Allowing the use of Modafinil would make our surface warfighters more resistant to fatigue and more effective fighters during extended combat.
Imagine the scenario. At 0100, Commander Kipp, commanding officer of the USS Dealey (DDG-130) in the Pacific, receives a call from the combat information center (CIC). His tactical action officer (TAO) has a message from Seventh Fleet to all forces in the Pacific stating that the People’s Liberation Army-Navy (PLAN) has been ordered to hunt and destroy all U.S. Navy ships inside the second island chain. The news is concerning, especially since the destroyer has been operating in the South China Sea with a Chinese Navy warship tailing her for the past two weeks. After he arrives to CIC, the captain is briefed on the situation. The Dealey is to find and destroy all PLAN military vessels.
After 30 hours of an intense cat-and-mouse game with the PLAN, Commander Kipp is completely fatigued and his cognitive abilities are hampered, but he decides to stay and continue searching. Recently received intelligence imagery reveals a PLAN destroyer within striking distance of his ship. He calls the ship’s corpsman to provide him with Modafinil to help alleviate the symptoms of fatigue. Soon after taking the medication, Commander Kipp regains full cognitive abilities and continues to fight with his ship, prevailing over the Chinese destroyer.
If this scenario played out today, Commander Kipp—without access to Modafinil—would have succumbed to fatigue and the ship could have lost its most experienced ship handler and warfighter at the most crucial time in the conflict. Even worse, he could have stayed awake and made critical mistakes in battle. Properly administered, modern cognitive enhancement medications like Modafinil can keep experienced warfighters alert and in the fight for much longer than otherwise would be possible.
Fatigue is an Enemy
Studies show that “sleep restriction and sleep deprivation degrade performance as much as, or more than, alcohol intoxication.”1 General George Patton once exclaimed, “Fatigue makes cowards of us all.” War planners often create conditions to fatigue the enemy. Sun Tzu mentioned the need to exhaust your enemy, “If he is taking his ease, give him no rest. When the enemy is relaxed, make them toil.”
Performance-enhancing drugs have entered the warfighting calculus. Many countries—Canada, China, the Netherlands, South Korea, Taiwan, Singapore, India, France, and Russia to name a few—are aggressively researching Modafinil or similar medications to extend the endurance of their militaries.2 In 2011, China unveiled its version of Modafinil, called Night Eagle. China claims this drug will keep its troops awake for up to 72 hours with minimum cognitive degradation. A Shanghai-based military expert captured the intent of the medication best: “Whether our troops can deprive themselves of sleep hours or even days longer than their opponents could make a major difference.”3
Russia also is interested, and it is perhaps the biggest advocate for the development of enhancing medications to improve human performance. Russia invented many of the medications on the market today, such as Noopept and Phenotropil. Moscow is not afraid to use medications to improve performance, as evidenced by recent allegations of state-sponsored doping of Russian athletes.4
While we do not want to get into a cognitive-enhancing race with Russia and China, we should not ignore the benefits of using FDA-approved medications as intended: to help Navy personnel to perform better, fight, and win.
Operating Under the Influence
Using medications to fight fatigue is not new to the military. As an FDA-approved medication, Modafinil has been in routine and successful use in other parts of the U.S. military for more than a decade. The Air Force, Marine Corps, and Navy pilots, for instance, use Modafinil (sold under brand names including Alertec, Modavigil, Provigil, and Nuvigil) during long-endurance flights. Prior to Modafinil (often referred to as “go-pills”), amphetamines were the medication of choice to combat fatigue.
Modafinil is an orally-administered medication used “to treat excessive sleepiness caused by narcolepsy . . . or shift work sleep disorder (sleepiness during scheduled waking hours and difficulty falling asleep or staying asleep during scheduled sleeping hours in people who work at night or on rotating shifts).” The most common side effects include headache, nausea, nervousness, dizziness, or difficulty sleeping. Rarer but more serious side effects include fast/pounding/irregular heartbeat and mental/mood changes (such as agitation, confusion, depression, hallucinations, and rare thoughts of suicide). Of note, the most common side effects of Modafinil are similar to those caused by caffeine use, including a faster heart rate, anxiety, depression, difficulty sleeping, nausea, restlessness, tremors, and more frequent urination.5 Modafinil is a Schedule IV (the second-lowest of five levels) controlled substance, on a level with other medications such as Xanax and Valium.6
While Modafinil is not known to be habit-forming, it does have a reputation for being used “off-label” for its performance-enhancing characteristics by groups such as college students and Wall Street traders.7
The extensive use of Modafinil by the U.S. military started in the early 2000s. Its use has become widespread, particularly in special operations and aviation communities throughout the U.S. and allied militaries. Modafinil has been shown to be less addictive and less disruptive to scheduled sleep patterns as compared to earlier stimulants such as amphetamines.8
Caffeine Is Not Enough
The surface community, however, has never promoted or approved the use of these medications. Instead, surface warriors rely on another well-known solution to fight the effects of fatigue: caffeine. Caffeine as the elixir of choice is almost legendary in the surface Navy. Sailors take pride in their coffee cups; the more stained the better. Having the dirtiest looking cup shows that you have endured long hours at sea without sleep. But studies suggest that the effects of caffeine are short lived and eventually can aggravate the effects of fatigue.9
The surface force recognizes the challenges of dealing with fatigue, and it has gone to great lengths in recent years to improve the balance between rest and wakefulness for its personnel operating at sea. By instituting watch rotations that ensure proper circadian sleep schedules among watchstanders and ensuring crew rest is a key part of operational planning, the Navy has gained what appear to be improvements in crew morale and operational effectiveness. But despite these efforts, situations may occur either in wartime because of extended combat operations or in peacetime because of circumstances such as unexpected operational crises or key personnel incapacitation where command-level decision makers and supervisors are forced to go without rest for extended periods to meet operational requirements.
