Sleep, Fatigue, and Performance. Gregory Belenky, M.D. Sleep and Performance Research Center

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1 Sleep, Fatigue, and Performance Gregory Belenky, M.D.

2 The Earth at Night: The Problem of 24/7 Operations

3 The 24-Hour Sleep/Wake Cycle Waking 0000 Slow Wave REM 1200

4 Sleep-Related Factors Affecting Performance Time awake (sleep/wake history) Time of day (circadian rhythm) Time on task (~shift length; % of shift spent on task) Sleep inertia Individual differences in response to Time awake Time of day Time on task Sleep inertia Adaptation to restricted sleep

5 Components of Fatigue Time Awake, Time of Day, Time on Task Adapted from Wesensten et al., 2004

6 Consequences of Sleep Restriction and Sleep Deprivation Short term Minutes, hours Error, accident, catastrophe Mid-term Weeks, months, years Bad planning, inadequate strategizing, poor life decisions Long-term Years Overweight/obesity, Type II Diabetes, Sleep Disorder Breathing, Metabolic Syndrome, etc. Fatigue and Health-Related Risk Management

7 Fatigue Risk Management (adapted d from Dawson and McCulloch, 2005) Three-tiered defense-in-depth to prevent fatigue related errors, incidents, and accidents Tier 1 Does system of shift timing and duration allow for adequate opportunity for sleep? Computer-based rostering Predictive Modeling Tier 2 Do employees take advantage of the sleep opportunity? Self-report Wrist-worn actigraph (sleep watch) Tier 3 In the workplace, do they maintain adequate alertness and performance? p Self-report & co-worker report Palm Pilot Psychomotor Vigilance Task (PVT) Embedded performance metrics

8 Tools for Field Studies Sleep watch actigraph to objectively measure total sleep time Palm OS base Psychomotor Vigilance Task (PVT) to objectively measure total sleep time

9 Objective Measurement of Sleep and Prediction of Performance The Sleep Watch Actigraph and Integration with Mathematical Modelling

10 Actigraphy and Sleep Scoring Nocturnal Awakening Nap

11 Performance Prediction Nocturnal Awakening Nap

12 Psychomotor Vigilance Task and Embedded Metrics

13 Sleep Restriction and Performance: ASl Sleep Dose/Response Study 8hrs in bed 3, 5, 7, 9 hrs in bed 8hrs in bed Adaptation Phase Experimental Phase Recovery Phase Release from study

14 Sleep Restriction and Performance Adapted from Belenky, et al., 2003

15 Driving Simulator Washington State University

16 RMS Lane De eviation Driving Simulator RMS Lane Deviation: An Embedded Performance Metric 3 Hr 5 Hr 7 Hr 9 Hr 0.5 T1 T2 B E1 E2 E3 E4 E5 E6 E7 R1 R2 R3 Day Washington State University

17 The Harvard Intervention Study Effect of Shift Timing and Duration on Sleep and Superimposed and Embdeded Performance Metrics A Case Example of Fatigue Risk Management

18 Traditional a vs. Intervention e t Schedule e Landrigan, et al. (2004) NEJM 351: 18,

19 Duration uato of Work Lockley, et al. (2004) NEJM 351: 18,

20 Duration of Sleep Traditional Intervention Hours/Week 45.9+/ /-6.0 Hours/Day 6.6+/ /-0.9 Lockley, et al. (2004) NEJM 351: 18,

21 Limiting Work Hours: Attentional Failures Lockley, et al. (2004) NEJM 351: 18,

22 Limiting Work Hours: Effect on Serious Medical Errors Landrigan, et al. (2004) NEJM 351: 18,

23 Point of Contact Gregory Belenky, MD Research Professor and Director Washington State University P.O. Box 1495 Spokane, WA Phone: (509) FAX: (509) Washington State University

Managing Sleep to Sustain Performance

Managing Sleep to Sustain Performance Sustaining Operational Effectiveness Gregory Belenky, M.D. The Earth at Night: The Problem of 24/7 Operations The Operational Environment Defined! Operational Environment