Sleep, Circadian Rhythms

and Fatigue
Introduction

• Sleep Deprivation , Circadian Rhythms Disruption &

Fatigue are identified as a risk factor in transportation
accident

• They have correlation each other

• Operator must understand , know its correlation &

how to manage
Content:
• Introduction
• Human physiology
• Correlation : Sleep, Circadian Rhythms & Fatigue
• Sleep
• Circadian Rhythms
• Fatigue
• Conclusion
 Physiological Correlation
Physical Sleep Circadian Psychology

Fatigue
 Human
 Impact every one

Human performance <<

 Cognitive
 Psycho motoric
 Affective

Unsafe action Unsafe action

Defense Success Defense Fail

Goal Accident
 Failure in Human Performance during Fatique
Judgment
ERROR
Perception Decision
Decission Making Error

ERROR ERROR
PROCESSING
ERROR DATA
CENTRAL

Long term Working

Skill Based
memory memory

Mistake
Emotional
Disturbance
PROCESSIN
SLOW

Response
INPUT ERROR Action
“INFORMATION”
UNSAFE
Object, voice, movement
Sleep:
• Naturally recurring state
• Characterized by total or partial unconsciousness
• Inactivity of nearly all voluntary muscles
• Can vary by age and among individual
• Adequate when no daytime sleep or dysfunction
Functions of sleep include:
• Energy conservation.
• Restoration of the brain and body.
• Memory consolidation
• Boost mood
 Sleep architecture
(American Academy of Sleep Medicine/AASM) :
V i g ilance
Non Rapid Eye Movement Unco n tr ol lable, maintain
Ability se
• ry lap
Stage 1. Somnolence, Micro sleep <,
focus <
,M e m o

• Stage 2. Light sleep r

&
mance ility,
rx time,
e rf o
ed p y ab
• Stages 3 , deep sleep, body restoration Impair n in memor ability
tio n
Reduc n in decisio
• Stages 4 , deep sleep, Sleep inertia, Reduc
tio

Parasomnia (night terrors, nocturnal enuresis, sleep walking )

 Sleep architecture (con’t)

Rapid Eye Movement

• (Paradoxal sleep) 20%-25% of total sleep
• Strengthening & organizing memory
• Re-energize and replenished ATP
 Quantity of Sleep
(TSB Canada)

• 90% of population needs 7,5–8,5 hours per 24 hour day

• Directly related to Alertness and Performance
• Acute sleep loss : awake without sleep beyond
14 -16 hour waking days
• Chronic under sleeping (Cumulative sleep debt) :

Insufficient quantity of sleep continues over several

consecutive days
• Staying up all night, then not able significant sleep
next day, usually take 2 normal night to full recovery
Quality of sleep
(TSB Canada)

• Restorative sleep
• Directly related to Alertness and Performance
• Better and last longer when it is in harmony with
our internal clock
• Each cycle last about 90 minutes and 4 to 5
uninterrupted sleep cycle
• Most effective nap is about 20 minutes
Physiological effects

Attention-deficit hyperactivity disorder [3]

Circadian Rhythm

The term circadian - Latin word:

Circa = around & diem or dies = day
Meaning literally “ approximately one day”

Meaning :
A daily rhythmic activity cycle, based on 24-hour intervals,
(timed to the rotation of the earth upon its axis)

Automatically clock in the brain

Circadian Rhythm Synchronization
Circadian rhythms are internally generated - our biological
clock - and also regulated by environmental cues such as the
cycle of daylight and dark.”

Biological clock Environmental cues

Supra Chiasmatic Nuclei Light– dark hours
Geography factor
Social factor
Regulated by Hormonal Physical activation
Meal schedule

Rhythm & time respect appropriate to the earth rotation

in one day ( 22 hours – 25 hours)
 The Human Biological Clock
“CR” is refers to collection of bodily rhythm (temperature, sleep,
wakefulness, physical activity, memory performance, cortisol and others)
Desynchronization :
Refers to the state in which a person’s circadian rhythm is inconsistent
with local environment’s cues as well as shift work, jet lag

10.00AM 02.00PM 07.00PM

You should
consider the
application of
circadian
rhythm in
your work
schedule
Jet lag
Psycho-physiological disorders due to flight distance across more
than four time zones in a short time and caused Circadian rhythm
disruption or desynchronization)
( The globe consist of 24 times meridian)
Symptom Desynchronization are multiple:
• Generalized discomfort
• Sense of fatigue
• A lowered physical activity level
• Reduced efficiency
• Impaired judgment or decision-making
Consequences of Circadian rhythm
Disruption on the Transportation safety
• Increased frequency and severity of operator errors
during duty operations.
• Increased frequency of operational incidents.
• Increased risk in duty operations.
Fatigue
• “Fatigue is a state of impairment that can include
physical and/or mental aspects, associated with lower
alertness and reduced performance”

• Usually accompanied by a feeling of weariness,

sleepiness, or irritability.

