The effect of sleep deprivation and motion sickness in military personnel operational effectiveness. Should we care?

1. Battle Stress Management
Supreme Joint War College, April 7, 2011
The effect of fatigue and motion sickness in
personnel operational effectiveness
Should we care?
LCDR P. Matsangas HN

2. Stress vs arousal
Yerkes & 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.

3. Sleep deprivation and fatigue
Basics and operational consequences

4. Sleep deprivation and fatigue
Sleep 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?

5. 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.

6. Sleep deprivation and fatigue
Sleep basics III (The processes underlying sleep need)
Adjusted from
A. http://www.acnp.org/g4/GN401000075/Default.htm
B. Borbély AA, Achermann P. Concepts and models of sleep regulation, an overview. J Sleep Res 1992;1:63-79

7. Sleep deprivation and fatigue
Sleep 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

8. Operational Environment
Basic stressors (from a sleep perspective)
Occupational
Stressors
Travel across
time zones Parameters Task Performance
Shiftwork influenced attributes
Environmental Sleep amount Duration Physical
conditions Sleep quality Pacing
Temperature Sleep timing Complexity Mental
Humidity Proficiency
Noise Feedback
Sleep conditions Fatigue
Light
Motion Physical
Mental
Psychological Moderating Moderating
stressors influences on influences on
Danger - Fear individual performance
Motivation response Naps
Sleep tendency Medication
Circadian rhythms Sleep scheduling
Ultradian rhythms Motivation
Individual Interest
differences Personality
Prior experience
System design
Individual
differences

9. 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)

10. Sleep deprivation and fatigue
Symptoms
• 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

11. Sleep deprivation and fatigue
PVT Adaptation to Chronic Sleep Restriction
Baseline 7 Day Restricted Sleep Recovery
110
Mean Speed on Psychomotor Vigilance Task
95
(as a % of Baseline)
9 Hr
80 7 Hr
5 Hr
3 Hr
65
SAFTE/FAST
R2 = 0.94
50
0 T1 T2 B 1 2 3 4 5 6 7 R1 R2 R3
Day
WRAIR Restricted Sleep Study
Dr. Nita Shattuck, Research Asst. Prof.; NPS

12. Sleep deprivation and fatigue
Effects are Task-Dependent
 Sense of well-being
 Vigilance & attention
More sensitive to Fatigue
 Judgment & decision making
 Well-learned More resistant to Fatigue
 simple intellectual tasks
 physical tasks

13. Fatigue Avoidance Scheduling Tool
FAST
Early AM dip
in performance
Afternoon dips in Drop in
performance performance
24 hour period
Blood Alcohol
Equivalence
Scale
Normal sleep periods Reduced sleep period
Dr. Nita Shattuck, Research Asst. Prof.; NPS

14. Example I
Reasonably Good Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS

15. Example I
Reasonably Good Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS

16. Example II
Poor Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS

17. Example II
Poor Sleep (from USS STENNIS)
Dr. Nita Shattuck, Research Asst. Prof.; NPS

18. Fatigue
Effects 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

19. Fatigue
Sleep studies at NPS
Operational Sleep
Predeployment training (USS RENTZ - FFG)
Predeployment training (USS CHUNG HOON - DDG)
Sea trials (HSV-2 SWIFT)
Sea trials (USS HENRY M. JACKSON - SSN)
RIMPAC 2008 (USS LAKE ERIE/ PORT ROYAL - CG)
GOMEX 05-1 (HSV-2 SWIFT)
Various operations (SSN/SSBN)
Infantry officers from Iraq/Afghanistan (Fort Benning Survey)
Mine hunting operations (Naval Aviation MH-53 squadron)
Flight operations in Iraq (USMC AH-64 Helicopter Battalion)
Operation Enduring Freedom (USS STENIS - CVN)
0.00 2.00 4.00 6.00 8.00 10.00
Daily Sleep [hrs]
Sleep during Training
FLW Basic combat training
Marine Aviation, Weapons and Tactics School (MAWTS WTI 1-06)
Marine Aviation, Weapons and Tactics School (MAWTS WTI 2-05)
USMA study (West Point)
USN enlisted training at RTC Great Lakes
0.00 2.00 4.00 6.00 8.00 10.00
Daily Sleep [hrs]

20. Motion sickness
Basis and operational consequences

21. The effect of motion on the human
A proposed model
Human Element
Working efficiency (or performance)
Motion Sickness Incidence
Motion Sickness (MSI)
Sopite Syndrome
Sleep
amount and quality Motion Induced Interruptions
(MII)
Manual Material Handling
Effects on human activity (MMH)
Other effects
Motion-induced fatigue
(MIF)
Induced Human
Motion Performance
Comfort or amenities
Comfort
Occupational health and safety
Long-term exposure
health effects
Health and safety effects
Short-term exposure
safety effects (injury)

22. 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
Vestibular system
Current
Vision sensory input
Proprioception
Error signal
Neural store

23. Motion Sickness
Symptoms and Effects on Performance
Symptoms II
Symptoms III
Symptoms I (Effects on
(Life threatening)
performance)
• Pallor • Nausea • Dehydration
• Cold sweating • Drowsiness (through (significant in life rafts)
• Yawning sopite syndrome) • Shock (during
• Burping • Retching sustaining symptoms)
• Increased salivation • Vomiting
• Mood changes • Carelessness
• Headache • Incoordination
• Significant reduction
in motivation to work

24. Motion Sickness
HFR model (1974, 1976)
Model Characteristics
Vertical Acceleration
Only true motion
MSI: % of people who vomit
Two-hour nauseogenic period
Nauseogenic frequency range
0.05 – 0.7 [Hz]
Central nauseogenic frequency
0.167 [Hz]
Used Metric
A 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.

25. Motion Sickness
Adaptation
 Space: 2 – 3 d 100
Proposed model
HFR data
MSI [%]
ARMS=0.333 [Hz]
Sea: 1-2 d
50
 0
1 2
10 10
 Motion specific 100
Proposed model
HFR data
MSI [%]
ARMS=0.222 [Hz]
50
 Adaptation transfer? 0
1 2
10 10
40
Proposed model
HFR data
MSI [%]
ARMS=0.111 [Hz]
20
0
10 20 30 40 50 60 70 80 100120
Time in [min]
Colwell, J. L. (1994). Motion sickness habituation in the naval environment
(No. DREA Technical Memorandum 94/211). Dartmouth, N.S.: Defence
Research Establishment Atlantic.

26. Motion Sickness
Effects are Task-Dependent
 Complex tasks
 Vigilance tasks More sensitive to
 Sustained performance (long) Motion Sickness
 Self-paced
 Viewed as non-essential
 Well-learned/simple tasks More resistant to
 Short Motion Sickness
 Externally paced

27. Countermeasures and
what should be done

28. Countermeasures I
Fatigue
Dark Dexedrine
(dextro-
amphetamine)
Prescription
Quiet
Sleep Modafinil
conditions Stimulants or
Temperate alerting drugs
Caffeine
Non-
Safe prescription
Nicotine
Pharmacol.
Work/rest Interventions
schedules Ambien
Daily activity (zolpidem)
Non- optimization Prescription
pharmacological Naps, rest
breaks Restoril
Interventions (temazepam)
Exercise
Sedatives or
sleep aids Melatonin
Physical
fitness
Non-
Benedryl
Environmental prescription
stimulation
Trytophan
Task
attributes
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.

29. Countermeasures II
Fatigue 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

30. 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.

31. 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.