The University of Texas Health Science Center at Houston - Health
Leader
Up All Night
By Anissa Anderson Orr, October 14, 2004
Coffee. No-Doze. Red Bull. Ginseng. Caffeine gum. Cold showers.
Students studying for exams will do almost anything to keep cramming
into the wee morning hours. A few will even go to dangerous extremes to
stay awake, using prescription drugs like Ritalin, Adderall or other-less
legal-stimulants.
How old school.
The newest way to beat the clock doesn't give you the jitters, is not
physically addictive and can keep you up for 10 to 15 hours at a stretch.
The drug modafinil is so effective at staving off sleep, yet has so few
side effects, that many doctors predict it will become enormously popular
with type-A college students.
"Since the drug has fewer side effects than traditional stimulants,
the concern is that more students may use it to get an edge over their
peers, to stay up later and study harder so that they can get a better
grade on a test," says Dr. Andrew Harper, associate professor of
psychiatry and behavioral sciences at The University of Texas Medical
School at Houston.
The drug is also gaining popularity with athletes wanting to train longer
as well as harder. Six American track and field athletes have tested positive
for modafinil, which is banned by the United States Olympic Committee.
"It is seen as a new type of performance-enhancing drug, not only
for the body, but for the mind." says Harper who is also medical
director of the UT Harris County Psychiatric Center.
How It Works
Modafinal, sold under the name Provigil, targets a more specific area
of the brain than stimulants, eliminating the "wired" feeling
common with that class of drugs.
The drug works on the hypothalamus, the area of the brain that regulates
sleep. Modafinal uses the opposite action of sleep-inducing drugs like
antihistamines, found in cold medicines, and gabba agonists, found in
alcohol and barbiturates.
Traditional stimulants also stimulate the pleasure centers of the brain,
which can make them addictive. Modafinal's lack of a "high"
coupled with its long onset of action (1-2 hours to take effect) make
it less likely to be abused by late-night partiers.
"Modafinal doesn't really give you a buzz," says Dr. Richard
Castriotta, professor of medicine and associate director of the Division
of Pulmonary, Critical Care and Sleep Medicine. "You also don't crash
like you do with amphetamines. You don't experience a sharp peak action
and then a sharp decline."
Castriotta is studying the effects of modafinil as a treatment for patients
with traumatic brain injury who can't stay awake. The drug is FDA-approved
to treat narcolepsy, sleep apnea and sleep problems caused by shift work,
and is being studied for non-sleep related problems including attention
deficit hyperactivity disorder.
However, like any drug, doctors can prescribe modafinil for reasons not
approved by the FDA, called off-label usage.
"I can envision it as a drug used by students and doctors,"
Castriotta says. "It is not the kind of drug people would use for
pleasure, but it can be used for people who need to stay awake to study,
to travel, or for those who need to accomplish more with less sleep."
Who Needs Sleep?
Everyone.
While modafinil is not physically addicting, a person can become emotionally
dependent on the drug.
"Some individuals are at greater risk for being psychologically
addicted," Harper says. "If they think that the drug is helping
their performance then they will be much less willing to give it up."
Continued use of the drug also can cause sleep deprivation, which can
weaken the immune system, increasing the risk of illness. Lack of sleep
also affects judgment, and can be dangerous if you are performing complicated
tasks like driving a car. The feeling you get when don't get enough sleep
is similar to drunkenness.
"College students tend to underestimate the risk of sleep deprivation,"
Harper says. "Ultimately, you can't go on forever. Even if you are
awake for as short a period as 18 hours, your performance will suffer."
Eyes Wide Shut
Is modafinil a Pandora's box for people seduced by the idea of living
the 24-hour life? Or is it a true panacea for people with serious sleep
problems? Castriotta believes it is a little of both.
"Modafinal is clearly the drug of choice for narcolepsy and excessive
sleepiness due to brain injury," Castriotta says. "It is a Godsend
to patients with these problems and has made a big difference in the treatment
for serious sleepiness syndromes."
The drug's non-addictive quality, also makes it a good choice for people
who would put themselves and others at risk if they fall asleep at the
job, like truck drivers or pilots. For example, the pilots who flew the
first bombing missions to Afghanistan took Provigil to stay awake on the
long transatlantic flight.
But the drug has limits, he warns. No one can cheat sleep indefinitely.
"It would be dangerous to think that you could have a chemical substitute
for sleep," Castriotta says. "We still don't know all the reasons
we sleep and why it is important."
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