Recent Newspaper & Online Columns by Kate Scannell MD

Sleep deprivation is a wake-up call in the air and on the ground

May 15, 2011

Tags: sleep deprivation, medical error, pilot error, patient safety, fatigue, Scannell

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 05/15/2011

FOR WEEKS, we've been reading about air traffic controllers falling asleep on the job. In one case, an airborne ambulance transporting a sick patient had to circle a Nevada airport for 16 minutes while the controller snoozed. In March, two jetliners inbound for Reagan National Airport were forced to land without clearance while the air controller slept.

In response to such disturbing incidents, the office of fatigue risk management at the Federal Aviation Administration (FAA) has been collaborating with the National Air Traffic Controllers Association to identify and remedy conditions fostering controller fatigue. While not an expert at such matters, I have a (grounded) hunch these agencies will discover that 99.3 percent of human beings who sit alone within a tower, staring out for hours at a yawning night sky, working irregularly staggered shifts -- will tend to feel a little sleepy.

So far, the FAA has recommended a minimum nine-hour break between controller shifts, and at least one additional buddy present on overnight shifts at 27 airports that had previously maintained only one controller.

On the runway of public opinion about aviation safety, concerns about pilot fatigue immediately preceded our current focus on air traffic controllers. An ABC News investigative report in February claimed that "despite denials from the airline industry, large numbers of pilots report to duty every day after getting only a few hours of what fatigue experts call 'destructive sleep' in crowded crew lounges and so-called 'crash pads'." More than two dozen accidents and 250 fatalities in the U.S. had been linked to pilot fatigue in the past 20 years.

Public anxiety associated with air traffic controller or pilot fatigue is soaring high, partly fueled by post-9/11 insecurities regarding flying in general. But the reality is that fatigue-related safety hazards loom even larger on the ground. Whether referring to ourselves or to others within our daily lives, being sleepless IN Seattle might be riskier overall than being sleepless over it.

When we really get down to earth about public and personal safety issues affected by human wakefulness, we encounter fatigue as a genuine sleeping dragon inhabiting most walks of life.

Exhaustion and sleep insufficiency are enormous problems in this country, affecting many workers upon whom we depend for our well-being. Doctors and nurses. Police officers. Caregivers. Pharmacists. Bus drivers. Teachers.

Last month, the Centers for Disease Control and Prevention (CDC) reported that 50 million to 70 million adults in the U.S. had chronic sleep and wakefulness disorders.
Analyzing data collected from more than 74,500 adults, the CDC determined that 35 percent of people slept less than the recommended 7-to-9 hours each night. More alarming, 38 percent reported "unintentionally" falling asleep during the day at least once within the prior month -- with more than 4 percent nodding off or falling asleep while driving.

Obviously, unintentional nodding-off can pose serious consequences on the ground -- while caretaking a child, operating on a gallbladder, climbing a ladder, or barbecuing burgers in the backyard. Each year, drowsy driving has been associated with more than 1,500 fatalities and 40,000 nonfatal injuries in the U.S.

In 2010 the National Sleep Foundation found that more than 75 percent of 1,000 surveyed adults reported having slept too little, and in more than half of cases, interviewees admitted that it had an impact on their job performance.

Long-held concerns about fatigued physicians causing medical errors and patient harm have led to recent changes in medical training programs. A pivotal study in 2004 had revealed that doctors-in-training working all-night shifts every third night were responsible for more than half of preventable errors. New rules mandating more work-free time and fewer work hours for doctors-in-training are scheduled to take effect in July.

The safety risks of sleeplessness and fatigue extend well beyond unique occupational considerations, to more generalized concerns for the human condition. For example, a sizable body of research now attests to the beneficial role of sleep in memory processing. Regarding our nation's obesity problem, emerging medical evidence implicates sleep deprivation as a major obstacle to the attainment and maintenance of healthy body weight. And reflecting on our epidemic of geriatric falls, a study in this month's Journal of the American Geriatrics Society provides compelling evidence that sleep can optimize motor skills in elderly people.

Our country may be waking up to the importance of sleep insufficiency and fatigue as public health issues of serious and widespread concern. Meanwhile, it may be best to heed this advice from Wilson Mizener: The amount of sleep required by the average person is -- five minutes more.
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Kate Scannell is a Bay Area physician and syndicated columnist. Her most recent book is "Flood Stage."

ゥ Copyright 2011, Kate Scannell

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