• Usually not aware until make serious error

Other scientific definition
Psychologist:
implies decreasing motivation, an elevated threshold for stimuli and
decrease in accuracy and speed in solving problems or carrying out
psychomotor task

Flight surgeons:
as that condition
characterized by detrimental
alteration or decrement in
skilled performance related
to duration or repetitive use
various skills lies
Basic cause of fatigue

• Sleep loss : erratic scheduling, family, extra curricular

activities, etc ; Cure normal of sleep but how much
• Work induced: High work load, long hours, mission stress.
• Circadian rhythm disruption: early/late mission,
exercise/shift work, deployment
 Types of fatigue:
·   Physical
·    Mental
·    Emotional
 
Fatigue may be:
·     Acute
·     Chronic
 
Acute Fatigue Associated with:
• Circadian rhythm disruption
• Acute sleep loss
• Excessive mental or physical work
- Intense
- Short duration
- Cured with a good night’s sleep
Fatigue can have a negative effect on,
•   Attention and reaction time
•    Short term memory
•   Decision making
•    The timing of tasks
•    The ability to judge

distance, speed, and time

•    The ability to perceive

and interpret information

•   Communication and
coordination
Acute fatigue characteristic :
• Decrement in psychomotor function /decreased coordination
/ slow reaction
• Narrowed span of attention
- Failure to scan the whole instrument panel,
- Slowing of the cross check,
- Fix on one instrument and neglected others,
- More forgetfulness
• Acceptance of lower standard of performance and
increasing preoccupation
• Distraction by minor discomfort or increasing state of
irritability
• Over control of voluntary muscles
• Allied phenomenon is known as vigilance decrement
Chronic Fatigue associated with:
• Symptom are the same as acute fatigue &
Frequent recurrence / reoccur daily ,
• Result of inadequate recovery
• Often resulting from physical sickness or some on
going mental/emotional stress
• Long duration / long term
Chronic Fatigue characteristic:
• Insomnia / Un refreshing sleep.
• Depressed mood
• Irritability
• Poor judgment
• Loss appetite / irritable bowel syndrome / Weigh loss
• Slowed reaction time
• Poor motivation and performance on the job
Fatigue countermeasures
• Get your 8 hours of sleep
• Proper sleep conditions (cool, dark, quiet)
• Nutrition / Balanced diet
• Maintain good health and physical fitness
• Maintain optimal working condition
• Take nap (Best time in low body temp)
• Moderate caffeine (Do not use caffeine when already alert
or before bedtime)
• Engage in active conversation
• Do something physical such as stretching or moving around
• Best treatment : Get rest and natural sleep.
• But If not relieve , Seek the advice of a professional
 Sleep Tips
• Stick to a regular schedule- • Avoid caffeine,
even on weekends alcohol, cigarettes,
• Exercise light late afternoon chocolate, heavy
or early evening meals
• Take quiet time before bed • Don’t eat after 6:30
• Don’t do stressful activities PM
in bedroom • Take warm bath
• Read boring book
• Meditate
• Listen to music
 Sleep Tips (con’t)
• If you aren’t asleep after • Rituals before bedtime
20 minutes-get up and do • Lower bedroom temperature
something relaxing until
• Wear socks
you feel sleepy
• Take 30 min power naps
• Drink something warm,
mild chamomile tea, • Get bright morning light
warm milk • Have sex
• Sleep in the dark • Massage
• Run a fan to create • No TV
“white noise”
 PHYSIOLOGICAL FATIQUE
CONING ATTENTION ?
- D-1: Flying from 07.00 PM – 07.00AM (Circadian Rhythm disruption)
( Jakarta – Jayapura)
- D (14/4/205; B737-200) : (planning 2 days rest)
Flight plan forward one day + different setting crew
- Leg 1 reserve ( Jayapura – Biak)
- Leg 2 ( Biak – Makasar) Bed weather, + radar not work well
- Pilot felt tense – Gruesome ( Fatigue?)
- Destination Air port (MKS) Risk skidding ( Rubber effect) + Mountain ( Anxiety ?)

- Co Pilot passive
- 50 ft did not hear alarm (GPWS)
- Late nose up at touch down point
- Nose wheel breakdown/collaps
Conclusions

• Sleep and circadian rhythm are normal human physiology

• Sleep deprivation, circadian rhythm disruption and fatigue
can affect the safety
• Operator must recognize the sign & Symptom of Sleep
deprivation, circadian rhythm disruption and fatigue
• Sleep deprivation, circadian rhythm disruption and fatigue
must be managed at the best way
• Leadership needs to manage fatigue!
Thanks for your attention

Any Question?
Reference
•Aero medical Training for Flight Personnel, Department of the Army ,
Washington DC, 29 September 2000.
• John Ernsting, Aviation Medicine.
•De Landre,J. Boag C.C & Fletcher A, (2002, Sept – Oct), Asleep at the control,
flight Safety Australia (24-29)
•Dawson. D., Fatigue Management in the New Millenium.
•Dinges, D.F., Graeber. R .C, Rosekind M.R., Samel.A. Wegman H.M., Principle and
Guidelines for Duty and Rest Scheduling in Commercial Aviation, Ames Research
center, May 1996
• Transportation safety board of Canada, A Guide for investigating fatigue, Quebec
Canada