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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 l.jpg

SLEEP

“perchance to dream”

Shakespeare


Slide2 l.jpg

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 l.jpg
Thanks to Robert J. Koester and team functioning in disaster response services.

  • Most of the material presented here is taken from:

    • Fatigue: Sleep Management During Disasters and Sustained Operations Published by dbS Productions 19


Overview l.jpg
Overview and team functioning in disaster response services.

  • 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 l.jpg
Objectives and team functioning in disaster response services.

  • 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


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Goals and team functioning in disaster response services.

  • Obtain core sleep

  • Utilization of naps

  • Recognition of sleepiness

  • Immediate appropriate responses


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Continuum and team functioning in disaster response services.

  • Lack of sleep

  • Sleep deficits

  • Sleep deprivation

  • Sleep demand

  • Sleep occurrence


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Circadian Rhythms and team functioning in disaster response services.

  • 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


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Owl or Lark and team functioning in disaster response services.

  • Morning People (Larks)

    • description

  • Night People (Owls)

    • description


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Your Sleep Pattern and team functioning in disaster response services.

  • 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”


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How and team functioning in disaster response services.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?


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My reaction to less sleep and team functioning in disaster response services.

  • 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


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Are you Legal? and team functioning in disaster response services.

  • Could you legally drive a big rig?

  • Are you at risk for being dangerous?


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Medical Implications and team functioning in disaster response services.

  • Lowest body temperature 4:00 AM

  • Lowest BP 00:00-04:00

  • Peak BP 15:00-16:00


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Sleep Gates and team functioning in disaster response services.

  • 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


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Sleep Requirements and team functioning in disaster response services.

  • 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


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Signs of Sleepiness and team functioning in disaster response services.

  • 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


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Effects of Sleep Loss and team functioning in disaster response services.

  • 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


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Sleep-Related Errors and team functioning in disaster response services.

  • 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


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The Test and team functioning in disaster response services.

  • 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.


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Paratrooper Study and team functioning in disaster response services.

  • 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


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Results of 9-Day Test and team functioning in disaster response services.

  • 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


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Shift Work and team functioning in disaster response services.

  • 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


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Optimizing Sleep and team functioning in disaster response services.

  • 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


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Naps and team functioning in disaster response services.

  • 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.


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Accident Prevention and team functioning in disaster response services.

  • 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


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Safety is not just the Safety Officer’s Job and team functioning in disaster response services.

  • Ask the import questions

    • When did you last sleep?

    • How long did you sleep?

    • How alert are you now?

    • Do you need a nap?


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Some Possible Rules and team functioning in disaster response services.

  • 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


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More Possible Rules and team functioning in disaster response services.

  • 20/4 – for every 20 hours worked, 4 hours of actual sleep is required

  • Naps are encouraged or required to maintain effectiveness


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Stanford Sleepiness Scale and team functioning in disaster response services.

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 l.jpg
Summary and team functioning in disaster response services.

  • 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 l.jpg
Summary (cont.) and team functioning in disaster response services.

  • 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