SLEEP

1
SLEEP

• perchance to dream
• Shakespeare

2
Sleep Understand it, managing it, and improving
individual and team functioning in disaster
response services.Presented by Robert L Bray,
PhD, LCSWwww.rlbray.com
3
Thanks to Robert J. Koester

• Most of the material presented here is taken
  from
• Fatigue Sleep Management During Disasters and
  Sustained Operations Published by dbS
  Productions 19

4
Overview

• Objectives
• Circadian Rhythm
• Owl or Lark
• Sleep Pattern
• Sleep-Related Errors
• Optimizing Sleep
• Naps
• Signs of Sleepiness
• Accident Prevention
• Safety is not just the Safety Officers Job

5
Objectives

• Recognize the sign and symptoms of lack of sleep
• Know the impact of lack of sleep on physical,
  emotional and mental functioning
• Develop a sleep management plan for yourself and
  your team

6
Goals

• Obtain core sleep
• Utilization of naps
• Recognition of sleepiness
• Immediate appropriate responses

7
Continuum

• Lack of sleep
• Sleep deficits
• Sleep deprivation
• Sleep demand
• Sleep occurrence

8
Circadian Rhythms

• Without light we will have a 25.5 hour day
• Persist regardless of amount of previous sleep,
  meals, activity, or changing shifts
• Rhythms of sleep, mental alertness, temperature
  and visual alertness

9
Owl or Lark

• Morning People (Larks)
• description
• Night People (Owls)
• description

10
Your Sleep Pattern

• When all is going well in my life I usually sleep
  _____ hours per 24 hour period.
• This is
• More than Normal
• Within the Normal Range
• This is less than Normal

11
How Alert are you?

• Rate your alertness on a one to ten scale
• One is total awake and alert
• Ten is unconscious and asleep
• How long would it take for you to fall asleep
  right now?

12
My reaction to less sleep

• I tend to be grumpy
• I tend to slow down
• I tend to miss details
• I tend to drift in conversations
• I tend to rush a decision
• I tend to delay decisions

13
Are you Legal?

• Could you legally drive a big rig?
• Are you at risk for being dangerous?

14
Medical Implications

• Lowest body temperature 400 AM
• Lowest BP 0000-0400
• Peak BP 1500-1600

15
Sleep Gates

• When the gates are open fatigue is felt
• Morning people most stable 2120-2320
• Night People After 0000
• Forbidden zone for sleep 2000 or- 40 minutes -
  Safest time

16
Sleep Requirements

• 7.5 8.5 hours of sleep depending on age and
  other individual factors.
• Core sleep 4.5 - 5.5 hours to maintain
  performance levels
• 3 hours voluntary sleep to maintain mood

17
Signs of Sleepiness

• Tunnel for fixed vision
• Eyes straining, eyes wanting to close
• Inability to focus
• Head nodding or bobbing
• Persistent yawning
• Wandering dream-like thoughts
• Micro sleeps

18
Effects of Sleep Loss

• Mood changes ( irritable fatigue)
• Impaired vigilance
• Faulty short tem memory
• Increased appetite
• Problems with communications
• Sleepiness, increased sexual drive, decreased
  performance and micro sleep
• After 2 days
• Illusions, hallucinations and paranoia

19
Sleep-Related Errors

• Typical error is completely forgetting to perform
  a task as opposed to incorrect performance
• Judgment and ability to perform complex tasks
  remain intact
• Low demand, self motivated tasks often failed
• Medics gave the correct drug and dose but
  sometimes forgot to even check the patient when
  sleep deprived

20
The Test

• Departing members are simply asked to lie down
  for 7 minutes prior to departure. If the member
  falls asleep, they are left sleeping for 30
  minutes or longer. If they get up after 7
  minutes, they are free to leave.

21
Paratrooper Study

• Three platoons tested on map plotting, encoding
  grid references, short-term memory tasks and
  vigilance-shooting
• First platoon never allowed to sleep, second
  platoon given 1.5 hours sleep, third given 3
  hours of sleep

22
Results of 9-Day Test

• Platoon One- lost military effectiveness after 3
  days and everyone quit after 4 days
• Platoon Two- lost effectiveness after 6 days and
  only half completed the study
• Platoon Three- maintained effectiveness for all 9
  days

23
Shift Work

• Like Jet lag circadian clock is only able to
  readjust 1-2 hours per day
• Adaptation to night shift requires several days
• Resetting the clock requires avoiding sunlight

24
Optimizing Sleep

• Schedule regular anchor sleep -4.5 -5.5 hours
• Avoid eating and reading in bed
• Avoid Caffeine near bed time
• Avoid nicotine, alcohol
• Create comfortable, dark and quiet environment

25
Naps

• May be the most effective method to increase
  performance during continuous operations.
• The longer the nap the greater its effectiveness.
• Most effective short naps last for 20 minutes
• Avoid sleep inertia or sleep drunkenness by
  taking a few minutes wake fully before performing
  critical functions.

26
Accident Prevention

• Change attitudes
• Assure adequate sleep
• Develop a sleep plan for the team
• Increase individual awareness
• Support one another in get all basic biological
  needs met
• Be aware of sleep needs at time of demobilization

27
Safety is not just the Safety Officers Job

• Ask the import questions
• When did you last sleep?
• How long did you sleep?
• How alert are you now?
• Do you need a nap?

28
Some Possible Rules

• 12/12- for every 12 hours worked, individuals are
  given 12 hours off duty and expected to maintain
  normal sleep patterns
• 16/8 for every sixteen hours of work, 8 hours
  of rest must be provided this includes eating
  personal time often resulting in disruption of
  normal sleep patterns

29
More Possible Rules

• 20/4 for every 20 hours worked, 4 hours of
  actual sleep is required
• Naps are encouraged or required to maintain
  effectiveness

30
Stanford Sleepiness Scale

• 1. Feeling active, alert , wide awake.
• 2. Functioning at high level but not at peak,
  able to concentrate
• 3. Relaxed, awake but not fully alert and
  responsive
• 4. A little foggy, let down.
• 5. Foggy, beginning to lose track, difficulty in
  staying awake.
• 6. Sleepy, prefer to lie down, woozy.
• 7. Almost in reverie, cannot stay awake, sleep
  onset appears imminent.

31
Summary

• Objectives
• Goals
• Circadian Rhythms
• Owl or Lark
• Your Sleep Pattern
• How Alert are you?
• Are you Legal?
• Medical Implications
• Sleep Gates
• Sleep Requirements
• Signs of Sleepiness

32
Summary (cont.)

• Effects of Sleep Loss
• Sleep-Related Errors
• The Test
• Paratrooper Study
• Results of 9-Day Test
• Optimizing Sleep
• Naps
• Accident Prevention
• Safety is not just the Safety Officers Job
• Some Possible Rules
• Stanford Sleepiness Scale