Better waking through chemistry

An overextended, overmedicated insomniac turns to Provigil, the skyrocketingly popular pill that's been a godsend for the narcoleptic, the jet-lagged and the just plain dog-tired.

Published November 12, 2004 4:52PM (EST)

This fall I hit rock bottom. I woke up after four hours each night, my unconscious roiling with thoughts of a new job, my first mortgage, family drama and what, really, there is to eat for breakfast that's tasty and not bacon. On one groggy morning, I was again late for work and nearly fell down a flight of subway steps. What I needed was a week on an island, a foot massage, or maybe a kick in the head. What I got was Provigil, a wonder drug for the sleep deprived.

You can blame the Internet, Starbucks, bin Laden, or your neighbor's barking beagle, but we're a nation of tossers and turners. Our battle with shut-eye goes all the way back to the turn of the 20th century, when Thomas Edison began to mass-manufacture an inexpensive carbon light bulb, and families could keep their homes lit longer, for cheaper. "Edison thought people used darkness as an excuse to be lazy and unproductive," says Dr. Stanley Coren, a sleep expert and psychology professor at the University of British Columbia in Vancouver. "Since then, as a society we have been constantly sleep deprived." In 1913, the average person enjoyed a whopping, wonderful nine and a half hours of sleep -- the ideal, according to Coren. Now most of us get seven and a half, tops.

Can't turn back time, so what's an insomniac to do? I've asked friends, consulted docs, and surfed the Web: The causes and fixes are commonly, eagerly spouted. Go to bed and wake up at the same time every day (impossible). Avoid caffeine in the afternoon (working on it). No alcohol for six hours before you go to sleep (get real). Make your bedroom a sanctuary for restfulness (not easy when your desk is planted 10 feet from your bed). I've tried to put myself to sleep by going through the alphabet and remembering all the women I've kissed letter by letter (Note to self: search for a set of triplets named Quinn, Ula, and Xena). I've tried Ambien and even more potent sleeping pills. Failures, all.

With slumber so elusive, it was time for plan B: To do better with less sleep. Would Provigil come to my rescue?

Provigil, the ask-your-doctor-about-it ready name for a drug called modafinil, has been on the market since 1998, produced by the drug giant Cephalon. It was invented by French researchers as an antidote to narcolepsy, which six years and skyrocketing sales later -- $290 million in 2003, up from $207 million in 2002 --remains its intended use. But who's kidding whom? One analyst from Bank of America Securities has estimated that fewer than 20 percent of Provigil's users medically drool in the middle of dinner. The rest of us just walked off the red-eye and have a big presentation, need to stay up all night to finish a project, or are fighting a war in Iraq.

Even though Cephalon does not have approval to market the drug for any use besides narcolepsy, physicians have been prescribing Provigil for fatigue (as well as depression), finding that it peps up people without the side effects of stimulants such as Ritalin, Dexedrine and Adderall. As it doesn't give you an instant high, and can't be chopped up and snorted like Oxycontin, Provigil hasn't surfaced on the streets. Nor does it seem to have turned into a party drug for bored teens.

The science behind Provigil remains cloudy. "We're not sure exactly where it's working in the brain, but it would seem to work in the histamine system, so it's very effective for keeping you awake," says Dr. Joyce Walsleben, director of the New York University Sleep Disorder Center. Unlike amphetamines, which take more of a wandering tour of the brain, including the motor areas (which is why people get all twitchy and have irregular heartbeats), modafinil's effect is subtle; many people report barely noticing it's there. That's huge, poising Provigil to be a Viagra-like blockbuster: a medicine that has an intended use for a real medical condition but that also sounds pretty good to the drug leisure class. And unlike Viagra, Provigil has resulted in no deaths, and few users report major side effects.

"Should people just use it because they'll feel better and stay awake?" ponders Walsleben. "That's a question for society to answer. Is Provigil better than drinking six cups of coffee and getting an ulcer? Is it better to fall asleep and drive into a tree?"

And is it better to take a pill than have your boss wonder every day why you're so tired and why you haven't edited the story that's been sitting on your desk for a month? Exactly. So I called my cousin, Dr. Brad Manin, a Philadelphia internist and the resident doc in the family, to see if he could hook me up with vitamin P. "Are you nuts?" he said, even more appalled than usual at my continual (fruitless) attempts to pry narcotics from his stingy hand. "That shit messes with your brain. Look at all the people who are sorry they took Vioxx. It will be years before we know what Provigil's real side effects are."

