The effect of fatigue and motion sickness in personnel operational effectiveness

Should we care?

LCDR P. Matsangas HN

Battle Stress ManagementSupreme Joint War College, April 7, 2011

Stress vs arousalYerkes & Dodson law

Selye (1975). "Confusion and controversy in the stress field". Journal of Human Stress 1: 37–44

Conceptual relationship between level of arousal and expected quality of performance

Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18, 459-482.

Sleep deprivation and fatigue

Basics and operational consequences

Sleep deprivation and fatigueSleep basics I

Sleep is an ACTIVE process

Probably all animals sleep (various lengths)

May be the strongest, most insistent drive

Still not known exactly why we sleep

Restorative function?

Adaptive function?

Sleep deprivation and fatigue Sleep basics II

Sleep patterns over a typical lifespan

Sleep stages over a typical 8-hour sleep period

Miller, N.L. Matsangas, P. & Shattuck, L.G. (2008) “Fatigue and its effects on performance in military environments” in Hancock, P. & Szalma, J., eds., Performance Under Stress. Ashgate Publishers. Aldershot, UK.

Sleep deprivation and fatigue Sleep basics III (The processes underlying sleep need)

Adjusted from A. http://www.acnp.org/g4/GN401000075/Default.htmB. Borbély AA, Achermann P. Concepts and models of sleep regulation, an overview. J Sleep Res 1992;1:63-79

Sleep deprivation and fatigueSleep Basics IV

Normal amount of sleep 8 - 8 1/4 hours

“minimum 5 hours/night to maintain performance”?

Genetically determined

Sleep cannot be “banked,” but sleep deficits

accumulate

Rest does not replace sleep

Operational EnvironmentBasic stressors (from a sleep perspective)

Occupational Stressors

Travel across time zones Shiftwork Environmental conditions Temperature Humidity Noise Sleep conditions Light Motion

Moderating influences on

individual response

Sleep tendency Circadian rhythms Ultradian rhythms Individual differences

Parameters influenced

Sleep amount Sleep quality Sleep timing

Moderating influences on performance

Naps Medication Sleep scheduling Motivation Interest Personality Prior experience System design Individual differences

Performance

Physical Mental

Task attributes

Duration Pacing Complexity Proficiency Feedback

Psychological stressors

Danger - Fear Motivation

Fatigue Physical Mental

Sleep deprivation and fatigue Effects Memory is impacted tremendously by sleep.

(Nature, October, 2003)

Creativity is impacted by sleep. (Nature, January, 2004)

Memories can actually be recovered or “healed” by getting sleep.

Decision-making under uncertainty may be particularly vulnerable to sleep loss and is more pronounced with increased age. (J. Sleep Research, 2006)

Moral judgment is altered by sleep deprivation. (Sleep, March 2007)

Sleep deprivation and fatigueSymptoms• Difficulty concentrating

• Decreased vigilance and reduced attention

• Slowed comprehension, responses/fuzzy reasoning

• Faulty memory

• Increasing number of "omission" errors

• Mood changes

• Impaired speed and accuracy of skilled tasks

• Droning/microsleep

• Reduced motivation to complete the mission

• Communication difficulties

Sleep deprivation and fatiguePVT Adaptation to Chronic Sleep Restriction

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9 Hr

7 Hr

5 Hr

3 Hr

SAFTE/FASTR2 = 0.94

Recovery7 Day Restricted SleepBaseline

WRAIR Restricted Sleep StudyDr. Nita Shattuck, Research Asst. Prof.; NPS

Sleep deprivation and fatigue Effects are Task-Dependent

Sense of well-being Vigilance & attention Judgment & decision making

Well-learned simple intellectual tasks physical tasks

More sensitive to Fatigue

More resistant to Fatigue

Fatigue Avoidance Scheduling ToolFAST

Afternoon dips in performance

Normal sleep periods Reduced sleep period

Drop in performance

24 hour period

Early AM dip in performance

Blood Alcohol Equivalence Scale

Dr. Nita Shattuck, Research Asst. Prof.; NPS

Example IReasonably Good Sleep (from USS STENNIS)

Dr. Nita Shattuck, Research Asst. Prof.; NPS

Dr. Nita Shattuck, Research Asst. Prof.; NPS

Example IReasonably Good Sleep (from USS STENNIS)

Dr. Nita Shattuck, Research Asst. Prof.; NPS

Example IIPoor Sleep (from USS STENNIS)

Dr. Nita Shattuck, Research Asst. Prof.; NPS

Example IIPoor Sleep (from USS STENNIS)

FatigueEffects on operational performance No-sleep platoons militarily ineffective after 48 hours without

sleep (Haslam, 1982)

Decreased vigilance, mood changes, perceptual and cognitive decrements (Krueger, 1990)

Deteriorating marksmanship (McLellan et al., 2005; Tharion, Shukitt-Hale, & Lieberman, 2003, Miller et al, 2010)

