Fighting Fatigue Perspectives, Strategies and Challenges

Panelists • Mr. Phil Comstock – President, Wilson Center for Public Research • Dr. Gregory Belenky – Research Professor, Director Sleep and Performance Research Center, Washington State University Spokane • Captain Bernie Sanders, Alaska Airlines – Human Performance Committee Chairman, ALPA • Captain Chris Beebe, US Airways – Vice President, Finance/Treasurer, ALPA • Mr. Jim Johnson – Senior Managing Attorney, Legal Department, ALPA • Captain Don Wykoff, Delta Airlines – Flight Time/Duty Time Committee Chairman, ALPA Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Managing Sleep and Circadian Rhythms to Sustain Operational Performance

Gregory Belenky, M.D. Research Professor and Director Sleep and Performance Research Center Washington State University

The Science of Sleep and Performance

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52nd Annual Air Safety Forum July 2006

The 24-Hour Sleep/Wake Cycle

0000 Slow Wave Waking 0600

1800

REM

1200 Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Factors Sustaining Health and Performance Sleep

• Obesity

• Insulin Resistance • Hypertension • Dyslipidemia

Metabolic Syndrome

Cardiovascular Disease

Type II Diabetes

Diet/Nutrition

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Overweight/ Obesity Sleep Disordered Breathing

Exercise

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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; work-load)

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52nd Annual Air Safety Forum July 2006

Sleep-Related Factors Affecting Performance • Sleep inertia • Individual differences in response to – – – –

Time awake Time of day Time on task Sleep inertia

• Adaptation to restricted sleep

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52nd Annual Air Safety Forum July 2006

Regional Brain Energy Metabolism in Slow Wave and REM Sleep

Frontal areas are deactivated during slow wave sleep; decline in flow of ~30% Air Line Pilots Association, Int’l

Frontal areas remain deactivated during rapid eye movement (REM) sleep

Frontal areas are re-activated only after awakening

Braun et al., Brain, 1997

52nd Annual Air Safety Forum July 2006

Total Sleep Deprivation Degrades Performance • Total sleep deprivation degrades performance in overall linear fashion (red line) • The circadian rhythm modulates temperature, alertness and performance (blue line) Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Psychomotor Vigilance Task

Sleep Deprivation Increases Lapses in Performance 10 minute psychomotor vigilance task ? 8000

12 Hours Awake 6000

Doran, Van Dongen & Dinges (2001)

4000 2000 0

1

4

7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70

8000

36 Hours Awake 6000 4000 2000 0

1

4

7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70

800 0

60 Hours Awake

Variability in psychomotor vigilance performance is potentially related to cortical columns switching on and off independent of whole-brain sleep/wake state Van Dongen & Belenky (2006) Air Line Pilots Association, Int’l

600 0 400 0 200 0 0 1

4

7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70

8000

84 Hours Awake 6000 4000 2000 0 1

4

7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70

RESPONSE NUMBER

52nd Annual Air Safety Forum July 2006

Sleep Deprivation Decreases Regional Brain Energy Metabolism • 6% global decrease in glucose uptake at 24 hours of total sleep deprivation • 12-14% decrease in glucose uptake in prefrontal cortex, parietal association cortex, and thalamus at 24 hours of total sleep deprivation

+ 32 mm AC-PC

Thomas et al., J. Sleep Res., 2000 Air Line Pilots Association, Int’l

Z > 4.16 3.08

24 h SD

2.58 2.33

+ 8 mm AC-PC

1.65 N = 17

52nd Annual Air Safety Forum July 2006

Sleep Restriction Degrades Performance Psychomotor Vigilance Task

• Increasingly restricted sleep degrades performance in a sleep dose dependent manner • Even mild sleep restriction (loss of 40 min of sleep/night) can degrade performance over time Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Time Awake, Time on Task and Circadian Rhythm Interact to Degrade Performance • Total sleep deprivation – Decreased average performance on a ten-minute psychomotor vigilance task (PVT) – With increasing time awake and adverse circadian phase there is increased sensitivity to time on task

38 Hours of Total Sleep Deprivation (n=40)

• Chronic sleep restriction – Decreased average performance – Increased sensitivity to time on task Air Line Pilots Association, Int’l