I don't have that kind of time. My own doctor, a much more reasonable man, understood my predicament and gave me a prescription for the standard dose of 200 mg. When my healthcare provider refused to approve it, I forked over $261.56 for 30 white pills the size of a large vitamin. "You really going to pay out of pocket for that?" asked an incredulous employee at my local Duane Reade drugstore. "I've paid a lot more for a lot less," I said. He seemed to understand. Off we go.

You can take Provigil morning or afternoon -- one of its greatest qualities is that it doesn't interfere with your ability to fall asleep at night -- and with or without food. It has a half-life -- the amount of time before half of the drug's peak plasma level is eliminated by the body -- of around 15 hours, so it's typically only taken once a day. My plan: Swallow the drug in the early afternoon, swapping better living through chemistry for my usual caffeine fix. I figured I'd give it a five-day trial but was prepared to love this drug for a lifetime.

I ingest my first pill on a Monday around 2 p.m. Within a half hour, I am, as advertised, totally alert. I am also happily hyper and I talk. A lot. When a chemical gets into your brain, boy, do you know it. This initial Provigil rush feels like the goody-two-shoes cousin of MDMA, a creamy icing of energy squashing my blahs away. OK, maybe knowing I was taking a wake-up pill automatically made me feel better, but I swear -- the rush was real. Luckily, rather than want to, say, stroke my co-workers' hair, I feel the need to share the smallest details of a story I'm editing on the new Mustang to anyone who has the misfortune of coming by my office. I've never been this excited about a muscle car.

An hour later, my eyes feel like they are popping out of my head. My hands want to move fast -- I'm pounding on my keyboard like I've just walked in on it sleeping with my girlfriend. I'm edgy and awake, but at the same time I feel sort of frozen, as if I were a big bee buzzing in a tiny, tense hive. I've never made the acquaintance of the drug ketamine, but I can't help but wonder: Is this what a K-hole feels like? And here comes downside No. 1: Like Ecstasy, Provigil causes me to clench my jaw and grind my teeth. Yuck.

Jaw aside, 24 hours into the five-day test drive, I'm feeling pretty good. At least I'm awake.

But I can't get my head around what this drug is doing to me. It's not exactly like ephedra (better for a physical, not mental, boost), and it's much more powerful than NoDoz and its "Let's stay up all night and write a comparative-lit paper" kin, Dexedrine. It's not like coffee -- a potion I've drunk so much of that I have started to hate everyone associated with it, with the possible exception of the nice lady at the bodega who's the only one open at 5 a.m. when I can't sleep. Like many other stimulants Provigil gives you an initial rush, but once you're up, you stay up and never come crashing down. Which is probably why people love it.

By the third day of feeling awake and full of plans to accomplish big things, the pile of unfinished work on my desk suggests that in reality I'm not getting much done. I'm more skittish than focused. All revved up with no place to go, I make this scary observation: Provigil reminds me of cocaine. Checking the Physicians' Desk Reference, I learn that when Provigil was given to monkeys who were already trained to self-administer coke, they happily inhaled Provigil, not realizing the difference, a behavior that is called "reinforcing." I can see how this could get addictive.

Four days and 96 hours into the experiment, I wake up with the shakes and shivers. Am I sick? Is it in my head? Is it the Provigil's fault? I take Advil, drink green tea, chug NyQuil, and sleep till noon. I just can't see munching Provigil today.

Later, I feel better. I have dinner plans with a friend. I want to feel focused and zippy, not like a cloudy, sick guy. I have an idea ... Provigil. The plan was to use it only to be a tiger at work, but it's a small leap to see it as pick-me-up party drug in lieu of a disco nap. Here we go. I'm up up up and away. I drink, but sloooowly, as if I just can't get to the bottom of my glass of red wine. The outer world moves at a happy, mellow speed, but my heart begins to race. The wine kicks the drug in a bit more, like a trainer providing a push that helps you bench-press that extra 25 pounds. I like that feeling. Provigil is giving me a catchy beat. I'm back, baby, I'm back!

That night, I fall asleep easily. When I wake up five hours later at 5:35 a.m., I pop a controlled substance called Temazepan that doctors give to people who laugh at Ambien (and my insurance company was kind enough to cover). For a split second it occurs to me that perhaps I shouldn't be mixing so many medicines, but the urge to see (at the very least) a "9" on my alarm clock bests the fear. I stay down till a whopping 10 a.m. Even though I am running way late for work, I feel ggggreat!

