Fighting Fatigue

| December 12, 2008

With the right planning and practices you can work around being too tired to work.

Harvey Runyan was in cruise control, doing 70 mph, when he fell asleep Oct. 16. He rear-ended a truck pulling onto the highway and totaled his rig. “I had a full eight hours the night before,” Runyan says. “I had no warning I was going to fall asleep. I can usually tell. Not this time.”

Runyan’s story is not uncommon. Long-haul trucks are involved in two-thirds of fatigue-related crashes, according to federal statistics. Nor is it unusual that Runyan had no training in recognizing the onset of fatigue or how to deal with it.

You can minimize the negative impact of fatigue by knowing how to anticipate its onset, understanding your sleep needs and patterns, and managing your time accordingly. Eating well and exercising also help manage fatigue and keep you healthier in the long run.

Experts say people are not as smart as they think they are about knowing when fatigue begins to impair their performance. It is even possible to fall asleep with your eyes open. “A person can feel wide awake but suffer performance degradation,” says Col. Greg Belenky, director of the Neuropsychiatry Division at Walter Reed Army Institute of Research.

So by the time you’re aware of getting tired – realizing that you’re yawning too much, or that your driving reflexes are slowed – you’re at risk. “When drivers experience any effort to stay awake – and must utilize methods to stay awake – driving ability is markedly worse,” says Jim Horne, a psychophysiology professor at Loughborough University in Leicester, UK.

Learning to recognize the onset of fatigue will help prevent a dangerous micro sleep, which lasts two or three seconds or longer. This advanced stage of fatigue, which can happen without warning, means the time to stop for rest has long passed.

Some 60 percent to 65 percent of drivers are sleep deprived most of the time, says Stuart Lowenthal, chief operating officer of HealthScreenings. “Drivers who routinely get less than six hours of sleep per night and who do not have sleep disorders will show signs of impairment,” he says.

Many drivers focus simply on getting the job done and put little thought or effort into managing their fatigue. Lance Gates, an ex-owner-operator who ran the I-95 corridor for many years, says, “My idea of fatigue management was to get to Florida from The City in 17 hours straight so I could get a good night’s sleep when I got there.”

Things such as a strong work ethic or arbitrary goals, however, should not interfere with a driver’s responsibility to operate safely. And common tactics to stave off fatigue work only to a point.

Drinking coffee or playing the radio loudly may be minimally effective for short periods – enough time to get you to a rest area, for example – but reliance on any kind of stimulant will eventually backfire because it does not restore your mind to its regular alertness levels. Only sleep can do that. Finding out exactly what your sleep needs are and making sure those needs are met is the initial step in successful fatigue management.

You instinctively know how much sleep you need. Getting it at night optimizes those resting hours because of the body’s circadian (24-hour) rhythms. After the sun goes down, the body automatically lowers its temperature. Also at night, digestion slows and your body releases melatonin, a hormone that triggers sleep, experts say. When you drive beyond your optimal bedtime, this cycle is disrupted and fatigue is much more likely. Even daylight driving between 1 p.m. and 4 p.m. requires extra watchfulness because a circadian trough, or dip in alertness, occurs then. The circadian cycle is so strong that even a completely rested driver can experience some afternoon fatigue.

Dean Croke, a sleep expert and consultant to the insurance industry, says you can pinpoint your daily afternoon energy trough. “First determine your sleep mid-point, which is the halfway mark during a normal night’s sleep,” he says. “Let’s say you fall asleep at 10 p.m. and wake at 6 a.m. In this case, the mid-point would be 2 a.m. Finally, add 12 hours to determine your afternoon trough, which in this case would be 2 p.m.”

Knowing this means you can plan for a break and a cup of coffee, or perhaps for a nap at the trough.

“Naps are most effective at the onset of fatigue,” says Richard Grace, who has developed a sleep monitor that measures eyelid closure. Strategic napping should be no more than 45 minutes if you need to wake up refreshed. Longer napping means you will get more fatigue reduction, but it will also be more difficult to come awake quickly.

