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For fighter pilots, alertness is everything. It's not out of the ordinary for them to sit tight in a cockpit for 12 hours at a time, traversing time zones while the civilian world takes turns dozing. The feat requires not only endurance, but also razor-sharp focus. Mantaining such unflinching vigilance means fighter pilots need to hit the sack between trips. It's a tricky balancing act: alternating alertness and shuteye, but they don't have a choice. So, flyboys keep fatigue in their crosshairs through a strict diet and sleep schedule. But, when the physical and mental rigors of life behind the sticks prove too great, they occasionally hit the bottle — the Rx pill bottle. 
 
Since the dawn of dogfighting, flyboys have been prescribed uppers, downers and everything in between. Speed, meth and new-age smart pills have all made their way into pilots' hands. In fact, Uncle Sam handed them the substances. As the demands on pilots only continue to increase, the search for ever-more powerful additives continues. Here’s a look at how aviators have learned to stay sharp under the most extreme circumstances since World War II.

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The Need for Speed

Though it had been synthesized in 1887, amphetamine, or speed, first hit the market in 1932 in the form of a  decongestant inhaler called Benzedrene. Besides helping asthmatics breathe better, it also had notable stimulant effects, which is why amphetamine "energy pills" became attractive to soldiers and pilots of both the Axis and Allies during WWII. Flyboys could pop a pill and suddenly be able to cruise unhindered for another four, six or eight hours. Notably, the frenzy and fearlessness of Japanese Kamikaze pilots has since been attributed to their being utterly cranked on speed. (Also: Hitler was a celebrity-level junkie, with a vicious methamphetamine habit.)
 
Researchers eventually picked up on the notion that amphetamines, which weren't initially considered to be addictive, were creating serious health problems — a somewhat serious issue since US and British forces consumed some 150 million speed pills during WWII. For instance, at one US military prison in 1945, a quarter of the population was found to be strung out, agitated and hallucinating, due to a habit of eating the amphetamine strips from Benzedrine inhalers (which were five times the normal dose).

Official Endorsement

Following WWII the US began testing the effects of the speed American troops were consuming, and found — wait for it — that not only did sleep-deprived volunteers exhibit faster reaction time and better and-eye coordination, but they also showed a complete restoration of normal functionality. Win-win! Thus, by 1960 the U.S. Strategic Air Command had officially approved the use of amphetamine-based "pep pills" for pilots. In fact, pep pills were so common they became part of pilots' flight kits during the Vietnam War. 

Uppers to Downers

Anyone who has had one too many cups of coffee, or has gotten hopped up on cold pills, knows the difficulty of coming down at the end of the day and achieving quality shut-eye. Add to that equation nighttime flights, a change in diet, cross-continental travel and combate-fueled adrenaline and the results are troubling. To a pilot, whose entire livelihood is based on an ability to perform with perfection, enough high-quality rest is not just crucial but essential; the timing of flights and Go Pill intake is all part of the calculus. So, the last decade has seen the introduction of hypnotics — sleeping pills like Ambien and Restoril — to the pilot's arsenal. They're uncreatively dubbed No-Go Pills, as a means to counter overstimulation, yes, but also as a way of forcing adherence to sleep regulations in the face of shifting schedules and locales. A Time magazine report estimated that as far back as 2007 some 10,000 soldiers stationed overseas were authorized to take sleeping pills. 
 
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An About Face

The routine use of Dexedrine during long haul and combat missions continued unabated for three decades until 1991, when General Merrill McPeak, a particularly anti-drug Air Force Chief of Staff, banned the use of Go-Pills and other in-flight medications at the conclusion of the first Persian Gulf War. McPeak, a pilot himself, railed against the use of any drugs, saying he'd flown without them and that they posed an unnecessary health risk.
 
Despite the honorable nature of McPeak's move, it was an unpopular decision, both among pilots and researchers, who pointed out that Go-Pills had an extended and overwhelmingly safe history, and were a fail-safe against deadly fatigue. The realities of modern warfare, such as night sorties by fighters and bombers, who routinely spent 30 hours or more in the cockpit, proved to be more convincing, however. And so the Air Force quietly reinstated the use of Dexedrine as a Go-Pill for pilots in 1996, though with strict guidelines that limited the frequency of use and quantity dispensed. (Fun fact: Dexedrine is the same drug as Adderall.) 

The Wonder Drug Years 

After Go-Pills were given the go-ahead, researchers were intrigued by the potential utility of an interesting new stimulant called Modafinil. While amphetamines had been used safely for nearly half a century to sharpen up pilots and prevent fatigue, there remained the nagging potential for abuse and addiction, as well as bouts of post-dose sleeplessness. In comparison, results of studies with Modafinil were eye-popping: It appear to enable intense and prolonged alertness without becoming addictive. It's a non-stimulant and so does not interfere with sleep patterns. And, amazingly, it doesn't yield tolerance. For all intents and purposes, Modafinil was a unicorn.
 
The Air Force tested this new wonder drug with helicopter pilots, fighter pilots and bomber pilots and found no apparent downsides, even after long-term use. As a result, the Air Force began administering the drug to fighter pilots during the 2003 invasion of Iraq along with Dexedrene, and have had no issues to date. (It also explains why Modafinil, which was formulated to help narcoleptics stay awake during the day, quickly became a darling of nose-to-the-grindstone Silicon Valley programmers.)
 
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The Future of Fighter Pilot Sleep

The use of drugs, especially for off-label use, has naturally caused some headaches for the Air Force, literally and figuratively. There have been periodic media flare-ups, especially after a tragic incident in 2002 when a Go-Pilled US air crew mistakenly bombed Canadian friendlies. But there's no doubting the scientific justification behind their use, especially when today's Air Force pilots scorch the sky for ever-increasing flight times in insanely complex $50-million rental vehicles. Consider a 2004 study by the Air Force, in which F-117 fighter pilots were subjected to flight testing for up to 37 continuous hours while taking regular doses of Modafinil, with no ill-effects. For fighter pilots, the future of sleep seems to be wide-awake.