The Use of Daytime Wakefulness-Promoting Agents in the Treatment of Insomnia

By Dr. Gregg D. Jacobs - June 28, 2004

Provigil (Modafinil) is a daytime wakefulness-promoting agent that was originally approved for the treatment of narcolepsy. It is now also being used to reduce excessive daytime sleepiness in patients with a variety of sleep disorders, including severe sleep apnea. In a study in a recent issue of the journal Sleep (27(4): 715-25, 2004), Dr. Michael Perlis and colleagues tested the use of Provigil in enhancing the efficacy of cognitive-behavior therapy (CBT) for insomnia. They hypothesized that Provigil would make insomniacs more alert during the day, which in turn would enhance compliance with CBT and result in greater improvements in sleep.

The researchers found that Provigil improved adherence to CBT but this benefit was only for two weeks and disappeared by week three of treatment with CBT. Furthermore, the improvement in compliance with CBT for the first few weeks of treatment with CBT did not result in improved sleep. In summary, Provigil did not produce lasting improvements in compliance with CBT, nor did it result in any improvements in sleep. Based on these findings, it is unlikely that Provigil is an appropriate drug for the treatment of insomnia.

This finding, in combination with prior findings indicating that insomniacs prefer non-drug therapies and that sleeping pills in combination with CBT do not produce greater benefits than CBT alone, once again underscore the emerging evidence that CBT alone is the treatment of choice for chronic insomnia. Sleep medications or daytime wakefulness-promoting agents do not provide significant additional benefit to CBT alone in the treatment of insomnia.