Flying a fighter jet over hostile territory sounds like it would be quite the adrenaline rush. But in reality, it can be quite challenging for military pilots to stay focused, says Wingelaar-Jagt. “Patrol flights often take place at night to remain undetected, and you might circle the same area for hours. There’s also a good chance you’re already fatigued. It can be hard to get enough sleep while deployed – you’re in a different climate, and there may be a lot of noise on and around the base.” But it’s essential to remain alert until the end of the flight. “Landing safely is the hardest part.”
In the past, people in the Dutch military were only allowed to use caffeine pills to combat fatigue. “But they complained it wasn’t very effective. One pill is equivalent to three to four cups of coffee. But if you’ve already been drinking coffee all day, as you may do during deployments, the effect is barely noticeable. It also wears off after a few hours.”
Speed
Are there better alternatives? That’s the question Wingelaar-Jagt set out to answer at the Centre for Man in Aviation of the Royal Netherlands Air Force, where she works as a flight surgeon responsible for “keeping military personnel as safe as possible while in the air”. One option on the table was a form of amphetamine, commonly known as speed, which became infamous for its use by German soldiers in World War II. “Because of that, we know a lot about how it works. But it turned out to be unsuitable – it can become addictive and may impair judgment, leading to risky behaviour. Not ideal for the military.”
Ultimately, they settled on modafinil, a stimulant used to treat the sleeping disorder narcolepsy that has been gaining popularity beyond that. It’s used by both the US and French militaries, and it’s a popular – though illegal – “study drug” among students, competing with Ritalin on the black market. The fact that we don’t know exactly how it works isn’t an issue, says Wingelaar-Jagt. “The same goes for paracetamol. Before using modafinil during flights, pilots first test it on the ground to check for side effects.”
Last line of defence
As part of an experiment, dozens of Dutch pilots used the stimulant during a deployment to the Middle East, doing so over nearly two hundred long night flights. “They reported feeling less fatigued. Side effects were rare, and it didn’t seem to affect their sleep afterwards. So that’s positive. But those are subjective reports. We also conducted objective measurements in a lab in the Netherlands. Participants were given modafinil, a caffeine pill or a placebo in the evening and then stayed up all night performing various tasks. Both caffeine and modafinil reduced the negative effects of fatigue, but modafinil’s effects lasted longer.”
The results were promising enough for the Royal Netherlands Air Force to approve modafinil for flight personnel. “And we’re considering wider use within the Dutch military.” However, Wingelaar-Jagt stresses that the stimulant is a last line of defence. “Ideally, you’d ground someone who is fatigued. But during deployments or in war situations, that’s not always possible. In those cases, modafinil can provide an extra boost. Given all the threats in the world today, it’s important to support our military as effectively as possible.”
Saving your country
Wingelaar-Jagt is less keen on the use of modafinil in civil aviation, where there has also been interest in the research results. “In my view, that’s a completely different situation – national security isn’t at stake. The same goes for students using modafinil as a study drug. This stimulant isn’t a substitute for sleep. Pulling an all-nighter is one thing, but chronic use is problematic. Sleep deprivation increases the long-term risk of diseases like cancer and cardiovascular conditions. Unless you’re saving your country, I’d think twice before taking it.”