Air Force Medical Systems addressing fatigue management

ROBINS AIR FORCE BASE, Ga. -- Fatigue for the Air Force is defined as "the state of tiredness associated with long hours of work, prolonged periods without sleep, physiologic stressors of the flight environment, or the requirement to work at times that are out of sync with the body's biological - or circadian - rhythms. 

Over the past decade, workplace mishaps, along with car, truck, rail and air accidents, have dramatically increased the focus on the dangers of fatigue. Fatigue has become a growing concern in the Air Force as sustained and continuous operations, along with global deployments, are stretching the ability of our forces to meet growing mission demands. 

Ensuring that everyone gets the correct amount of sleep has become a huge challenge. As we increasingly strive to do more with less, the problem will only get worse without the proper attention.  

For the military environment, the root of the problem boils down to two main issues: sleep loss stemming from extended duty periods and restricted sleep opportunities or body clock disturbances that result from rapid time zone transitions like jet lag and shift lag.

So what's the solution?  After years of study, it has become clear that the only real answers are to understand the nature of sleep/fatigue and implement scientifically proven countermeasures.  

Let's see why sleep is important.

Optimal performance and health
Sleep plays a vital role in good health and well-being throughout our lives. By getting enough quality sleep at the right times we can help protect our mental health, physical health, quality of life and safety. The way we feel while awake greatly depends on what happens while sleeping because during sleep the body is working to support healthy brain function and maintain physical health. 

Just consider the damage that can occur from sleep deficiency; it can occur in an instant  - such as a car crash or on the job accident from inattentiveness - or it can harm you over time by raising your risk for chronic health problems. Sleep deficiency affects how well you think, react, work, learn, and get along with others.

Healthy brain function and emotional well-being
While sleeping, the brain is preparing for the next day by forming new pathways to help learn and remember information. 

A good night's sleep improves learning. So whether learning math, how to play the piano, how to perfect your golf swing, or how to drive a car, sleep helps enhance your learning and problem-solving skills. It also helps you pay attention, make decisions and be creative. 

If you're sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Sleep deficiency has also been linked to depression, suicide, and risky behavior. Children and teens who are sleep deficient may have problems getting along with others and may feel angry and impulsive, have mood swings, feel sad or depressed, or lack motivation. 

Physical Health
Sleep also plays an important role in your physical health.  Proper sleep is involved in healing and repairing your heart and blood vessels and ongoing sleep problems are linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke. 

Sleep deficiency also increases the risk of obesity. Studies have shown that with each hour of sleep lost, the odds of becoming obese go up. It helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down making you feel hungrier than when you're well-rested.

Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level.  Sleep deficiency can result in higher than normal blood sugar levels, which may increase your risk for diabetes.

Sleep supports healthy growth and development when deep sleep triggers the body to release the hormone that promotes normal growth in children and teens, boosts muscle mass, and helps repair cells and tissues. 

Even your immune system relies on sleep to stay healthy in order to defend your body against foreign or harmful substances.  Ongoing sleep deficiency can change the way in which your immune system responds and you may have trouble fighting common infections. 

Daytime Performance and Safety
Getting enough quality sleep at the right times helps you function well throughout the day while people who are sleep deficient are less productive at work and school even when they are there.  They take longer to finish tasks, have slower reaction times, and make more mistakes.

After several nights of losing sleep - even a loss of just 1 to 2 hours per night - your ability to function suffers as if you haven't slept at all for a day or two.

Lack of sleep also may lead to microsleep, brief moments of sleep that occur when you're normally awake.  You can't control microsleep, and you probably aren't even aware of it.  Have you ever driven somewhere and then not remembered part of the trip?  If so, you may have experienced microsleep. 

How Much Sleep Is Enough?
The amount of sleep you need each day will change over the course of your life. Although sleep needs vary from person to person, the following chart from the National Heart and Lung Institute shows general recommendations for different age groups.

-Newborns - 16 to 18 hours a day
-Preschool-aged children - 11 to 12 hours a day
-School-aged children - At least 10 hours a day
-Teens - 9 to 10 hours a day
-Adults - (including the elderly) - 7 to 8 hours a day

Routinely losing sleep or choosing to sleep less than needed adds up and becomes sleep debt. For example, if you lose two hours of sleep each night, you'll have a sleep debt of 14 hours after a week.

Some people nap as a way to deal with sleepiness but, while naps can provide a short-term boost in alertness and performance, they don't provide all of the other benefits of regular sleep. Some people sleep more on their days off than on work days which may be a sign that you aren't getting enough sleep and although extra sleep on days off might help you feel better, it can upset your body's sleep - wake rhythm.

Sleeping when your body is ready to sleep is very important and sleep deficiency can affect people even when they sleep the total number of hours recommended for their age group.  For example, people whose sleep is out of sync with their body clocks or routinely interrupted - such as caregivers or emergency responders - might need to pay special attention to their sleep needs.  

Write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel during the day. If your job or daily routine limits your ability to get enough sleep or sleep at the right times, or if you are worried about how bad sleep habits and long-term sleep loss will affect your health, try using a sleep diary for a couple of weeks and talk with your doctor. You should also talk with your doctor if you sleep more than eight hours a night, but don't feel well rested. You may have a sleep disorder or other health problem.   

For more information on sleep look for the schedule of 78th Medical Group sleep classes offered by our counselors or call 497-8398.