Monday September 14, 2009
Reaction to Modafinil for Sleep Deprivation
Our first episode of the new season of WCBA was a hard hitting look at sleep deprivation among resident physicians at Canada's teaching hospitals. If you missed it, you can listen today at 1130 am (noon in NT) on CBC Radio One, or download the podcast from our podcast page.
As a radical solution to the problem of sleep deprivation, I interviewed Dr. Mike Wansbrough, an ER colleague who uses the prescription medication modafinil to help him stay awake and alert at nights. As a disclaimer, I should mention (as I did on the show) that I use modafinil as well.
Modafinil is a drug first approved as a treatment for excessive daytime sleepiness associated with a medical conditiion called narcolepsy.
Some of you were quite disturbed at the prospect of being treated by a physician "under the influence".
Anne Ptasznik sent this email to firstname.lastname@example.org:
"Great show today challenging the culture of docs with their extended work hours...But I have to say I was stunned by the last segment, which came across as a commercial for Modafinil. I'm sure it's not only physicians who are eagerly now going to start reaching for the drug (or in the case of patients asking their docs for an Rx) rather than getting what theyactually from a health perspective need--work-life balance and more
Anne, no commercial was intended. Modafinil is the generic name for a medication that is approved for use in shift workers who have excessive daytime sleepiness. It's the first drug in its class to be approved for this indication. That approval is based on a growing body of scientific evidence:
* A placebo-controlled clinical trial involving 278 adults found that modafinil significantly improves functioning and quality of life in patients with shift work sleep disorder. Prim Care Companion J Clin Psychiatry. 2007;9(3):188-94.
* A three month trial by Czeisler and colleagues at the U.S. Modafinil in Shift Work Sleep Disorder Study Group found -- compared to identical placebo -- that 200 mg modafinil given prior to the start of the night shift resulted in a small but significant improvement in performance as compared with placebo. However, the residual sleepiness that was observed in the treated patients underscores the need for the development of interventions that are even more effective. N Engl J Med. 2005 Aug 4;353(5):476-86.
* A placebo-controlled trial of modafinil in emergency physicians found that modafinil increased certain aspects of cognitive function and subjectively improved participants' ability to attend post-night-shift didactic sessions but made it more difficult for participants to fall asleep when opportunities for sleep arose. Acad Emerg Med. 2006 Feb;13(2):158-65. Epub 2006 Jan 25.
Panacea? Of course not. But this is hardly a reckless idea. There is nothing -- repeat, NOTHING -- normal or physiological about physicians and other health professionals having to treat patients at night. Unless the health professional is completely adapted to working permanently at night (which means always working at night and sleeping during the day, even on days off), then chronic sleep deprivation will be a problem.
If anyone reading is likewise stunned, let me give you another reason why. It's because until this show, FEW if any health professionals talked about sleep deprivation and its impact on them and on you. Frankly, my colleagues have been far too silent about how difficult they find it to stay awake and alert. In being silent, they may have given you the erroneous impression that the problem is being taken care of, and that it's nothing you need to worry about.
Nonsense! It's only by talking about it that you get the real picture as to what is going on.
Previous Comments (5)
It is almost 60 years since I did my nursing training; there has been a huge change in the way that nurses are trained, but no such advances in the in human hours that resident doctors are expected to work. I would have thought that the dangers of sleep deprivation would be paramount in emergency work; saying that it has always been that way is not good enough. Perhaps the answer is in training more physicians, or lengthening the training period to allow more down time.patricia jones, September 14, 2009 4:17 PM
Brian, I think you're a little off. Modafinil is not indicated for Shift workers with daytime sleepiness. It's indicated for Shift workers to take 1 hour before their shift to keep them more awake.
This is very different than what Dr. Wansbrough was taking it for: after a night shift, he wanted to be more awake for his busy day. This 'prescription creep' is easy enough to justify to yourselves but is NOT how the medication is currently indicated for shift workers.
There is something inherently unsafe with the practice of working more than 18-24 hrs in a row. Using this medication just perpetuates the problem without addressing the root cause. Instead you should focus on alternative scheduling strategies that try to keep a more physiologic schedule.
I do appreciate your show for uncovering this important issue.Chuck Hansen, September 14, 2009 11:36 PM
I HAVE been treated AND operated on by sleep-dep'd Docs and I WISH someone had been honest enough to get and use modafinil (spelling corrected by US) vs. my having to go thru a repeat proceduce to repair the errors caused in the first case.
I could have died due to that sleepy slip-up, luckily I didn't and weirdly saw the same doc, much more alert that 2nd time!!! who did repair his own damage as best as possible.
I will always have "health issues" due to that one sleepy shift he had to do. And, no judgements of right or wrong involved, I do think you, dr. brian are right to do modophii and crazy to not fight the doctrine of "pain & suffering build a great Doctor", Hazing-based methodology. Of course i'd rather be seen by you in the ER on modo vs. too sleepy to remember which way the blood flows and you hurt me. However, that does make an ER-BOT begin to look good too!
love your show and am SO GLAD I dropped out of med-school to do trans-media art! of course I do keep up my CPR skills, and do grass roots barefoot medicine education in the community!! ;-)
my wish list for upcoming shows: ok you did religion&abortion, what about social consciousness and identity? eg: What about Women Dr's of colour and gay women doctors experiences?? in med school and after?Vee Walquabelle, September 15, 2009 12:51 AM
scares me how readily your guest for that final segment turns to yet another pharmaceutical in efforts to cover up deficiencies in lifestyle. To suggest there may be some sort of negligence in not taking the latest wonder chemical in lieu of suggesting more physiologically friendly work hours/shedules is truly the tail wagging the dog!
In what possible universe is that real healthcare?sadlynotsurprised, September 15, 2009 3:34 PM
I currently work as a process operator for a major oil company in Alberta. Shift work has been a way of life for me for years now. I am responsible for safely operating a multi-billion dollar plant and have to be alert at all times, day or night. About 3 years ago I stumbled across modafinil in an issue of Popular Science. I have been taking it on night shifts for about two years and I have to say it has been a great experience. On night shifts I am far more alert and able to perform my job at a much higher level. I feel this has contributed to the safety of my fellow operators and allowed me to be a much more efficient employee. Some of my co-workers have taken it as well and all make similar comments.
When I drive home following a night shift, I no longer experience sleepiness while driving; making the roads a safer place. I now have more energy to take care of myself physically as my work in the control room is sedentary. I have lost 25 lbs over the past 2 years through diet and exercise.
Bottom line is that modafinil has made me a more productive, safer, healthier and happier person and I have no qualms whatsoever about using it. In fact, I would be more comfortable if our medical professionals were using it as well. Our biological processes are all chemically driven; whether we receive these chemicals from natural or man-made sources is irrelevant. There are plenty of medications which have improved lives, and I am living proof that modafinil has improved mine.Operator, September 23, 2009 5:17 PM