Making sleep optional

It’s a safe bet that there have been a lot of bleary-eyed people around Regina this week, following last week’s Grey Cup revelry.  But then, there are a lot of bleary-eyed people around all the time, since very few of us ever get as much sleep as we really need.

That being the case, wouldn’t it be great if you could just take a pill and feel alert enough to do everything you need to do today?

I’m not talking about amphetamines, the traditional pick-me-up of the exam-cramming student.  A whole new class of drugs is making its way into the mainstream that some think have the potential to make sleep almost optional.

Modafinil, developed in the 1990s in France and available in Canada since 1999 under the brand name Alertec, is a prescription drug currently approved only for narcolepsy.  However, it’s beginning to find its way into the hands of other people who need to stay awake, from soldiers to workaholic businesspeople.

Using chemicals to stay awake is hardly new.  The Chinese used green tea and a herb called ma huang, which contains ephedrine.  Incan warriors chewed coca leaves.  Millions use coffee.

In this century, we developed amphetamines, nicknamed “go-pills” by the U.S. Air Force, whose pilots have used them since the Second World War (and still do–the U.S. pilots who bombed Canadian soldiers in Afgahnistan were taking them).  Amphetamines stimulate the entire central nervous system, essentially fooling the brain into thinking it’s being threatened.  That means they also raise your pulse rate and give you jolts of adrenaline.  Not surprisingly, they interfere with normal sleep patterns, and you have to take larger and larger doses to get the same effect until, inevitably, you crash. Amphetamines can also be addictive, which is why there’s also a thriving illegal trade in them.

Scientists long believe that waking and sleeping were controlled by the same part of the brain.  But in the late 1980s, a team of researchers at Stanford University’s Sleep Research Center  discovered that a part of the hypothalamus called the suprachiasmatic nuclei controls wakefulness, while sleepiness is controlled elsewhere.  Rather than jazzing up the entire nervous system, modafinil somehow (the precise mechanism still isn’t understood) keeps the wakefulness center active long after it would normally have shut down.  As a result, the rest of the brain thinks it’s well-rested, even when it’s not.

Research subjects report feeling nothing at all when they take modafinil–the only difference they note is that, by the time they’re usually yawning, they still feel alert.  Better yet, modafinil doesn’t interfere with normal sleep–subjects could take it, stay alert until they decided it was bedtime, then go to sleep as usual.  Modafinil also shows no signs of being addictive and only rarely causes minor side effects like headache and nausea.

So will there eventually be an over-the-counter version?  Not in the short term.  Modafinil is still a fairly new drug, and long-term side-effects aren’t known.  As well, experts worry that although it isn’t addictive, people might begin using it constantly, shirking on sleep–and sleep is important for more reasons than just mental alertness, also helping to regulate our hormonal and immune systems. There is also concern about unknown interactions with other drugs.

However, tests are underway for its use with other sleep disorders, such as chronic fatigue syndrome and sleep apnea, those caused by multiple sclerosis, and more.  Doctors are also interested in testing it in patients with depression.  Tests are now underway in Chicago to see if modafinil can help shift workers who report being intensely sleepy when they’re supposed to be working–a potentially dangerous condition in many lines of work. And, of course, military forces around the world are experimenting with it; it’s apparently already in use, in a limited and somewhat unofficial fashion, by the U.S. forces in Iraq.

Already companies around the world are working on even more effective drugs to help people stay awake–and, since a better understanding of the wake/sleep mechanisms in the brain cuts both ways, to help them fall asleep more quickly and sleep better.

We may eventually be able to customize our sleep-wake cycles to our own particular needs, scheduling sleep when its convenient, staying fully alert when it’s not. Exactly what that might mean for society, no one can yet say.

But it’s not here yet.  For now, the age-old solution to drowsiness remains the best:

Take a nap.

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