MIYB 2016FATIGUE MITIGATION

Mark Sherwood, ND

Michele Neil-Sherwood, DO

Managing Fatigue

What is fatigue

Signs of fatigue

What causes fatigue

Ways we often address

fatigue

Fatigue mitigation

strategies

What is Fatigue

“A reduction in physical and/or

mental capability as the result of

physical, mental or emotional

exertion which may impair nearly all

physical abilities including: strength;

speed; reaction time; coordination;

decision making; or balance.”

Source: International Maritime Organization, Maritime Safety Committee Circular

YOU KNOW YOU’RE FATIGUED IF:

Constant yawning

Blurred vision

Heavy or sore eyes

Poor concentration

Slowed reaction time

Poor judgment

Speech slurred

Headaches

Decreased ability to exert

force

High/low emotional

outbursts

Leg pain and cramps

Loss of appetite

Giddiness

Decreased ability to pay

attention

Irregular heart beats

Heaviness in arms and

legs

Decreased eye-hand

coordination

Irritability/shortness

IS IT “THAT BIG” OF DEAL TO BE FATIGUED?

What do the following have in

common?

•Three Mile

Island

•Chernobyl

•Bhopal

•Exxon Valdez

The Midnight Shift

1979 - Three Mile Island – 4 am local time -

Pressure relief valve opens dumping reactor

coolant – control room operators failed to

recognize the event. Core meltdown

1984 – Bhopal, India – shortly after midnight

Methyl Isocyantate Gas (MIC) leak kills 3,800

1986 - Chernobyl Reactor disaster – 12:23 am –

1:28 am local time - critical control room operator

error in failing to reset a controller. Core meltdown

and release

1989 – Exxon Valdez – 12:04 am ship hits Bligh

Reef and spills 10.8 Million gallons of oil

MORE FATIGUE RELATED EVENTS

The space shuttle exploded just seconds after its January 1986 launch, killing all

seven crew members. According to a 1988 report, certain managers involved in the launch had only slept two hours before

arriving to work at 1 a.m. that morning. The Presidential Commission on the accident admitted the danger of this deprivation in

its June 1986 report, writing, “The willingness of NASA employees in general to

work excessive hours, while admirable, raises serious questions when it jeopardizes job performance, particularly when critical

management decisions are at stake.”

CHALLENGER EXPLOSION

AMERICAN AIRLINES FLIGHT 1420 CRASH

On June 1, 1999, American Airlines Flight

1420 overshot the runway at Little Rock

National Airport, killing 11, including the

captain, and injuring the first officer, the

flight attendants and 105 passengers. Only

24 passengers were not injured. Severe

thunderstorms played a role, but the

National Transportation Safety Board also

determined that “impaired performance

resulting from fatigue” was involved.

What Causes Fatigue

Lack of sleep and sleep quality

Biological Clock (circadian rhythm)

disruption

Shift work

Extended Hours

Health (diet and/or illness)

Ingested chemicals (alcohol, drugs,

caffeine)

Stress (overactive mind)

Lack of Sleep Individuals’ needs are unique

Most Americans get less than 6.5 hours daily

Recommended 7 – 8 hours of sleep per 24 hour period

5 stages of Sleep

Stage 1 – Light Sleep - less than 10% of a night's

sleep. If woken up, will claim was not asleep.

Stages 2-4 – Deep Sleep - approximately 65% of a

night’s sleep metabolic rates vary between the

stages

Stage 5 - REM Sleep – Rapid Eye Movement Sleep –

approximately 25% of a night's sleep – most vivid

dreams

Each cycle takes about 90 minutes = 5-1/2 cycles per 8

hour night

Need all five stages for the body’s recovery from daily

fatigue

Practice good sleep hygiene

Quality of Sleep

Sleep should be Uninterrupted

Try for long periods of sleep

Short naps can improve alertness for a

short time (10 minute nap – alertness

improved for about an hour), but will not

restore the body to full normal

operation.

One seven hour period of sleep is much

more restorative than seven one hour

naps

Try for sufficient sleep before any periods

you anticipate a sleep deficiency

CIRCADIAN RHYTHM

Most animals (including Humans) follow a daily

routine (song birds in the morning, nocturnal

animals, etc.)

Called Circadian Rhythm

Scientists have found that the time related

information is controlled within the hypothalamus

region of the brain and believe that it stimulates

the production of a hormone called melatonin. The

increase in melatonin levels corresponds with the

reduction in body temperature and alertness.

