their dispersal of modafinil.
"The research evidence shows it works, and, as a drug, it's very safe. But the research protocols were very clear. This is not for people who have been out until 5 a.m., and have to get work the next day. That's a misuse," he says, sighing impatiently over the phone.
"Having said that, people misuse medication all the time," he continues. "And we all self-medicate with coffee or Wake Ups. But if you're using it for sleep deprivation, at some point, you're going to have to address that sleep debt. Getting adequate sleep is the appropriate response."
Modafinil, which doesn't prevent you from falling asleep when you want to, cuts the recovery time of sleep debt in half. You can stay awake for 48 hours and need only eight hours of sleep, instead of 16, to catch up. But researchers are doubtful that anyone could take it every day without consequences. Sleep is necessary for the endocrine system, immune function and hormonal growth.
Yet, there is already a new class of drugs being developed that may, it is hoped, eliminate sleep debt altogether. A trial compound called CX717, one of the "ampakine" drugs originally developed to fight Alzheimer's, has shown remarkable restorative powers. According to New Scientist, the Defence Advanced Research Projects Agency plans tests this year "that will push volunteers through four consecutive nights of hard work with only four hours of recovery sleep in between."
But even if Mother Nature is conquered some day, there are still big societal questions to contend with. If we can safely skip on sleep, what's to keep us from working around the clock? Will people who choose to sleep be overlooked for promotions? Will the super sleep drugs, which are not likely to be covered by health insurance, cause even greater class divisions?
Back at the clinic, the doctor says he is uncomfortable prescribing modafinil. "How's your thyroid?" he asks, filling out a laboratory requisition for a battery of blood tests. Then he hands me several photocopied pages, modafinil's monograph from the pharmaceutical encyclopedia.
"We'll see how the tests go. And in the meantime I want you to read this. Maybe it will scare you to sleep."
Alexandra Gill is The Globe and Mail's western arts correspondent, based in Vancouver.