“Studying   doesn’t   affect  my   sleeping   pa5erns   at   the  moment.   I’ve   learned   that   if   I   try   and  work   against   when   I’m   >red   then   I   don’t   get   the   best   outcomes.  

Obviously  there  are  deadlines  where  you  have  to  ignore  that  feeling  of  3redness.  I  think  that’s  jus3fiable  for  the  short  term  but  not  for  the  longer  term.  Before  exams  I  can  never  sleep.  That’s  just  something  I’ve  got  used  to.  I  don’t  do  all-­‐nighters,  but  obviously,  when  I’m  a  junior  doctor  I  will  have  to  do  them.  I  have  no  choice  in  that;  it’s  just  part  of  the  package.  

 I  think  sleep  is  very  important.  I  am  fine  as  long  as  I’ve  had  6.5  –  7  hours  sleep  but  I  know  when  I’m  >red.  I  can  s>ll  func>on  to  a  certain  level  but  my  mood  and  my  interpreta>on  of  things  will  change.  Sleep  seems  to  enable  your  brain  to  func>on  at  its  op>mum  level  and  it  seems  to  have  such  a  connec>on  with  energy  and  drive  as  well.  I’ll  have  less  energy  and  mo>va>on.  It  seems  to  all  be  connected.  The  first  thing  I  think,  if  I’m  >red  is,  “I’ll  go  to  bed  early  tonight”  but  it  never  happens.  Within  a  couple  of  hours  I  forget  that  I’m  >red  and  that’s  where  that  sleep  debt  can  build  up.  I  don’t  take  naps.  I  don’t  have  >me  to  and  I  don't  think  I  would  even  if  I  had  >me  because  I  would  probably  be  doing  other  things.  

 Before  I  studied  medicine  I  used  to  have  insomnia,  about  three  nights  a  week.  I  was  working  away  from  home  and  I  wouldn’t  be  able  to  switch  off.  I  would  sleep  

three   or   four   hours   a   night,   then   catch   up   when   I   got   home.   I   experimented   with   quite   a   few   different   ways   of   trying   to   get   to   sleep.   I’ve   tried  an3histamines  that  are  packaged  as  sleeping  aids.  Also  the  Nytol  herbal  ones,  and  Melatonin,  which  I  got  from  the  Internet  because  you  can’t  get  it  in  the  UK.     I  didn't  really  feel  that  a  GP  would  be  able  to  do  much  to  help  because  I  felt  that  a  lot  of  it  was  a  behavioural  based  thing  so,  psychological.  I  was  confident  that  I  could  deal  with  that  myself.    

In  terms  of  wakefulness,  I  will  resort  to  energy  drinks  on  an  excep3on.  Most  of  the  3me  I’ll  have  coffee  because  I  prefer  it  and  it’s  got  less  sugar,  so  I  think  it’s  healthier  for  you.  I  tried  Yarba  Mate  tea  bags  last  year  and  they  were  so  much  more  powerful  than  coffee.  I  ended  up  having  heart  palpita>ons   and   I   couldn’t   sleep   for   two   days   -­‐   I   soon   stopped   taking   them.   I   wouldn’t   recommend   that   to   anyone!   I   was   awake   but   I   was   so   irritable   and  hypersensi>ve;  it  wasn’t  a  produc>ve  state  to  be  in  at  all.  I  took  an>histamines  as  a  way  of  counterac>ng  the  Yarba  Mate  and  I  ended  up  sleeping  for  16  hours  and  missing  a  whole  morning’s  worth  of  lectures  because  it  was  just  going  from  up  to  a  down.  

 I  know  people  who  have  taken  Ritalin  to  stay  awake  longer  and  study  in  the  run  up  to  exams  and  I  can’t  think  of  anything  worse,  maybe  due  to  my  experience  of   insomnia   in  the  past  and  having  to  stay  up  all  night.   I  would  rather  sleep,  to  be  honest.  There   is  always  another  day  to  do  whatever  you’ve  got  to  do,  why  do  it  through  the  night  as  well?  I  think  people  have  more  problems  than  they  have  benefits  from  taking  these  things.  They're  more  likely  to  jeopardise  things  than  the  benefit  that  you  can  derive  from  working  steadily  and  surely  over  the  semester.  It  doesn’t  get  me  angry  in  terms  of  I  feel  cheated,  or  anything  like  that,  it  just  makes  me  concerned  for  them  because  they  are  poten>ally  messing  with  their  own  brain.    I  would  suggest  that  

if  you  don't  need  to  use  drugs  in  terms  of  prescribed  medica3on  then  don’t  use  them  because  everything  has  a  side  effect  at  the  end  of  the  day.  

My  concern,  in  current  society,  is  that  wakefulness  drugs  would  be  very  highly  abused  because  everything  is  much  more  24/7  than  it  used  to  be.  There  are  so  many  reasons  why  you  would  want  to  think  that  sleep  is  the  last  of  your  priori>es.  I  think  you  would  have  more  people  choosing  to  take  them  that  don’t  actually  need  them,  using  them  to  facilitate  their  lifestyle.  From  a  health  perspec>ve,  I  think  that  can  have  bad  long-­‐  term  implica>ons.  Sleep  is  good  for  you,  rest  is  good  for  you.  I  don't  think  we  need  these  drugs  to  stay  awake  more;  that’s  a  direc>on  for  society  that  we  don't  need  to  take.”  

Project  Team:    Professor  Jonathan  Gabe,  Royal  Holloway,  University  of  London  Professor  Simon  Williams,  University  of  Warwick  Professor  John  Abraham,  King’s  College,  London  Dr.  Catherine  Coveney,  University  of  Warwick/  University  of  Sussex  

MEDICATED  SLEEP  AND  WAKEFULNESS:  A  Social  Scien3fic  Inves3ga3on  of  Stakeholder  Interests,  Policies  and  Prac3ces

Research  funded  by  The  Economic  and  Social  Research  Council  UK  

NEIL  is  a  25  year  old  MEDICAL  STUDENT.  His  ethnic  background  is  White  Bri3sh.  

Neil  has  tried  lots  of  different  ways  to  manage  sleep  and  wakefulness.  He  knows  people  who  have  taken  Ritalin  as  a  study  drug.  He  is  against  lifestyle    uses  of  prescrip>on  medica>on  on  health  grounds.