Zolpidem in fatigue management for surge operations of remotely piloted aircraft

Zolpidem is a hypnotic medication approved to manage sleep for crewmembers involved in combat operations in the USAF and other services. Previous studies demonstrated the effectiveness of zolpidem under laboratory conditions, but confirmation from the field is needed.

We evaluated zolpidem in managing sleep-work cycles for crews of remotely piloted aircraft (RPA) during surge combat operations. There were 3 10-mg tablets of zolpidem dispensed to each of 43 crewmembers tasked to support RPA surge combat operations requiring rapid unscheduled shift changes. All personnel were required to take the drug on a non-flying day to evaluate its individual effect; use of the drug during operations was voluntary.

The surge operations were carried out successfully with no flight or ground mishaps. There were 27 crewmembers (63%) who used the medication. Of those, 19 reported that the intervention resulted in good sleep without side effects or morning drowsiness. The other eight subjects reported side effects consisting of drug hangover (N = 4) or poor sleep with frequent awakening (N = 4). There were no reports of abnormal sleep behaviors. Five crewmembers considered the medication essential to duty performance.

Zolpidem promoted the safe induction of sleep and was used successful by a majority of the RPA crewmembers. Side effects occurred in some crewmembers even though they had previously tested the drug without side effects. A small subset of the test group heavily relied on medication to successfully manage their sleep-rest cycle.