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The effect of sleep deprivation and motion sickness in military personnel operational effectiveness. Should we care?
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The effect of fatigue and motion sickness in personnel operational effectiveness
Should we care?
LCDR P. Matsangas HN
Battle Stress ManagementSupreme Joint War College, April 7, 2011
Stress vs arousalYerkes & Dodson law
Selye (1975). "Confusion and controversy in the stress field". Journal of Human Stress 1: 37–44
Conceptual relationship between level of arousal and expected quality of performance
Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18, 459-482.
Sleep deprivation and fatigue
Basics and operational consequences
Sleep deprivation and fatigueSleep basics I
Sleep is an ACTIVE process
Probably all animals sleep (various lengths)
May be the strongest, most insistent drive
Still not known exactly why we sleep
Restorative function?
Adaptive function?
Sleep deprivation and fatigue Sleep basics II
Sleep patterns over a typical lifespan
Sleep stages over a typical 8-hour sleep period
Miller, N.L. Matsangas, P. & Shattuck, L.G. (2008) “Fatigue and its effects on performance in military environments” in Hancock, P. & Szalma, J., eds., Performance Under Stress. Ashgate Publishers. Aldershot, UK.
Sleep deprivation and fatigue Sleep basics III (The processes underlying sleep need)
Adjusted from A. http://www.acnp.org/g4/GN401000075/Default.htmB. Borbély AA, Achermann P. Concepts and models of sleep regulation, an overview. J Sleep Res 1992;1:63-79
Sleep deprivation and fatigueSleep Basics IV
Normal amount of sleep 8 - 8 1/4 hours
“minimum 5 hours/night to maintain performance”?
Genetically determined
Sleep cannot be “banked,” but sleep deficits
accumulate
Rest does not replace sleep
Operational EnvironmentBasic stressors (from a sleep perspective)
Occupational Stressors
Travel across time zones Shiftwork Environmental conditions Temperature Humidity Noise Sleep conditions Light Motion
Moderating influences on
individual response
Sleep tendency Circadian rhythms Ultradian rhythms Individual differences
Parameters influenced
Sleep amount Sleep quality Sleep timing
Moderating influences on performance
Naps Medication Sleep scheduling Motivation Interest Personality Prior experience System design Individual differences
Performance
Physical Mental
Task attributes
Duration Pacing Complexity Proficiency Feedback
Psychological stressors
Danger - Fear Motivation
Fatigue Physical Mental
Sleep deprivation and fatigue Effects Memory is impacted tremendously by sleep.
(Nature, October, 2003)
Creativity is impacted by sleep. (Nature, January, 2004)
Memories can actually be recovered or “healed” by getting sleep.
Decision-making under uncertainty may be particularly vulnerable to sleep loss and is more pronounced with increased age. (J. Sleep Research, 2006)
Moral judgment is altered by sleep deprivation. (Sleep, March 2007)
Sleep deprivation and fatigueSymptoms• Difficulty concentrating
• Decreased vigilance and reduced attention
• Slowed comprehension, responses/fuzzy reasoning
• Faulty memory
• Increasing number of "omission" errors
• Mood changes
• Impaired speed and accuracy of skilled tasks
• Droning/microsleep
• Reduced motivation to complete the mission
• Communication difficulties
Sleep deprivation and fatiguePVT Adaptation to Chronic Sleep Restriction
50
65
80
95
110
0 T1 T2 B 1 2 3 4 5 6 7 R1 R2 R3Day
Mea
n Sp
eed
on P
sych
omot
or V
igila
nce
Task
(as
a %
of B
asel
ine)
9 Hr
7 Hr
5 Hr
3 Hr
SAFTE/FASTR2 = 0.94
Recovery7 Day Restricted SleepBaseline
WRAIR Restricted Sleep StudyDr. Nita Shattuck, Research Asst. Prof.; NPS
Sleep deprivation and fatigue Effects are Task-Dependent
Sense of well-being Vigilance & attention Judgment & decision making
Well-learned simple intellectual tasks physical tasks
More sensitive to Fatigue
More resistant to Fatigue
Fatigue Avoidance Scheduling ToolFAST
Afternoon dips in performance
Normal sleep periods Reduced sleep period
Drop in performance
24 hour period
Early AM dip in performance
Blood Alcohol Equivalence Scale
Dr. Nita Shattuck, Research Asst. Prof.; NPS
Example IReasonably Good Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS
Dr. Nita Shattuck, Research Asst. Prof.; NPS