7 Days of Sleep Restriction (n=16/group) 52nd Annual Air Safety Forum July 2006

Psychomotor Vigilance Task Lapses Æ

Increased Time on Task Degrades Performance

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Cognitive Workload high (2nd 10 min) high (1st 10 min) moderate

Vitellaro, Levin, Ballas, Dinges & Van Dongen (2003)

52nd Annual Air Safety Forum July 2006

Individual Differences Affect Performance Degradation

3 Hours Sleep/Night X 7 Days

Speed on PVT

0.005 0.004

Baseline

Recovery

0.003 0.002 0.001

Mean +/- SEM (n = 18) Resistant Subject

0 1

2

3

4

5

6

7

Days Air Line Pilots Association, Int’l

8

9 10 11 12Sensitive 13 Subjet #1 Sensitive Subject #2

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American International Flight 808, 18 August 1993, Guantanamo Bay, Cuba

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The Approach to Guantanamo

Approach to Guantanamo requires a sharp right bank to avoid Cuban air space Air Line Pilots Association, Int’l

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Crash Site

All 3 crew members were rescued from the cockpit and survived Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Cockpit Voice Recorder Engineer: Co-Pilot: Captain: Co-Pilot: Captain: Co-Pilot:

Slow, Airspeed Check the turn. Where’s the strobe? Right over here. Where? Right inside there, right inside there. Engineer: You know, we’re not getting our airspeed back there. Captain: Where is the strobe? Co-Pilot: Right down there. Captain: I still don’t see it. Engineer: #, we’re never going to make this. Captain: Where do you see a strobe light? Co-Pilot: Right over here. Captain: Gear, gear down, spoilers armed. Engineer: Gear down, three green spoilers, flaps, checklist.

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?????:

There you go, right there, looking good. Captain: Where’s the strobe? Co-Pilot: Do you think you are going to make this? Captain: Yeah… if I can catch the strobe light. Co-Pilot: 500, you’re in good shape. Engineer: Watch the, keep your airspeed up. Co-Pilot: 140. [sound of stall warning] ?????: Don’t – stall warning. Captain: I got it. Co-Pilot: Stall warning. Engineer: Stall Warning Captain: I got it, back off. ?????: Max power! ?????: There it goes, there it goes! ?????: Oh no!

52nd Annual Air Safety Forum July 2006

Point of Contact

Gregory Belenky, MD Research Professor and Director Sleep and Performance Research Center Washington State University Spokane 310 N. Riverpoint Blvd. Spokane, WA 99210-1495 Phone: FAX: Email: Air Line Pilots Association, Int’l

(509) 358-7738 (509) 358-7627 [email protected] 52nd Annual Air Safety Forum July 2006

Fatigue Risk Management Systems (FRMS)

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Regulation & Prescriptive Hours of Service Rules • Regulation & prescriptive rules - rigid, single-line of defense against fatigue related errors, incidents and accidents – Hours of service regulations promulgated by regulatory bodies (governmental, international) – Context is typically labor management relations

• Assumption – if you live within the regulations you will be safe – Ignores local conditions – One size fits all approach – Likely to be at points overly restrictive and/or unsafe Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

The Emerging Art and Science of Fatigue Risk Management • Fatigue risk management systems (FRMS) – Multi-layered defense against fatigue-related error, incident, and accident – Each layer “sloppy” but in the Swiss cheese model highly efficient at preventing fatigue-related errors

• Embed within corporate safety management system (SMS) – Move fatigue issues from labor/management to safety – Safety enhances productivity (and the reverse) – SMS has built-in structure, yields economies of scale

• Examples are Union Pacific Railroad and easyJet Airlines Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Union Pacific Railroad Fatigue Risk Management System (FRMS) • 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? – Tier 2 – do employees take advantage of the sleep opportunity? – Tier 3 – In the workplace, do they maintain adequate alertness and performance?

