By Steve Dow

It’s the 24-hour sleepless society. Supermarkets and factories are now working around the clock. Children are cramming into their leisure time more before- and after-school activities. The net result? We’re averaging about an hour’s less sleep a night than we were even a decade ago, by best expert estimates.

Employers in the competitive hospitality business have their workers on long haul shifts. Executives have to go that little bit extra and push the unpaid overtime barrier. It is no surprise to see people desperately trying to regain some control over their lives on the midnight treadmill at 24-hour gymnasiums.

Teenagers and twenty-somethings have eschewed alcohol in their droves, in favour of the all-night ecstasy and other amphetamine binges. Why cut the night short when you can dance brightly among the shiny, happy people?

Small wonder 40 per cent of us have sleep disorders, ranging from the intermittent lack of sleep to the chronic. Sleep experts estimate up to 15 per cent of us have “restless legs” in bed. We’re literally running in our dreams.

Most sleeping pills leave us groggy. How tempting it would be then to pop a "wakefulness pill" to snap us into order during the day, given the sleep-filled nights are so increasingly fragmented. Perhaps that day has arrived.

Enter the new wonder drug, modafinil.

Modafinil will likely soon officially arrive here in Australia from Laboratoire Lafon in France via CSL Ltd. It’s a wakefulness drug unlike any other, awesomely effective in narcoleptics; that very small group of people who fall asleep at the wrong time.

Its brand name is Provigil. Even the connotation of the name – “pro” and “vigil” – suggest this new compound, discovered in the early 1980s but only recently put into effect, might hold the key to understanding what it is for us to be awake.

But federal health bureaucrats fear the drug’s potential misuse and abuse among shift workers, executives and party animals. Mostly, they fear more taxpayer hip-pocket damage in the wake of cost blow-outs on drugs such as the heart statins, Celebrex and Viagra.

Modafinil, US sleep expert David Dinges recently told The New Yorker, is “the most tempting drug for our society to come along in decades.

“It promises to satisfy our relentless desire to control time.”

And, it raises a key question: can we one day control and repress the urge to sleep? Maybe do away with it all together?

Consider the longest any human has ever been made to stay awake in peacetime has been in Pennsylvania trials, for some 63 to 64 hours. In Australia, the limit has been just 48 to 50 hours. Humans have been deprived of sleep longer in wartime concentration camps, but any scientific data gleaned from the effects has been deemed too deeply inhumane to use for research purposes.

Presumably, if we were forced to stay awake long enough, our immune systems would collapse. Rats forced to stay awake have lived a month at longest, though usually much less. They were invaded by their own bacteria. Trials on cats kept awake some 30 years ago in New Zealand under threat of being tilted into water also resulted in death.

But humans? None have obviously ever been kept awake long enough in peacetime tests to see whether they would die without sleep. We’d probably just sleep where we stood or fell, if the experience of firefighters at work for days on end is any indication.

Perhaps, though, science is already on the road to keeping us awake, and to make redundant the benefits sleep is thought to bring – immune maintenance, and tissue building.

We’re not there yet. But the strides forward continue. Modafinil works on a relatively newly identified group of neurotransmitters in the brain called orexins. These are essentially proteins located in the hypothalamus. It is now known that a deficiency of orexins causes narcolepsy.

Unlike traditional stimulants, such as the common narcolepsy-treating amphetamine Dexedrine, which work on the central nervous system to release the chemical dopamine to suppress sleep, modafinil takes a novel approach.

Instead, modafinil stimulates adrenaline sensors in the brain to promote wakefulness. It peaks at 40 minutes to an hour, but remains effective for six to eight hours.

And, unlike Dexedrine, there are significantly fewer side-effects with modafinil: no heart palpitations, no rush, no hyperactivity, and, in most cases, it promotes much less over-confidence than do amphetamines.

The side-effects that make amphetamines such as Dexedrine unattractive for misuse by a large swathe of the population simply do not exist with modafinil. So the potential for abuse is greater.

Doctors treating children for attention deficit hyperactivity disorder (ADHD) with the amphetamine Ritalin are also showing a big interest in modafinil. The Australian and United States military, among others, are also intensely interested in modafinil’s battlefield potential.

Small wonder that Australian doctors are pushing federal health bureaucrats to strictly limit the type of patient and the type of specialist who can prescribe modafinil – a virtual handful, maybe a few thousand, narcoleptics.

John Swieca of the Melbourne Sleep Disorders Centre says modafinil is highly effective in narcoleptics. And he admits there is potential for abuse of the drug – to use pharmacology to “put a Band-Aid over sleep”, though partiers seeking a buzz might be disappointed.

“You won’t be able to replace every aspect of sleep,” says Swieca. “Not in the foreseeable future”. And if we eschewed sleep for days on end through currently available pharmacology, would we eventually die? “There’s no evidence we would do the same as animals," he says. "But you would get sick through immune dysfunction”.

David Joffe of Sydney’s Royal North Shore Hospital’s respiratory and sleep medicine department says there is an “undercurrent of anxiety” about modafinil’s potential cost.

“The obvious group (for abuse) would be truck drivers,” says Dr Joffe. “When I took this drug (in a sleepy state) as part of a study it worked for a good eight hours. Maybe I’m just susceptible.” The effect leaves over-the-counter stimulants such as Sudafed, caffeine and guarana in the shade.

It is believed that CSL have had their application to licence modafinil in Australia before the Therapeutic Goods Administration for some months. Once the Australian Drug Evaluation Committee makes a recommendation to the Minister of Health to approve the marketing of the product, says CSL general counsel Peter Turvey, CSL will then be able to make an application to the Pharmaceutical Benefits Advisory Committee to establish Pharmaceutical Benefits Scheme listing. This would reduce the cost to patients from about $250 to $20 a month.

Mr Turvey denies any conflict with health bureaucrats. “There has been no delay at all in processing our application.”

A TGA spokeswoman, Carina Tan-van Baren, refused to confirm or deny whether an application had been received to register modafinil, because such information was considered commercial-in-confidence by sponsors.