Don Arthur, MD Emergency Medicine Physician Rider

1. And Riding Smart Don Arthur, MD Emergency Medicine Physician Rider

2. Endurance Rallying The “Secrets” • You can’t win without bagging the BIG points. • You can’t win without the REST BONUS. • You can’t win unless you ride a LOT. • Even if you ride a LOT, you can’t win unless you ride SMART.

3. Sleep & Fatigue • Sleep restores the brain’s chemical balance • Wakefulness develops a sleep ‘debt’ • Needs are individual and genetic • Cycle is normal and cannot be changed • Lack of sleep has a cumulative effect • We cannot ‘bank’ sleep Computing Power Fatigue Debt “More than any other factor, a winning ride almost invariably correlates with total miles ridden. “Never forget, however, that fatigue can easily take it all back.” Bob Higdon

4. Circadian Rhythm • Our internal clock controls sleep-wakefulness cycle • Tries to keep us on a ‘normal’ 24 hour cycle • Synchronized to light (day) and dark (night) cycles • Mid day urge to sleep is normal and can help you “Normal” Sleep Need Sleep Urge Sleep Sleep 12 2 4 6 8 10 12 2 4 6 8 10 12 NOON

5. Can You Change Your Cycle? • Yes… and everyone’s internal clock is unique • Can easily adapt to sleep cycle shifts • Adapts to three time zone shifts in as little as one day • Need an additional day for each time zone shift over three • Can adapt to work ‘shift’ changes – but slowly (days or weeks) • But we cannot decrease our overall sleep need “Normal” Sleep Need Sleep Urge Sleep Sleep 12 2 4 6 8 10 12 2 4 6 8 10 12 NOON

6. 12 NOON Disturbing the Rhythm • Sleeping less than normal results in accumulation of a sleep debt • Debt lasts until rest fulfills normal sleep needs and repays the debt Sleep Need Sleep Urge Sleep Sleep 12 2 4 6 8 10 2 4 6 8 10 12 Awaken early

7. 12 NOON Fatigue Effects • Gradual and insidious • You may not be consciously aware – especially if engaged in high skill or high tempo activity • Effects are modified by: • Individual task skill level • Level of training/experience Less experienced riders are at greater risk! Sleep Need Sleep 12 2 4 6 8 10 2 4 6 8 10 12

8. Microsleeps You’ve had a microsleep if… ? • Variable and unpredictable lapses in full consciousness • Can last a few seconds • Open-eyed sleep, paralysis, blurred vision, or other effects • Victim is unaware except for a vague feeling of missing time • May occur during periods of otherwise ‘normal’ functioning • At 70 mph, rider covers 103 feet every second! “How did I get in this lane?”

9. The Slowing Phenomenon • Faulty appreciation for speed • Decreasing ‘computing power’ • Riding speed slows 70 60 50 40 Brain’s ability to process information and perceive speed “Ummmm… Hey Don, the speed limit here is 65.”

10. Dangerous Mental Changes • Decreased performance  slower thinking • Reduced vigilance • Loss of situational awareness • Impaired decision-making  • Tend to choose uncomplicated options • ‘Fill in’ perception gaps – especially at night • Impaired long and short term memory • Task fixation and slowed reaction time You know you’re tired when you try to put drops in your eyes and miss. You know you’re REALLY tired when it’s because you’re still wearing your glasses.

11. Fatigue Manifestations • Psychological changes • Sleep becomes major subconscious focus • Mood slowly degrades and interferes with socialization • Motivation declines  faulty decisions • Eating and drinking tasks are ignored • Inhibitions wane  impatience, frustration, anger • Personal hygiene ignored • Unexplained refusal to recognize sleep deprivation • Impaired ability to take corrective action • Deepens fatigue and increases danger The greater the fatigue, the greater is our tendency to underestimate the fatigue burden and magnitude of the drive to sleep. This adds to the danger of unrecognized fatigue effects.

12. Countermeasures • Socialization and physical activity • Enhances alertness while engaged in activity • But… you will be more prone to sleep afterward • Prescription medications • Effects may be affected by other riding factors • May increase susceptibility to problems while riding • Consult your primary care provider • Other drugs • May improve wakefulness but only for very short periods • Do not enhance long term (days) performance • Significantly decrease performance after dose wears off JUST SAY NO! There is NO place in any sport for stimulant drugs. PERIOD.

