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Stay-awake drugs high in demand
Despite society's chronic lack of sleep
_Sharon KirkeyOttawa Citizen; CanWest News Service
Monday, December 29, 2003
OTTAWA - Psychologist Stanley Coren finds a particular lunacy to our determination to squeeze more minutes out of every day, when science shows not getting enough sleep is putting people at risk.
Humans have been hardwired through evolution to require nine, even 10 hours of sleep a night, but the average North American is getting more like seven, says Coren, director of the Human Neuropsychology and Perception Laboratory at the University of British Columbia. "Generally, we're about two hours sleep-deprived every night."
Some polls suggest one out of every three Canadians is managing just six hours of sleep a night, or less.
But what if you could get the equivalent of a good night's sleep in a pill, a drug that would keep you awake for 40 hours or more with little, if any, of the jitteriness, agitation, anxiety and insomnia associated with other brain stimulants?
"Wake-promoting" agents have become one of the hottest fields of drug research, with a vast, mostly untapped market potentially worth billions.
One such drug is already here: Modafinil (sold as Alertec in Canada and Provigil in the U.S.) has been available since 1999 for the treatment of narcolepsy, a devastating disorder that affects one out of every 3,000 people and causes uncontrollable sleep attacks at inappropriate times.
But now, the U.S. Food and Drug Administration has given preliminary blessing to expanded uses of the drug to treat excessive daytime sleepiness in shift workers as well as for sleep apnea, a condition that causes people to stop breathing at night. Official approval, which is expected soon, will mean Cephalon can start promoting the drug not just to sleep doctors but to family doctors. The company is gearing up to deploy an "expanded sales force" early next year.
But the prospect of people swallowing pills to postpone sleep has some critics nervous. When is sleepiness a sickness? Doctors can't even agree whether "shift work sleep disorder" is a true medical illness, and there's evidence people are taking Modafinil for conditions not sanctioned by government regulators.
In the U.S. alone, some 250,000 people are using Modafinil, even though only 150,000 Americans are estimated to have narcolepsy. Canadian prescriptions have nearly doubled since 2001. Nearly 28,000 prescriptions were dispensed in Canadian drugstores during the 12 months ending October 2003, compared to 14,648 in 2001, according to Health Canada.
People have always searched for ways to get by on less sleep. Coffee has become the second most commonly traded commodity in the world, next to oil.
But now athletes and CEOs and college students "and everyone who wants to stay wide awake all day long under minimal sleep are asking their physicians for prescriptions," for Modafinil, says Cornell University psychologist and sleep expert James Maas.
"There is this notion that if you sleep a lot, you're lazy and useless," Coren says.
Add that to our frenetic lives, the growing numbers of harried, dual-income families trying to cope with the demands of work and home, the seductive all-night allure of the Internet, and it's little wonder we've become a nation "of walking zombies," says Maas. Millions try to catch up by oversleeping on holidays and weekends, but our sleep debts just keep accruing, week after week.
Studies have found that people who sleep six hours or less a night have an increased risk of high blood pressure, heart attacks and stroke.
Just one bad night's sleep can have a dramatic effect on memory, alertness, concentration and judgment, and chronic sleep deprivation can lead to depression.
More worrisome, "when we're really sleep deprived, at some point in time we start to micro-sleep," says Coren. "No matter what we're doing, our brain goes into a sleep state, and it can remain there anywhere from 10 seconds to a minute.
"Now suppose that you're tooling down the road in your car at 50 kilometres an hour and you have one of these small little micro-sleeps, and it's the 10-second kind. What that means is that your car will travel more than the length of a football field while you're asleep."
Still, Coren worries about using drugs to manipulate the body's need for sleep.
"Obviously if you have an individual who is in jeopardy of losing his livelihood if he can't adapt to shift work, you might consider it."
But given the huge number of people in the world who work odd hours, from nurses, firefighters, and factory workers to pilots and 911 operators, "we could be talking about a large number of individuals who are going to start to muck up their sleep chemistry."
And no matter how safe drugs that beat back sleep become, they will always bump up against the fact that the brain will always find a way to sleep, no matter what we're doing. That, the experts say, is enough to lose sleep over.
