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SLEEP. “perchance to dream” Shakespeare. Sleep: Understand it, managing it, and improving individual and team functioning in disaster response services. Presented by Robert L Bray, PhD, LCSW www.rlbray.com. Thanks to Robert J. Koester. Most of the material presented here is taken from:

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sleep

SLEEP

“perchance to dream”

Shakespeare

slide2

Sleep: Understand it, managing it, and improving individual and team functioning in disaster response services.Presented by Robert L Bray, PhD, LCSWwww.rlbray.com

thanks to robert j koester
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
overview
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 Officer’s Job
objectives
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
goals
Goals
  • Obtain core sleep
  • Utilization of naps
  • Recognition of sleepiness
  • Immediate appropriate responses
continuum
Continuum
  • Lack of sleep
  • Sleep deficits
  • Sleep deprivation
  • Sleep demand
  • Sleep occurrence
circadian rhythms
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
owl or lark
Owl or Lark
  • Morning People (Larks)
    • description
  • Night People (Owls)
    • description
your sleep pattern
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”
how alert are you
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?
my reaction to less sleep
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
are you legal
Are you Legal?
  • Could you legally drive a big rig?
  • Are you at risk for being dangerous?
medical implications
Medical Implications
  • Lowest body temperature 4:00 AM
  • Lowest BP 00:00-04:00
  • Peak BP 15:00-16:00
sleep gates
Sleep Gates
  • When the gates are open fatigue is felt
  • Morning people most stable 21:20-23:20
  • Night People After 00:00
  • Forbidden zone for sleep 20:00 +or- 40 minutes - Safest time
sleep requirements
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
signs of sleepiness
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
effects of sleep loss
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
sleep related errors
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
the test
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.
paratrooper study
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
results of 9 day test
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
shift work
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
optimizing sleep
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
slide25
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.
accident prevention
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
safety is not just the safety officer s job
Safety is not just the Safety Officer’s 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?
some possible rules
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
more possible rules
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
stanford sleepiness scale
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.

summary
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
summary cont
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 Officer’s Job
  • Some Possible Rules
  • Stanford Sleepiness Scale
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