Substance Use & Misuse ISSN: 1082-6084 (Print) 1532-2491 (Online) Journal homepage: https://www.tandfonline.com/loi/isum20 Sleep- and Wake-Promoting Drugs: Where Are They Being Sourced, and What Is Their Impact? Rowan P. Ogeil, James G. Phillips, Michael Savic & Daniel I. Lubman To cite this article: Rowan P. Ogeil, James G. Phillips, Michael Savic & Daniel I. Lubman (2019): Sleep- and Wake-Promoting Drugs: Where Are They Being Sourced, and What Is Their Impact?, Substance Use & Misuse, DOI: 10.1080/10826084.2019.1609040 To link to this article: https://doi.org/10.1080/10826084.2019.1609040 Published online: 08 Jul 2019. Submit your article to this journal Article views: 4 View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=isum20 SUBSTANCE USE & MISUSE https://doi.org/10.1080/10826084.2019.1609040 ORIGINAL ARTICLE Sleep- and Wake-Promoting Drugs: Where Are They Being Sourced, and What Is Their Impact? Rowan P. Ogeila,b , James G. Phillipsc, Michael Savica,b , and Daniel I. Lubmana,b aEastern Health Clinical School, Monash University, Box Hill, VIC, Australia; bTurning Point, Eastern Health, Richmond, VIC, Australia; cPsychology Department, Auckland University of Technology, Auckland, New Zealand ABSTRACT KEYWORDS Background: Recent decades have seen both an increased number of shift workers in order to deliver Sleep-promoting drug; services 24/7, and increased potential for social interactions at all hours of the day. People have wake-promoting drug; sought to engage in strategies, which either promote vigilance or facilitate sleep, with the use of sleep quality; performance; insomnia; daytime sleep- and wake-promoting drugs representing one strategy. Methods: We investigated use of sleep- dysfunction and wake-promoting drugs in participants (n ¼ 377) who completed a survey investigating the type and source of sleep- and wake-promoting drugs, and their impact on sleep and performance out- comes. Results: The most commonly reported wake-promoting drugs were amphetamine and dextro- amphetamin salts, modafinil, and illicit substances including methamphetamine and cocaine, while the most commonly reported sleep-promoting drugs were benzodiazepines and antihistamines. Use of a sleep-promoting drug in the past month was associated with higher odds of having poorer sleep quality (OR ¼ 3.15) and moderate-high insomnia (OR ¼ 3.30), while use of a wake-promoting drug was associated with poor sleep quality (OR ¼ 3.76), or making a fatigue-related error (OR ¼ 2.65). Conclusions: These findings represent novel data on the use and source of sleep- and wake-pro- moting- drugs, and suggest that despite their use, poor sleep and performance outcomes persist, likely representing individuals struggling to keep up with the 24/7 world. Introduction Rajaratnam & Arendt, 2001; Schmidt, Collette, Cajochen, & Peigneux, 2007). The 24/7 society There is increasing recognition of poorer health and We live in a society where services across industries safety outcomes in groups that act in opposition to this are increasingly available across all hours of the day, circadian drive (Harrington, 2001; Lockley et al., 2004; with an increasing proportion of the population Rajaratnam et al., 2011;Bargeretal.,2015). For engaged in employment during non-traditional hours example, shift workers have increased prevalence of car- (Rajaratnam & Arendt, 2001). In addition to employ- diovascular disease (Bøggild & Knutsson, 1999; ment, social interactions including online services and Kivim€aki, Kuisma, Virtanen, & Elovaino, 2001;Vyas social media have resulted in more people being et al., 2012), type II diabetes (Kivim€aki, Batty, & Hublin, awake at times opposing their natural biological drive 2011; Vetter et al., 2015), poorer mental health (Bara & for sleep (Levenson et al., 2016; Garett, Liu, & Young, Arber, 2009;Thunetal.,2014; Lee et al., 2017)and 2018). Regardless of the impetus underlying this increased levels of sleep disturbance (Axelsson, drive to be awake, the 24/7 world presents an envir- Åkerstedt, Kecklund, & Lowden, 2004; Rajaratnam et al., onmental challenge to underlying human physiology 2011). Beyond discrete health outcomes, there is also (Monk, 1988), which has biologically adapted to evidence of poorer work performance, alertness, and an the light-dark cycle (Reppert & Weaver, 2002). increased propensity to make errors in those who work Homeostatic circadian rhythmicity is pervasive across nights, rotating or extended shifts (Rogers, Hwang, both physiological and biochemical outputs (Czeisler Scott, Aiken, & Dinges, 2004;Bargeretal.,2006). These et al., 1999; Pevet & Challet, 2011). In addition, circa- decrements in performance associated with increased dian rhythmicity underlies