We Cannot Allow a Sleep Gap!

[Norfolk]

Seriously, this is an interesting - and a rather underappreciated - subject that was examined recently by the JASON panel: Human Performance (http://www.fas.org/irp/agency/dod/jason/human.pdf), JSR-07-625, March 2008.




Non-medical applications of the advances of neuroscience research and medical technology also pose the potential for use by adversaries. In this context, we must consider the possibility that uses that we would consider unacceptable could be developed or applied either by a state-adversary, or by less-easily identified terrorist groups. In the following, we consider first the issues of what types of human performance modification might alter a military balance, and how those issues can be evaluated. We then address two broad areas where there are significant, and highly publicized, advances in human performance modification. These are the areas of brain plasticity (permanently changing the function of an individual’s brain, either by training or by pharmaceuticals), and the area of brain-computer interface (augmenting normal performance via an external device directly linked to the nervous system). The present status of technology in these areas is evaluated, and the context for potential threats in the future is described. As will be seen, there are no serious immediate threats, however the advance of technology and the accompanying commercial interest, are such that close attention must be paid to the future potential for threats.

In The RCR, we were lectured that a soldier was supposed to retain more or less full combat efficiency for a period of 7-10 days on 1 1/2 to 2 hours' sleep a day; the basis for this "standard" was that it had all been tested and verified by the Canadian Forces Civil and Military Medical Institute. Needless to say such a claim attracted doubts amongst soldiers, for all sorts of reasons and considerations. That said, if a foreign adversary were able to devise means by which to reduce their soldiers' (or operatives') need for sleep or at least to very substantially increase their capacity for awareness for much longer periods of time than is normal, this could make quite a difference at the tactical level, at least in the short term.

[selil]

Here is a link to a really good study (www.netrider.net.au/articles/fatigue.pdf) on fatigue when riding a motorcycle long distances rapidly. Now before you say "so what" it is by Vice Admiral Don Arthur, former Surgeon General of the United States Navy. This is likley the best real world written study on the topic I have EVER seen. For Spec Ops, and the average war fighter this little PDF should be MANDATORY reading. Yeah, it's about motorcycles, but it applies to everybody.

ETA: Don't put those motorcyclists off. They are experts at fatigue management as a group.

[Schmedlap]

To put a number or ratio on this - x number of hours for y number of days - seems highly subjective to the point of not being practical. It seems that the threshold for minimum amount of sleep while retaining effectiveness is driven more by leadership and circumstances than in some physiological norm. I recall several occasions in Iraq when I was talking to someone and fell asleep in mid-sentence and then realized that I had been awake for several days (when you do most operations at night, spend most of the daylight in a building where the windows are sandbagged, and operations are driven by the situation, rather than a battle rhythm, it is extremely easy to miss out on sunrises/sunsets and lose track of days). On the other hand, at Fort Benning I could get a solid 8 hours of sleep every night and still not be able to stay awake for more than 45 minutes in building snore (4).

[jcustis]

Very interesting stuff, especially the motorcycle fatigue stuff. Even better that I could read it in less than 30 minutes.

Quite a bit of that relates to my community, where 16-20 hours of continuous roadmarching while standing in the turret wasn't uncommon. In fact, the fatigue mitigation recommendations make all the sense in the world as I look back and remember getting fatigued more during high-speed runs approaching the LAV tops speed. I know the sensation of falling asleep standing up, and it ain't fun.:D

[RTK]

I tried to read it, but I fell asleep.

Tip your waitress.....

[SWJED]

Tip your waitress.....

Crab Cake to show in the 7th.

[AGBrina]

Our night vision capability gives our forces such a distinct advantage over the insurgents and the Taliban, that we can't pass up the opportunity to use it. The trouble is that we don't know when/how to stand down during the day. This is exacerbated by the guys in the TOC, who probably don't give a damn about sleep deprivation, nor its lingering effects, on the maneuver forces. So, they plan operations round the clock; and keep the officers and NCOs, who are commanding maneuver forces, in Prep mode or in extensive after-action debriefings when these guys should be getting some rest themselves.

"Fatigue makes cowards of us all!"

