Sleepless In America

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If you're like most people, you know that a sleepless night can sap your energy and turn your brain into mush. So it may be hard to fathom how anyone could complain about having too much sleep. And yet that's the predicament faced by the estimated 200,000 Americans who suffer from a condition called narcolepsy. They don't generally fall asleep in the middle of a meal or a conversation--that happens in movies and television sitcoms. But they struggle with an overwhelming sense of drowsiness they can't shake--even after a good night's rest.

Many narcoleptics found relief two years ago when the Food and Drug Administration approved a drug called Provigil that helps promote daytime alertness. Although technically a stimulant, the drug seemed to be relatively free of the kind of twitchy side effects produced by amphetamines.

That prompted Cephalon, the biotech firm that markets the drug in the U.S., to begin studies to determine whether the pill could prove useful for a wider variety of problems, including obstructive sleep apnea, a condition in which various breathing problems make restful sleep nearly impossible. (Even after successful treatment of the breathing problem, some people with sleep apnea still feel extremely drowsy during the day.) Last week Cephalon announced plans to acquire--for $450 million in cash--the small French pharmaceutical company from which it licenses Provigil.

But before you decide to ring up your physician for a Provigil prescription, there are several things you need to know. This is not a drug you take just because you've got a paper due tomorrow or a long drive ahead. Like all other drugs, Provigil has side effects. The most common short-term effect is headache, though some folks have reported nausea and anxiety too. It may also make birth control pills less effective. And no one knows what the long-term effects may be. Indeed, researchers aren't even sure what the drug does to the brain on a biochemical level.

What doctors do know is that burning the midnight oil is bad for your health. Sleep is the body's great restorer. It helps ensure the proper working of the brain, balances the emotions and maintains the immune system. Despite news reports last week suggesting that Provigil might make sleep unnecessary, even Cephalon execs don't go that far. "Provigil is not a substitute for sleep," insists Matthew Miller, senior director of pharmacology. "That's the last thing I want to see happen."

As a society, we tend to underestimate sleep. We stay up late to watch television. We're open for business 24/7. We don't get enough exercise and depend too much on coffee to get us through the day.

If you have a sleep disorder that is rooted in biology, a drug like Provigil might make a difference. For the rest of us, it's the last thing we need.

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