Commanding officers typically have limited options to meet the challenge of command-level fatigue in such operational situations, with available choices in some cases narrowing down to a suboptimal solution set, such as:
1. Getting rest while the executive officer or other senior officer oversees the situation (which may or may not be advisable given capabilities or experience level).
2. Continuing to stay up to oversee operations (thus becoming less effective over time as a decision-maker and leader because of growing fatigue).
3. Aborting whatever operations are in progress that require command-level oversight (which may or may not be possible given the ship’s tactical situation).
Commanding officers typically have chosen a combination of these alternatives to meet their commitments. Use of modern commercially available wakefulness-promoting medications such as Modafinil can allow command-level leaders to operate at near-optimal levels for extended periods (up to 40 hours) as needed for combat operations or during an extended peacetime crisis.
Sound Implementation Required
Detractors of Modafinil claim that there is no need for medications to fight fatigue because an exhausted commanding officer is just an example of feeble leadership—of a leader who did not properly plan or train his or her crew sufficiently to operate without direct senior supervision. Nevertheless, having the most senior and experienced officer on the ship overseeing a dangerous situation could be the difference between success and failure. The implementation of Modafinil can provide a “break-glass” solution to commanding officers under these circumstances.
The key to successfully introducing Modafinil to the surface fleet will be a sound implementation plan. This plan should include the following steps:
1. Conduct a pilot program to assess the effectiveness of Modafinil in improving key leaders’ tactical and operational performance under conditions of sleep deprivation. This pilot program could start with the issuance of Modafinil to volunteer prospective commanding officers who could conduct practice tactical simulation sessions during periods of extended sleep deprivation.
2. Update independent duty corpsman training programs to support at-sea use of Modafinil.
3. Revise the Navy’s medical standards to allow use of Modafinil under specific circumstances with specific mitigating measures.
4. Give surface commanding officers the authority and discretion to approve the administration of Modafinil. They will be fully accountable for anything that happens to their ship/boat and crew; therefore, relying on their judgment to decide when key personnel need Modafinil is a logical extension of the authority and trust already vested in them.
5. Issue written guidance to clarify the authority on the use of Modafinil.
• Restrict Modafinil’s use to commanding officers, executive officers, and key warfighters.
• Require commanding officers to personally approve a clearly defined usage time line for designated personnel prior to administration.
6. Pending a successful Modafinil pilot program for key shipboard leaders, consider adding its use to training scenarios to more realistically train and certify shipboard leaders in maximizing combat effectiveness under simulated wartime operations.
Go Pills to Fight and Win
The Navy is investing extensively in the research and development of hypersonic missiles, energy weapons, cybersecurity, artificial intelligence, and unmanned systems, but most of these developments will not be in the fleet for many years. Use of Modafinil, however, will allow us to quickly tilt the balance by making our warfighters more resistant to fatigue. The most important element in winning wars is the human element. Approving the use of go-pills for black shoes would make a significant, immediate difference in our ability to think clearly under the arduous rigors of sustained combat and prevail over our adversaries.
1. John A. Caldwell, et. al., “Fatigue Countermeasures in Aviation,” Aviation, Space, and Environmental Medicine, vol. 80 no. 1 (January 2009), www.asma.org/asma/media/asma/pdf-policy/2009/fatigue-counters.pdf.
2. William Saletan, “The War on Sleep,” Slate, 29 May 2013, www.slate.com/articles/health_and_science/superman/2013/05/sleep_deprivation_in_the_military_modafinil_and_the_arms_race_for_soldiers.html.
3. Staff writer, “PLA eyes ‘Night Eagle’ to make army of night owls,” South China Morning Post, 16 October 2011, www.scmp.com/article/982075/pla-eyes-night-eagle-make-army-night-owls.
4. Camila Domonoske, “More Than 1,000 Russian Athletes Involved in Doping Conspiracy, Report Says,” NPR, 9 December 2016, www.npr.org/sections/thetwo-way/2016/12/09/504937994/more-than-1-000-russian-athletes-benefited-from-doping-conspiracy-report.
5. The information in this paragraph was obtained from MedlinePlus, medlineplus.gov.
6. “Controlled Substance Schedules,” U.S. Drug Enforcement Administration, www.deadiversion.usdoj.gov/schedules/.
7. Olga Khazan, “The Rise of Work-Doping: The drug Modafinil was recently found to enhance cognition in healthy people. Should you take it to get a raise?” The Atlantic, 27 August 2015, www.theatlantic.com/health/archive/2015/08/the-rise-of-work-doping/402373/.
8. Saletan, “The War on Sleep.”
9. Wyatt Myers, “Can Caffeine Relieve Your Chronic Fatigue?” Everyday Health, 3 April 2010, www.everydayhealth.com/chronic-fatigue-syndrome/relief-with-caffeine.aspx.
Commander Gonzalez commanded the USS Momsen (DDG-92). He recently completed a federal executive fellowship at the Johns Hopkins University Applied Physics Laboratory and is a graduate of Jacksonville University and the Naval War College, holding master’s degrees in both business administration and national security and strategic studies.