Everything I learned about the adverse consequences of sleep deprivation, I learned in Ranger School. Everything I learned about patrolling, tracking, concealment and intelligence gathering, I learned in Recondo School. In the former, we just endured and struggled to stay awake. In the latter, we got stronger, sharper, and better in every way every day. Every day, we crawled into covered and concealed positions at the end of Evening Nautical Twilight; and there we stayed, still and quiet, until the Beginning of Morning Nautical Twilight. (Of course, if Recondo Schools are still run today by Special Forces, I'm sure that Recondos are being trained to take advantage of Night Vision devices as well. I just hope that they are given enough rest to stay alert and to learn their craft.)

I do believe that the battalion S-1 and Medical Officer of each battalion should be monitoring the operational tempo of maneuver forces within the battalion; and should be able to alert the battalion commander and company commanders before their troops wear down. (It is not as easy to track, of course, but the battalion S-2 should be trying to do the same for known enemy forces.) I never saw nor heard of this being done during my limited time in active duty. In Vietnam and Korea, my units never sustained a high tempo of operations for more than a few days without a pause. [And we never (Vietnam) and rarely (Korea) maneuvered at night.] So, it did not seem necessary. But, since we have made it "normal" to do too much with too few troops for several years now, it should be a major responsibility for someone at staff level.

[TX Grayman]

FM 22-9 Soldier Performance in Continuous Operations (The first edition) was one of the least read manuals in the 1990's Army. Download a copy and find out a lot more about sleep deprivation than you know now and it's effects on combat operations. Consider that we have been in a high optempo since 2001 and what effects has that has had on the force. Some General Officers have been deployed for 4 years, longer than WWII when they didn't have video teleconfrences and unending powerpoint shows. The sleep gap is no joke.

[Cavguy]

TX,

A great article on the subject "Rest for the Weary" (https://www.knox.army.mil/center/ocoa/armormag/backissues/1990s/1994/so94/5chaisson94.pdf) was published in the September-October 94 issue of ARMOR (http://www.knox.army.mil/armormag/).

I've used it for OPD since.

[Pete]

They say that at Fort Wainwright during the winter Reveille is sounded at 1030 hours and Taps is at 1700. I was there with my FOs attending Arctic weather training with 1/32 Infantry in November-December 1982. ;)

[Cavguy]

Just got here in late Jun, waiting to see what winter holds. :eek: Summer weather is very pleasant though ....

[carl]

An extremely large amount of research on this subject has been done by the aviation community, both military and civilian. There are even computer programs where you can plug in quantity, quality and times of sleep and learn how well or poorly you are performing relative to an equivalent blood alcohol level since x amount of sleep deprivation directly correlates to x b.a.c.. The fundamental point is if you don't sleep you won't perform and if you still don't sleep you are going to and not be able to control it.

[Van]

a soldier was supposed to retain more or less full combat efficiency for a period of 7-10 days on 1 1/2 to 2 hours' sleep a day

That is a load of blithers.

Multiple independent observations (including my own) is that when you go past about three days (72 hrs) on this kind of sleep cycle, judgement and quality of higher brain functions goes right out the window. The problem is that in training, most small unit field exercises are about three days, so you can usually push your people and get away with it.

Yes, I had some near misses because a group of soldiers I was leading had gotten to about four days without sleep and were still handling pyro. To this day, I am fire-breathing death on sleep discipline.

[Redactor]

May be of interest.

[warrengoff]

FM 22-9 Soldier Performance in Continuous Operations (The first edition) was one of the least read manuals in the 1990's Army. Download a copy and find out a lot more about sleep deprivation than you know now and it's effects on combat operations. Consider that we have been in a high optempo since 2001 and what effects has that has had on the force. Some General Officers have been deployed for 4 years, longer than WWII when they didn't have video teleconfrences and unending powerpoint shows. The sleep gap is no joke.

Frankly, I wouldn't believe anything Don Arthur has to say. Read this and then you decide: http://en.wikipedia.org/wiki/Donald_Arthur

[TX Grayman]

Hi Warrengoff
I read the wiki article but I was not able to find a reference to Don Arthur and FM 22-9.