I celebrate with two cups of coffee and a mango banana protein smoothie for breakfast. I eat broccoli rabe and fennel and sausage pasta for lunch. I'm fattening myself up for the kill. Provigil for an afternoon snack? Bring. It. On.

And so I do. Which brings on downside No. 2: More than halfway though my adventures with Provigil, I'm beginning to notice some unpleasant adventures with my digestive system. Now, I reckon, would be a good time to look into the possible side effects of a pill I've put into my body for four days. Turning to Cephalon's handy FAQ, I discover that I may experience headache, nausea, nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble sleeping, dizziness and upset stomach. True, I've got a knot the size of a grapefruit in my back, but more pressingly, I really have to go to the bathroom.

The Physicians' Desk Reference reports that in clinical trials in the United States, 5 percent of some 369 patients who received Provigil discontinued its use because of a bad experience, the most frequently given reasons being headaches, nausea, depression and nervousness. Five percent is not an insignificant number, as I'm slowly learning.

I decide to check in with my favorite online repository of drug information, the Vaults of Erowid, which offers information on illegal and legal drugs, as well as the Experience Vaults, which are like the customer reviews of drugs, but much more entertaining. Provigil customers are largely satisfied, especially when they compare it to other common stimulants. "I was just alert, with no unwelcome desire to go curl up and snooze unless I wanted to -- and I could if I wanted to," wrote Benjy. "With speed, the reinforcing event is the horrible eternity when sleep's no option but the sparkle is gone -- that's what makes people blow another line at 4 AM. Provigil isn't like that; it doesn't make me think I'm Jean Fucking Baudrillard, and it doesn't make another hit seem quite so compelling. All it does is make me alert, anytime I want. Like coffee without the corpse breath."

Many others users write of similarly positive results, so I am wondering if my increasingly negative reaction to Provigil is about my own physical and mental constitution or just bad karma for using a drug in a way it's not supposed to be used. It's nice to cut down on corpse breath, but I am really grinding my teeth. I am too hyper, too often, madly jumping from one project to another, making lists with even more zeal than normal. During a staff meeting in which I know I am going to be grilled on topics I am extremely familiar with, I feel like I am going to have a heart attack. Or at least a panic attack. Are my fingers tingling or shaking or not actually moving at all? I'm going a little crazy.

But I vow to keep taking it. If some 95 percent of its users dig it, then dammit, I will too. There's a saying in my office that I don't think anyone understands but everyone sort of likes: Go with your weakness.

The next day I take it earlier in the day than usual. Almost instantly, I want to start pulling at my hair. At the office, I zig and zag among my co-workers, though I can't tell if I appear alive and charming, or nervous and annoying. I know for sure that I look pasty. I also know I haven't touched the big story I wake up each morning vowing to conquer.

And then there's this strange feeling: I can, for the first time, understand how people who are heavily medicated feel crazy and out of control and even suicidal.

I'm not going to kill myself, but somehow this drug in my body makes that all seem less scary, less completely and totally out of the question. I don't know exactly how (nor, apparently, do the makers of the drug), but my brain chemistry has been altered, and I don't like where it's headed. I've had enough.

When I wake up the next day after a fitful night's sleep I say, without a smirk for possibly the first time ever, thank God it's Friday, the fifth and final day of my test drive. I take my final Provigil with ruby red orange juice at 2:38 p.m. My insides instantly fill with butterflies. At 2:46 my hands feel more tingly than twitchy, not so bad at all. The rush feels like an eight-year-old's first downhill slide on the log flume ride at an amusement park -- fast, cold and just a little scary. Am I going to miss it? Maybe. But this shit isn't good for me. And even if it is, I can't afford it. I vow to get more exercise, drink less coffee, and meet a woman named Ula.

That night I remove my computer from my room, tuck myself into bed with a cup of decaf green tea, a good book, and no impending panic of another day on a drug that I've loved to hate. To my right is a beside light -- damn that Edison. I read a few pages, then flip the switch and doze off into the unknown.

By Larry Smith

Larry Smith has written about his and other people's lives for ESPN magazine, the New York Times, Teen People, and other publications.

MORE FROM Larry Smith

Related Topics ------------------------------------------