Example IReasonably Good Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS
Example IIPoor Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS
Example IIPoor Sleep (from USS STENNIS)
FatigueEffects on operational performance No-sleep platoons militarily ineffective after 48 hours without
sleep (Haslam, 1982)
Decreased vigilance, mood changes, perceptual and cognitive decrements (Krueger, 1990)
Deteriorating marksmanship (McLellan et al., 2005; Tharion, Shukitt-Hale, & Lieberman, 2003, Miller et al, 2010)
In SUSOPS of an artillery fire direction center, planning and maintaining situational awareness most affected; evident decrements in the first 24-48 hours (Banderet et al, 1981)
Decreased pilot performance, less accurate flight maneuvers, increased error rates, significant judgment lapses(Billings, Eggspuehler, Gerke, & Chase, 1968; Krueger, Armstrong, & Cisco, 1985; Pereli, 1980, J. A. Caldwell, 2005, Brictson, 1990; Brictson, McHugh, & Naitoh, 1980; Brictson & Young, 1980)
Micro-sleeps
FatigueSleep studies at NPS
0.00 2.00 4.00 6.00 8.00 10.00
Operation Enduring Freedom (USS STENIS - CVN)
Flight operations in Iraq (USMC AH-64 Helicopter Battalion)
Mine hunting operations (Naval Aviation MH-53 squadron)
Infantry officers from Iraq/Afghanistan (Fort Benning Survey)
Various operations (SSN/SSBN)
GOMEX 05-1 (HSV-2 SWIFT)
RIMPAC 2008 (USS LAKE ERIE/ PORT ROYAL - CG)
Sea trials (USS HENRY M. JACKSON - SSN)
Sea trials (HSV-2 SWIFT)
Predeployment training (USS CHUNG HOON - DDG)
Predeployment training (USS RENTZ - FFG)
Daily Sleep [hrs]
Operational Sleep
0.00 2.00 4.00 6.00 8.00 10.00
USN enlisted training at RTC Great Lakes
USMA study (West Point)
Marine Aviation, Weapons and Tactics School (MAWTS WTI 2-05)
Marine Aviation, Weapons and Tactics School (MAWTS WTI 1-06)
FLW Basic combat training
Daily Sleep [hrs]
Sleep during Training
Motion sickness
Basis and operational consequences
The effect of motion on the humanA proposed model
Induced Motion
Motion Sickness
Effects on human activity
Sleep amount and quality
Sopite Syndrome
Motion-induced fatigue (MIF)
Human Element
Motion Sickness Incidence (MSI)
Human Performance
Working efficiency (or performance)
Motion Induced Interruptions (MII)
Other effects
Manual Material Handling (MMH)
Occupational health and safety
Health and safety effects
Long-term exposure health effects
Short-term exposure safety effects (injury)
Comfort
Comfort or amenities
Motion Sickness General term that describes the discomfort and
associated emesis (vomiting) induced by many kinds of motions
Airsickness, space sickness (SAS), cybersickness, simulator sickness, etc
Current sensory input
Neural store
Vestibular systemVision
Proprioception
Error signal
Motion SicknessSymptoms and Effects on Performance
Symptoms I
• Pallor• Cold sweating• Yawning• Burping• Increased salivation• Mood changes• Headache
Symptoms II(Effects on
performance)
• Nausea• Drowsiness (through
sopite syndrome)• Retching• Vomiting• Carelessness• Incoordination• Significant reduction
in motivation to work
Symptoms III(Life threatening)
• Dehydration (significant in life rafts)
• Shock (during sustaining symptoms)
Motion SicknessHFR model (1974, 1976)
Model CharacteristicsVertical AccelerationOnly true motionMSI: % of people who vomitTwo-hour nauseogenic period
Nauseogenic frequency range0.05 – 0.7 [Hz]
Central nauseogenic frequency0.167 [Hz]
Used MetricA historically common index of motion sickness severity is the Motion Sickness Incidence (MSI), which is the percentage of people who vomit when exposed to a nauseogenic environment.
O'Hanlon, J. F., & McCauley, M. E. (1974). Motion sickness incidence as a function of the frequency and acceleration of vertical sinusoidal motion. Aerosp Med, 45(4), 366-369.McCauley, M. E., Royal, J. W., Wylie, D. C., O'Hanlon, J. F., & Mackie, R. R. (1976). Motion Sickness Incidence: Exploratory Studies of Habituation, Pitch and Roll, and the Refinement of a Mathematical Model (Technical Report No. HFR 1733-2). Santa Barbara, CA: Human Factors Research, Inc.
Motion SicknessAdaptation Space: 2 – 3 d Sea: 1-2 d Motion specific Adaptation transfer?
Colwell, J. L. (1994). Motion sickness habituation in the naval environment (No. DREA Technical Memorandum 94/211). Dartmouth, N.S.: DefenceResearch Establishment Atlantic.