[TLoder]

"we were lectured that a soldier was supposed to retain more or less full combat efficiency for a period of 7-10 days on 1 1/2 to 2 hours"

I have a hard time comprehending this. Generally speaking, after 2 days with the sleep that you speak of, even with proper nutrients and hydration; the body begins it's process of microsleeps. As soon as this begins, combat efficiency and effectiveness is most definitely not full. This subject is definitely going to be brought up in the future as military budgets get tighter and tighter, units are going to be forced to get the bang for the buck.

Effective combat should always contain an element and concept of swift rotations. We learned this after Vietnam.

[Ken White]

Effective combat should always contain an element and concept of swift rotations. We learned this after Vietnam.We also relearned it in WW I, relearned it in WW II, relearned it in Korea, relearned it in Viet Nam ...

Now we get to relearn it again. :mad:

[Steve Blair]

The US has never been big on pulling units out of the line for rest periods. Goes all the way back to the Civil War, and most likely before that as well.

[jcustis]

That is a load of blithers.

Multiple independent observations (including my own) is that when you go past about three days (72 hrs) on this kind of sleep cycle, judgement and quality of higher brain functions goes right out the window. The problem is that in training, most small unit field exercises are about three days, so you can usually push your people and get away with it.

Yes, I had some near misses because a group of soldiers I was leading had gotten to about four days without sleep and were still handling pyro. To this day, I am fire-breathing death on sleep discipline.

As I am confident jmm99 can attest to, leaders stand to be at the highest risk of losing judgement and higher brain functions, especially when crappy sleep patterns are interrupted by those moments of sheer violence.

In the days leading up to the moment when I crossed into Iraq, I had a series of tactical problems, kinetic events, and the issue of a large caliber HE round landing 50m away from my vehicle ruin any sleep discipline I was hoping to maintain. When the embedded Fox News reporter ran footage of my passed out on the back of my vehicle, with a CVC helmet still connected, I was just that...passed out. No effort by anyne to rouse me would have worked, because I had been going for at least 72 hours with about the 1-2 hours of interrupted sleep mentioned so far. jmm99 likely witnessed that clip, but I had no idea he had followed out movements until just recently...small world.

I think the key distinguishing factor here revolves around the fight or flight reflex. When there is enough going on to retain a certain level of excitement and interest to one's mind, sleep can definitely be avoided with some degree of impairment. It's when you mix in the parasympathetic backlash from life-and-death events (I think this is the only thing I believe from Grossman) that you get the massive dumps of adrenaline which cause your body to short circuit and crash. That happened time and time during the invasion, leaving me half-asleep in the turret as we moved north. The exhaustion never really went away until we were outside Samarra, and watching elements of the 4th ID roll north.

The body and the brain can be condition to adjust to the lack of sleep, and would hazard a guess that at the time I was most adjusted, I could have gone 96 hours without too terrible impairment. Now, throw in a firefight or two, and that changed the calculus significantly.

Some of you may know CWO5 Timothy Gelinas. He was our battalion's Gunner, or Weapons Officer, during the invasion. A multiple-tour vet of Vietnam and Silver Star winner, Gunner Gelinas was some 55 years old IIRC when we crossed the border. He spoke to the mortarmen of my company a fe w months before the war, and when asked what could be done to do well in combat, he spoke highly of the notion of physical fitness. He was very clear in stating that a high state of physical fitness wil allow one's mind and body to withstand the rigors of combat.

I offer that if we are going to look for ways to beat back the body's reaction to fatigue and stress, functional fitness is where we should focus our effort.

[jmm99]

to any recollection of Custis sacking out, passing out or engaging in any other sort of inactivity caused by counting sheep. But, I now understand the real reason for this thread, Counting sheep... (http://council.smallwarsjournal.com/showthread.php?t=6154)

I have to plead guilty to watching Fox News and have always liked Rick Leventhal's reporting. So, when in spring 2003 (because of post-surgical complications), I was stuck for several months at home, lying on my side surfing the Net and watching TV, I followed Jon's company as it led the "East Side" charge to Baghdad.

I can truthfully say that Custis is the best combat officer posting to this forum whom I've seen in action. Of course, he is the only one whom I've seen in action. :D

Call it coincidence, but tomorrow I have to sit down with a "sleep doctor" to go over the results of my recent "sleep test". A small world indeed.