13. Sleep Timing • Normal circadian rhythm favors sleep at two times • Try to time sleep to coincide with circadian rhythm • Light and other cues lessened at night  increased risk • Fall asleep more quickly • Nap effectiveness will be enhanced Sleep Need NAP Sleep Need Sleep Urge Nap Sleep Sleep Sleep Sleep 12 2 4 6 8 10 12 2 4 6 8 10 12 NOON

14. Sleeping or Napping • Resting – naps v. prolonged sleep • Repetitive ‘missed sleep’ has cumulative effect • Prolonged sleep is necessary to repay fatigue debt • Some sleep is better than no sleep • Naps provide significant recuperation but not as good as prolonged sleep • Any sleep longer than 5 minutes is beneficial • Waking after more than 45 minutes but less than 2 hours  sleep inertia • Two hours of continuous sleep ensures complete sleep cycle • Grogginess during sleep inertia is dangerous! • Prophylactic naps help • Sleep timing • Combine with gas/food stops… or not? • Rest without sleep does not pay fatigue debt

15. The Sleep Cycle • Moderately deep sleep • Dreaming phase • Erratic heart rate and breathing • Easily awakened • Light sleep • Jerky movement • Easily awakened 90-120 MINUTE SLEEP CYCLE • 40-50% of sleep time • No eye movement • Brain function slows • Easily awakened DANGER “DON’T WAKE ME UP” Stages of Sleep STAGES 3 & 4 Nap for 5-45 minutes to avoid sleep inertia. Sleeping more than 2 hours provides a full sleep cycle. • Deep sleep phases • Brain function very slow • Difficult to awaken • Inertia if interrupted REM = Rapid Eye Movement – the stage of sleep where dreams occur

16. Where to Sleep • Be physically and mentally comfortable • Shelter is better than open air • Police guarded rest stops are best • Company is good • Use a ground cloth or pad to keep dry • Stay away from pet walking areas • Beware of ants and other creatures • Leave your helmet and riding suit on • Remove your ear plugs • Don’t wake others with your Screamin’ Meanie® • Yes, you can sleep while resting on your tank bag There is no substitute for sleep. “REST TO GO FARTHER.”

17. The Iron Butt Hotel

18. How to Sleep the Night Before Overcoming Pre-Rally Excitement • Clear your mind • Don’t keep planning your ride • If something is bothering you, fix it! • Develop a bedtime routine and stick to it • Yoga, meditation, reading • Train your mind to anticipate sleep • Avoid activities which require complex thought • Have everything packed and ready to go when you awaken • Turn your phone off • Pay your bill ahead of time • Set your alarm and ask for a wake-up call • Have your bike gassed up and ready to ride • Have something to eat and drink ready for the morning • Sleep where and how you’re comfortable and fall asleep easily • Roommate? Find one with similar/complementary habits

19. Preparing for the Ride • Carefully consider potential riding impact • Chronic illnesses • Predisposing conditions • Carry a card with emergency information • Name, address, phone numbers • Next of kin and how to contact • Significant health history • Medications and allergies • Health insurance information • Vehicle insurance and towing information • Make an ICE entry in your cell phone contacts • Put a sticker on the back of your driver’s license • Take extra medication (in safe and dry place) • Prevention is better than treatment • When in doubt, talk with your primary care provider

20. Personal Preparation • Begin well rested • Maintain physical fitness • Eat properly • Small, balanced meals • Easily digested, low bulk foods • Afternoon snack to counter circadian dip • Avoid caffeine, alcohol, and tobacco • Participate in several small rallies before “the big one” to develop a successful routine and confidence. Can you find your gear… In the dark? In the rain?

21. Bike Preparation Prepare your bike to eliminate variability • Consistent systematic packing • Communication equipment (phone cards, too) • Ergonomics – form and function • Comfortable seat that fits YOU • If you’re worried about your tires, change them! • Tools and tire repair kit – know how to use them! • Can you pick it up? “SKERT”

22. Eliminate Riding Stressors • Severe time constraints • Bad weather • Excessive heat or cold • Unfamiliar roads • Monotonous scenery • Extended night riding • Increased threats – wildlife and traffic • Riding conditions beyond the rider’s ability • Complex tasks required while riding • Distractions – mechanical or personal problems YOU’RE LATE! Know your limits ahead of time and stick to them. PLAN YOUR RIDE. RIDE YOUR PLAN.

