Modafinil's effects on simulator performance and mood in pilots during 37 h without sleep

Modafinil is a relatively new alertness-enhancing compound of interest to the military aviation community. Although modafinil has been well-tested in clinical settings, additional studies are required to establish its safety and efficacy for use in pilots.

The purpose of this study was to determine whether modafinil (100 mg after 17, 22, and 27 h without sleep) would attenuate the effects of fatigue on fighter-pilot mood and performance during 37 h of continuous wakefulness.

A quasi-experimental, single-blind, counterbalanced design tested the effects of modafinil in 10 Air Force F-117 pilots.

Modafinil attenuated flight performance decrements on six of eight simulator maneuvers. Overall, modafinil maintained flight accuracy within approximately 15-30% of baseline levels, whereas performance under the no-treatment/placebo condition declined by as much as 60-100%. Modafinil decreased self-ratings of depression and anger, while improving ratings of vigor, alertness, and confidence. Benefits were most noticeable after 24 to 32 h of continuous wakefulness. One potential drawback of modafinil was that, at least at the 100-mg dose level, the drug's effects were not subjectively salient. Since this may lead personnel to escalate the dose without flight surgeon approval, personnel should be cautioned regarding this particular drug characteristic.

Although modafinil did not sustain performance at predeprivation levels, the present study suggests that modafinil should be considered for the military's armament of short-term fatigue countermeasures. Future research will evaluate whether 200-mg doses are more beneficial than the 100-mg doses used here.