Sleep and Fatigue — Page 220, Lesson 356

Let’s talk about drugs and sleep management first, because this is a real-world area where pilots sometimes look for a quick fix — and that can be dangerous. People vary in how well they tolerate sleep disturbance. Some individuals may need the help of drugs either to get to sleep or to stay awake. The most common drug used to delay sleepiness is caffeine, which you find in tea or coffee, and it will help you stay awake. That’s the straightforward end of the spectrum. Now, you’ve probably heard of melatonin being widely publicised as a cure for jet lag. Here’s the rule for aircrew: you must not take melatonin or any other drug or medicine without first seeking advice from your aviation medical specialist. Not your GP, not the pharmacist — your aviation medical specialist. Then we have the drugs that must be rigorously avoided: barbiturates and benzodiazepines. The brand names you might recognise include Valium, Mogadon, Librium, and Normison. Barbiturates are not only addictive but fatal if taken in overdose. And contrary to common belief, benzodiazepines can also be addictive, and all of them have an adverse effect on performance — especially if taken with alcohol. The bottom line is that there is no place in aviation for such drugs except under the strict supervision of an aviation medical specialist. Now let’s move into fatigue itself. Fatigue is deep tiredness. Like stress, it is cumulative. It can be caused by a lack of restful sleep, a lack of physical or mental fitness, excessive physical or mental stress and anxiety, or desynchronisation of the body cycles — that’s jet lag. Here’s a key distinction. Tiredness is instantly recognisable by the person experiencing it, and it’s an acceptable social admission — you can say ‘I’m tired’ without stigma. Fatigue is more insidious. A pilot suffering from fatigue can be unaware of their condition for a long period of time, until a crisis forces realisation. And even if a pilot is aware that fatigue is a problem, they will be hesitant to admit it openly. It feels like an admission that they are not up to the job. That’s why it is critical to be able to recognise the symptoms of fatigue both in yourself and, just as importantly, in other members of your crew. Fatigue can be subdivided into short-term and long-term — also called chronic — fatigue. Short-term fatigue is akin to tiredness. It’s usually due to a lack of sleep, hard physical or mental exertion, crew scheduling, a long duty period, lack of food, or jet lag. It is easily recognised and remedied by not flying and getting sufficient rest. Long-term, or chronic, fatigue is much more difficult to recognise and admit. It can come from a number of different causes: a lack of physical or mental fitness, a stressful marriage coupled with problems at work, financial worries, and a high workload. It can also be subjective — one pilot may be able to tolerate more than another before chronic fatigue sets in. And the rule is clear: anyone who suspects they are suffering from chronic fatigue must take themselves off flying.