I recently had the opportunity to listen to a rather provocative podcast at All in the Mind about cognitive enhancing drugs. Specifically they discuss Modafinil, a drug used to treat Narcolepsy, a disease in which sleep comes suddenly and often, to help them with excessive daytime sleepiness. I was startled to learn that many in the neuroscience community are using this drug, openly, and sharing it with others in order to work longer hours, get more done, focus more, and think more. This blew we away.
You would think a Neuroscientist, of all people would understand that sleep has a purpose. I would think they might have an idea as to what that purpose is. The brain clearly needs downtime to process and integrate memory and information from the previous day. It is necessary for brain function. In fact, humans who have the most complex brains of any animal, also require the largest amount of sleep.
Sleep is also resorative for the body. Stress tolerance is much greater when we are getting adequate sleep. When I was in medical school, we had a psychiatry professor who shared the observation that most psychotic breakdowns in Schizophrenics occurred in College kids during finals week. It was almost as if they blew a fuse. While this is anecdotal, it causes me concern. Evidence has shown that students who pull all-nighters before an exam do worse on tests than those who get a full nights sleep.
What does this have to do with cognitive enhancement and Modafenil, you may ask? It seems to me the idea is to stay awake, while focusing and doing better, but an unavoidable effect will be reduced sleep. Oddly enough, I think these scientists are actually making their brains function worse. The reason I mention schizophrenia is that there is that extreme sleep deprivation can actually causes psychosis. Furthermore, Modafenil is actually used in night shift workers for daytime sleepiness. In this group, Modafenil and sleep deprivation are were associated with psychosis.
So it seems what we have is a group of scientists bent on driving themselves mad!! I wonder if their motives are as pure as presented. Are they thinking it is a dog eat dog academic world and they need to publish or perish, or are they thinking, “Fools, I’ll destroy them all!! I’m going to take over the world!” I wonder how much sleep Frankenstein or Dr. Evil missed?
Bwahahahaha!
Look out, their coming after you.
Mind, Soul, and Body 
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June 30, 2008 at 1:47 am
Julia
I’ll admit it, I’ve seriously looked into getting a prescription of provigil for use on call nights. I don’t have the backup of caffeine to keep me awake, and those early post-call mornings, when I’m going on 45 minutes of sleep and trying to recall important patient details, not to mention keeping them alive, I wonder if taking provigil would help with post-call rounding and making it safer when I drive home afterwards. Right now, I snack constantly to keep myself awake, and I’ve definitely put on the weight since starting residency and that’s certainly not more healthy.
June 30, 2008 at 10:06 am
Doc
Julia,
I understand what you mean. I have been no stranger to on call eating and have had not insignificant weight gain in residency. I am guessing that caffeine doesn’t do it for you (any more)? If your interested, I discussed my own struggle with this very issue in this post.
June 30, 2008 at 8:18 pm
Julia
I’m Mormon too. 🙂 Ergo, the avoidance of coffee and tea. I’ve never liked sodas, so even the amount of caffeine in them is enough to make me shaky and ill. Provigil sounds like a dream. Less addictive. Improved functioning. Still able to sleep afterwards. It’s approved now for night shift-workers; aren’t residents the epitome of shift workers?
And yet, I agree with your stance, that the word of wisdom is there to protect us from habit forming substances, so is the few hours of alertness worth the risks of getting addicted and those you listed above?
I don’t have an answer yet. I haven’t gotten the prescription (insurance doesn’t cover it and I’m too waffling to pay for it myself). I’ve looked into the anecdotes of other physicians and residents who have taken it, to see the effects they’ve noticed. Right now, I’m leaning against the idea. I’m finished with the hard labors of internship, so most call nights I at least get some sleep and I’m learning (just a little) to perform better when I’m sleep-deprived, and I’ve never had a bad patient outcome because I was post-call. My opinion might change if I do.
June 30, 2008 at 11:23 pm
Dennis
Wow, I would never have thought that modafinil would be in such high demand by workaholics. I’ve taken it for the past 9 years (for narcolepsy). It really is a wonder drug, I must say. Virtually no side effects. Though I think I’ve developed a mild tolerance.
So, a question (for Julia or Doc) from a fellow Mormon who is not involved in medicine. Is it legal for modafinil (a Schedule IV controlled substance) to be prescribed for the purpose of staying awake at work? This seems somewhat shady to me. But then again, who knows what favors doctors do for each other… (I wonder how much money I could make peddling mine outside of hospitals? (j/k) I get them for free from the National Organization for Rare Disorders.)
I’ve read a little bit about problems with medical internships and residencies, and frankly it really surprises me that the medical profession doesn’t do something about the crazy shifts. This cannot be a good thing for anyone. Doesn’t the real blame lie in your profession? Wouldn’t it be better for everyone if more people were admitted into medical school and the shifts were more reasonable? What’s keeping there from being some kind of medical residency union or something? Is it because more reasonable hours would require there to be more doctors, which would translate into less money? If so, it seems a very high (and dangerous) price to pay.
It will be interesting to see what happens when modafinil becomes a generic drug. There will probably be a lot of addictions among workaholics. From the looks of things, though, Provigil is fighting tooth and nail to keep their rights as long as possible….
July 1, 2008 at 1:31 pm
Doc
Dennis,
Modafenil is a medically indicated treatment for shiftwork sleep disorder, which strictly speaking is only for people whose work schedule causes total disruption of their sleep wake cycle so they cannot sleep when they need to, nor function when they need to. As far as where these scientists were getting it from, well I smell a rat in there somewhere.
As far as the medical profession, the shifts are changing. After decades of a machomasichistic training regimen, Medical schools are starting to see the light as Medical students demands for an outside life have grown, patient lawsuits for mistakes have loomed, and data on the real danger of sleep deprivation in medicine has accrued. We are currently in the midst of a great sea change with relatively new caps on both the number of hours we can work in a week (80) and the number of hours we can work straight through one shift (36). We are moving toward shift work where feasible, but people are finding the change of shift can lead to medical errors as well so the system is still trying to work itself out. Some people can function through a 36 hour shift. I, however, cannot do so without becoming scattered, drowsy, and basically a mess.
Doctors don’t unionize because it is considered unethical to leave the very ill in the lurch by going on strike. Then again, this is America, health care is a commodity, so why not. That subject is a whole other can of worms. I will leave it to tackle some other day.
September 2, 2008 at 8:03 pm
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February 22, 2009 at 8:27 am
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