This blog post explores whether Somnacin, featured in the movie Inception, and similar real-world sleeping pills could actually be possible, and the ethical issues they might raise.
If you enjoy watching movies to some extent, you’ve likely seen Inception and probably suffered its aftereffects for a while afterward. This film poses profound philosophical questions beyond being a simple sci-fi movie. Is what we believe to be reality truly real? Or are we trapped in a dream manipulated by someone else? These doubts linger in the audience’s mind long after the film ends. In the film, we see the drug Cobb’s team uses to enter dreams and the device that administers it, the Dream Machine, also known as ‘Somnacin’. The suffix ‘somn-’ is attached to words related to sleep; there is even a real-life sleeping pill called Somnos. From a neuroscience perspective, the concept of entering another person’s dream remains largely theoretical. While attempts have been made to analyze what people dream about during sleep using fMRI (functional magnetic resonance imaging), it remains largely uncharted territory.
Furthermore, the ability to create and manipulate a world within a dream according to one’s will is even more surreal. The film explores the boundaries between human consciousness and unconsciousness, reality and dreams, prompting audiences to consider new dimensions of thought. If a drug like Somnacin existed in reality, wouldn’t it have adverse effects on the protagonists? Furthermore, if such a powerful sleeping drug were actually possible, how should we accept it? These questions extend beyond the film’s narrative, connecting to ethical dilemmas in modern society. What price would we pay when drugs slip beyond the control of consciousness?
First, it’s necessary to clarify the concept of sleeping pills. Drugs that induce sleep can be broadly divided into sleeping pills and sleep aids. The latter, sleep aids, can be purchased over-the-counter at pharmacies without a prescription. They typically use antihistamines, which do not act directly on brain cells. The drowsiness experienced after taking cold medicine stems from blocking histamine, a substance that causes arousal—this mechanism is exploited. However, stronger sleeping pills that induce deeper sleep act directly on the brain. Commonly used drugs are broadly categorized by chemical structure into barbiturates and benzodiazepines. Among these, benzodiazepines, which are relatively less toxic, are widely used. They act directly on GABA receptors in the brain’s neurons, which are involved in calming effects, inducing sleep. This is because GABA inhibits adrenaline, which excites and arouses the body.
These sleeping pills are classified as psychotropic drugs and are subject to strict legal control; they can only be purchased and administered with a prescription. Depending on dosage, they can function as sleep aids, anti-anxiety medications (sedatives), or even general anesthetics. To induce rapid and powerful sleep like Somnacin, one must administer a sleep agent that acts directly on nerve cells via intravenous injection, ensuring immediate distribution into the bloodstream.
Cobb and his team carry a case-like device called PASIV (Portable Automated Somnacin IntraVenous Device). They administer Somnacin intravenously as needed, then proceed with the Inception operation to carry out their mission. PASIV is a device that enables the stable administration of Somnacin and monitors the drug’s concentration within the body. A single PASIV unit can be used by up to eight people simultaneously. Although not shown in the film, administering the sleep-inducing drug intravenously requires calculating the dosage based on ‘milligrams per kilogram of body weight’. Therefore, the team must know the weights of the Cob team members beforehand. In other words, to achieve the same effect on the lean Arthur and the larger Yusuf, the amount of drug injected must differ. Therefore, the PASIV’s internal configuration must not deliver the same drug dose through all eight injection lines; it must allow for individual dose adjustment.
Meanwhile, the film states that the ‘drug administration time’ equates to the duration spent in the dream, which is factually incorrect. Even if the drug is injected directly into the bloodstream, it takes time for the drug to reach its final destination—the GABA receptors in the brain. Furthermore, the drug’s effect does not end immediately after injection; the drug continues to bind to and act on the receptors until it dissociates, at which point the effect concludes. Furthermore, the concentration of the drug and its efficacy do not have a perfectly linear relationship. Therefore, it is practically difficult to precisely calculate in advance the exact dosage needed to ensure the drug’s effects manifest for only a few minutes or hours. To use PASIV for such a purpose, an additional mechanism would likely be required—perhaps one that uses electrical stimulation, separate from the drug itself, to alter the potential of brain neurons and halt the drug’s effects.
Another critical issue is physical dependence on sleeping pills. Repeated use of potent sleeping pills like the Somnacin used by Cobb and his team can lead to the body becoming dependent on the drug, potentially causing severe withdrawal symptoms upon cessation. Furthermore, tolerance to the drug may develop, requiring increasingly larger doses to achieve the same effect. This process can ultimately lead to fatal consequences for both the body and mind.
Anyway, since it’s a movie, they immediately fall into a deep sleep upon receiving the injection and enter someone else’s dream. After completing their mission within the dream, they must wait for the drug’s effects to wear off to return to reality. If they need to regain consciousness before the effects end, a powerful external stimulus called a ‘kick’ is required. Pouring water or a specific song (Edith Piaf’s chanson in the film) serves as the kick. Therefore, the person in the dream must be conscious enough to recognize the kick and must also be able to feel physical stimuli or pain. Midazolam is a drug that induces sleep or anesthesia without causing analgesia or loss of consciousness. Midazolam belongs to the benzodiazepine class of drugs mentioned earlier and is commonly used for anesthesia during dental or surgical procedures, or for sedation during endoscopy. While the drug is active, the patient can breathe on their own and communicate simply. However, after the drug wears off, they have no memory of the process. Simply put, they black out. In the film, Ariadne, the student who designs dreams, cannot recall when she first entered the dream world upon accessing it. This appears to be due to the sleeping pill inducing anterograde amnesia.
