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In a busy work day where there never seems to be enough time, a drug like Provigil is a powerful draw. Just take this FDA approved pill and zip though your day on a couple hours of sleep—no coffee, no soda, no naps necessary. You'll feel more productive and less tired even several hours later. The best part: Provigil wears off after 7 hours, so when you finally want to turn in for the night, you'll be able to quickly fall asleep.

It all sounds too good to be true, so some are concerned by the promise Provigil brings of adding hours to the day by shaving time off sleep.

Keeping Alert and Productive
Provigil (modafinil) is the first drug in a class of medications called central nervous stimulants and is the only one approved to treat "excessive sleepiness." While scientists are not totally sure how it works, the drug seems to alter chemicals in the small region of the brain that controls sleep and wakefulness.

Provigil was first prescribed for patients with narcolepsy and sleepiness associated with sleep apnea, but, in 2004, the FDA broadened its use to include sleepiness associated with shift work sleep disorder (SWSD).

This latest indication is for a newly-described disorder of people who work overnight or rotating shifts, defined by excessive sleepiness on the job, insomnia, lack of energy, headaches and difficulty concentrating. While this diagnosis seems like it could apply to just about anyone who is overworked, estimates of those who suffer from shift work sleep disorder vary widely from 8 percent to 25 percent of the six million U.S. shift workers.

"Patients with this under-recognized condition are just as sleepy at night as patients with narcolepsy or obstructive sleep apnea are during the day," said lead study author Dr. Charles A. Czeisler, professor of sleep medicine at Harvard Medical School.

In the first study to look at SWSD, published August 3 in the New England Journal of Medicine, 204 patients with the condition said they had modestly increased alertness and less sleepiness after taking Provigil, and during a 20 minute computerized test, the subjects had fewer lapses in attention. After taking the drug for three months, they reported only minimal side effects, including headache, nausea and nervousness.

In an editorial accompanying the study, Dr. Robert C. Basner, of the Duke University Medical Center, was less than convinced with the study's conclusion. "It is simplistic to consider that a pill alone could sufficiently modify the effects of this disorder," he wrote.

Even though Provigil is meant to provide a gentle boost for those who cannot adjust to an odd sleep and work schedule, some worry that it may be taken as crutch to overcome long work hours

"While [Provigil] is modestly helpful in keeping people awake, the correct management of the disorder would include keeping to a set sleep schedule even on the weekends, having bright lights at work and practicing safe driving," said Dr. Thomas Scammell, associate professor of neurology at Beth Israel Deaconess Medical Center at Harvard University.

Everyone Could Use a Little Pep
The warning on the label clearly states that Provigil is not a substitute for sleep, yet the U.S. Military has already tested how long they can keep soldiers awake without detrimental side effects. So far, they have found that soldiers on Provigil can function for up to 88 hours without sleep.

The drug should help soldiers who need to stay alert on the battlefield and emergency room doctors who work 12-hour shifts. But what about the mom who feels like she needs a few more hours in the day?

The curious thing about a drug that enhances alertness is that it seems like everyone could use a dose or two now and then.

"My understanding is that the three approved uses, [narcolepsy, sleep apnea and SWSD] only account for 50 percent of the prescriptions," said Dr. Scammell.

Provigil is now being studied for use in helping those with Alzheimer's disease, attention deficit disorder, schizophrenia and depression to maintain focus and alertness. And while studies have been inconclusive, it is also being given to energize those fatigued from multiple sclerosis and HIV. It's even being used to counteract the terrible inconvenience of jet lag, drowsiness after anesthesia and the grogginess associated with many drugs.

Although it may have legitimate uses, there would seemingly be a high possibility for abuse of this drug by overachievers and go-getters looking for another way to get their job done and then some. While the FDA includes a warning on the label that the drug has a potential for addiction, many doctors prescribing Provigil believe the risk for abuse is small. The drug only stimulates a small region of the brain, so it doesn't give you the high that is associated with other abused uppers like amphetamines.

"It just isn't showing up as a street drug," said Dr. Scammell. "There's really not much of a buzz to it." Even so, the ability to get that term paper finished or to pick up extra overtime at work could turn out to be a hard habit to break.

"There you are talking about people who want to stay up even when their body is telling them to go to sleep," said Dr. Scammell. "That can be seen as a form of abuse—abusing your body. But it's one that's tolerated in society."