Somnacin, the powerful sleeping pill in the movie ‘Inception’: what are the real-world possibilities and problems of scientific imagination?

We explore the real-world possibilities of Somnacin, the powerful sleeping pill used in the movie Inception, and discuss what ethical and scientific issues the movie’s scientific imagination might raise in the real world.

 

If you enjoy movies to any degree, you’ve probably seen the movie Inception, and you’ve probably felt the after-effects for a while afterward. More than just a sci-fi movie, the movie raises deep philosophical questions. Is what we believe to be real really real? These questions linger in the audience’s minds long after the movie ends. In the movie, we see the drug that the Cobbs use to enter their dreams and the device that administers it, the Dream Machine, aka Somnacin. The somn- suffix is attached to words related to sleep, and there is a real-life sleeping pill called somnos. The idea of entering someone’s dreams is still very much in the realm of imagination when it comes to neuroscience. Of course, there have been attempts to analyze what dreams a person is having while asleep using fMRI (functional magnetic resonance imaging), but it’s still uncharted territory.

 

 

Furthermore, the ability to create and manipulate the world at will in dreams is even more surreal. In this way, the movie explores the boundaries between consciousness and unconsciousness, reality and dreams, and takes the audience to a new level of thinking. If sleeping pills like Somnacin existed in the real world, what would be the negative effects of the drug on the characters? And if such a powerful sleeping pill is actually possible, what should we make of it? These questions are not just about the movie, but also about ethical dilemmas in the modern world. What price do we pay when drugs take over our consciousness?
First, we need to clarify the concept of sleeping pills. There are two main types of drugs that induce sleep: sleeping pills and sleep inducers, the latter of which can be found over the counter in pharmacies and usually use antihistamines, which don”t work directly on the brain cells. This is why cold medicines make you feel sleepy: they block histamine, a substance that causes wakefulness. However, more potent sleeping pills, which are meant to help you fall into a deeper sleep, work directly on the brain. In practice, the most commonly used drugs are barbiturates and benzodiazepines, which are classified according to their chemical structure. Among these, benzodiazepines are the least toxic. They work by directly acting on the GABA receptors in the brain, which are responsible for calming the body down, because GABA inhibits the adrenaline that makes us feel excited and alert.
These sleeping pills are classified as psychotropic medicines, which means that they are subject to strict legal controls and can only be purchased and administered with a prescription. Depending on the dose, they can be used as sleeping pills, anxiolytics (sedatives), and even general anesthetics. In order to enter a state of sleep as quickly and powerfully as Somnacin, you’ll need to inject a sleeping pill that works directly on nerve cells, rather than a sleep-inducing drug, intravenously so that it can be distributed directly into the bloodstream.

 

 

Cobb’s crew carries a case-like device called a Portable Automated Somnacin IntraVenous Device (PASIV), which they use to inject Somnacin intravenously as needed to carry out their missions in Inception. The PASIV is a device that reliably delivers Somnacin and monitors the amount of drug in the body. Each PASIV device can be used by up to eight people simultaneously. Although we don’t see it in the movie, when injecting sleeping pills intravenously, the dosage is calculated in “milligrams per body weight,” so it’s important to know the weight of the Cobb team in advance. This means that to get the same effect from a slimmer Arthur and a heavier Yusuf, the amount of medication needed to be injected would be different. Therefore, the composition of the PASIV should not be such that the same amount of drug is injected into eight injection lines, but that the dose can be individually adjusted.
In the movie, it is said that the ‘dosing time’ is the duration of the dream, but this is not true. Even if the drug is injected directly into the blood, it takes time for the drug to reach its final destination, the GABA receptors in the brain, and the drug’s effectiveness does not end when the injection is over, but rather when the drug continues to stay in the receptors, acting on them, and then comes off. In addition, the concentration and potency of the drug is not exactly linear, so it is difficult to accurately calculate the dose in advance to ensure that the drug is effective for only a few minutes or hours. It is likely that PASIVs would require an additional mechanism to stop the effects of the drug by changing the potential of the brain’s nerve cells through electrical stimulation other than the drug.
Another important issue is physical dependence on sleeping pills. Repeated use of powerful sleeping pills like Somnacin, which Cobb used, can cause the body to become dependent on the drug and experience severe withdrawal symptoms when it is stopped. In particular, you may develop a tolerance to the drug and need to use increasingly higher doses to achieve the same effect. This process can eventually have devastating consequences for the body and mind.
After all, a movie is a movie, and as soon as they receive the injection, they fall into a deep sleep and enter other people’s dreams. After performing their mission in the dream, the drug must wear off in order to bring them back to reality, and if they need to regain consciousness before the drug wears off, they need a strong external stimulus called a “kick”. The kick can be a splash of water or a certain song (in the movie, Edith Piaf’s chanson). The dreamer must then be awake enough to recognize the kick and feel the physical stimulus or pain. There is a drug called midazolam that induces sleep and anesthesia without causing analgesia or loss of consciousness. Midazolam is a member of the benzodiazepine family, and is commonly used to anesthetize patients during dental or surgical procedures, or during sleep endoscopy. While it’s taking effect, you can breathe on your own and even communicate briefly. However, once the effects are over, you have no memory of the process. In other words, the film stops. In the movie, Ariadne, the girl who designs the dreams, can’t remember when she first accesses the dream and when she entered the dream, which is likely due to the anterograde amnesia induced by the sleeping pills.
Given this, the closest analog to Somnacin’s ingredients among current sleep medications is midazolam, which can be injected intravenously, has a relatively fast onset of action, and does not cause loss of consciousness. When we dream, especially aggressive dreams, it’s mainly during REM sleep, when the brain is active. In Inception, the main characters’ brains are said to be activated at 12 times normal brain activity and up to 20 times during special operations, so it’s likely that they’re in REM sleep when they carry out their operations. Many sleeping pills suppress the REM stage, but midazolam is the least affected. This also supports the idea that midazolam is the closest drug to Somnacin. Therefore, we will continue with the premise that Somnacin is similar to midazolam.

