September 2,2008:  Seven years of combat operations have forced the U.S. Air Force to pay more attention to fatigue. That's because in a combat situation, more troops have to deal with unexpected surges in activity by working double shifts and overnight. This leads to people getting drowsy and inattentive. The air force has found the midnight to dawn activity the most likely to cause inattention and error. This has been a particular problem with Predator and Reaper UAV operators, who are based in the United States. The UAVs are eight or more time zones away, so mid-day combat operations mean UAV operators have to be on their toes in the drowsy pre-dawn hours. The problem also applies to maintenance personnel running a 24/7 operation to support the higher sortie rates often encountered in the combat zone, and to headquarters troops, who have to maintain a war room full of large flat screen displays and many computer programs and radios chugging away with reports of who is doing what to who.

The air force has told its pre-dawn warriors to change their work time diet (more protein, less sugar), take exercise breaks (a dozen sit-ups will do wonders for your attention span), and more chatter with your fellow workers, as well as more checking on each others work.

Troops are also warned to stay away from "alertness" drugs, as these can backfire (when you crash) at an inopportune time. The air force has a lot of experience with this, as a major problem in modern warplane operations is pilot fatigue. This is particularly the case in the U.S. Air Force, which often sends aircraft out on missions that can take 12, 24 or more hours to complete. Actually, the problem is an old one, dating back to World War II. Then, as now, the cure has been dextroamphetamine (speed). Air force pilots have come to call this drug "go pills", and they are basic equipment for pilots who operate long range aircraft.

But one problem with the go pills is that they make some pilots more aggressive. For heavy bomber and transport pilots, this is not much of a problem. But for fighter pilots it can cause some errors in judgment (as with the F-16 bombing Canadian troops in Afghanistan six years ago.) The air force has tried to find new drugs that lack the bad side effects. One that showed promise was Modafinil (sold as Provigil). This stuff is described as a mood-brightening and memory-enhancing psychostimulant which enhances wakefulness and vigilance. It sounded promising, and the tests showed that pilots that took Modafinil saw their performance degraded 15-30 percent, versus 60-100 percent for those who took nothing at all after 24 hours of being awake. These tests had pilots in simulated cockpits for up to 37 hours, and performing realistic flight chores periodically (which were measured, producing a rating for pilot performance). While the Modafinil did a pretty good job, the dextroamphetamine ("go pills") was still a bit better. So the air force made Modafinil available as an acceptable alternative to dextroamphetamine, particularly for fighter pilots (who might need their moods brightened, in addition to being kept awake.) Pilots were also warned that Modafinil often works without users being aware that they are cranked (as one tends to be when taking speed.) So the search for the perfect go pill continues. And the danger of "pre-dawn madness" remains.