Do You Have Excessive Sleepiness?

(Martha Rosenberg)

Do you work in customer service? Health care? The restaurant industry? You might be suffering from shift work sleep disorder (SWSD) says a new ad campaign from Frazer, Pa.-based Cephalon, which makes the Schedule IV stimulants Provigil and Nuvigil.

One out of four people working nontraditional schedules suffers from this hitherto unrecognized epidemic, say radio ads in Chicago.

SWSD is characterized by trouble focusing, increased irritability, and poor work performance explains Thewakeupsquad.com. But don’t think the answer is your alarm clock. “Just improving your sleep may not improve your ability to cope with shift work,” says the website, which offers a self-assessment quiz and chance to “take action” and “tell a friend” without saying what that action might be or what you are telling your friend. No drugs are mentioned.

Of course SWSD is only one reason for the national epidemic of excessive daytime sleepiness (EDS). Other reasons are obstructive sleep apnea (OSA) and narcolepsy, for which Cephalon’s drugs are also approved.

Additional reasons for excessive Sleepiness (ES) are non-restful sleep (NRS), restless legs syndrome (RLS), and middle-of-the-night insomnia (MOTN). You might also suffer from late night TV addiction syndrome (LNTVAS) or experience daytime sleepiness because what you are doing and the people you are with are boring.

Then there are all the people with sleepiness-from-treating-their-insomnia and insomnia-from-treating-their-sleepiness in a kind of pharmaceutical jet lag that began when insomnia meds like Ambien, Lunesta, Sonata, and Rozerem first appeared on late night TV.

Sleeping-pill hangovers are nothing new. In the 1960s, barbiturates, immortalized in the movie the “Valley of the Dolls” and by Marilyn Monroe’s death, spawned a “bennie” or Benzedrine subculture to offset their effects.

In 1993, the sleeping pill Halcion was banned in the U.K. and other countries for causing amnesia, paranoia, depression, hallucinations, and violence in users. And in 2001, the related pill, Dalmane, was said to “increase the risk of an injurious accident more than five times normal,” at FDA and National Transportation Safety Board hearings.

And who can forget Rep. Patrick Kennedy (D-R.I.) driving to Capitol Hill to vote at 2:45 a.m. in May 2006 and crashing his Ford Mustang? He reported that he had been taking the prescription medications Ambien and Phenergan.

In addition to sleep-driving and sleepwalking, Ambien is indicted for sleep eating—horrified dieters finding themselves surrounded by Haagen-Dazs empties consumed by their evil twin in a blackout.

Cephalon shouldn’t have a hard time convincing people they have SWSD or EDS judging from all the unprescribed Adderall, Vyvanse, Ritalin, and Strattera people are taking—and the number of meth labs.

Provigil “is increasingly being diverted for nonmedical use by healthy individuals with the expectation that it will improve cognitive performance,” says an article in the March 18, 2009, JAMA.

An article this week in the Daily Northwestern, Northwestern University’s student paper, says college kids who’ve outgrown their ADHD can make a quick $300 a month flipping their Adderall and Concerta scripts on campus.

But the reason FDA rejected Provigil (modafinil) in 2006 for children with ADHD was not for its abuse potential but for its Stevens-Johnson Syndrome (SJS) potential—a drug reaction so severe patients are treated in burn units and resemble napalm victims.

At FDA-advisory committee hearings in 2006 (attended by Joseph Biederman and Jorge Armenteros, later accused of drug industry conflicts of interest), between 15 to 400 children were projected to die from SJS if Provigil (modafinil) were approved for ADHD in children.

Provigil’s molecular cousin Nuvigil (armodafinil) was also rejected by the FDA in March as a jet lag drug.

Still, an ad for a clinical trial for “excessive sleepiness associated with narcolepsy” in this week’s University of Illinois student newspaper, the Flame, suggests that “being sleepy throughout the day is more than just a nuisance—it’s a heavy burden,” and sleepy students might “suffer from Excessive Daytimes Sleepiness.”

They may even have study-shift sleep disorder.

Martha Rosenberg is a journalist who lives in Chicago.