City Never Sleeps

Is New Drug a Workaholic's Dream—or Nightmare?

When Ross Pigeau, a researcher with the Canadian military, first heard about a new drug that can keep people awake as effectively as amphetamines but without the jitters, "it just sounded too good to be true," he recalls. But after studying the drug, called modafinil, and trying it himself, Pigeau is a believer, and he ticks off the benefits: "Apparently not addictive, apparently no withdrawal, and very few side effects. Someone tried to OD on modafinil by taking almost a whole bottle, and he just had a night without sleep."

So far, the drug has caught the attention only of National Public Radio and a smattering of other media outlets. Perhaps that's because the Food and Drug Administration is expected to approve modafinil, probably by the end of the year, for a rare illness which French doctors have for several years been using the drug to treat: narcolepsy, a disorder in which people fall asleep suddenly in the middle of the day. But once a drug is approved, doctors can prescribe it for almost any reason, however frivolous, such as enabling a healthy person to pull an all-nighter.

The Canadian military—like the French and American armed forces, which have also studied the drug—wanted to be able to keep soldiers awake for long stretches. So in Pigeau's experiment, healthy subjects were kept awake for three days while adhering to a grueling work regimen that permitted only one 15-minute break every two hours. Modafinil improved performance just as much as amphetamines, but it didn't give people a high; they simply felt awake. What's more, when test subjects were finally allowed to get some shut-eye, those on modafinil had sleep cycles that were normal. The only drawback—which Pigeau terms "very interesting"—is that people on modafinil were consistently overconfident, estimating their proficiency to be better than it actually was.

So will workaholics flock to the drug? "We are all concerned about that," sighs Joyce Walsleben, director of the New York University Sleep Disorders Center, where modafinil has been studied. She worries that people will "think it is a magic bullet so they can do without sleep." That's a dangerous misconception, because the drug does not keep people operating at peak performance. When Pigeau gave his subjects modafinil after they had been awake for two nights, the drug only restored them to the level of performance they had following their first night without sleep—and that was a whopping 35 percent below their rested performance. Imagine people driving cars, flying planes, or wielding scalpels at such perilously subpar levels—yet overconfident about their ability—and suddenly Walsleben's worry seems a lot more urgent.

No one knows the function of sleep—a complex biological phenomenon quite distinct from mere resting—but it must be extremely important. Sleep renders animals unconscious, and thus easy prey, yet all mammals, birds, and reptiles sleep. What's more, they have evolved elaborate adaptations to do so. Horses sleep while standing, birds while perching, and dolphins while swimming. And dolphins even sleep with one-half of their brain at a time.

Allan Rechtschaffen, a professor at the University of Chicago and one of the foremost authorities on sleep, found that rats deprived of sleep die in two to three weeks. Yet despite extensive study, neither he nor anyone else has been able to determine the cause of death. In humans, says Rechtschaffen, the record for staying awake "is 11 days, by one high school student who did it as a science project." But no lasting physiological harm was detected.

Of course, while people are sleep-deprived, their irritability soars and sense of humor plummets. "There is often some hallucination," adds Pigeau. "It's very subtle: they'll say, 'Did you hear that sound?' or 'I think I saw something running across the floor.' " Even mild sleep loss has been shown to impair creative or complex thinking. No one knows how or why sleep deprivation causes these problems, much less what sleep is ultimately for.

But the inquiry can be flipped on its head: "What is wakefulness for?" asks Merrill Mitler, a clinical professor at the University of California at San Diego and a consultant to Cephalon, which is developing modafinil for the U.S. market. Chuckling slyly, he offers an off-the-cuff answer to his own question: wakefulness is for eating, drinking, and procreating.

Maybe that's true, but it hardly gets at why we value being awake. In a similar way, even if the Darwinian, biological function of sleep is found, it may have only limited relevance to our experience of sleep. And that personal, almost existential understanding of sleep may be the best bulwark against the abuse of caffeine substitutes. Most people hate feeling sleep-deprived and love feeling well rested. No drug on the horizon can equal that natural high.

Research assistance: Tyler Schnoebelen, Sam Bruchey

 
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