DLMO (Dim light melatonin onset)

CIRCADIAN RHYTHM

Humans exhibit two “Troughs” or low points

in alertness

One between midnight and 6 am

One between 2 and 4 pm

Fatigue related motor vehicle accidents are:

Twice as high at 2 pm as they are at 10

am

Six times as high at 2 am as they are at

10 am

CIRCADIAN RHYTHM

Extended awakened hours

A study by sleep researchers in Australia found

that:

A person kept awake for 17 hours will exhibit

behaviors and performance of someone with a

Blood Alcohol Concentration (BAC) of 0.05

A person kept awake for 24 hours will exhibit

behaviors and performance of someone with a

BAC of 0.10

Performance WILL BE impaired

Health Issues with fatigue:

It is YOUR responsibility

Fatigue can be associated with:

Medical Conditions (such as heart problems, BP,

Diabetes, Depression)

Diet can affect feelings of fatigue - Refined sugars can

cause a short term energy boost but are often

followed by a rapid drop in blood sugar levels causing

weakness and instability – INCREASED CRAVINGS!

Eating a large meal before bedtime can disrupt sleep

(insulin elevation prior to bed time)

Ingesting chemicals to stay alert

Caffeine can give short duration

alertness but has side affects such as

hypertension, headaches, mood

swings and anxiety. Be cautious with

the total consumption (200-300 mg).

SLEEP AIDS

• Antihistamines : Tolerance can occur

quickly so the more you use them the

more you have to take (cough medicine)

• Can leave you groggy and unwell the next

day the so called HANG OVER effects – this

leads to stimulating with caffeine or food

• Doxylamine ( Unisom), Benadryl

• Ambien, Lunesta, Trazadone, Xanax

NATURAL SLEEP AIDS

• Melatonin

• 5-HTP

• Valerian root

• Passion flower

• Magnesium

• Meds may pull out Vitamin B’s (critical for energy)

or Magnesium

• Magnesium is also pulled out by increased stress

FATIGUE DEBT IS A HIGH RISK PROPOSAL

• Can Show up as Chronic Disease-

• Metabolic syndrome

• High blood pressure

• Sleep apnea

• Diabetes

• Depression

• Fibromyalgia

FATIGUE DEBT (IS THIS YOU?)

1. Not waking up

refreshed and ready

to go.

2. Decrease in attitude

of thriving &

striving.

3. Lack of focus.

4. Reduced activity &

problem solving

skills.

5. Depression & Anxiety

6. Inability to cope

with stress.

7. Reduced immunity:

Frequent colds &

infections.

8. Weight Gain

9. Difficulty making

decisions

10. Impaired motor

skills & high risk of

accidents.

Fatigue Mitigation Strategies(for everybody)

Develop a pre-sleep routine (warm shower,

reading a book)

Sleep in a dark, quiet, cool environment

(below 68 degrees)

Avoid alcohol prior to sleep

Avoid caffeine at least six hours prior to

sleep

Keep the sleep room clean and tidy

Fatigue Mitigation Strategies(for everybody)

Eat regular, well balanced meals

Drink a sufficient amount of water

Exercise regularly

Get enough proper sleep

Avoid BLUE light (computers, TV, phones) ---- 6500 Kelvin ----

Fatigue Mitigation Strategies (day sleeping shift workers)

Make sleep a priority during off-duty hours

Install room darkening shades in the bedroom

Decrease room temperature (below 68 degrees)

Consider ear plugs to block outside noise

Put a “Do Not Disturb” sign outside the door

Unplug the telephone

Do not exercise prior to sleeping. It raises body

temperature and heart rate

Naps are appropriate (bi-phasic and poly-phasic

patterns)

Fatigue Mitigation Strategies (for shift workers needing to stay

alert)

Exercise when feeling fatigue

Schedule short breaks

Avoid unhealthy foods during the

shift

Never rely on medications to

enhance alertness

Exercise caution when driving

home

FATIGUE BUSTER LUNCH BOX

• Boiled eggs

• Fruit (low glycemic)

• Yogurt

• Jerky (no sugar)

• Carrots

• Green wraps

• Salad (avocado and/or olive oil dressing)

QUESTIONS

•Functional Medical Institute

• 918-748-3640

•Mark@live4e.com