In SUSOPS of an artillery fire direction center, planning and maintaining situational awareness most affected; evident decrements in the first 24-48 hours (Banderet et al, 1981)

Decreased pilot performance, less accurate flight maneuvers, increased error rates, significant judgment lapses(Billings, Eggspuehler, Gerke, & Chase, 1968; Krueger, Armstrong, & Cisco, 1985; Pereli, 1980, J. A. Caldwell, 2005, Brictson, 1990; Brictson, McHugh, & Naitoh, 1980; Brictson & Young, 1980)

Micro-sleeps

FatigueSleep studies at NPS

0.00 2.00 4.00 6.00 8.00 10.00

Operation Enduring Freedom (USS STENIS - CVN)

Flight operations in Iraq (USMC AH-64 Helicopter Battalion)

Mine hunting operations (Naval Aviation MH-53 squadron)

Infantry officers from Iraq/Afghanistan (Fort Benning Survey)

Various operations (SSN/SSBN)

GOMEX 05-1 (HSV-2 SWIFT)

RIMPAC 2008 (USS LAKE ERIE/ PORT ROYAL - CG)

Sea trials (USS HENRY M. JACKSON - SSN)

Sea trials (HSV-2 SWIFT)

Predeployment training (USS CHUNG HOON - DDG)

Predeployment training (USS RENTZ - FFG)

Daily Sleep [hrs]

Operational Sleep

0.00 2.00 4.00 6.00 8.00 10.00

USN enlisted training at RTC Great Lakes

USMA study (West Point)

Marine Aviation, Weapons and Tactics School (MAWTS WTI 2-05)

Marine Aviation, Weapons and Tactics School (MAWTS WTI 1-06)

FLW Basic combat training

Daily Sleep [hrs]

Sleep during Training

Motion sickness

Basis and operational consequences

The effect of motion on the humanA proposed model

Induced Motion

Motion Sickness

Effects on human activity

Sleep amount and quality

Sopite Syndrome

Motion-induced fatigue (MIF)

Human Element

Motion Sickness Incidence (MSI)

Human Performance

Working efficiency (or performance)

Motion Induced Interruptions (MII)

Other effects

Manual Material Handling (MMH)

Occupational health and safety

Health and safety effects

Long-term exposure health effects

Short-term exposure safety effects (injury)

Comfort

Comfort or amenities

Motion Sickness General term that describes the discomfort and

associated emesis (vomiting) induced by many kinds of motions

Airsickness, space sickness (SAS), cybersickness, simulator sickness, etc

Current sensory input

Neural store

Vestibular systemVision

Proprioception

Error signal

Motion SicknessSymptoms and Effects on Performance

Symptoms I

• Pallor• Cold sweating• Yawning• Burping• Increased salivation• Mood changes• Headache

Symptoms II(Effects on

performance)

• Nausea• Drowsiness (through

sopite syndrome)• Retching• Vomiting• Carelessness• Incoordination• Significant reduction

in motivation to work

Symptoms III(Life threatening)

• Dehydration (significant in life rafts)

• Shock (during sustaining symptoms)

Motion SicknessHFR model (1974, 1976)

Model CharacteristicsVertical AccelerationOnly true motionMSI: % of people who vomitTwo-hour nauseogenic period

Nauseogenic frequency range0.05 – 0.7 [Hz]

Central nauseogenic frequency0.167 [Hz]

Used MetricA historically common index of motion sickness severity is the Motion Sickness Incidence (MSI), which is the percentage of people who vomit when exposed to a nauseogenic environment.

O'Hanlon, J. F., & McCauley, M. E. (1974). Motion sickness incidence as a function of the frequency and acceleration of vertical sinusoidal motion. Aerosp Med, 45(4), 366-369.McCauley, M. E., Royal, J. W., Wylie, D. C., O'Hanlon, J. F., & Mackie, R. R. (1976). Motion Sickness Incidence: Exploratory Studies of Habituation, Pitch and Roll, and the Refinement of a Mathematical Model (Technical Report No. HFR 1733-2). Santa Barbara, CA: Human Factors Research, Inc.

Motion SicknessAdaptation Space: 2 – 3 d Sea: 1-2 d Motion specific Adaptation transfer?

Colwell, J. L. (1994). Motion sickness habituation in the naval environment (No. DREA Technical Memorandum 94/211). Dartmouth, N.S.: DefenceResearch Establishment Atlantic.

