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Cassandra D Howard, Col, FS, MC, TNANG

Photo source: ANG Creative, Health Professions Recruiting Campaign. Cassandra D Howard, Col, FS, MC, TNANG . 164 MDG/CC, Memphis, TN AANGFS, Vice-President Cassandra.Howard@ang.af.mil. Endurance Management Ground Initiative. Air Force Medical Operating Agency. Sleep or Die.

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Cassandra D Howard, Col, FS, MC, TNANG

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  1. Photo source: ANG Creative, Health Professions Recruiting Campaign Cassandra D Howard, Col, FS, MC, TNANG 164 MDG/CC, Memphis, TN AANGFS, Vice-President Cassandra.Howard@ang.af.mil

  2. Endurance Management Ground Initiative Air Force Medical Operating Agency

  3. Sleep or Die Basic Sleep Physiology

  4. Overview • Impact of Fatigue • Sleep Physiology • Circadian Rhythm • Consequences • Recognition • No-Go Pills

  5. China Air Flight 006 2 people injured, AC major structural damage 228 killed, AC destroyed Korean Air Flight 801 American Flight 1420 FedEx Flight 1478 11 killed, AC destroyed Impact of Fatigue Fatigue Related Crashes 3 severely injured, AC destroyed

  6. Three Mile Island Challenger Space Shuttle Exxon Valdez Impact of Fatigue The Cost Major Accidents

  7. Impact of Fatigue • The Evidence • Major Accidents • Annual Cost • Military Strategy • Human Performance

  8. Aeromedical Causal Factors

  9. Military Strategy While remembering our own limitations Exploit the Enemy’s Weakness

  10. Monday Night Football

  11. Types of Fatigue Acute:Work induced Chronic:Repeated sleep loss Subjective:Stress induced Circadian Rhythm:Shift Work or Jet lag Causes of Fatigue Circadianrhythms Sleep loss FATIGUE Effect of operations on sleep and circadian physiology

  12. Basic Human Physiology:Sleep & Circadian Rhythms • Sleep – A Vital Physiological Function • Sleepiness Affects Waking Performance, Vigilance, and Mood • Sleep Loss Accumulates Into A Sleep Debt • Physiological Versus Subjective Sleepiness • The Circadian Pacemaker

  13. Stages 1 & 2 Stages 3 & 4 Physical Restoration Hormone Production Tissue Repair Dreams Muscle Twitching Rapid Eye Movement Problem Solving Short- to Long-Term Memory Physiology of Sleep NREM Sleep REM Sleep

  14. What’s Supposed To Happen(Normal Sleep Histogram) Wake REM Stage 1 Stage 2 Stage 3 Stage 4 REM Sleep NREM Sleep 2400 0100 0200 0300 0400 0500 0600 0700

  15. Wake REM Stage 1 Stage 2 Stage 3 Stage 4 2400 0100 0200 0300 0400 0500 0600 0700 Sleep Histogram REM - Mental restoration NREM - Physical restoration

  16. Types of Physiological Rhythms • Sleep-Wake • Temperature • Mental Performance • Hormones • Digestion

  17. Body Temperature Sleep No Sleep 98.6 96.5 Maximum Sleepiness 2400 0600 0900 1200 1500 1800

  18. Alertness Level Maximum Alertness High Low 0900 1200 1800 0000 0600 0900

  19. Fatigue, Alcohol and Performance • After 17 hours of sustained wakefulness, performance decreased to a level similar to .05 BAC • After 24 hours of sustained wakefulness, performance decreased to a level similar to .10 BAC Center for Sleep Research, University of South Australia,and University of Adelaide, South Australia (Nature, 1997)

  20. Fatigue, Alcohol and Impairment

  21. Forgetful Poor decisions Slowed reaction time Reduced vigilance Poor communication Fatigue Signs & Symptoms • Fixated • Apathetic • Lethargic • Bad mood • Nodding off

