A conversation with Jonathan Poole can be a surreal experience. The first thing he says is, “Write down your name - I can’t do names”. He begins to speak normally, then sticks a finger in one ear, and his speech turns to gobbledegook. He takes out his finger and he can speak again. “I don’t know why that happens,” he smiles.

As long as you talk to him in a steady flow of words, Mr Poole can understand you. But if you say one word in isolation - as I do, with “refrigerator” - he looks blank. “Erm, was that ferogram?”, he asks. “I know it was frane something.”

Mr Poole, a 59 year old former bank manager, suffers from aphasia, a condition brought on by a stroke four years ago which damaged a part of the brain responsible for communication. He knows what he wants to say but often cannot think of the words he needs to say it. He also hears what you say but cannot always translate it into meaning. The Stroke Association’s description of the condition best describes it: “A person with aphasia may literally be ‘lost for words’.”

What is unusual about Mr Poole, however, is that his condition has been improving thanks to a drug licensed as a sleeping pill. In his case, it doesn’t send him to sleep - it makes him more alert, able to concentrate and better equipped to communicate.

Zolpidem, prescribed in the UK as Stilnoct, caused excitement last year when a report by two South African doctors claimed to have successfully used it to awaken patients in a persistent vegetative state (PVS), a kind of deep coma where the patient simply exists without consciousness.

Since then, the families of around 150 British patients with brain damage - many caused by strokes - have contacted the doctors, GP Dr Wally Nel of Springs, near Johannesburg, and Professor Ralf Clauss, a physician of nuclear medicine at the Royal Surrey County Hospital. Many have gone on to try zolpidem under the supervision of their GPs - and some of the results in stroke patients have been remarkable.

Newsmonster meet Mr Poole at the Surrey home he shares with his wife, Susan, and their children Harry, ten, and Alexandra, 11. In spite of his difficulties, he is cheerful and oozes charm. He takes his 5mg of zolpidem shortly after we meet.

“It’s very frustrating but there are millions of people worse off than me,” he says. “I want to say something but I can’t always find the right words. Quite often I miss words that people say, and if two people are speaking either side of me, I can only understand one of them. Phone calls are strange too. Because of my problem with names, I have no idea who is on the other end of the line.”

With zolpidem, however, Mr Poole’s powers of communication are heightened. His consultant audiological physician, Dr Jay Jarayajan of the Royal Surrey County Hospital, says: “There has been an enormous improvement. We carried out IQ tests with and without zolpidem. Without it, he was 90; with it his IQ rose to 132.”

An IQ of 90 is at the lower end of normal. 132 is classed as “very superior intelligence”.

“In speech audiogram tests, where he is asked to understand and repeat words, the results are improving,“ says Dr Jarayajan. “We do tests before and after he takes zolpidem, and he is consistently doing better.”

In spite of the results, Mr Poole says he doesn’t actually feel zolpidem working. His wife Susan, however, laughs when he says this. “The improvement is huge,” she says. “His understanding is much better and so is his speech. It also seems to lessen his frustration and improve his temper. He used to get a little angry with being unable to express himself. Now he’s calm.”

Most remarkably, Professor Clauss conducted brain scans on Mr Poole before and after taking the drug. Beforehand, a considerable section of the brain appeared dead. Afterwards, that section was greatly reduced as if cells had come back to life.

“Experience had shown us that zolpidem can work in some people with severe brain injuries, those in a minimally conscious state or PVS, but it also appears to work with some lesser brain injuries caused by strokes,” says Prof Clauss.

Nobody knows for sure how zolpidem works - and in the majority of brain injury patients it doesn’t work at all - but Prof Clauss and Dr Nel have a theory. After the brain has suffered severe trauma, a chemical known as Gaba (gamma amino butyric acid) closes down brain functions in order to conserve energy and help cells survive. After a period of months, sometimes years, the receptors in the brain cells that respond to Gaba become hypersensitive, and as Gaba is a depressant it closes down affected parts of the brain.

The doctors believe that during this process the receptors are in some way changed or deformed so that they respond to zolpidem differently from normal receptors, thus breaking the hold of Gaba. This could mean that instead of sending patients to sleep as usual, the sleeping pill makes dormant areas of the brain function again.

Kathleen Griffin, 81, from West Molesey, Surrey, suffered a stroke in July 2006 that left her paralysed down the right side, unable to speak and doubly incontinent.

“It was so bad that the doctors said she would never speak or walk again and she would always suffer the indignities of not being able to control her bowels,” says Mrs Griffin’s daughter, Linda Baki (Mrs Griffin still cannot speak).