Despite society's chronic lack of sleep
_Sharon KirkeyOttawa Citizen; CanWest News Service
Monday, December 29, 2003
OTTAWA - Psychologist Stanley Coren finds a particular lunacy to our determination to squeeze more minutes out of every day, when science shows not getting enough sleep is putting people at risk.
Humans have been hardwired through evolution to require nine, even 10 hours of sleep a night, but the average North American is getting more like seven, says Coren, director of the Human Neuropsychology and Perception Laboratory at the University of British Columbia. "Generally, we're about two hours sleep-deprived every night."
Some polls suggest one out of every three Canadians is managing just six hours of sleep a night, or less.
But what if you could get the equivalent of a good night's sleep in a pill, a drug that would keep you awake for 40 hours or more with little, if any, of the jitteriness, agitation, anxiety and insomnia associated with other brain stimulants?
"Wake-promoting" agents have become one of the hottest fields of drug research, with a vast, mostly untapped market potentially worth billions.
One such drug is already here: Modafinil (sold as Alertec in Canada and Provigil in the U.S.) has been available since 1999 for the treatment of narcolepsy, a devastating disorder that affects one out of every 3,000 people and causes uncontrollable sleep attacks at inappropriate times.
But now, the U.S. Food and Drug Administration has given preliminary blessing to expanded uses of the drug to treat excessive daytime sleepiness in shift workers as well as for sleep apnea, a condition that causes people to stop breathing at night. Official approval, which is expected soon, will mean Cephalon can start promoting the drug not just to sleep doctors but to family doctors. The company is gearing up to deploy an "expanded sales force" early next year.
But the prospect of people swallowing pills to postpone sleep has some critics nervous. When is sleepiness a sickness? Doctors can't even agree whether "shift work sleep disorder" is a true medical illness, and there's evidence people are taking Modafinil for conditions not sanctioned by government regulators.
In the U.S. alone, some 250,000 people are using Modafinil, even though only 150,000 Americans are estimated to have narcolepsy. Canadian prescriptions have nearly doubled since 2001. Nearly 28,000 prescriptions were dispensed in Canadian drugstores during the 12 months ending October 2003, compared to 14,648 in 2001, according to Health Canada.
People have always searched for ways to get by on less sleep. Coffee has become the second most commonly traded commodity in the world, next to oil.
But now athletes and CEOs and college students "and everyone who wants to stay wide awake all day long under minimal sleep are asking their physicians for prescriptions," for Modafinil, says Cornell University psychologist and sleep expert James Maas.
"There is this notion that if you sleep a lot, you're lazy and useless," Coren says.
Add that to our frenetic lives, the growing numbers of harried, dual-income families trying to cope with the demands of work and home, the seductive all-night allure of the Internet, and it's little wonder we've become a nation "of walking zombies," says Maas. Millions try to catch up by oversleeping on holidays and weekends, but our sleep debts just keep accruing, week after week.
Studies have found that people who sleep six hours or less a night have an increased risk of high blood pressure, heart attacks and stroke.
Just one bad night's sleep can have a dramatic effect on memory, alertness, concentration and judgment, and chronic sleep deprivation can lead to depression.
More worrisome, "when we're really sleep deprived, at some point in time we start to micro-sleep," says Coren. "No matter what we're doing, our brain goes into a sleep state, and it can remain there anywhere from 10 seconds to a minute.
"Now suppose that you're tooling down the road in your car at 50 kilometres an hour and you have one of these small little micro-sleeps, and it's the 10-second kind. What that means is that your car will travel more than the length of a football field while you're asleep."
Still, Coren worries about using drugs to manipulate the body's need for sleep.
"Obviously if you have an individual who is in jeopardy of losing his livelihood if he can't adapt to shift work, you might consider it."
But given the huge number of people in the world who work odd hours, from nurses, firefighters, and factory workers to pilots and 911 operators, "we could be talking about a large number of individuals who are going to start to muck up their sleep chemistry."
And no matter how safe drugs that beat back sleep become, they will always bump up against the fact that the brain will always find a way to sleep, no matter what we're doing. That, the experts say, is enough to lose sleep over.