 

 

Meanwhile, Cobb and his team approach Fisher on an airplane to execute Inception on their target. When the flight attendant offers him a drink, it’s a good thing he chooses water instead of scotch. This is because taking a sleeping pill like midazolam at the same time as alcohol can be synergistic in its effects, causing very severe sedation. In this case, Fisher would have been in “limbo,” the deepest state of unconsciousness and the most dangerous state, before Inception even began. Since Fisher was “orally administered” a sleeping pill to put him to sleep before he was injected with Somnacin, couldn’t Somnacin also be administered by eating rather than injecting? It’s worth mentioning here the difference between oral administration and injection. When a drug is injected into a vein, the drug is immediately distributed throughout the body’s bloodstream, and the drug reaches its final destination more quickly, resulting in a quicker onset of action. However, when you take a drug orally, it takes longer to work because it needs to pass through the digestive system and be absorbed. For those who need to fall asleep immediately after an injection, oral medication won’t be able to fulfill its mission quickly. In addition, the rate of absorption varies depending on the state of the stomach and digestive system, so you may not be able to reach your dreams at the same time. For example, Arthur, who is a bit thin, may have a weak digestive system, or Cobb, who suffers from a stressful stomach ulcer after the death of his wife, may have a low pH (pH is the concentration of hydrogen ions, indicating acidity) in his gastrointestinal tract, which results in different absorption rates and therefore different effects. Therefore, intravenous injection of a dose of the drug that is appropriate for each person’s weight or body surface area is suitable for multiple people to perform the mission at the same time.
The tragic love story between Cobb and his wife Mal is also an important element of the movie. The couple creates their own happy place in their dreams during the “limbo” phase and enjoys their life there, but even after returning to reality, Mal believes it is a dream and feels compelled to return to reality by committing suicide. She eventually fulfills her belief by jumping off a skyscraper. This can be seen as a withdrawal symptom after prolonged use of sleeping pills. While Cobb continued to use Somnacin because of his job, Mal would have been physically dependent enough to have developed a physical dependency, and because he stopped the drug abruptly when he returned to the real world, the withdrawal would have resulted in increased anxiety, depression, and suicidal thoughts. In the movie, Mal bites her nails and shows signs of anxiety and agitation. She also confuses reality with fantasy and acts impulsively. Cobb should have tapered Mal’s Somnacin use to avoid withdrawal, allowing her to adjust to the change in dose. This process is called drug tapering.
What else should I be aware of when using Somnacin? While the movie portrays the PASIV as simply manipulating the drug to adjust the dose proportionally to the time required for the mission, the reality is that most drugs need to be dosed according to the individual’s metabolic capabilities. Midazolam is metabolized in the liver. The liver is the body’s chemical factory, where many substances are stored, broken down, and detoxified, and liver enzymes play an important role in this process. Therefore, interfering with the enzymes that metabolize midazolam can reduce the amount of midazolam that is broken down or rendered inactive, which can lead to high levels of the drug in the body, prolonging its effectiveness or causing toxicity. For example, the antifungal drug itraconazole interferes with the metabolism of midazolam in this way. If Cobb has been using itraconazole for a long time because he has severe athlete’s foot, the same dose of Somnacin could leave him in limbo. Liver function itself is also an issue. If Yusuf has a fatty liver and his liver function is significantly impaired, the dose will need to be adjusted. As such, it’s important to always adjust the dose of any medication to take into account the metabolic function of the person taking it.
In the end, Somnacin and PASIV may be unrealistic, cinematic devices and medications, but they represent the human desires and fears behind them, and a warning about the future that advances in technology and medicine can bring. We should use this cinematic imagination to think ahead to the ethical issues that future technologies may bring.
So far, we’ve discussed sleeping pills by relating various scenes from Inception to sleeping pills, specifically midazolam, which is most likely the ingredient in Somnacin. While the idea of artificially inducing sleep and controlling someone’s thoughts is a novel and exciting one, it seems clear that adapting current sleeping pills to Somnacin would present a number of challenges to the Inception mission.
But movies are movies, and reality is reality. Unless we are forced to return to a dream “limbo,” it would be both mentally and physically desirable for us to get healthy, regular, restful sleep without sleeping pills, and to live without the confusion of dreams and reality. Speaking of which, when does Kob, the main character, get his “real sleep”?