Regards

Mike

[carl]

The body and the brain can be condition to adjust to the lack of sleep, and would hazard a guess that at the time I was most adjusted, I could have gone 96 hours without too terrible impairment.

and


I offer that if we are going to look for ways to beat back the body's reaction to fatigue and stress, functional fitness is where we should focus our effort.

I may get in trouble by saying this, but these statements frighten me. You are an extremely exceptional individual if these statements hold true for you; and you may be but this will absolutely not hold true for everybody else. It is not possible to condition to the body and brain to sleep deprivation. It is not possible to beat back the body's reaction to sleep deprivation no matter how fit you are. The only way to counteract the effects of lack of sleep is to sleep.

Performance after a period without sleep can be directly related to performance with a specific blood alcohol content, 24 hours without sleep and you will act as if you have a blood alcohol content of .10. You are drunk in all the states I know of. 72 hours without sleep and you are performing at about 20% of your normal capacity. You can breathe and maybe walk.

You must sleep. There is no way around it. I know the exigencies of combat dictate that sometimes you must go anyway and accept the consequences but it is vital that it be recognized that there will be consequences. They are absolutely unavoidable.

As I have pointed out before there is huge body of research and material available on this subject. Go to the websites of the National Transportation Safety Board, Flight Safety Foundation, Coast Guard, Airline Pilots Association etc and type in "fatigue". Dozens of extremely good, readable and concise references will come up. One of the classic fatigue accidents is the DC-8 a crew flew into the ground at Gitmo because they were just too tired to move the controls. This is a HUGE deal in the transportation business.

Here is a link to a PDF about the Sleep, Activity, Fatigue, and Task Effectiveness (tm) Model and Fatigue Avoidance Scheduling Tool (tm).

Link:http://faculty.nps.edu/nlmiller/Fatigue/HurshSAFTEFAST.pdf

It provides a nice overview of the problem. FAST (tm) is a computer program that provides a graphic depiction of sleep deprivation vs. performance and might be a useful tool, maybe good to use in a briefing.

You must sleep. You can't get around it.

[jcustis]

I think a point of clarification is in order. At "my prime" so to speak, I could function off of intermittent sleep that amounted to about 1 1/2 to 2 hours total. Not 96 hours straight. I may have been a little tired when I wrote that. :D

[reed11b]

Another factor is that our jobs are often highly "scripted" or regimented, which allows us to "function" despite sleep deprivation. If you found yourself needing to do complex formulas or compared reaction and actual choices to what you did when you were not sleep deprived you might not feel the same way. I find myself seeing ghosts and second guessing my actions after being awake for 48hours or longer.
Reed
P.S. I agree whole heartedly with Carl

[Jedburgh]

Another factor is that our jobs are often highly "scripted" or regimented, which allows us to "function" despite sleep deprivation. If you found yourself needing to do complex formulas or compared reaction and actual choices to what you did when you were not sleep deprived you might not feel the same way. I find myself seeing ghosts and second guessing my actions after being awake for 48hours or longer.
Reed
P.S. I agree whole heartedly with Carl
Many years ago, when I was working tac nukes, the relevant USAREUR reg dictated that any of us about to work on a nuke round had to have had a minimum of 4 hours of uninterrupted sleep prior to slapping it together.....

[Adam L]

One thing I have not heard yet is the definition of "combat effectiveness."
This claim of maintaining "full combat efficiency" is idiocy. There is no way that efficiency after 7 days isn't lower than after 1.

The way I see it is that we should look for ways of increasing human performance in periods of extreme sleep deprivation by chemical or other means. Also, we need to come up with a better concept than simply "combat efficiency."

My personal experience with sleep deprivation.

No Sleep: 72 hours...after that you start to go down hill very quickly. I've been out to 5 days without sleep a number of times, but my personal record is 7 days 6 hrs. Most people will be completely useless on day 5.

1-3 hrs/day: You can actually survive for quite a long time this way. you can maintain near full efficiency for 3 days. After this point there is a steady decline until 5-9. After that point you tend to level out. You won't start to hit bottom for a while. That comes somewhere from 3-14 days later. At that point you will have a hard time telling the difference between when you are sleeping and when you are awake. Somewhere between 21 and 30 days you will lose that ability. At this point you still are functional to some degree, but you will start to lose your sanity soon.

