Provigil, a small, white and slightly oblong pill taken orally, is the first in a new class of wake-promoting drugs. Originally approved by the Food and Drug Administration (FDA) in 1998 for the treatment of EDS associated with narcolepsy, today Provigil is the only FDA-approved prescription medicine for treatment of excessive sleepiness associated with OSAHS and SWSD. (Is there a difference between modafinil and Provigil?)
How does Provigil work?
Provigil acts on areas in the brain having to do with the sleep/wake mechanism. It increases alertness in sleepy individuals, but probably not to normal alertness levels. Provigil is rapidly absorbed the body and it is at its most effective within two hours of ingestion.
Recent research in found that Provigil works in the brain's dopamine system. Two proteins that are affected by dopamine are essential for the drug's activity, but scientists don't know if dopamine is the drug's target or just a link in a chemical cascade in the brain that Provigil also affects.
Scientific Summary of Provigil Effects
Who should use Provigil?
Provigil is only approved for use by adults and children over the age of 16. It should only be taken by those suffering from EDS associated with narcolepsy, OSAHS or SWSD. Provigil should only be taken under the direction of a board-certified sleep specialist. To find a sleep specialist in your area, visit the Web site of the American Board of Sleep Medicine at http://www.absm.org/diplomates/listing.htm.
How does sleepiness affect a person?
Sleepiness significantly increases the potential for compromised attention, impaired cognition, lengthened reaction time, and negative mood. The medical community believes that sleepiness should be recognized as a serious symptom and problem, and can be a risk factor and precursor to accident, injury, destruction and death. Two-thirds of all Americans don’t get enough sleep, according to the NSF. For those with critical attention responsibilities, including truck drivers and people who work night shifts on a permanent or rotating basis, sleepiness can make them more prone to accidents. In contrast, optimal alertness is a fundamental requirement for successful and safe functioning in our society. A reduction in sleepiness has the potential to reduce accidents and injuries believed to be associated with this disorder.
What is Excessive Daytime Sleepiness (EDS)?
EDS is a condition in which a person feels very sleepy during the day and has a hard time staying awake, even after getting enough sleep the previous night. EDS can interfere significantly with a person's ability to concentrate and perform daily tasks and routines. People with EDS frequently nap or fall asleep in situations where they need or want to be awake and alert. This can be particularly dangerous when the subject needs to drive a car or operate other hazardous machinery.
Excessive sleepiness is often misinterpreted as laziness or a lack of
a capacity to learn. Excessive sleepiness can also have a negative impact
on a person’s relationships with his or her family, coworkers, and
friends. Sleep experts worldwide use the Epworth Sleepiness Scale (ESS)
to measure general levels of daytime sleepiness. To take a short test
that measures your level of sleepiness on the ESS, visit www.sleepfoundation.org/epworth/quiz.cfm.
You should discuss your test results with your doctor.
Provigil may help people suffering from the following conditions that lead to EDS:
a chronic neurological disorder that affects the region of the central nervous system that regulates sleep and wakefulness
Obstructive sleep apnea/hypopnea syndrome (OSAHS)
Experienced by sufferers as a lack of airflow throughout the night. This leads to frequent brief arousals.
Shift work sleep disorder (SWSD):
SWSD is a sleep disorder that affects people who frequently rotate shifts or work at night.
Is Provigil ever prescribed for conditions other than the ones the drug is FDA-approved for?
Yes. While Provigil is FDA-approved only for narcolepsy, OSAHS and SWSD, physicians sometimes prescribe it for patients who do not suffer from one of these conditions. More on off-label Provigil use.
What are some of the reasons why Provigil should not be prescribed solely to relieve fatigue?
Some doctors worry that people taking Provigil to combat fatigue might go undiagnosed for underlying diseases such as diabetes or sleep apnea that cause fatigue.
What is Excessive Daytime Sleepiness (EDS)?
EDS is a condition in which a person feels very sleepy during the day and has a hard time staying awake, even after getting enough sleep the previous night. EDS can interfere significantly with a person's ability to concentrate and perform daily tasks and routines. People with EDS frequently doze, nap, or fall asleep in situations where they need or want to be fully awake and alert. This can be particularly dangerous at times, such as when driving a car or operating other hazardous machinery.
For many people, excessive sleepiness can be misinterpreted as laziness or not having the capacity to learn. Excessive sleepiness can also have a negative impact on a person’s relationships with his or her family, coworkers, and friends. Sleep experts worldwide use the Epworth Sleepiness Scale (ESS) to measure general levels of daytime sleepiness.
More questions and answers on Provigil
Provigil and weight loss or gain
Can you use Provigil as a study drug?