performance and behav- sleepiness are not trivial, with performance impacted to ioral outputs including sleep-wake states, alertness, a similar magnitude as having a blood alcohol concen- and mental performance (Carrier & Monk, 2000; tration, which approaches or exceeds the legal limit for CONTACT Rowan P. Ogeil [email protected] Turning Point, Richmond, 110 Church St., Richmond, VIC 3121, Australia. ß 2019 Taylor & Francis Group, LLC 2 R. P. OGEIL ET AL. driving (Dawson & Reid, 1997; Arnedt, Wilde, Munt, & (Ogeil & Phillips, 2015). Other drugs with wake-pro- MacLean, 2001). moting properties have been proposed as countermeas- To combat the environmental challenges associated ures to excessive sleepiness especially within shift work with being awake during the circadian nadir, people settings including modafinil, amphetamine, and pemo- have sought to engage in strategies which either facili- line (Åkerstedt & Ficca, 1997), however there is limited tate sleep (e.g., after a night shift) or promote vigi- data on their effectiveness. For example, a Cochrane lance (e.g., to remain ‘on task’ while at work, or to review reported limited efficacy of wake-promoting stay up to engage with social contacts) (Keith, agents including modafinil and caffeine in shift workers Gunderson, Haney, Foltin, & Hart, 2017). One strat- (Liira et al., 2014). Both illicit use of prescription egy involves the use of sleep- and/or wake-promoting stimulants such as methylphenidate and dextroamphe- drugs, however to date there has been limited investi- tamin salts and other putative cognitive enhancers have gation of where such drugs are sourced, and whether been used by college students to aid concentration or not their use is associated with better or poorer (Hall, Irwin, Bowman, Frankenberger, & Jewett, 2005; outcomes, particularly in the general population. Teter, McCabe, LaGrange, Cranford, & Boyd, 2006; Ram, Hussainy, Henning, Jensen, & Russell, 2016; Papazisis et al., 2018). As with sleep-promoting medi- Who is using sleep and wake-promoting drugs? cation, there may be negative consequences that Approximately one-in-ten adults have used alcohol as accompany their use (Smith, Martel, & DeSantis, a sleeping aid (Roehrs & Roth, 2001a), with increased 2017). For example, nicotine dependence has been use reported by shift workers where one-in-six have associated with poorer sleep quality, and increased use consumed alcohol to help initiate sleep between shifts of sleep medication and sleep disturbances (Ogeil & (Dorrian, Heath, Sargent, Banks, & Coates, 2017). In Phillips, 2015). A recent study reported that wake-pro- addition to alcohol, benzodiazepine use is common, moting medication use, high caffeine use, and smoking with 5% of adults in the United States having used a to stay awake were associated with increased odds of benzodiazepine across a 12-month period, with higher fatigue-related errors, and increased stress and burnout rates in the elderly (Olfson, King, & Schoenbaum, in police officers (Ogeil et al., 2018) suggesting a rela- 2015). Benzodiazepine use is also common among shift tionship with psychological distress. workers (Dorrian et al., 2006) and astronauts (Barger Despite recent interest in this area, few studies have et al., 2014) in order to help initiate sleep. Despite this, investigated important facets of the use of sleep- and both high alcohol or long-term benzodiazepines use is wake-promoting drugs including: (i) an assessment of of concern (Brett et al., 2017), given that tolerance to the type of drug(s) being used beyond binary categories; their effects develops, with a subsequent risk of (ii) their source (e.g., whether they were prescribed, dependence (Urru, Pasina, Minghetti, & Giua, 2015), diverted or sourced online) and their (iii) impact on which can then impact on performance (Schuckit, sleep and performance outcomes. The present study 2009). Roche, Pidd, Berry, and Harrison (2008)for examined which drugs were reportedly used to promote example, reported that high-risk drinkers were more sleep/wake states, their source, and whether use of these than 20 times more likely than low-risk drinkers to be drugs impacted upon specific sleep (e.g., sleep quality, absent from work due to their alcohol use, placing a insomnia symptoms and excessive sleepiness) and psy- large burden on the economy due to lost productivity. chological distress outcomes. Importantly, we then While sleep-promoting drugs are used to help initi- investigated whether use of sleep- and/or wake-promot- ate sleep, wake-promoting drugs are used to promote ing drugs was associated with an increased risk of hav- vigilance, or to increase concentration. Wake-promot- ing clinically relevant sleep problems,