Dawson & McCulloch 2005 Air Line Pilots Association, Int’l

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easyJet Fatigue Risk Management System • System Integrated Risk Assessment (SIRA®) – A safety risk management system incorporating fatigue and other risks

• Multiple, interacting tiers of hazard detection and analysis – System sensory network (data collection – System risk matrix • System risk model (feedbacks to company operational strategy and to regulators) • System defense analysis (feedbacks through intervention to system sensory network) Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Fighting Fatigue Perspectives, Strategies and Challenges

Regulatory History of Flight Limitation Rules Presented by Jim Johnson Senior Managing Attorney Legal Department

Regulatory Actions 1931 1934 1934

Behncke campaigns for flight time limits Limitation on flying hours for First Officers (Captains) Decision 83 limited flight time to 85 hours a month

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Regulatory Actions 1937 1942 1945 - 1947

CAB issued domestic flight rules. Limited flight time to 8 in 24 Amended to add 30 hours per week CAB issued flag and supplemental flight rules

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Regulatory Actions 1953 - 1954 1962 1976

Supplemental and flag rules amended (deadhead not rest) Moratorium on series of flight rules ALPA sues FAA to remove moratorium

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Regulatory Actions 1946 - 1982 1985

1989

30 CAB/FAA proposals to amend flight limit rules Domestic flight limit rules revised (rest for less than 8 hours flight and look back provision) Two-pilot aircraft limited to 8 hours in flag operations

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Regulatory Actions 1985 - 1990 1992 1995

ATA(2), RAPA and ALPA file petitions for rulemaking Reserve rest interpretation enforced FAA issues NPRM 95-18 to revise all flight limitation rules

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Regulatory Actions

1995 - 2006

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No action by FAA

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Thank You

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52nd Annual Air Safety Forum July 2006

Fighting Fatigue Perspectives, Strategies and Challenges

Is Fatigue an International Issue? Bernie Sanders, Human Performance Committee Chairman

11 Fatigue-inducing Factors (595 responses) Schedule regulation

85 84 80 76

Long commute time Circadian desynchronization

Factors

Hotel disconfort Wait at the airport between flights

70

Increased workload

63

Crew & Aircraft

36 34

Airport delay Personal problem

28

Weather

23

Sudden schedule change

16 0

20

40

60

80

Percent of Applicability Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

100

Factors Affecting Fatigue Levels on Trips

Days on trip

Factors

Overnight rest time Non US Pilots

Off-duty Hrs

US Pilots

Duty Hrs

Flying Hrs

0

0.5

1

1.5

2

2.5

3

3.5

4

(1) Minimum (2) Slightly; (3) Moderately; (4) Extreme affect

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52nd Annual Air Safety Forum July 2006

Scheduling Factors Factors: that are of importance when pilots bid for their monthly schedule

US

NON-US

Fatigue due to duty time length

2.37

2.62

Fatigue due to multi-day trips

2.35

2.59

Fatigue due to timing of the flights

2.61

2.88

Fatigue due to short breaks between trips

2.25

2.41

Total days off in a month

3.38

3.01

Continuous days off

3.22

2.88

Particular days off (weekends, holidays)

3.1

2.84

Estimated chance of getting scheduled bid

2.35

2.57

In relation to daily family schedule

2.11

2.68

In relation to commute to the airport

2.15

2.0

Destinations

2.64

2.53

Pay

2.78

2.17

Flight hours

2.58

2.37

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52nd Annual Air Safety Forum July 2006

Conclusions • Circadian disruption and partial sleep loss due to erratic flight schedules are a safety concern in aviation • Pilots cannot readjust their schedules once they have arrived in their layover city due to: – Rapid turn-around with Light/dark cycles that are different form their home city

• As a result, pilot's sleep may be disrupted due to early or late awakening, difficulties initiating or terminating sleep and disrupted sleep. Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Conclusions • Flight Schedules disrupt pilot's circadian cycle: – Cause sleep disorders, such as erratic episodes and sleep debt – A probable detriment to pilot performance ?????

• Flight Schedules are overloading pilot performance, by – – – –

Long duty days Short off duty rest periods Overnight duty, Minimum days off

= Fatigue is real Air Line Pilots Association, Int’l

52nd Annual Air Safety Forum July 2006

Fighting Fatigue Perspectives, Strategies and Challenges