Should we be banning Stilnox?

It is call to action that has been mentioned on a regular basis. There is a drug on the market that despite repeated requests from the public and medical profession continues to be available. It's called Stilnox, the chemical name being Zolpidem. It's a newer type of sleeping tablet, and has been linked to a number of adverse events, usually related to amnesia after taking it, and has been reported to have led to patients performing acts they have no recollection of the next day.
This I don't refute, and, just as an aside, other sleeping tablets can lead to the same adverse effects. The risk of these events occurring seem to be increased when patients combine Stilnox with alcohol, which is against the recommendations of the manufacturer.
The NRL have raised concerns that Stilnox use is rampant among rugby players, and they feel the medication is being used to achieve a 'high' in players that are subjected to random drug tests, because it is not seen as a performance enhancing drug, hence goes undetected during routine drug screening. Perhaps they are referring to the adverse effects as outlined above. But Stilnox does not act on the same chemicals in the brain as amphetamines, so I am not sure about this.
What really annoys me about this whole debate associating athletes and sleeping tablet use is that we are not addressing the underlying question. Why do elite athletes need to use sleeping tablets like Stilnox at all?
As a clinician who specialises in sleep disorders, I am aware of the high rates of anxiety and sleep problems in elite athletes. While there will always be a temptation for some to misuse substances, by and large elite athletes have sleeping problems because of unrealistic expectations placed on them by their clubs. Athletes become sleep deprived as they attempt to adhere to match timetables, early morning training and jet lag when travelling to and from international events.
What is more rampant within the sporting profession than Stilnox use is a lack of understanding of the impact of 'cheating sleep'. Sleep is often seen as something to trade off against late nights and early morning obligations. This is despite the growing body of evidence which demonstrates convincingly that chronic sleep deprivation leads to a range of health problems, including obesity and cardiac disease.
Take for example the way the AFL match fixture runs in 2014 compared to when I started watching about 30 years ago. Matches can run untill 11pm on a Friday or Saturday night, players travel interstate on a regular basis and must attend early morning training sessions. Or, what about Olympic athletes that travel to other countries and are in the pool or on the track well before jet lag has dissipated, expected to do their very best during hours when they would normally be asleep. Sleep is 'cheated' at the very times that they are under scrutiny to do well. And this is without the added effects of performance anxiety which may also cause temporary insomnia.
So do we ban a drug or educate the sporting profession about the need for restorative sleep? I don't advocate that we use sleeping tablets on anything more than a temporary basis, and always in conjunction with psychological and behavioural strategies. But if external pressures mean physically less time in bed, how do athletes cope? Is this really why the use of sleeping tablets is rife within the sporting profession? And why label an athlete as a drug user when they have legitimate sleep disturbance and need professional help?

Taking it for the team

It is always hard to stick your head up and fight for a cause. Or so I hear. I have always been a crusader thats is passionate and controversial. I don't always conform but often question, looking for solutions where possible. As a result, I dont always 'fit in'. That can be tough, and I know I can polarise, but it's all I know, even if it creates personal angst at times. 

The recent @AHPRAaction debate has fuelled passion and outrage within me from the get go. I have watched the argument intently, and yesterday, I added my name to a petition that will be delivered to my governing body as a doctor and psychiatrist. Many of my colleagues agree with my views on this assault on free speech but are too concerned of potential backlash, and as such resist from adding their name to the petition. It doesn't mean they don't care but they fear consequences. 

Do I fear consequences? Of course I do. Do I fear my potential vulnerabilities as we move to a society focused on social media? Resoundingly, yes. I felt comforted today as I checked the list and found doctors I admire adding their names to the petition. Today, Dr Mukesh Haikerwal threw his support behind #APHRAaction that counter proposed regulations by AHPRA regarding social media. If there is one doctor I would state cares about his peers, its Mukesh. I was priveliged to have an office bearer position within AMA when he was involved at state level, then as federal president. I am reassured that I am actively supporting a cause with no certain conclusion, and involves a body that can de-register me, but I am one of many including Mukesh. I can state vehemently that this is not fair, encourage lively debate and influence a decision that can only become more relevant as we move towards a future intertwined with social media. 

I have been reflective during this debate. Why do we fear backlash as doctors? It begins as medical students and interns.  We learn not to show weaknesses or vulnerabilities, or ask for help. We work hard but don't make it into our chosen specialty. We fail our college exams a few times and we keep fronting up for work. We struggle with the challenge of entering private practice while distracted by the intricacies of small business, while feeling we are alone. We learn somewhere in medical student training it's not OK to say we are struggling, and as such, human. But when we feel we are being treated unjustly? Why do we find it so hard to stand up for our rights?

The @AHPRA debate has been one sided largely because of lack of comment from the body that has imposed the regulations. I am proud I am on the side that has united doctors that are fearful of governing bodies, but more fearful of living in a world where all that is said about us publicly is negative. I know I am not alone when stating I am not a doctor for the notoriety. I don't need testimonials. My patients thank me behind closed doors, and on a difficult day that is all I need to keep going. But what of the next few years and social media trends? Did I sign up for a calling that is gruelling, challenging, terrifying yet rewarding only to see criticism about me? The balance might tilt and the tweets, posts and updates may shatter me on a difficult day. That's why I am fighting now. And being surrounded by the likes of Mukesh, I know I am doing the right thing by myself and my profession. And I am so proud to be one of my colleagues that has put their fears aside recently and exposed themselves as campaigners against these regulations. 

Let's hope we tip the balance in our favour.