During the years of Nazism, when the triumph of the will was extolled, drugs triumphed to control something that even the strongest do not escape: sleep.
Pervitin, a stimulant in the methamphetamine family, kept young Germans who took over half of Europe during blitzkrieg awake for days.
Hitler consumed all kinds of substances to keep himself alert and euphoric during the day, but he soon realized that manipulating a mechanism as complex as sleep had costs.
During the night, he suffered from insomnia and his doctor, Theodor Morell, gave him tranquilizers to sleep.
In the morning, he would inject her with stimulants again to compensate for the drowsiness caused by the drugs from the night before.
More information
Discover the new section EL PAÍS Health and Wellbeing
The aspirations to control sleep continue today.
Amphetamines like pervitin are not legal without a prescription, but coffee, a tool for maintaining productivity at the cost of adequate rest, is the most widely used drug on the planet.
And on the other side of our fight against sleep, the use of benzodiazepines, created to combat anxiety but often used against insomnia, is growing steadily in Europe.
In countries such as Spain, Portugal or the United Kingdom, around 100 daily doses are taken for every 1,000 inhabitants.
The study of the biological bases of sleep is already offering some pharmacological alternatives to these substances that turn off the entire brain and have important secondary effects.
A few days ago, the European Commission authorized the marketing of daridorexant, a drug aimed at adults with chronic insomnia, which affects between 6% and 12% of the European population.
This drug blocks the activation of orexin receptors, a type of hormone that maintains wakefulness, thus allowing sleep to come.
In an article published in
The Lancet Neurology
The drug is presented as a safe sleeping pill that induces and maintains sleep throughout the night and does not cause drowsiness the next day.
In addition, it would not produce tolerance either, something that makes many drugs lose effectiveness with use.
Odile Romero, coordinator of the Sleep Unit at the Vall d'Hebron Hospital in Barcelona, has participated in clinical trials with this drug, and believes that the experts are keen "for it to be marketed, because the studies offer very high expectations." positive and no new treatments appeared for years”.
In his opinion, after studies of up to a year, it has been seen "that it is not necessary to increase the dose over time and dependence is not generated" and that "there is no rebound effect [and greater drowsiness] when stopping taking the drug”.
Milagros Merino, president of the Spanish Sleep Society, also considers daridorexant a positive addition to the arsenal of insomnia treatments, especially because "usually, until now,
the treatments used were not based on the pathophysiology of insomnia.”
This new drug "allows direct impact on orexin, a neurotransmitter that maintains wakefulness."
“If you don't sleep well, it's because something is wrong.
The problem of modern society is stress, and insomnia is a response to that”
Luis de Lecea, Stanford University
The incorporation of this new drug against insomnia also shows how the study of basic biology ends up, over time, having practical applications.
Orexins were discovered in animal models more than two decades ago by two researchers simultaneously.
One of them is the Spaniard Luis de Lecea, head of the Department of Psychiatry and Behavioral Sciences at Stanford University.
De Lecea, who has done consulting work for the company that has developed the drug but has not participated in the trials, considers that the results are good.
“Awakening in the middle of the night is avoided [something that happens with other current drugs] because it has a fairly long half-life, but it does not leave you groggy the next day, as happens with benzodiazepines,” explains De Lecea.
Chemical structure of the active principle of the new drug.
If daridorexant has no or minimal side effects, if it doesn't build tolerance and the next day you wake up full of energy to face the day, you might wonder why we shouldn't take all of it every time we have trouble falling asleep.
De Lecea insists that the study with which the approval of the drug has been supported is of good quality, but recalls, on the one hand, that long-term side effects cannot be ruled out and that, in any case, "interfering with the sleep has consequences.
“If you don't sleep well, it's because something is wrong.
The problem in modern society is stress, and insomnia is a response to that,” she continues.
The researcher from Stanford University states that "the numbers of people with sleep problems reflect a brutal epidemic", and that "sleep problems involve additional problems of depression, the immune system or susceptibility to being overweight".
In his opinion, insomnia should be treated as a public health problem, with a reflection on what causes us stress: our obsession with productivity and growth, work schedules or the use of electricity.
"A pill is not a collective solution and we cannot pretend that society is continually drugged," he concludes.
"Nobody would think of asking a relative how to treat diabetes, but with sleep it happens"
Milagros Merino, president of the Spanish Sleep Society
Despite being a social problem, insomnia is treated as a private problem.
In fact, much more than with other ailments, people go to family or friends in search of solutions and self-medication is massive.
"Nobody would think of asking a relative how to treat diabetes, but it happens when you sleep," says Merino.
"Those of us who do sleep medicine believe that all products given to sleep should be regulated as medications and prescribed by specialists, and we must raise awareness so that people do not self-medicate," he adds.
In that sense, regarding daridorexant and other drugs for sleep, he explains that their use would be considered progressively and taking into account the options that already exist, "because it will come out with a higher price than what we use now."
"There are some action protocols and it's like with pain, it goes from less to more, you don't start with morphine derivatives," he adds.
In fact, at the moment, the first line for severe insomnia is cognitive behavioral therapy, a treatment that is sometimes combined with drugs, but which requires specialists who are sometimes not as affordable.
Odile Romero agrees on the need for a change of mentality in the population.
“Sometimes, there is still talk of taking advantage of the time to do more things and take it out of sleep.
There is a lack of social awareness, as happened before with diet or exercise, that a well-slept population is a healthier population with a better mood, ”he says.
New drugs such as daridorexant, based on a deeper understanding of sleep mechanisms than current solutions, will be much more effective tools than self-medication with benzodiazepines to treat insomnia problems in a large number of individuals.
But in the long term, sleep should stop being something to regulate with chemical help to be understood as a pillar of physical and mental health.
And it is a goal that, like a proper rest,