Commentary: Lack of sleep can have deadly consequences

Blackanthem.com, EGLIN AIR FORCE BASE, Fla., September 22, 2005

The long and winding road rolls before you. Your eyes hurt. Shiny reflective strips and opposing headlights only worsen the visual discomfort. At 2:30 a.m., you swerve from lane to lane. A flashing red light and siren heralds a concerned police officer. Though your words are not slurred and you pass your field sobriety test, the officer announces you are driving under the influence-not the influence of alcohol, but fatigue.

Studies have found drivers who have been awake for 17 hours have driving abilities similar to people who have a blood alcohol level of 0.05 percent. Drivers who have been awake for 24 hours straight have driving abilities equivalent to people with a blood alcohol level of 0.10 percent, which constitutes legal drunkenness in all 50 states.

The National Highway Traffic Safety Administration estimates at least 100,000 police-reported vehicle crashes and 1,500 deaths occur annually due to fatigue. A recent survey by the Traffic Injury Research Foundation reported that one in five drivers fell asleep at the wheel during the last 12 months.

In our busy and full Air Force lives, fatigue is a real threat that each one of us must recognize and effectively manage. Fatigue is the physiological experience of being sleepy, tired or exhausted. The resulting physical or mental work is highly influenced by time of day, time when sleep last ended and adequacy of hours and quality of sleep. Fatigue symptoms may include yawning, sore eyes, difficulty concentrating, slow reactions, irritability, boredom, or if driving, missing road signs, difficulty maintaining lane control and large steering corrections.

Well-defined instructions detail crew rest for our flying community, however, most Air Force personnel rely on common sense or their supervisor's job performance evaluation to estimate their need for rest. Numerous sleep deprivation studies validate the traditional advice of mothers everywhere. Eight hours of sleep is the gold standard for maximizing health and job performance. Significantly degraded job and driving performance occurs for most individuals when sleep falls below six hours per day. Additionally, for people who typically work and live during daylight, the 24-hour body clock, also know as circadian rhythm, predicts likely low points in human attention and performance. Typically, performance decreases and fatigue is manifested in early afternoon (hence the phenomena of the afternoon siesta) and late evening. We are most fatigued and prone to poor performance in the early morning hours between 2 a.m. and 5 a.m.

If you think you're suffering from fatigue, act on the following recommendations:

1. If you are tired, you need to rest. There is a myth that people can will themselves past fatigue. The only way to alleviate fatigue is sleep. Most people need seven to nine hours of sleep per 24-hour period to optimally function. Sleep quality is better in a quiet, cool, darkened room.

2. Avoid scheduling demanding work during low performance periods of your daily routine.

3. Avoid driving late at night. When driving, take regular breaks every two to three hours. Don't drive if you take sedating medications or have consumed alcohol. If you are driving and feel tired, pull over at a safe location and take a 20-minute nap. Better yet, check in at a hotel for the night. Caffeine can help maintain alertness for a short period of time-one to two hours or less depending on your level of fatigue and sensitivity to caffeine-but only delays the inevitable need for sleep.

4. Finally, a balanced diet, which limits refined sugar, can also minimize fatigue.

If you are interested in learning more about fatigue and fatigue countermeasures, visit the following Web sites, www.sleepfoundation.org, and www.brooks.af.mil/AFRL/HEP/HEPF/News. Shift workers face additional challenges. For more information, visit, www.sleepfoundation.org/sleeptionary and www.cdc.gov/niosh/pdfs/97-145.pdf . For commanders and supervisors, an excellent local reference that can consult on work performance issues or speak to unit gatherings is your base aerospace physiology office.

By Col. David M. O'Brien
Commander, 96th Aerospace Medicine Squadron