A long nap cannot take the place of core sleep, which generally lasts four to five hours. Core sleep is the first and deepest portion of your nightly sleep. A nap can help in a pinch when you need core sleep, but continued hard running with no sleep other than naps will cause you to accumulate a sleep debt, which is chronic fatigue. Until you receive the full rest of a core sleep, you will operate at sub-par performance levels.

EXERCISE

Owner-operators tend to be workaholics, ignoring their health while focusing on the task at hand. Yet health is foundational to all work, and not coincidentally also bolsters alertness.

One aspect of staying healthy involves exercise. While it’s difficult to get a workout while on the road, there is nothing stopping you from using breaks to walk or do simple exercises. Even something as minimal as getting out of the driver’s seat, stretching your legs and taking your mind off traffic is beneficial. Dr. Gerald Krueger, who teaches fatigue management on contract for the American Trucking Associations, says, “Research shows that taking a half hour break away from the driving task and out of the truck every three hours helps maintain alertness.”

More vigorous activity, though, will improve your overall health, and that in itself will heighten your performance behind the wheel. “Exercise speeds up metabolism and increases blood flow, carrying oxygen to the brain,” according to “Getting’ In Gear,” a wellness program developed by the U.S. Department of Transportation.

“If you have difficulty falling or staying asleep, the quality of your sleep is likely to improve if you adhere to a regular exercise program,” says The Transportation Research Board’s “Toolbox For Transit Operator Fatigue.” While exercise can be a tool in managing fatigue, you also need to manage the timing of the exercise. “Exercise within two hours of sleep may make it difficult for you to fall asleep,” says the TRB publication.

DIET

Choosing what, when and how much you eat impacts alertness. A healthy diet leads to more energy throughout the day, higher alertness and better sleep, says the “Gettin’ In Gear” program.

When it comes to fatigue management, there is more to observe than the basic rules of eating a varied diet of fresh fruit and vegetables and whole grains, and limiting your intake of processed foods and snacks.

Some foods can initiate sleep. Studies show, for example, that foods high in l-tryptophan, an essential amino acid, aid in production of melatonin, a substance that makes you sleepy. L-tryptophan is found in rice, peanut butter, milk, tuna, turkey, meat, chicken, beans and eggs, among other foods. Foods high in carbohydrates, such as whole wheat bread, brown rice, pasta and beans, also tend to induce sleep, dietitians say.

Conversely, some foods promote alertness. Foods high in protein can keep you alert since they contain tyrosine, an amino acid that induces wakefulness. High-protein foods include cottage cheese, nuts and, when eaten together, rice and beans. Protein is helpful at the noon meal since it will help counter the effects of your afternoon circadian trough.

However, some foods, notably meat and fish, contain both tryptophan and protein. If you’re looking for protein without drowsiness side effects, a protein bar might be the right choice.

Large meals and meals high in carbohydrates are problematic if eaten less than four hours before bedtime because the stomach is forced to digest at times when it is slowing down, dieticians say. This can cause sleep disturbances.

LEGAL STIMULANTS

Caffeine, especially the dose in a cup of coffee, is perhaps the most effective wakefulness agent. Caffeine can stay in the body for up to six hours, Krueger says, but its effect on wakefulness will vary with the strength of the coffee and a person’s individual susceptibility to it. Typically a cup of coffee will keep you alert for an hour or two after it takes effect, about 20 minutes after you drink it.

The average cup of coffee has 90 mg of caffeine, while a 12-ounce Diet Coke has half that. A 1.5-ounce chocolate bar contains only 10 mg. Researchers recommend about 150 mg. of coffee to provide wakefulness for short periods.

“It is easy to build a tolerance to coffee and negate its effectiveness as a stimulant,” Krueger says. So drinking six cups of coffee in the morning may destroy its usefulness when you need it later that day. Caffeine is also available in over-the-counter products, but consumption of too large a dose can cause jitteriness.

There are other wakefulness products on the market, but you should be cautious about them. Some energy drinks and diet pills contain ephedrine, a powerful stimulant. Ephedrine has been tied to severe medical problems. The Federal Drug Administration warns against its use. Be sure not to exceed recommended dosages if you use such products.

