Aerospace Medicine Topics

1. Lt Anthony Francisco 89th Physiological Training Flight DSN 857-4654 Anthony.Francisco@andrews.af.mil Aerospace Medicine Topics

2. Overview • Medical Standards • Fatigue and Performance • Spatial D Awareness

4. Causes of Fatigue • Sleep Loss • Poor Quality Sleep • TDY/Travel • Circadian desynchrony • Jet Lag • Shift Work

5. Fatigue and Performance • Studies show sleep loss results in: • Increased reaction time • Decreased vigilance • Cognitive slowing • Memory problems • Time-on-task decrements • Let’s talk about sleep...

6. Sleep Requirements 5 hours 8% of population 5-6 hours 15% 6-8 hours 64% 8-10 hours 13%

7. Stages of Sleep • Rapid Eye Movement (REM) sleep • increased physiological and mental activity • Non-Rapid Eye Movement (NREM) sleep • slowed physiological and mental activity • stages 1 and 2 - light sleep • stages 3 and 4 - deep sleep

8. Wake REM Stage 1 Stage 2 Stage 3 Stage 4 2400 0100 0200 0300 0400 0500 0600 0700 Sleep Histogram

9. Many Factors Can Disrupt Sleep • Environmental (temperature, noise, light) • Alcohol (more than 2 drinks) • Caffeine prior to bedtime • Jet lag • Medical conditions (sleep apnea, restless legs) • Medications

10. Circadian Rhythm • Natural “body clock” • Influences performance, sleepiness • Influenced by hormones, body temp, eating patterns • Reset by environmental zeitgebers • light!

11. Circadian Rhythms • Body clock resynchronized by external cues • the most studied and accepted is bright light • others may include social cues, temperature, exercise, and diet • poorly timed exposure to bright light may prolong or worsen circadian desynchrony

12. Circadian Rhythms • Cyclical fluctuations in biologic activities • results in peaks and troughs in function/performance • sleepiness is normally increased twice per circadian day • 3-5 A.M. • 3-5 P.M.

13. Day Sleep Expectancies

14. Typical Circadian Rhythm

15. Circadian Rhythms Fatigue -related vehicular accidents by time of day International Data (N=6,052) 1200 1100 1000 900 800 Number of accidents 700 600 500 400 300 200 100 Midnight 6 a.m. Noon 6 p.m. Midnight Time of day

16. Recovery from Operational Fatigue • Effects of sleep loss are under-appreciated • adverse effects of fatigue often attributed to other factors (inattention, performance errors, poor judgement, etc.) • Yes motivation helps, but it is impossible to will yourself fully alert • if sufficiently sleep deprived, individual may experience unintended sleep episodes

17. Preventive Strategies - One technique Report Time Midnight Noon Midnight Duty Day 12 Hr Off Duty Sleep Sleep Awake Awake Early Sunlight Limit sunlight during day Caffeine Avoid Caffeine during day Exercise Limit activity during day

18. Operational Strategy-Caffeine • Tasteless substance • Powerful CNS stimulant • Addictive • Be aware of how much you’re taking in

19. Caffeine Content* TEA COFFEE BREWED …………...…. 80-135 mg INSTANT ………………. 65-100 CAPPUCCINO (16 oz) ..70 DECAF .....……………... 3-5 GREEN..………….. 30 mg LEAF/BAG ....….... 50 SNAPPLE(16 oz) .. 48 COFFEE, GRANDE (16oz) STARBUCKS …. 550 mg MOUNTAIN DEW .......…... 55 mg COKE (12 oz) ...............…. 45 WATER JOE (16 oz) .…….60-70 Recommended Maximum Intake for 24 Hours = 200 - 250 mg *From: Barone, J.J. and Roberts, H. R. 1996. “Caffeine Consumption.” Food Chemistry and Toxicology, vol. 34, p 119-129.

20. Too Much Caffeine • ANXIETY • DEHYDRATION • DEPRESSION • FAULTY THINKING/FALSE SENSE OF ALERTNESS • FINGER TREMOR • INSOMNIA • FATIGUE/SLEEP LOSS

21. Considerations to minimize problems associated with shift work: • Ensure good exposure to sunlight during the day • Take proper “lunch” breaks during night shifts • Avoid a heavy meal • Napping on lunch breaks • Lighting techniques/temperature control • Take extreme care when driving home after shift • Physical activity (take walks, drink water, get fresh air, etc…)

22. Strategies - Sleep Hygiene • Try to maintain consistent bedtime habits to set stage for sleep (pre-sleep routines) • Muscle relaxation techniques may help with stress reduction and sleep onset • Avoid heavy meals, caffeine and alcohol prior to sleep • Ensure a good sleep environment • Cool, dark, quiet… • If you can’t sleep within 30 minutes of getting in bed get up.

23. Spatial Disorientation Awareness

24. VISUAL VESTIBULAR SEAT-OF-THE-PANTS AUDITORY Balance and Orientation

25. When does SD occur?

26. Types of Disorientation • Type I - Unrecognized • Type II - Recognized • Type III - Incapacitating

27. Factors conducive to SDO • Poor outside references (dusk to dawn, clouds, haze, etc) • High G, sustained/high roll rate • High workload, distraction • runway change, short approach, IFE, etc. • Fatigue

28. Two ship NVG Upgrade Sortie 21 Jan 2000, Boise, ID, 1840L

29. 10 28 Impact HDG 270o 90 o right bank 37 o nose low Two ship NVG Upgrade Sortie 21 Jan 2000, Boise, ID, 1840L 2 o / sec turn for 23 seconds 15-20 o bank Dogleg 70o 3000 FPM Descent to 3192 MSL 3500 MSL 2.5 mi Last radio call 400 ft AGL 1.25 mi = MAP Descend to 4200 MSL Enter IMC

30. 2.7o/sec, 28 seconds 4492 ft MSL 3292 ft MSL 1.60/sec turn to base for 56 seconds 2.0o/sec turn, 23 seconds Impact: 900 right bank 37o nose low 5092 ft MSL Enter IMC

31. How Can Controllers Help? • Query significant flying deviations • Query significant communications lapses or miscommunications • BE ASSERTIVE AND SPECIFIC!!!

32. How Can Controllers Help? • At night/in Wx: • minimize heading and altitude changes • use short phrases • use calm, unhurried communications • If the pilot reports a problem with SDO: • while maneuvering for approach, direct pilot out of Wx, if possible • Offer PAR or ASR if available

33. SDO can happen... • To who? • Anyone • When? • Day or Night • Good Wx or Bad

34. You can... • Be aware of SDO • Crosstalk with wing pilots • Treat high risk conditions with caution

35. Questions?... Lt Anthony Francisco 89 PTF/SGPT 7-4654 89th PHYSIOLOGICAL TRAINING FLIGHT