(I should note that my experiences with sleep deprivation were during periods of extreme pain. I'm sure that in some way impacted my ability to stay awake. Still, in times of non extreme pain I've found this to still hold true, but I have never had to go past 10 days since then.)

Adam L

[carl]

Adam L:

You can do that. I can't. Therein lies the problem. If you are going to give a task to a group, how effective will that group be if there are many more people who can only go as far I can and only a few who can go as far as you? How do you judge?

Also even if I was dealing with just you, how would prudence dictate my actions? If you showed up at an airplane not having slept for 24 hours, I wouldn't let you touch the controls. I'd fly the airplane and your job would be to sleep. If you were a crew member who had not slept for 36 to 48 hours I would flat out refuse to fly with you and I'd advise everybody else to get off the plane.

You say you can function with those levels of sleep deprivation. I have no reason to doubt you. But...knowing what I know about how humans function when sleep deprived, I'd have to be in extremely desperate straits to bet my life on it. If I were in a leadership position and had to trust you to lead a group effectively, would it be responsible for me to allow you to do so at such high levels of fatigue?

[Ron Humphrey]

I think a point of clarification is in order. At "my prime" so to speak, I could function off of intermittent sleep that amounted to about 1 1/2 to 2 hours total. Not 96 hours straight. I may have been a little tired when I wrote that. :D

You at least have the catch up 5-6 hour power coma once every few days or so when scheds running like that.

[Adam L]

Carl: I agree with you 100%. I wasn't suggesting otherwise. I think where we are seeing things differently in that you are viewing this in terms of practically giving a task to a group of men. I'm looking at it with regard to what is the absolute limit we can push men to in combat. A conflict may very well be decided because of the endurance of the soldiers on one side. Of course I would never want to plan, on someone lacking sleep to go out and perform a mission. On the other hand I do want to know the point when a man becomes completely and utterly useles in unrelenting combat and how if possible we can delay that point in time.

Adam L

[carl]

Adam L: Very well stated. I can see your point.

[jcustis]

Once told me that when you saw a homeless person who was talking to themself, and looking around without their wits, it was often because they lived in a constant state of sleep deprivation, and had effectively gone insane.


That comes somewhere from 3-14 days later. At that point you will have a hard time telling the difference between when you are sleeping and when you are awake. Somewhere between 21 and 30 days you will lose that ability. At this point you still are functional to some degree, but you will start to lose your sanity soon.

[Adam L]

Once told me that when you saw a homeless person who was talking to themself, and looking around without their wits, it was often because they lived in a constant state of sleep deprivation, and had effectively gone insane.

This is supported by some of the studies I have read on the issue. Another factor that is believed leads to mental issues among the homeless is a lack of human contact. This reminds of something that is not pertinent to the "sleep gap", but still interesting. After long periods without sleep you begin to feel a great loneliness. During the daytime you become less and less social, while at night you are completely alone often without a person to talk to. (If you live with someone you may feel even more isolated. As supportive as your wife/GF/etc. may be they still just want to sleep. It is very unsettling to be awake unable to sleep while peopel are only a few feet away from you sleeping soundly. This further isolates you as you more and more feel and almost believe yourself to be an individual, more accurately and entity, seperate from the rest of the world.)

Adam L

[carl]

I just finished " A Devil of a Whipping: The Battle of Cowpens" by Lawrence E. Babits. The author partially attributes the collapse of the British infantry to their being dog tired. They awoke at 0200, walked 12 miles and started the fight at around 0730 just as the sun was coming up while having only slept 4 hours in the previous 48. I never knew that and thought it very interesting.

The book was filled with good info but was heavy going. If I was to read it again I would start with the epilogue. Morgan appears to have been a very smart man.

[jcustis]

I suspect that this article will end in a dead link within 6 months, so I am posting the whole piece:

Get Some Sleep: Are you a night owl? Here's why
I hear the floorboards creak, the toilet flush, first one shoe drop to the floor, then the other. My husband pulls back the covers and climbs into bed, disturbing the dog, who now spins around rattling her tags looking for a new, cozy den. I groan and turn over to look at the clock: 3 a.m., an early night for him. You see, my husband is what many people call a "night owl," but really he suffers from a circadian rhythm sleep disorder called delayed sleep phase disorder.