Other stimulant products, such as Beat Fatigue, contain no ephedrine but rely upon herbs such as gotu kola, guarana and astragalus. They may work for you, but be aware that the jury is still out on their long-term health effects.

One thing that is known about long-term health is that those who get plenty of rest live longer. Lowenthal cites a nine-year California Department of Health Study that found a 70 percent higher death rate among subjects sleeping six hours a night rather than seven or eight hours. Do yourself a favor and make adequate rest your first tool in managing fatigue.


Alertness products available at truck stop counters typically rely on one or more active ingredients: Vivarin, which has 200 mg of caffeine per tablet, about twice the dose of a cup of coffee; Pure Ephedrine, which relies on the controversial stimulant ephedrine; and Bee Awake, which contains bee pollen, guarana and Siberian ginseng.

RESTLESS SLEEP
Sleep disorders are one of the most manageable aspects of fatigue. A recent University of Pennsylvania study found that 21 percent of commercial driver’s license holders had some degree of sleep apnea, the most common sleep disorder.

Sleep apnea causes breathing to stop for short periods. Its most obvious marker is snoring: Blocked air pathways cause a person to gasp for breath, disrupting sleep, though usually without waking. Apnea not only disrupts sleep, but reduces oxygen to the brain. In effect, people with sleep apnea are “strangling in their sleep,” says Jane Amberson, program director with the Sleep Center Development Corp. Because a person’s quality of sleep suffers, apnea often causes fatigue.

Many people don’t know they are affected by sleep apnea. Ex-trucker Tim Douglas didn’t know he had the condition until after he fell asleep at the wheel and killed seven people. “I will live with that the rest of my life, and I am very sorry,” Douglas says. “But I spent two years in prison because I had a disease I didn’t know I had.”

Overweight people are at higher risk for sleep apnea. If you snore and have a neck size larger than 17, you should consider seeking medical advice about apnea. The most common treatment is using a continuous positive air pressure machine while sleeping. CPAPs keep the air passageway open, helping the user to get quality sleep. A version of the machine is available for use in trucks. So-called smart CPAPs are hooked to monitors that record when drivers use the machine, allowing them to document treatment when that is considered crucial to their ability to operate safely.


RED FLAGS

In addition to the obvious signs of fatigue, such as unintentional lane departure, fatigue expert Dr. Gerald Krueger lists these warning signs and circumstances that point to fatigue:

WARNINGS

  • Driving judgment and other decision making not as crisp and quick as normal.

  • Concentration waning, reduced awareness of surroundings.

  • Inadequate scan in mirrors.

  • Sporadic variations in speed.

  • Failure to heed road signs.

  • Following too closely.

  • Intermittent braking.

  • Missing gears.

    CIRCUMSTANCES

  • You’ve driven more than five hours without a break.

  • You had fewer than eight hours sleep in the past 24.

  • You’re in one of two circadian lulls – 1-4 p.m. or 1-4 a.m.

  • You’ve driven all night and the sun is rising.

    FATIGUE-FIGHTING TIPS

    According to Dr. William Dement and other leading sleep researchers, professional drivers should take these approaches to managing fatigue:

  • Get the amount of sleep you require in one continuous stretch.

  • If you are unable to get a full night’s rest, get four to five hours of core sleep and supplement with strategically timed naps.

  • Know the timing of your nighttime and daytime circadian troughs and compensate for them with naps, coffee or a half-hour break.

  • Plan your trips to optimize rest and performance.

  • Learn to recognize the onset of fatigue and stop to deal with it.

  • Understand how caffeine affects you and use it strategically.

  • Don’t take stimulants stronger than caffeine. They mask fatigue but do not get rid of it. When stimulants wear off – often suddenly – fatigue can be deadly.

  • Develop strategies to stay alert for short periods, such as getting to the next rest stop. Some breathing exercises, such as yoga’s rapid “breath of fire,” briefly increase alertness.

  • Do not accept loads that will require you to exceed your performance limitations.

  • Get a medical opinion if you have signs of a sleep disorder, such as excessive snoring or waking after a complete sleep without feeling refreshed.

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