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Could Nightly Sleep Become Optional?
(please view the original at ABCNews.com)
From ABCNews.com

Scientists say modafinil, a stimulant that is currently used to treat narcolepsy, could keep people awake for days at a time. (PhotoDisc) Sleepless Nights (or Days) Pill Could Make Sleeping Optional

N E W Y O R K, Dec. 3 -- Imagine a pill that would make sleep unnecessary for fighter pilots on long-range missions, or even the high-powered executives and parents of newborns among us.

It might not be too far off. Scientists are looking at a variety of uses for modafinil, a stimulant that is currently used to treat narcolepsy, a sleep disorder characterized by uncontrollable sleepiness and frequent daytime sleep.

Modafinil (sold under the name Provigil) has been found to increase both wakefulness and what researchers call "vigilance," the ability to stay on task, thinking clearly and functioning normally. Other drugs designed to keep people awake, such as amphetamines, or "uppers," are not nearly as good at keeping users mentally sharp, and they often make people jumpy and anxious.

"It seems to work dramatically," Thomas Scammell, a sleep expert from the Beth Israel Deaconess Medical Center in Boston told Good Morning America. Most studies of "normal" volunteers have used military recruits, and the maximum they've kept them up is about four days, with nearly normal performance on mental tasks, he said. But that doesn't mean that people should start taking pills to stay awake three or four days at a time.

"Even if the drug is safe, it seems dangerous to mess with your body's sleep needs," Scammell said. "Aside from the obvious effects on brainpower, which modafinil does seem to counter, there is evidence that lack of sleep hurts the endocrine system and the immune system."

Currently, modafinil is only approved and prescribed for those with narcolepsy. But it is also being studied as an option to treat syndromes where fatigue plays a role, such as multiple sclerosis. Researchers are also exploring the possibility that healthy people could take the pill in order to stay awake, and mentally alert, for days at a time.

The Sleep Disorders Center at Rush-Presbyterian-St. Luke's Medical Center in Chicago is doing a study to see if it can help those with Shift Work Sleep Disorder, which often hits those on the 10 p.m. to 8 a.m graveyard shift.

Not for Everyone

Though sleep experts acknowledge the drug's effectiveness for narcoleptics, they raise alarms about using it for the average, healthy person who simply wants to do more and sleep less.

Joyce A Walsleben, director of the Sleep Disorder Center at the New York University School of Medicine, said that overall, modafinil is good at keeping people awake without side effects.

"Well, one looks at the risks of sleepy people driving and working and clearly they can be a danger to themselves and others, so improving that is a service," she said. "However, none of us wants to suggest that this drug will replace sleep yet, and we are careful to say that at all times."

Sleep research took a big step forward three years ago, when scientists discovered a new family of neurotransmitters called orexins. Studies showed that a deficiency of orexin causes narcolepsy.

Somehow, the drug modafinil makes up for the missing orexin, though scientists are not clear on how it does so. In a recent study led by Dr. Charles Czeisler, a professor at Harvard, and Dr. David Dinges, a sleep deprivation researcher at the University of Pennsylvania, 16 healthy people were placed in a lab where some were given modafinil and the rest took a placebo.

Staying Sharp in Sleep Lab

First, participants had to stay awake for 28 hours to mimic the sleep-deprived state of shift workers, those who alternately work day and night shifts.

Then they began a four-day period of being awake at night and sleeping from 11 a.m. to 7 p.m. The volunteer subjects who had taken the modafinil sustained their alertness and the capacity to perform well on a variety of tests, while those who had taken the placebo had a significantly higher error rate.

The military is spending more than $100 million on similar research, on the rationale that soldiers who sleep less will give the United States a military edge.

Rosalind Cartwright, a sleep expert from Rush-Presbyterian-St. Luke's Medical Center in Chicago, said that the research center is looking at the impacts of the drug on those who suffer from excessive daytime sleepiness, associated with chronic shift work. Modafinil is also being tested on those with sleep apnea.

"But this is all very early. No one knows what the longer-term effects of this will be," she said. "The biggest problem is drug interaction effects about which nothing is known."

Furthermore, not enough is known about how the drug will affect those who do not have an orexin problem, she said. The drug also raises serious social issues, she said.

"My take on this is that as a culture, we already over-work and under-rest," she said. "We are too driven to do more and more to keep ahead of the game. We abuse the natural sleep-wake cycle and so far it appears to turn around and bite us when we do."