Should Sleep-deprived Pilots Take Modafinil Too?

On our debut episode of the current season of WCBA (check out the Podcast dated September 12, 2009 at cbc.ca/whitecoat if you missed it) talked about sleep deprivation among resident doctors. Residents are medical school graduates who are taking postgraduate training to become, family physicians, surgeons and other specialists.

Onerous on-call schedules make for sleepy residents. The problems that ensue include increased medical errors, not to mention stress and illness among overworked residents. We’ve also heard of sleep-deprived residents who have gotten into serious (and even fatal) car accidents on the drive home following a night on call.

I’ve been a student of both sleep deprivation among health professionals and medical errors for more than twenty years. Over the years, many experts have told me that the airline industry is far ahead of the world of medicine in developing a culture in which passenger safety takes precedence over all other considerations.

Evidently, I was wrong.

Last week, the Globe and Mail's Tu Thanh Ha had a disturbing story about pilots who do sleep-stealing work schedules and the resulting accidents and near misses that arise from putting sleep-deprived residents to work. The Globe and Mail cited records from the Transportation Safety Board of Canada showing that in the last 12 years, fatigue was investigated as a possible factor in nine aviation incidents in Canada, involving 23 deaths.

“There's a consensus in the pilot community in Canada that the rules have to change, said Air Transat Captain Martin Gauthier, who was quoted in the article.”

Sounds an awful lot like the residents we interviewed for WCBA.

Apparently, it’s unlikely there will be changes in pilot work schedules in Canada any time soon. The Globe and Mail says the United Nations agency that sets global aviation standards has asked countries to update their regulations by this week, but federal official quoted in the article said Canadian standards are consistent with those guidelines.

Residents who work in European Union (EU) countries work far fewer hours a week than their Canadian counterparts. Evidently, so do pilots. The EU has a 13-hour daily maximum that is trimmed if more than two legs of a flight are flown or if the shift starts between 2 a.m. and 6 am, less than the 14 hours Canadian pilots are permitted to work.

More than that, the Globe and Mail gave the example of pilots who pull what’s known as continuous or stand-up duty, where pilots handle a late evening flight, stay overnight at their destination, and then fly back in the morning. While this fits within the mandatory 14-hour limit, it means pilots are able to manage only a few hours sleep before stepping back into the cockpit.

Clearly, this has to change. On the other hand, anyone who thinks they can snap their fingers and make pilot work schedules more healthy and humane is dreaming.

In the meantime, let me make a suggestion. Pilots who are sleep deprived should be offered the option of taking Modafinil, a medication that has been shown to help shift workers – including health professionals -- stay awake at night.

Next time you have an early morning flight, and you wonder just how much sleep your pilot has gotten, I have a question for you:

Which pilot do you prefer? A pilot who takes Modafinil when he or she recognizes they need a bit of help staying alert. Or, one who doesn’t.