The Vital Role of Sleep for
Safety, Health, and PerformanceMark R. Rosekind, Ph.D.
Board Member
6th Annual Meeting
Integrated Sleep Medicine Society Japan
August 2, 2014

1) determining the probable causeof transportation accidents
2) making recommendations toprevent their recurrenceAll ModesIndependent Federal Agency: Created in 1967

• >140,500 accident investigations• 14,000+ safety recommendations• ~ 2,300 organizations/recipients• 82% acceptance rate

Challenges of a 24/7 SocietyFour Fatigue Factors +• Sleep loss
• Extended wakefulness• Circadian/time of day• Sleep disorders• Other considerations

Uncontrolled In-Flight Collision with Terrain
AIA Flight 808, Douglas DC-8-61, N814CKU.S. NAS, Guantanamo Bay, Cuba, August 18, 1993
First NTSB aviation accident investigation
to cite fatigue as probable cause• acute sleep loss, sleep debt, circadian disruptionCrew Sleep
History
8/17/93

8/16/93
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0800

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8/18/93

1600

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Accident MGUM
Capt.

8h

9h

2h

17.5 h5h23.5 h

F/O

8h

9h2h

19 h

8h

19 h

F/E

9.5 h

6h

21 h

15 hSleep

6h

9hWakeDuty

Observed Performance Effects• Degraded decision-making• Visual/cognitive fixation• Poor communication/coordination• Slowed reaction timeUncontrolled In-Flight Collision with Terrain
AIA Flight 808, Douglas DC-8-61, N814CKU.S. NAS, Guantanamo Bay, Cuba, August 18, 1993

“The National Transportation Safety Board
determines that the probable causes of this
accident were the impaired judgment, decision
making, and flying abilities of the captain andflight crew due to the effects of fatigue…”

Probable Cause (fatigue)“. . . failure of the crew of the striking train tocomply with the signal indication requiringthem to operate in accordance with restricted
speed requirements and stop short of thestanding train because they had fallen asleep
due to fatigue resulting from their irregular
work schedules and their medical conditions.”

Miami, Oklahoma (June 26, 2009)
Fatigue Factors• Off work for 3 weeks: day active/night sleep schedule• 3am to 3pm shift work/drive schedule (since 1997)• Early bedtime (2 hr phase advance in sleep time)• Obtained min 3 hrs/max 5 hrs sleep prior to accident• Subsequently diagnosed with mild sleep apnea

10 fatalities
3 serious injuries
2 minor injuries
5 no injuries

HyundaiSonata

Source: Oklahoma State Police

Ford
Windstar

KiaSpectraProbable Cause (fatigue)“. . . driver’s fatigue, caused by the combined
effects of acute sleep loss, circadian disruption
associated with his shift work schedule, andmild sleep apnea, which resulted in the driver’s
failure to react to slowing and stopped traffic
ahead by applying the brakes or performing
any evasive maneuver to avoid colliding withthe traffic queue. . . .”‘Bronx Bus’, New York, NY (March 12, 2011)15 fatalities
17 injuries

Probable Cause“The National Transportation Safety Board
determines that the probable cause of theaccident was the motorcoach driver's failure
to control the motorcoach due to fatigue
resulting from failure to obtain adequate
sleep, poor sleep quality, and the time of day
at which the accident occurred.”Asiana 214 (July 6, 2013)
San Francisco, CA (SFO)
3 fatalities
49 seriously injured

Probable Cause

Contributing to the accident were . . .
(5) flight crew fatigue, which likely
degraded their performance.

Fatal Aviation Accidents(examples: fatigue cited)• 8/97 Guam: 228 fatalities• 6/99 Little Rock AK: 11 fatal• 10/04 Kirksville MO: 11 fatalities• 8/06 Lexington KY: 49 fatalities• 7/08 Owatonna MN: 8 fatalities• 2/09 Buffalo NY: 49 fatalities• 6/09 Santa Fe NM: 2 fatalities• 7/13 San Francisco, CA: 3 fatalities

Honorable John K. Lauber:

No Accident =Safe Operation

Go! Flight 1002

• early starts, multiple segment days, sleep apnea

NTSB Safety Recommendations: Fatigue• MOST WANTED 1990 - 2011• ~200 fatigue recommendations

Complex Issue:
Requires Multiple Solutions
Scheduling Policies and Practices
Education/Awareness
Organizational Strategies
Healthy Sleep
Vehicle and Environmental Strategies
Research and EvaluationNTSB Safety Recommendations: Fatigue
Status (May, 2012)• Total:194• Open:48• Closed: 146• CUN*:

26

CUN = closed unacceptableHealth: Sleep Disorders
restless legs

sleep apnea
parasomnias

shift work

narcolepsy

hypersomnia
REM behavior

jet lagsleep phaseinsomnia

Health: Medical Conditions

obesityhypertension

inflammation metabolic dysfunction

cancergene regulation

Mood disorders

strokediabetes
immune dysfunction

Fatigue Risks

Fatigue can degrade
every aspect ofhuman capability.

Fatigue Risks

awake/alert

asleepreduced performancevariability

Fatigue Risks• degraded 20 – 50%+:- reaction time
- judgment- memory- attention- communication- mood- situational awareness• increased:- irritability- apathy- attentional lapses- microsleeps

Fatigue and Reaction Times

Doran SM, Van Dongen HP, Dinges DF. Sustained attention performance during sleep deprivation:evidence of state instability. Archives of Italian Biology: Neuroscience 2001;139:253-267.

Alertness Reports Often Inaccurate
Subjectivealertness

14720

Physiologicalalertness 15
1050Time
Adapted from Sasaki et al., 1986

Success requires . . .

A culture change that supports
different attitudes and behaviors

Your Personal Role/Responsibility

Be an educator
Challenge attitudes

Enact change
Personal life

Workplace

FamilyOrganization

Model good sleep behavior

#40 Ceremonial Swearing In

Good sleep is vital for . . .
• safety• health• performance