• Sleep is a biological need for life and health, similar to the need for food. Sleep affects your mental and physical performance as well as long-term health.
• Most adults need 7 to 8 hours of good-quality sleep every 24 hours to perform during emergency operations.
• When you lose sleep, you build up sleep debt that will seriously impair your performance. The only way to pay off this debt is to get enough sleep. Willpower alone will not keep you safe from the mounting effects of sleep debt.
• As someone who is deployed, you should view sleep as a critical logistical item, just like water, food, and the supplies needed to carry out operations.
• The longer you go without sleep, the more you are prone to slow thinking, confusion, and making mistakes. This could put you and others around you at risk for injuries and death.
• Fatigue has been identified as a causal factor of vehicle crashes and several well-known industrial disasters.

When the brain is deprived of adequate sleep, at some point it will go to sleep no matter what the situation.

• The brain moves rapidly from wakefulness to sleep, like an on/off switch
• This leads to dangerous situations while performing critical tasks (such as driving)
• There are warning signs when the brain is close to falling asleep:
  • Difficulty focusing
  • Frequent blinking, heavy eyelids, eye-rubbing
  • Daydreaming or disconnected thoughts
  • Repeated yawning, difficulty keeping head up
  • Feeling restless and irritable

If you start to feel drowsy, you must protect yourself and others:

• Stop driving or performing any critical activity
• Consume caffeine
• Take a nap
• You can have caffeine and then take a short nap; when you wake up you get the alerting benefits from both

If you are struggling to stay awake while driving, you are impaired enough to cause an accident. Pull over and rest. No research has shown anything like rolling the window down, turning up the radio, or pinching yourself will keep you alert.

If you have a long commute between the disaster site and the place where you sleep, take extra precautions: drive with another person, take a nap, or consume caffeine prior to the commute.

About 20% of all vehicle crashes are from driver fatigue. Workers who are young men, night workers, or who work long hours are at highest risk.

Impaired performance from lack of sleep mimics alcohol intoxication

• Being awake for 17 hours is similar to having a blood alcohol concentration (BAC) of 0.05% (the level some countries use for drunk driving violations).
• Being awake for 24 hours is similar to having a BAC of 0.10% (above the U.S. drunk driving level of 0.08.

Warning: For someone who has been awake for long hours, consuming even a small amount of alcohol reduces performance further. Don’t drink any alcohol when you are sleep-deprived if you need to drive or if you need to perform other critical tasks.

Lack of sleep can increase symptoms and problems for a wide range of chronic illnesses, such as these:

• Sleep disorders, such as sleep apnea and restless legs syndrome
• Headaches
• Rheumatoid arthritis and other musculoskeletal disorders
• Asthma
• Cancer
• High blood pressure and other heart problems
• Stomach and digestive problems, such as ulcers and irritable bowel syndrome
• Diabetes
• Seizure disorders, such as epilepsy
• Mood disorders and other mental conditions
• Alcohol or drug abuse
• Reproductive problems
• Poor eating habits leading to obesity

Even well-controlled chronic illnesses can worsen from the demands of long work hours, stress, and lack of sleep.

If you have a chronic illness, meet with your healthcare provider before deployment to discuss the impact this may have on your health and to adjust your medicines, if needed.

Misconceptions

• You may mistakenly think the effects of sleep deprivation can be overcome by motivation, professionalism, training, and experience.
• Research shows that sleep-deprived persons do not always recognize a decline in their performance. This can lead to dangerous situations if they perform tasks such as driving.

Long Work Hours and Impaired Performance

As compared with 8-hour shifts, risks for accidents and errors increase the longer your shift lasts. For example,

• Working 10-hour shifts increases the risk for accidents and errors by 13%
• Working 12-hour shifts increases the risk for accidents and errors by 28%

You can take steps to improve your sleep habits. First, make sure that you give yourself enough time to sleep. With enough sleep each night, you may find that you're happier and more productive during the day.

Sleep is often the first thing that busy people squeeze out of their schedules. Making time to sleep will help you protect your health and well-being now and in the future.

To improve your sleep habits, it also may help to:

• Go to bed and wake up at the same time every day. For children, have a set bedtime and a bedtime routine. Don't use the child's bedroom for timeouts or punishment.
• Try to keep the same sleep schedule on weeknights and weekends. Limit the difference to no more than about an hour. Staying up late and sleeping in late on weekends can disrupt your body clock's sleep-wake rhythm.
• Use the hour before bed for quiet time. Avoid intense exercise and bright artificial light, such as from a TV or computer screen. The light may signal the brain that it's time to be awake.
• Avoid heavy or large meals within a few hours of bedtime. (Having a light snack is okay.) Also, avoid alcoholic drinks before bed.
• Avoid nicotine (for example, cigarettes) and caffeine (including caffeinated soda, coffee, tea, and chocolate). Nicotine and caffeine are stimulants, and both substances can interfere with sleep. The effects of caffeine can last up to 8 hours. So, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night.
• Spend time outside every day (when possible) and be physically active.
• Keep your bedroom quiet, cool, and dark (a dim night light is fine, if needed).
• Take a hot bath or use relaxation techniques before bed.