Based on these points, the existing sleeping pill most similar to Somnacin’s composition is thought to be midazolam, which can be administered intravenously, has relatively fast onset, and does not cause loss of consciousness. People dream, especially aggressive dreams, primarily during REM sleep when the brain is highly active. Since the protagonists in Inception state have brain activity 12 times higher than normal, and up to 20 times higher during special operations, their operational state would likely correspond to the REM sleep phase. While many sleep medications suppress the REM stage, midazolam is the drug that affects it the least. This further supports the argument that midazolam is the drug closest to Somnacin. Therefore, we will proceed with the discussion based on the premise that Somnacin’s composition is similar to midazolam.
Meanwhile, Cobb and his team approach Fischer on the plane to execute Inception on their target. It was fortunate that when the flight attendant offered drinks, Fischer chose water instead of scotch. This is because taking a sleeping pill like midazolam simultaneously with alcohol can cause a synergistic effect, leading to extremely severe sedation. In such a case, Fischer would have fallen into the deepest unconscious state, the most dangerous realm known as ‘limbo,’ before the Inception operation could even begin. Before injecting Somnacin, Fischer was given a sleeping pill ‘orally’ to induce sleep. Couldn’t Somnacin also have been administered orally instead of by injection? Here, we should briefly mention the difference between oral administration and injection. When a drug is injected intravenously, it immediately distributes throughout the bloodstream, allowing it to reach its final destination faster and thus producing effects more rapidly. However, when a drug is taken orally, it must pass through the digestive tract and undergo absorption, which means it takes longer for the effects to manifest. For those who must enter a sleep state immediately after injection, oral administration prevents them from swiftly completing their mission. Furthermore, absorption rates vary depending on gastrointestinal function and digestive tract condition. Consequently, this creates the problem of not reaching the dream simultaneously. For instance, Arthur, who is somewhat thin, might have weaker digestive function. Or Cobb, suffering from stress-induced gastric ulcers after his wife’s death, might have a lower pH (hydrogen ion concentration, indicating acidity) in his gastrointestinal tract. These factors alter drug absorption, leading to greater individual variation in efficacy. Therefore, administering an intravenous dose of medication appropriate for each individual’s weight or body surface area is suitable for multiple people performing tasks simultaneously.
The film also features the tragic love story between protagonist Cobb and his wife Mal as a significant element. The two create their own happy space within a dream at the ‘limbo’ stage and enjoy life there. However, after returning to reality, Mal becomes convinced that reality is the dream and develops an obsession that she must commit suicide to return to reality. Ultimately, she jumps from a high-rise building, acting on her belief. This can be seen as withdrawal symptoms from abruptly stopping long-term sleeping pill use. While Cobb continued using Somnacin for his job, Mal, having developed sufficient physical dependence, returned to reality and suddenly stopped the medication. This withdrawal likely intensified her anxiety and depression, leading to suicidal impulses. In the film, Mal’s behavior—biting her nails and displaying anxiety and restlessness—reflects this pattern. Her confusion between reality and illusion, along with her impulsive actions, also align with this. Cobb should have gradually reduced the intensity of Somnacin use for Mal to prevent withdrawal symptoms, allowing her to adapt to the dosage changes. This process is called drug tapering.
Are there additional precautions when using Somnacin? The film depicts it as simply adjusting the drug dosage proportionally to the mission’s required duration through PASIV manipulation. In reality, most drugs must be administered considering an individual’s metabolic function. Midazolam is a drug metabolized in the liver. The liver functions like the body’s chemical factory, where storage, breakdown, and detoxification of many substances occur. Liver enzymes play a crucial role here. Therefore, if the enzyme metabolizing midazolam is inhibited, the extent to which midazolam is broken down or rendered inactive decreases. This leads to persistently high drug concentrations in the body, potentially prolonging the drug’s effect beyond necessity or causing toxicity. For example, the antifungal drug itraconazole acts in this way to interfere with midazolam metabolism. If Kob had a severe fungal infection requiring long-term itraconazole use, even the same dose of Somnacin could send him into a coma. Liver function itself is also problematic. While appearance alone is insufficient for judgment, if Yusuf had fatty liver disease causing significantly impaired liver function, dose adjustment would be necessary in this case too. Thus, it is crucial to always adjust drug dosage considering the metabolic function of the individual taking it.
Ultimately, even though the Somnacin and PASIV depicted in the film are unrealistic devices and drugs infused with cinematic imagination, they carry warnings about human desires and fears, and the future that technological and medical advancements could bring. We should use this cinematic imagination to contemplate the ethical issues future technology might raise.
Thus far, we’ve explored sleep-inducing drugs, particularly midazolam—thought to be most similar to Somnacin’s composition—by linking it to various scenes from the film ‘Inception’. While the concept of artificially inducing sleep to manipulate another’s thoughts is truly novel and fascinating, applying existing sleep drugs to Somnacin would clearly present numerous difficulties in executing an ‘Inception’ mission.
But movies are movies, and reality is reality. Unless we find ourselves in a situation where we absolutely must return to the dream ‘limbo,’ it is far more desirable for our mental and physical health to sleep soundly and regularly without sleeping pills, living our lives without confusion between dreams and reality. Come to think of it, when does the protagonist, Cobb, actually get his ‘real sleep’?
