Clinic Locations

Woolcock Sleep Clinic
Phone: (02) 9114 0000
Address: 431 Glebe Point Road, Glebe, NSW, 2037 Email: reception@woolcock.org.au
Royal Prince Alfred Hospital
Phone: (02) 9515 6655
Address: Level 11, Main Block, Missenden Road, Camperdown, NSW, 2050
Integrated Sleep Health
Phone: (02) 9238 2209
Address: MLC Building, Level 57, 19-29 Martin Place, NSW, Sydney, 2000 Email: info@isleephealth.com.au

Professor Ron Grunstein

Professor of Sleep Medicine

MBBS, MD, PhD, FRACP

Cognitive enhancement and sleep research bump into each other.

Posted: January 4, 2015

According to today’s Sydney Morning Herald, the drug habits of Australian students will be the focus of new research to determine whether prescription medications are being misused in a bid to enhance academic performance.A survey, commissioned by the National Drug and Alcohol Research Centre, will seek information from students across four Australian universities.

Suffers of Idiopathic ("cause unknown") Hypersomnolence ("excessive sleepiness") have 'sleep attacks' during irregular times.

The findings, due to be released in 2016, will build on the first big study of prescription stimulant misuse at Australian universities, published last year, which found 8 per cent of undergraduate participants had used the drugs in a manner not specified in the approved packaging label. This research, led by University of NSW performance psychologist Jason Mazanov, will poll more than 1700 students at four large south-eastern universities about their use of cognitive enhancers, illicit drugs, caffeine and natural diet supplements.

Its interesting that the newspaper highlights Ritalin when probably the number #1 stimulant being used  is caffeine – hopefully this will be measured in research. Its interesting that there was no mention of the wakefulness promoter, modafinil in this context. Modafinil has a different mode of action than Ritalin and arguably fewer side-effects and is not a classical stimulant.

This type of research is not novel. Last year, researchers from King’s College, London wrote about cognitive enhancing drugs and responses from a large convenience internet sample of university students. Use of ‘smart drugs’ among UK students is described in frequent media reports as a rapidly increasing phenomenon. Conducted from February to September 2012, the survey involved 877 students and measured phamacological cognitive enhancement (PCE) (i.e. smart drugs) prevalence, attitudes, sources, purposes and ethics. Lifetime prevalence of PCE using modafinil, methylphenidate (Ritalin) or dexamphetamine was under 10%, while past regular and current PCE users of these substances made up between 0.3%–4% of the survey population. A substantial majority of students was unaware of and/or uninterested in PCE; however about one third of students were interested in PCE. PCE users were more likely to be male, British and older students; predictors of PCE use included awareness of other students using PCEs, ADHD symptomatology, ethical concerns, and alcohol and cannabis use. Lifetime prevalence for caffeine pills use was 49.4%, with 24.3% lifetime prevalence for cognitive enhancement. A very small proportion of those surveyed were unfamiliar with caffeine pills (1.5%), while over 10% identified as current users, with current users choosing caffeine pills for cognitive enhancement than for other purposes.

The ethical debate over the use of cognitive enhancement is complex and controversial. Some have been labelled cognitive enhancement as “cosmetic neurology”. Others have stated the view that the use of mind-altering drugs by famous bands like the Beatles never led anyone to discount their music output. There is clear evidence that a lot of famous music has been written (and often played) with pharmacological enhancement. In contrast, others raise safety issues with widespread use of these drugs and issues of dependency, adverse effects and so on. Use of these drugs by the military or critical operators in the transport industry is another part of the topic that needs to be discussed.

Debate around this topic needs to be data driven and not simply philosophical. We do not know enough about these drugs and need to learn more. Our group has extensively studied modafinil and its longer acting cousin armodafinil. We have used armodafinil as an effective agent in trials of narcolepsy and sleep apnea with persisting sleepiness. More recently we published evidence of short term efficacy of modafinil in treating sleepy patients with mild sleep apnea and have followed this with an ongoing study of armodafinil as a potential weight losing drug through cognitive enhancement to assist weight loss and sleepiness reduction. This latter study forms part of the PhD of Julia Chapman and is headed by Nat Marshall from our Faculty of Nursing. As well we have shown that modafinil improves simulated driving and alertness compared with placebo in patients with severe obstructive sleep apnea. David Wang from our group has just had a paper accepted in the journal Sleep showing how this is achieved through EEG activation.

This just forms part of the large ongoing effort to understand how drugs like modafinil work in clinical settings and by extension could potentially be used by individuals trying to maximise outcomes while temporarily deprived of sleep.

 

Professor Ron Grunstein is a Sleep Disorder Specialist based in Sydney, who consults at the Woolcock Clinic and Royal Prince Alfred Hospital and undertakes research at the Woolcock Institute, University of Sydney.