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Proposed modelHFR dataARMS=0.333 [Hz]

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Proposed modelHFR dataARMS=0.111 [Hz]

Motion SicknessEffects are Task-Dependent Complex tasks Vigilance tasks Sustained performance (long) Self-paced Viewed as non-essential

Well-learned/simple tasks Short Externally paced

More sensitive toMotion Sickness

More resistant toMotion Sickness

Countermeasures and what should be done

Countermeasures IFatigue

Non-pharmacological

Interventions

Sleep conditions

Dark

Quiet

Temperate

Safe

Daily activity optimization

Work/rest schedules

Naps, rest breaks

Exercise

Physical fitness

Environmental stimulation

Task attributes

Pharmacol.Interventions

Stimulants or alerting drugs

Prescription

Dexedrine (dextro-

amphetamine)

Modafinil

Non-prescription

Caffeine

Nicotine

Sedatives or sleep aids

Prescription

Ambien(zolpidem)

Restoril(temazepam)

Non-prescription

Melatonin

Benedryl

Trytophan

Miller, N.L. Matsangas, P. & Shattuck, L.G. (2008) “Fatigue and its effects on performance in military environments” in Hancock, P. & Szalma, J., eds., Performance Under Stress. Ashgate Publishers. Aldershot, UK.

Countermeasures IIFatigue and motion sickness Fatigue/Sleep deprivation Operational

Observe your personnel Napping Duty cycle optimization Morningness-eveningness preference

Organizational Regulations’ development and implementation NSWW

Motion sickness Observe you personnel Assigned duties optimization Screening Better system designs

Warfare is a ‘24-7’ activity What should we do? Operational sleep hygiene Regulatory policies Optimize sleep/wake cycles/duty time Use appropriate Human Performance models Observe your personnel (for fatigue and soporific symptoms) Better system design Education and training on human performance Kill the “myth of the warrior” (Shay, 1998)

“[Fatigue is] … the big gray elephant we muscle out of the cockpit when we fly, step around when we enter the bridge, and push aside when we peer into the periscope” (CAPT Davenport, 2006).

Shay, J. (1998). Ethical Standing for Commander Self-Care: The Need for Sleep. Parameters, 28(2), 93-105.

Bibliography for further reading Matsangas, P. and Miller, N.L. (2006). The Effects of Ship Motion on the Sleeping Patterns of Crewmembers aboard a High

Speed Naval Vessel. Sleep, 29(Suppl.S), A126-A126.

McCauley, M.E., Pierce, E., and Matsangas, P. (2007). The High Speed Navy: Vessel Motion Influences on Human Performance. Naval Engineers Journal, 119(1), 35-44.

Miller, N.L., Shattuck, L.G., Matsangas, P., and Dyche, J. (2008). Sleep Patterns and Academic Performance in U.S. Military Training and Education Programs. Mind, Brain, and Education, 2(1),29-33.

Matsangas, P., McCauley, M.E., Miller, N.L. (2008). [The effect of fatigue and motion sickness in ship operational effectiveness: review and preliminary results from non-conventional naval designs] [in greek]. Nafsivios chora, 2, 113-132.

Miller, N.L., Shattuck, L.G., Matsangas, P. (2009). Sleep and Fatigue Issues in Continuous Operations: A Survey of U.S. Army Officers. Behavioral Sleep Medicine. Accepted for publication.

McCauley, M.E., Matsangas, P., and Lewis-Miller, N. (2005). Motion and Fatigue Study in High Speed Vessel Operation: Phase 1 Report. Technical Report. Prepared for Naval Surface Warfare Center, Coastal Systems Station, Panama City, Florida.

McCauley, M.E., Matsangas, P., Pierce, E., Price, B., LaBreque, J., and Blankeship, J. (2007). Vessel Motion Effects on Human Performance aboard the FSF-1 Sea Fighter. Technical Report. Prepared from PMS-501, NSWC Panama City, Florida, and Naval Postgraduate School, Monterey, California, October 2007.

Miller, N.L., Shattuck, L.G., Tvaryanas, A. Matsangas, P. (2010). Effects of Sleep on Training Effectiveness in Soldiers at Fort Leonard Wood (Phase 1). Technical Report NPS-OR-10-003, February 2010, Monterey, California, USA.

Miller, N.L. Matsangas, P. & Shattuck, L.G. (2008) “Fatigue and its effects on performance in military environments” in Hancock, P. & Szalma, J., eds., Performance Under Stress. Ashgate Publishers. Aldershot, UK.

McCauley, M.E. & Matsangas, P. (2005). Ship’s Motion Effects on Crew Performance: A Preliminary Analysis of Motion Induced Effects on High Speed Vessel (HSV). Presented in Network Centric Warfare Conference 2005, 09-10 November, Athens,

McCauley, M.E., Pierce, E., and Matsangas, P. (2007). The High Speed Navy: Vessel Motion Influences on Human Performance. Presented in Human Systems Integration Symposium 2007, 16-19 March, Annapolis, USA

Pierce, Ε., McCauley, M.E., Price, B., Matsangas, P. (2008). Vessel motion influences on human performance and manual materials handling. Presented in Pacific 2008 International Maritime Conference (IMC), 29-31 January, Sydney, Australia.