Circadian rhythm means a 24-hour cycle. Humans have a 24-hour sleep/wake cycle that is linked to the 24-hour cycle of the sun. So, in the optimal situation, we rise in the morning and after about 16 hours of wakefulness we are sleepy and we go to bed and sleep for eight hours. In my last blog, I talked about shift work disorder and how shift workers are not able, because of their jobs, to flow with this natural rhythm.

People with delayed sleep phase disorder also get out of sync with what we would consider normal bed times (10 p.m. to midnight), but for unknown reasons. The exact prevalence in the general population is unknown, but it is estimated to affect 7 percent to 16 percent of teens and young adults.

Delayed sleep phase disorder usually begins in adolescence or early adulthood. Sleep onset is delayed at least two hours from social norms, and these altered sleep/wake times can impair the work, academic and social parts of sufferers' lives. People with DSPD often complain of insomnia because they try to go to sleep at a normal time but their internal rhythm is set to a later time and sleep is usually impossible until very late. Then, if they have to get up for work or school, they are very tired and sleepy in the daytime and are not functioning at their highest capabilities. Often, they will steal a nap, but that only sets them up for further delay in their bedtime.

Usually the patients who show up at the sleep center are teens who are brought in by their mothers because they can't get up and make it to their early morning classes. Their grades are failing and the school is threatening to expel them. How do I help them? Well, I must return to my near-constant theme: Light.

We get them on a schedule where we slowly move up their bedtimes - just 15-30 minutes each time over a series of weeks. With each change in bedtime, they are instructed to be sure to avoid bright light two hours before the desired bedtime. We often need to use glasses that filter the blue light because it is not realistic to think that teenagers are not going to be on the computer or using some electronic device. I also have them get outside and get some bright light in the mornings. Where I am in Chicago, for much of the year we recommend that such patients use light boxes in the morning. I recommend the ones made by Lite Book because they use LED technology, which means they are smaller and patients need to spend only 15-30 minutes in front of the unit.

We also use melatonin, but not as a sleep aid. Instead, we use it to alter people's circadian rhythm, and therefore, we give it 5-7 hours before desired bedtime and we use small doses (0.5-1.0 mg). And I always recommend that they try this at home the first few times in case it makes them sleepy right away.

I would like to caution that although this general principle of bright light in the morning and dim light before bedtime is easy enough to understand, it is also easy to apply the principle incorrectly and actually make matters worse. For example, a well-meaning mother of a 16-year-old reads this and tomorrow morning hauls her son out of bed at 6:30 a.m. to get him to his first AP class. The next night, to her dismay, he stays up even later, and getting him up the following morning would require inviting the marching band to hold practice in his bedroom.

What has gone wrong? Well, when mom got him up at 6:30 a.m., he had only had 4½ hours of sleep and his core body temperature had not reached its low point. When his eyes received bright light before the lowest drop in core body temperature, then the internal clock in the brain was being reset to a later time and actually delaying the sleep onset for the next night. Many times we have to wait until a vacation to try to reset someone's clock. Most times, the help of a sleep physician is essential, and always, the patients themselves have to want to change their schedule.

Another word of caution: It is easy to confuse this disorder with insomnia, but just giving the young person a sleeping pill doesn't usually work to reset the internal clock.

Why do some teens have these dramatic shifts in sleep onset and not others? This can run in families and changes in one of the circadian clock genes have been associated with this disorder but we cannot yet point to a specific genetic mutation that causes this problem. Delayed sleep phase can be associated with depressive symptoms but the good news is: Many will naturally outgrow it, especially when the responsibilities of adult life force them into becoming morning people. Some, like my husband, will return to their nocturnal ways every chance they get.

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois.

http://pagingdrgupta.blogs.cnn.com/2010/11/30/get-some-sleep-night-owl-its-a-real-condition/?hpt=C2

[davidbfpo]

I always recommend a guide published by the Newcastle on Tyne NHS Trust: http://www.ntw.nhs.uk/pic/leaflets/Sleeping%20Problems%20A4%202010.pdf

Now to walk in the light snow to work.