Medical Issues in Aviation

1. Medical Issues in Aviation Lima, Peru: March 2009 Flight Crew, Circadian Rhythms, Fatigue, Alertness & Long Haul Opearations Dr. Jarnail Singh Civil Aviation Authority of Singapore

2. Fatigue and alertness : • Rest and sleep • Time since awake • Type of activity • Time on task • Type of task • Circadian rhythm • Drugs/Medication/Aids to alertness • Manual • Mental • Monotony/Boredom • Challenging

3. Measuring Fatigue: Wouldn't it be nice? Fatigued Get Out Fatigue Meter ALERT BUSHED

4. Can Fatigue be measured? Physical: Yes Mental: No Research Ongoing -- US Navy Studies Alcohol Equivalence : Caution!!! In Using Such measures Surrogate Measures eg. Karolinska / Stanford Scales Concept of AVOIDANCE of Fatigue

5. Can Alertness Be Measured? *Sleep Vs Wakefulness -- EEG (Polysomnography) • *Psychomotor Vigilance Tests: • Simple Reaction Time • Choice Reaction Time • Tracking Tasks • etc *Performance Based Measures: LOSA, FOQA etc

9. Yerkes-Dodson Curve OPTIMUM Acceptable GOOD Performance POOR POOR LOW HIGH Arousal * Stress * Workload etc.

10. Yerkes-Dodson Curve Acceptable Performance GOOD Arousal Stress Workload etc.

11. Yerkes-Dodson Curve Shift to the Right OPTIMUM Well Rested GOOD Good Sleep Good Handle on Life Stressors Etc.. Acceptable Performance POOR POOR LOW HIGH Arousal Stress Workload etc.

12. Yerkes-Dodson Curve Shift to the Left • Not Slept Well • Not Well Rested • Circadian Desynchrony Not Managed • Work Overload • Excess Alcohol OPTIMUM GOOD Acceptable Performance POOR POOR LOW HIGH Arousal Stress Workload etc.

13. General Idea: Build up reserves Spare mental capacity

14. NOT a good example of a person with reserves and spare mental capacity

15. In the Aviation World Rest & Sleep Circadian Desynchrony ?

16. Time Since Awake Sleep Awake In - Between Take - Off 0800 2000

17. Yerkes-Dodson Curve Which Side of the Curve are you on? • Right OPTIMUM GOOD Acceptable Performance • Left POOR POOR LOW HIGH Arousal Stress Workload etc.

18. TYPE OF ACTIVITY Vs PHYSICAL MENTAL

19. Time On Task Remember Yerkes-Dodson! Type Of Task Cockpit Environment

20. Flight Time Limits... .... in Aviation

21. A

22. B

23. Factors that moderate alertness/fatigue on the flight deck: • Number of flight crew • Composition of flight crew • Status of circadian acclimatization • Previous duty duration • Opportunity for pre-flight rest/sleep • Opportunity for in-flight rest/sleep • Post-flight recovery and sleep

24. Ultra Long Range Flights What were the issues to be resolved?

27. B

29. Lessons From ULR Studies

30. Departure windows that factor in circadian shifts and a systematically thought out plan for rest/sleep in the overall duty cycle, alongside appropriate crewing, are the key to maintaining alertness.

31. Aids To Sleep & Alertness

32. Alertness Sleep zzzzzzzzzz Relaxation

33. Aids to Alertness COFFEE

34. Time of Consumption and Amount Consumed are Important Coffee Within the Duty / Rest Cycle

35. Sleeping Aids What a coincidence, so does he

36. Melatonin Hormone produced mainly in Pineal gland Regulates circadian rhythm in the normal dark/light cycle ?Assist in jet-lag Should a pilot use it? When to use it

37. Hypnotics.....Zzzzzzzzzzzz What are they? Dose Tranquility Sleep Death Unconscious Pilots ---- ? Take Hypnotics

38. What about Alcohol?

39. NOT a good Sleeping aid !

40. Sleep Hygiene...zzzzzzzz Humans (like all animals) are creatures of habit Establish sleep habits --- follow the routine Healthy Life Style Essential Moderation is the key

41. Sleep structure across the ages

42. The Bedroom..... HOTEL HOME .... for sleep only ..... For Sleep Only

43. OK, Provided You Get Some Sleep As Well !!

44. Definitely Not Recommended

45. Zeitgerbers Entrain the Circadian clock eg. Light vs Dark