“We read about zolpidem and asked her GP if she could try it. On February 1 we gave her her first dose and within moments she was just different. She got rosy cheeks, her eyes went bright and her face, which drooped to the left, straightened up.

“She would dribble her food and drink, and that stopped, too. She continued to improve and regained complete control over her bowels - you can imagine what that did for her self esteem - and in physiotherapy she actually began to walk with a three-pronged stick.”

However, several months ago Mrs Griffin had a setback not unusual in stroke patients; she had an epileptic fit.

“She had so much other medication that she was taken off zolpidem for two weeks,” says Linda. “Straight away she became incontinent again, began to dribble and appeared less communicative. Then she went back on zolpidem and she’s going from strength to strength. She’s up again walking with a stick and all the incontinence has stopped.

“I thought the medication was helping her but before the fit I wasn’t sure. Now, with the way she was during the two weeks without zolpidem, I’m sure that is what is causing her improvements. It’s incredible.”

Matthew Tomlin was devastated when his father, Brian, a 63 year old retired postman from Colchester, Essex, had a stroke two years ago. Brian was unconscious for three weeks before coming round to be told he had suffered damage to his brain stem. His upper brain function - intelligence, ability to think and so on - had not been affected, but he was paralysed to varying degrees in his legs and arms, could not speak, swallow or see properly.

In May, Matthew heard about zolpidem and asked his GP if he would prescribe it for Brian. We speak on the phone.

“Would you come and see for yourself,” says Matthew. “I’m not sure if it’s just me, but I really think he’s much better. Perhaps I’m just going mad.”

Brian is being cared for at a nursing home near Maldon in Essex. When I arrive it is clear that he has been very severely affected by his stroke. He is hunched up in a chair, his head is tucked into his chest, his face droops on one side, he is drooling and both his arms and hands are twisted tightly into his sides. I know he can hear and understand every word, but there is little outward evidence of this.

Matthew crushes 7.5mg of zolpidem into water and feeds it through a tube into Brian’s stomach. It is 5.59pm. While it takes effect, I ask Brian some questions.

“Do you feel better since you have been taking the medication?”. He nods, yes. “Does it make you feel more awake?”. Yes. “Does it make you feel more alert?”. Yes. “Does it help with movement?”. He shakes his head to this, No, and Matthew is surprised. “But dad,” he says, “your physiotherapist says you are making huge improvements. Is it that it makes you feel stronger?”. Brian nods.

By 6.11pm his arms are visibly more relaxed and less in spasm. He lifts up his right arm to show us the improvement.

By 6.21pm his arms are much more loose. He is still dribbling but is able to wipe his own mouth. His grey pallor is being replaced by flushed cheeks and his eyes seem brighter.

“Do you feel more relaxed?”. Yes, he nods. “More alert, more with us?”. Yes.

At 6.32pm he lets out a long sigh. His posture has visibly improved and he holds his head upright. He looks 10 years younger.

This, of course, is all very subjective but evidence is growing that something is happening in some patients.

“I would like to see a pilot study or a controlled trial in stroke patients with auditory problems to find out more about what is happening with this drug,” says Dr Jarayajan, Jonathan Pool’s consultant. “It is easy to have objective measures that can confirm the findings with such patients but, obviously, the potential could be there to help other stroke victims.”

At present, Stilnoct is being prescribed informally by helpful GPs but any new licensing of the drug as a brain injury or stroke treatment would have to be preceded by formal clinical trials. ReGen Therapeutics, a tiny British pharmaceutical company, has applied for a patent to use zolpidem in this way, but Dr Andrew Sutton, ReGen’s medical director, says it needs to find a partner with financial clout before embarking on trials.

“They take a long time and cost a lot of money, but the returns and the potential to improve people’s lives could be enormous,” he says. “More research needs to be done to find out exactly how zolpidem works in some patients. Perhaps then we might be able to develop a whole new generation of drugs.

“We believe the ambulant [mobile] victims of stroke or other brain injury could best benefit from this. We have worked out that the size of the market for such people, taking the medication every day for life, would be worth $4.2bn a year.”

For now, that is as far as the zolpidem story goes. In most patients it has no effect; in others it is almost instantly dramatic. In August, the results of trials in South Africa on 200 patients who have reacted well to the drug are due to be published. Those trials are aimed at pinpointing the most efficacious dose - and not on finding out how and why it works. Answering those questions is likely to cost millions of pounds and take years of arduous and puzzling research.

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