But Beware, Sleep Deprivation Seriously Harms Health
http://my.webmd.com/content/article/1836.50502
Jan. 16, 2002
We're a sleep-deprived nation, fighting
stress and insomnia, and squeezing as many hours as possible out of every
day.
But could a drug ever replace a good
cup of coffee to keep us alert after a bad night's sleep? What's the buzz
about the "wake-up" pills that have been in the news lately -- a compound
called NADH (sold as ENADA and ENADAlert), and modafinil (a drug sold as
Provigil)?
WebMD spoke with sleep experts to
find out what you need to know about these pills. However, they caution
that long-term pill popping isn't the answer to our chronic sleep problems.
"There is real hard evidence that
sleep deprivation is not good for performance, health, or immunity," says
Joyce A. Walsleben, MD, director of the Sleep Disorder Center at the New
York University School of Medicine in Stony Brook. "A drug cannot replace
sleep."
In fact, even cutting sleep for one
week's time can affect the body. Studies at the University of Chicago show
that when college-aged men were allowed to sleep for just four hours a
night for one week, their insulin reactions were that of "old diabetics,"
she tells WebMD.
"To flog the brain to stay awake
just doesn't make sense," says Richard Castriotta, MD, a sleep disorders
expert and associate professor of internal medicine at the University of
Texas Medical School at Houston. "We have a physiologic need for sleep.
I liken it to the pain receptors that warn us to take our hand away from
the flame. There are reasons why we evolved to need sleep."
But What About ENADA?
Sold as nutritional supplements in
health food stores, ENADA and ENADAlert are pill forms of NADH, a co-enzyme
that is present in all living cells and necessary for cell development
and energy production. It stimulates dopamine, noradrenaline, and serotonin
receptors, thereby improving mental clarity, alertness, and concentration,
says the web site for Menuco Corp., the manufacturer.
NADH is not a hormone, not a steroid,
"not a stimulant," says Margaret Moline, PhD, director of the sleep-wake
disorders center of New York Presbyterian-Weill Medical College of Cornell
University.
Small studies have shown that the
compound helps people cope with chronic fatigue syndrome -- "it helps people
feel more alert," she says. It could also help with jet lag.
Those all-nighters that people can't
avoid -- that's what Moline looked at in her study. A group of 25 people,
all between 40 and 59 years old, were kept up all night under supervision,
then were randomly given either ENADAlert or placebo right before breakfast
the next day. Researchers measured their sleepiness and gave them cognitive
tests to perform.
Despite feeling sleepy, those taking
ENADAlert still performed better than those who took the placebo. "They
performed better in terms of performance efficiency -- they had higher
numbers of correct answers per minute," Moline says. The effects of taking
the supplement long term to compensate for chronic sleep deprivation have
not yet been studied, she says.
Is it addictive? ENADA developer
Georg D. Birkmayer, MD, PhD, reports that more than 1 million Americans
have been taking the supplement on a daily basis for a number of years.
"I have not heard of any effects related to addiction," he tells WebMD.
The Buzz on Modafinil
Available only by prescription, modafinil
is only approved to treat narcolepsy, a disorder in which sleepiness is
uncontrollable even during daytime.
"It's a good wake promoter," Walsleben
tells WebMD. "It takes two hours to get going but has a half-life of 10
hours, so it works all day long. By evening, there are no after-effects
that affect overnight sleep. It allows the sleep rhythm to be normal."
Extensive studies have shown that
modafinil is not addictive because it works on different receptor systems
than do amphetamines, she says. "There are very few side effects, if any,
and there's little concern about abuse. People don't develop a tolerance
to it. It's a really neat drug."
Military fighter pilots can stay
alert for several days at a time on modafinil -- and perform mental tasks
with "near normalcy," she says. The drug may also help people with depression
and related psychiatric disorders, "people who get the doldrums and just
can't get going."
Night-shift workers also might benefit
from modafinil. At the University of Pennsylvania, a study involving 16
participants tested the theory. The group first had to stay awake for 28
hours. Then they began a four-day period of sleeping from 11 a.m. to 7
p.m. and being awake at night. Half were randomly given modafinil during
their awake hours, half got a placebo.
Those taking the drug were able to
stay alert and performed well on tests, while the placebo group had a significantly
higher error rate, she reports.
Modafinil is also being tested as
a complementary treatment for sleep apnea (a breathing disorder that causes
chronically interrupted sleep) and as an option to treat syndromes like
multiple sclerosis, where fatigue is a big problem, Walsleben tells WebMD.
The only caution: modafinil does
seem to have problems interacting with other drugs such as anti-seizure
and heart medications. "It also lessens the effectiveness of birth control
pills," she says. "People need to discuss this with their doctors."
Words of Caution
"It's clear [modafinil] can make
people more alert," says Thomas Scammel, MD, a sleep disorder specialist
and assistant professor of neurology at Beth Israel Deaconess Hospital
in Boston.
"The danger," Scammel tells WebMD:
"It's easy to imagine people using it casually. One of our real concerns
is that people will start taking it to make up for the fact that they're
not getting enough sleep."
The average person needs eight hours
of sleep, yet the average American gets about seven hours. "Many, many
people get far less than that," says Scammel. "Sleep serves a very important
purpose. Sleep deprivation causes serious changes in endocrine and immune
systems. To patch up that sleep loss is to do our bodies a real injustice."
"If people are having sleep problems,
they need to get to the underlying problem," says Walsleben. "The drug
can only serve people well if their underlying condition is first treated."
Medically Reviewed
© 2002 WebMD Corporation
By Jeanie Davis
WebMD Medical News
By Dr. Gary Vogin