  22. If You Remember Nothing Else… • Physiological mechanisms underlie fatigue • Just like water and food,sleep is a physiological necessity • Fatigue can havesevere consequences • Financial • Human performance • Take sleepand fatigue seriously

  23. Fight The Good Fight Combating Fatigue

  24. Fatigue Countermeasures:Personal Strategies • Preventive Strategies • Minimizing sleep loss • Naps • Good sleep habits • Effects of food, alcohol, and exercise • Sleep environment • Circadian strategies

  25. Preventive Strategies:Sleep Loss & Strategic Napping • Sleep Requirements and Debt • Strategic Napping (Prior to Duty) • Can Acutely Improve Alertness • Limit Nap: 10 - 30 Minutes • Decreases Continuous Wakefulness • Some Sleep is Better Than None

  26. Wake REM Stage 1 Stage 2 Stage 3 Stage 4 2400 0100 0200 0300 0400 0500 0600 0700 Sleep Histogram • Best method to minimize fatigue • Limit to 10 or 20 minutes • Try not to nap within 5 hours bedtime • Avoid sleep inertia • Disorientation and lethargy for 5-20 mins

  27. Preventive Strategies:Good Sleep Habits • Regular Sleep/Wake Schedule • Develop/Practice Regular Pre-Sleep Routine • Avoid Heavy Meals • Avoid Alcohol and Caffeine • Physical/Mental Relaxation Techniques • No Sleep in 30 Minutes…Get Out of Bed

  28. Preventive Strategies:Sleep Environment • Dark, Quiet Room • White Noise • Comfortable Temperature • Comfortable Sleep Surface • Large Meals & Indigestion • Lack of Food

  29. Self-Medication

  30. Supplements and the Human Trend • 2000 B.C….Here, eat this root. • 1000 A.D….Roots are heathen. • Say this prayer. • 1850 A.D….Prayer is superstition. • Drink this potion. • 1940 A.D….That potion is snake oil. Swallow this pill. • 1985 A.D….That pill is ineffective. • Take this antibiotic. • 2000 A.D….That antibiotic is artificial. • Here, eat this root.

  31. Self-Medication • Effects of Medications • Desired Effects – treats the symptoms • Side Effects – other effects on the body • Allergic Reactions • Combined Effect – 1 + 1 = 3 • Companies combine antihistamines and decongestions to off set each other • Over-the-Counter Medications • Antihistamines = sedation, drowsiness • Decongestants = nervous, dizzy, sleepy • Cold preps = most contain alcohol

  32. Personal Strategies:Operational Countermeasures • Physical Activity Combats Sleepiness • Social Interaction and Conversation • Diet and Hydration • Bright Lights • Strategic Caffeine Consumption

  33. Strategic Caffeine Use • 15 to 30 minutes to take effect • Effects can last for up to 3-4 hours • Chocolate 1-35 mg caffeine 1 oz • Pepsi 36 mg caffeine 12 oz • Coke 46 mg caffeine 12 oz • Mt Dew 54 mg caffeine 12 oz • Instant Coffee 40-108 mg caffeine 5 oz • Drip Coffee 90-150 mg caffeine 5 oz

  34. Sleep Food • Carbohydrates • Pasta • Corn • White Bread • Potatoes

  35. Alert Foods • Protein • Nuts and Seeds • Meats/Cold Cuts • Peanut Butter • Cheese • Eggs • Fish • Yogurt • Beans

  36. “No Go” Pills • AF guidance (vol 3) • <= 7 consecutive days (Sonata <=10 consecutive days) • <= 20 in a 60 day period (Sonata <= 28 in a 60 day period) • FS Recommendations • As little as needed (but they can help jet lag) • Bad sleep is not an Ambien deficiency • Melatonin is a no-go that’s a no-go Ground testing required prior to operational use.

  37. Smart Phone Apps

  38. Summary • Impact of Fatigue • Sleep Physiology & Circadian Rhythms • Consequences & Recognition • Preventive Strategies • Operational Countermeasures • No Silver Bullet, No Magic Pill

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