101
102
0
50
100
MS
I [%
]
Proposed modelHFR dataARMS=0.333 [Hz]
101
102
0
50
100
MS
I [%
]
Proposed modelHFR dataARMS=0.222 [Hz]
10 20 30 40 50 60 7080 1001200
20
40
Time in [min]
MS
I [%
]
Proposed modelHFR dataARMS=0.111 [Hz]
Motion SicknessEffects are Task-Dependent Complex tasks Vigilance tasks Sustained performance (long) Self-paced Viewed as non-essential
Well-learned/simple tasks Short Externally paced
More sensitive toMotion Sickness
More resistant toMotion Sickness
Countermeasures and what should be done
Countermeasures IFatigue
Non-pharmacological
Interventions
Sleep conditions
Dark
Quiet
Temperate
Safe
Daily activity optimization
Work/rest schedules
Naps, rest breaks
Exercise
Physical fitness
Environmental stimulation
Task attributes
Pharmacol.Interventions
Stimulants or alerting drugs
Prescription
Dexedrine (dextro-
amphetamine)
Modafinil
Non-prescription
Caffeine
Nicotine
Sedatives or sleep aids
Prescription
Ambien(zolpidem)
Restoril(temazepam)
Non-prescription
Melatonin
Benedryl
Trytophan
Miller, N.L. Matsangas, P. & Shattuck, L.G. (2008) “Fatigue and its effects on performance in military environments” in Hancock, P. & Szalma, J., eds., Performance Under Stress. Ashgate Publishers. Aldershot, UK.
Countermeasures IIFatigue and motion sickness Fatigue/Sleep deprivation Operational
Observe your personnel Napping Duty cycle optimization Morningness-eveningness preference
Organizational Regulations’ development and implementation NSWW
Motion sickness Observe you personnel Assigned duties optimization Screening Better system designs
Warfare is a ‘24-7’ activity What should we do? Operational sleep hygiene Regulatory policies Optimize sleep/wake cycles/duty time Use appropriate Human Performance models Observe your personnel (for fatigue and soporific symptoms) Better system design Education and training on human performance Kill the “myth of the warrior” (Shay, 1998)
“[Fatigue is] … the big gray elephant we muscle out of the cockpit when we fly, step around when we enter the bridge, and push aside when we peer into the periscope” (CAPT Davenport, 2006).
Shay, J. (1998). Ethical Standing for Commander Self-Care: The Need for Sleep. Parameters, 28(2), 93-105.
Bibliography for further reading Matsangas, P. and Miller, N.L. (2006). The Effects of Ship Motion on the Sleeping Patterns of Crewmembers aboard a High
Speed Naval Vessel. Sleep, 29(Suppl.S), A126-A126.
McCauley, M.E., Pierce, E., and Matsangas, P. (2007). The High Speed Navy: Vessel Motion Influences on Human Performance. Naval Engineers Journal, 119(1), 35-44.
Miller, N.L., Shattuck, L.G., Matsangas, P., and Dyche, J. (2008). Sleep Patterns and Academic Performance in U.S. Military Training and Education Programs. Mind, Brain, and Education, 2(1),29-33.
Matsangas, P., McCauley, M.E., Miller, N.L. (2008). [The effect of fatigue and motion sickness in ship operational effectiveness: review and preliminary results from non-conventional naval designs] [in greek]. Nafsivios chora, 2, 113-132.
Miller, N.L., Shattuck, L.G., Matsangas, P. (2009). Sleep and Fatigue Issues in Continuous Operations: A Survey of U.S. Army Officers. Behavioral Sleep Medicine. Accepted for publication.
McCauley, M.E., Matsangas, P., and Lewis-Miller, N. (2005). Motion and Fatigue Study in High Speed Vessel Operation: Phase 1 Report. Technical Report. Prepared for Naval Surface Warfare Center, Coastal Systems Station, Panama City, Florida.
McCauley, M.E., Matsangas, P., Pierce, E., Price, B., LaBreque, J., and Blankeship, J. (2007). Vessel Motion Effects on Human Performance aboard the FSF-1 Sea Fighter. Technical Report. Prepared from PMS-501, NSWC Panama City, Florida, and Naval Postgraduate School, Monterey, California, October 2007.
Miller, N.L., Shattuck, L.G., Tvaryanas, A. Matsangas, P. (2010). Effects of Sleep on Training Effectiveness in Soldiers at Fort Leonard Wood (Phase 1). Technical Report NPS-OR-10-003, February 2010, Monterey, California, USA.
Miller, N.L. Matsangas, P. & Shattuck, L.G. (2008) “Fatigue and its effects on performance in military environments” in Hancock, P. & Szalma, J., eds., Performance Under Stress. Ashgate Publishers. Aldershot, UK.
McCauley, M.E. & Matsangas, P. (2005). Ship’s Motion Effects on Crew Performance: A Preliminary Analysis of Motion Induced Effects on High Speed Vessel (HSV). Presented in Network Centric Warfare Conference 2005, 09-10 November, Athens,
McCauley, M.E., Pierce, E., and Matsangas, P. (2007). The High Speed Navy: Vessel Motion Influences on Human Performance. Presented in Human Systems Integration Symposium 2007, 16-19 March, Annapolis, USA
Pierce, Ε., McCauley, M.E., Price, B., Matsangas, P. (2008). Vessel motion influences on human performance and manual materials handling. Presented in Pacific 2008 International Maritime Conference (IMC), 29-31 January, Sydney, Australia.