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.