Can we sleep less?

The quest to build better people.
March 7 2003 5:08 PM

Wake Up, Little Susie

Can we sleep less?

Will new drugs help replace sleep?
Will new drugs help replace sleep?
David Plotz David Plotz

David Plotz is the CEO of Atlas Obscura and host of the Slate Political Gabfest.

On most days, my accumulated sleep deficit and post-lunch stupor gang up on me around 2 p.m., and I begin my slow fade. My eyes droop. Saliva dribbles onto my sweater. If I were trying to write this sentence at 2 p.m. on a normal day, it would read something like: "If I were tryyyyyyyyyyyyyyy … "

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But today, I am bright-eyed and bushy-tailed, a chatty Kathy with my officemates, eager to spend all afternoon banging on the keyboard. (I normally prefer chewing my fingers off to writing.) I am not exactly wired, but I'm more alert, more focused, more Plotz-like. Today I am my own Superman, dosed on 100 milligrams of modafinil.

Every year, we need the same amount of sleep, and every year we get less. Since the invention of artificial illumination, sleep has been a bear market. There are many reasons we catch fewer Z's: Round-the-clock workplaces, longer commutes, brighter lights, 24-hour Krispy Kreme stores, the Home Shopping Network—the list goes on. According to University of Pennsylvania professor of psychology David Dinges, Americans probably sleep about six and a half to seven hours per night, compared to the more than eight hours our bodies want.

There's more at stake than "beauty sleep"
There's more at stake than "beauty sleep"

We have learned to cope with a regular sleep deficit, but we pay a price (and not just $4.05 for the venti latte). Studies by Dinges and military scientists have proved that performance deteriorates when you sleep less than eight hours. People who rest seven or six or five hours a night may not feel tired, but their thinking and dexterity are suffering. We medicate ourselves with caffeine, a drug that raises alertness but at a cost of jitteriness, irregular heartbeat, and addiction. Folks who really need to stay awake dope themselves with amphetamines—stimulants that can ward off sleep for days but cause terrible crashes when they wear off. (And we don't know what long-term damage they cause.)

The military is enthralled with the possibility of doing away with shut-eye. The supersecret Defense Advanced Research Projects Agency is investigating drugs that would keep soldiers awake for a week. The Air Force prescribes "go pills"—small doses of the amphetamine Dexedrine—to pep up long-haul pilots. (But hopped-up pilots may be dangerous: The American pilots who accidentally bombed and killed Canadian soldiers last spring were taking go pills.)

Avoiding sleep for a week might be necessary in an extreme situation like war, but the run-of-the-mill, office-working, wannabe Superman requires something different. We don't want a pill that will keep us Exceling and Power Pointing for three days straight. We just want something that makes us feel alert through an entire normal day—a drug that makes us feel as lively for the 18-hour-day we have to live as for the 16-hour-day we ought to live.

Hence my rendezvous with modafinil. The drug, made by Cephalon, is marketed under the creepy, pharma-Orwellian name Provigil. The FDA approved it in 1998 to treat narcolepsy, but it is starting to have a underground life as a pick-me-up for the routinely sleep-deprived. The military has tested it heavily, particularly on pilots.

The way modafinil works is not understood. It seems to slow the release of GABA, a sleep promoter in the brain. It also may act on the histamine system, which is connected to sleep regulation. What is clear is that modafinil differs from most other pick-me-ups, which tend to be indiscriminate in their function. Amphetamines like Dexedrine, for example, promote wakefulness by interfering with uptake of the neurotransmitter dopamine, causing dopamine to flood the brain. Dopamine, says Joyce Walsleben, director of the NYU Sleep Disorders Center, is a "broad hitter" that sets the heart racing, causes twitchiness, and makes you feel high. When the effect of such stimulants wears off, the crash is nasty. Caffeine affects a different pathway, involving adenosine, but that, too, spills over the brain's flood wall, making coffee drinkers jittery.

Charting the neurology of sleep
Charting the neurology of sleep

But modafinil tiptoes around dopamine, confining its activity to the particular neurological processes connected to wakefulness. It doesn't seem to act as a broad stimulant. (This is one reason, Walsleben says, that modafinil has not become a street drug. Unlike cocaine or amphetamines, modafinil doesn't make you feel high, and it acts very slowly, taking a couple of hours or more to kick in.) Narcoleptics seem to love modafinil. (By boosting alertness throughout the day, modafinil reduces the narcoleptic's compulsion to nod off.) Now doctors are getting barraged by requests from regular folks who want to use it to cut down on sleep.

The seduction of modafinil is that you can feel as peppy after six hours sleep as you would after nine. (It may also have a more drastic effect.) Doctors see modafinil as an occasional pick-me-up. They doubt you could take the drug everyday without consequences: Most sleep researchers agree that the longer sleep is necessary for hormonal regulation, among other essential bodily functions. (Drugs aren't the only way we may steal less sleep. Click here to read about how we may enlist gene therapy to help us stay awake.)