Shiftwork
In recent years, as a response to social and economic demands, the so-called ’24-h society’ has dramatically evolved and expanded. According to surveys in European countries, the USA and also in developing countries, approximately 20% of employees are working in alternating shifts. However, the number of people working alternating shifts in social, communication, leisure, transportation, medical services and in factories is probably rapidly rising.
Several headline catastrophes such as the Challenger explosion, the Bhopal disaster, the Exxon Valdez oil spill, the Three Mile Island and the Chernobyl reactor meltdown have been, at least in part, attributed to human errors secondary to fatigue and sleepiness, which might have been related to the effects of shiftwork.
Effects of the atypical stimulant Provigil on a brief gambling episode
Pathological gambling (PG) is a serious psychiatric disorder afflicting 1-3% of the general population. Experimental evidence indicates shared neurochemical substrates for PG and psychostimulant addiction. Impulsivity characterizes one key subtype of PG. Therefore, medications that ameliorate psychostimulant addiction and impulsive syndromes might also benefit impulsive PG subjects.
The atypical stimulant, Provigil reduces cocaine abuse and impulsivity in patients with ADHD. The present study sought to determine if Provigil (200 mg) would reduce the reinforcing effects of slot machine gambling in PG subjects, and if this effect was stronger in high (H-I) vs. low (L-I) impulsivity subjects (N = 20). A placebo-controlled, double-blind, counterbalanced, repeated measures design was employed. Apart from bet size, which declined uniformly in both groups under drug, Provigil had bi-directional effects in the two groups. In H-I subjects, the drug decreased desire to gamble, salience of Gambling words, disinhibition and risky decision-making. In L-I subjects, Provigil increased scores on these indices.
Provigil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea
Patients with obstructive sleep apnea/hypopnea syndrome can experience residual daytime sleepiness despite regular use of nasal continuous positive airway pressure therapy. This randomized, double-blind, placebo-controlled, parallel group study assessed the efficacy and safety of Provigil for the treatment of residual daytime sleepiness in such patients.
Obstructive sleep apnea/hypopnea syndrome (OSA/HS) is a serious and chronic disorder characterized by repeated episodes of complete or partial collapse of the upper airway during sleep. The resulting disruption (or fragmentation) of sleep leads to excessive daytime sleepiness.
A relatively common condition, OSA/HS is estimated to affect 2 to 4% of middle-aged adults. Because the disorder has been associated with impairments in neurophysiologic, respiratory, cardiovascular, and cerebrovascular function, patients with OSA/ HS may experience significant morbidity and there is suggestive evidence of increased mortality.
Provigil improves wakefulness
Although its mechanism of action is unknown, Provigil appears to be unlike classic stimulants. We investigated this generality by testing the selectivity of this compound for wake-promoting effects (e.g., relative to locomotor effects) and homeostatic sleep responses after drug-induced waking relative to the prototypical stimulant methamphetamine (METH).
Continuous measures of electroencephalogram (EEG) sleep-wakefulness, locomotor activity (LMA) and body temperature (Tb) were obtained from adult male Wistar rats 3 days before and after treatment with Provigil (30, 100 and 300 mg/kg i.p.), 0.25% methylcellulose (vehicle) or METH (0.5 and 1.0 mg/kg i.p.). Individually housed rats in a 24-h light-dark cycle (LD 12:12) were treated 5 h after lights-on (CT-5).