23. Courtesy: Paige Ortiz Environmental Stressors • Helmet – proper fit, full face, liner • Windshield – laminar flow • Eye protection • UV filtering sunglasses • Prescription lenses/bifocal inserts • Hearing protection • Skin and lip protection • Powder to prevent chaffing • Sun • Wind • Dryness • Moisture • Temperature • Vibration • Noise ENVIRONMENATL EFFECTS

24. Clothing • Full body protection of your choice • Waterproofing – including gloves and boots • Ballistic contact point pads • Make sure everything is ‘broken in’ • Heated clothing – vest at least • Evaporative cooling garments • The perennial undergarment debate…

25. Dehydration • Water loss from heat exposure – primarily sweating • Normal vapor loss from lungs • Normal ‘insensible’ water loss from skin • Increased water loss during heat exposure • Keep skin covered • Use cooling methods • Significantly affects mental and physical functions • Can accelerate development of fatigue • Accentuates fatigue effects • Many symptoms mimic fatigue • Dry mouth, headache  nausea, muscle weakness • Increases risk for heart and circulation problems • Especially when taking some medications

26. Rehydration • Stay ahead… DRINK before you need to • Water AND electrolyte (salt) solution • Sweating causes loss of water and electrolytes • Need to replenish BOTH • Low salt levels can be harmful • Read the labels • Amounts of electrolytes vary • May contain carbohydrates (sugar) • Avoid caffeine or alcohol for hydration • Both cause water loss by increasing urination • And this can accelerate dehydration

27. For Diabetics • Carbohydrate (sugar) in drinks can be dangerous for diabetics • Can raise blood sugar level acutely • May result in rebound decreased blood sugar • May increase water output through urine • Most athlete supplements contain sugar + Sugar No Sugar • Contains necessary electrolytes • No carbohydrates/sugars • Add to your water bottle

28. Caffeine • Caffeine is not a substitute for rest! • Should be avoided prior to an event – habituation • Can be used ‘strategically’ to improve alertness • Mental awareness improved by 100-200 mg • Peak effect seen in 30 minutes, lasts 3-4 hours • Don’t consume prior to anticipated rest – disturbs sleep • Will increase urine output! • The ‘Caffeine Nap’ • Drink a caffeinated beverage just before a nap • The caffeine will be absorbed during the nap • Caffeine effects will manifest upon awakening 100 Caffeine is a drug – use it wisely!

29. Caffeine Sources Effective dose = 100-200 mg Grande 330mg 12 ounce 30-45mg 200mg/ Tablet 400mg/ Packet 10 ounce 130mg 12 ounce 55mg* 12 ounce 140mg 12mg/ Piece TEA 8 ounce 60mg 2 ounce 207mg 8 ounce 80mg 9mg/ Piece 8 ounce 5-25mg Remember, caffeine is a diuretic! * NOT IN CANADA

30. 5-hour Energy Drink “Regain the feeling of energy and mental alertness with 5-Hour Energy Drinks. It’s better because you can actually feel it working. It starts with a tingle, a sudden rush, then KAPOW. Grogginess is gone and you’re running on all cylinders. Your mind is alert and focused. Your body is ready for action. “5-Hour Energy Drinks provides a boost of energy and mental alertness that lasts for hours – with no crash. That’s because 5-Hour Energy is packed with B-Vitamins, enzymes and amino acids.”

31. 5-hour Energy Drink • Contains 207mg of caffeine. • (“…as much as a cup of coffee”) • … and a whopping dose of Niacin (Vitamin B3) which causes dilation of blood vessels and a flushed feeling, giving the impression “It’s working.” • These effects may increase water and heat loss due to blood vessel dilation. • Side effects include nausea, vomiting, dizziness, insomnia, arm and leg numbness, rapid heart beat. Other Ingredients: Purified Water; Natural and Artificial Flavors; Sucralose; Potassium Sorbate, Sodium Benzoate and EDTA (to protect freshness).

32. Ride Safely • Know when to stop. • Stop before you need to • Stop to go farther! • Have a routine for stops. • Gas… log? • Food • Et cetera • Get gas before you need to. • Separate gas from rest stops? • Avoid high speeds. • Greatly increases fatigue • Greatly increases risk • Consistency wins! • Stay away from trucks! NO RIDE IS WORTH YOUR LIFE!

33. You’re four times It’s hard to more likely to have concentrate on a road accident two things when you’re on at the same time. a mobile phone. Be On The Lookout! Distracted drivers …are out to kill you!

34. Enjoy the Ride! donald.arthur@comcast.net