Approche pharmacologique de la désynchronisation du rythme veille-sommeil en milieu militaire et sportif

Sports and military environments have many common features - intense physical activity, rigorous physical environment (heat, cold, high or low pressure, hypoxia, acceleration…), specific psychosocial atmosphere, team spirit. If combined with jet lag syndrome, these specific conditions can favor altered physical and mental performance. There is always the temptation to use drugs as a simple way to reduce the penalizing effects. The available compounds known to affect sleep and wakefulness include hypnotics, benzodiazepines and non benzodiazepines such as temazepam, zolopidem, and zopiclone, stimulants such as amphetamine and amphetamine-like agents, adrafinil, modafinil, caffeine and chronobiotics substances such as melatonin and, more recently, slow release caffeine. In the sports area, all of these substances except caffeine are on the list of forbidden products, although special authorizations linked to known disease conditions are allowed. In the military setting, the environment may be similar, but the context of use is very different. In the context of a rescue mission, the current practice in the French military organization is to place modafinil pills in the ejection seat of fight planes and in rescue boats. A second context is the use of anti-sleep agents under orders; the debate continues on this and the appropriate recommendations in this context. Self-medication is a third condition, in which case no rules have been defined.