Napping during the day may boost your alertness and performance. However, if you have trouble falling asleep at night, limit naps or take them earlier in the afternoon. Adults should nap for no more than 20 minutes.

Napping in preschool-age children is normal and promotes healthy growth and development.

Strategies for shift workers

Some people have schedules that conflict with their internal body clocks. For example, shift workers may have trouble getting enough sleep. This can affect how they feel mentally and physically.

If you're a shift worker, you may find it helpful to:

• Take naps and raise the amount of time available for sleep
• Keep the lights bright at work
• Limit shift changes so your body clock can adjust
• Limit caffeine use to the first part of your shift
• Remove sound and light distractions in your bedroom during daytime sleep (for example, use light-blocking curtains)

If you're still not able to fall asleep during the day or have problems adapting to a shift-work schedule, talk with your doctor about other options to help you sleep.

What is an Extended/Unusual Shift and when are they used?

A normal work shift is generally considered to be a work period of no more than eight consecutive hours during the day, five days a week with at least an eight-hour rest. Any shift that incorporates more continuous hours, requires more consecutive days of work, or requires work during the evening should be considered extended or unusual. Extended shifts may be used to maximize scarce resources. Long or unusual shifts are often required during response and recovery phases of emergency situations such as terrorist threats, which generally come without warning, require continuous monitoring, and may overwhelm local responders both technically and tactically. These schedules ensure that the appropriate scarce resources are in place and accessible while full mobilization is being developed.

What should workers know?

Extended or unusual work shifts may be more stressful physically, mentally, and emotionally. Non-traditional shifts and extended work hours may disrupt the body's regular schedule, leading to increased fatigue, stress, and lack of concentration. These effects lead to an increased risk of operator error, injuries and/or accidents.

Society is oriented toward traditional daytime work hours and work at night will often intensify fatigue and reduce alertness. Workers generally will not acclimate to night work, and sleep patterns will generally be disrupted so the non-work periods do not provide full recovery, resulting in sleep deprivation. Studies suggest that it can take up to 10 days to adapt to a night time work schedule.

Fatigue is a message to the body to rest. It is not a problem if the person can and does rest. However, if rest is not possible, fatigue can increase until it becomes distressing and eventually debilitating. The symptoms of fatigue, both mental and physical, vary and depend on the person and his or her degree of overexertion. Some examples include:

• weariness
• sleepiness
• irritability
• reduced alertness, lack of concentration and memory
• lack of motivation
• increased susceptibility to illness
• depression
• headache
• giddiness
• loss of appetite and digestive problems

Emergency responders, particularly those who are assigned to work for extended hours, must be aware of the limitations of the protective equipment they use and the allowable or safe duration of exposure to hazardous environments. It is not practical or safe to wear some forms of protective equipment for extended periods. Fatigue and heat-related illness are common problems.

How can I address these hazards?

When there is a choice, managers should limit the use of extended shifts. Working shifts longer than 8 hours will generally result in reduced productivity and alertness. Additional break periods and meals should be provided when shifts are extended past normal work periods. Tasks that require heavy physical labor or intense concentration should be performed at the beginning of the shift if possible. This is an important consideration for pre-emergency planning.

Managers and supervisors should learn to recognize signs and symptoms of the potential health effects associated with extended and unusual work shifts. Workers who are being asked to work extended or irregular shifts should be diligently monitored for the signs and symptoms of fatigue. Any employee showing such signs should be evaluated and possibly directed to leave the active area and seek rest. Employers should have plans in place to assist and address workers experiencing serious or severe effects of fatigue.

Make efforts, whenever feasible, to ensure that unavoidable extended work shifts and shift changes allow affected employees time for adequate rest and recovery. Extended shifts should not be maintained for more than a few days, especially if they require heavy physical or mental exertion.

Plan to have an adequate number of personnel available in order to enable workers to take breaks, eat meals, relax, and sleep. If at remote sites, ensure, as far as possible, that there is a quiet, secluded area designated for rest and recuperation.

Plan for regular and frequent breaks throughout the work shift. In addition to formal breaks such as lunch or dinner, encourage the use of micro breaks to change positions, move about, and shift concentration.

In addition to fatigue, employers must ensure that employees are not exposed to hazardous chemicals or other agents in excess of health standards. Working extended shifts may involve prolonged exposures to hazards which exceed established standards. Therefore, employers should implement measures to monitor and limit exposures. Those may include administrative controls such as limiting the time employees may remain at the response site; engineering controls such as clean locations for employee rest areas; or rest areas located sufficiently up wind of contaminated sites.