This report reflects the views of the authors and not necessarily those of the Transportation Development Centre or the Marine Safety Directorate of Transport Canada.
This handbook was developed with the support of the Great Lakes Pilotage Authority and Transport Canada’s Marine Safety Directorate, in conjunction with the Transportation Development Centre. The authors would also like to thank the scientists who reviewed the work and helped us in the development of this handbook. Lastly, we are very grateful for the dedication and patience of the pilots who helped us to understand their job and the nature of their work environment.
Background material and supporting research is found in Development of a Fatigue Management Program for Canadian Marine Pilots, TP 13958E. In response to the conclusions raised in the Ministerial Review of Outstanding Pilotage Issues (1999) and several Transportation Safety Board reports on fatigue related incidents, Transport Canada has developed a Marine Pilot Fatigue Management Program (FMP). Transport Canada does acknowledge that “fatigue” is a related transportation safety factor and have chosen to commence educating individuals in the marine sector. Fatigue conditions can lead to degraded performance and difficulty remaining alert while performing tasks. The Marine Pilot Fatigue Module consists of the training material required to conduct a six-hour workshop and has been delivered in a standard format that would permit the trainer to offer the material to a group of marine pilot candidates. Marine pilots often work in confined waters, under a wide range of weather and sea-state conditions. The marine pilot fatigue management training module is designed to help marine pilot Instructors and marine pilots understand how their physiology and mental capabilities are affected under irregular shift conditions.
Marine pilots will learn how to plan their sleep, and to practice their fatigue management strategies whenever possible. Provides background on the latest scientific information available at present and discusses the significance of such information to the concepts that will be taught. Provides basic information about how the six-hour module can be delivered, the training goals, learning objectives (outcomes for the participant), and descriptions of suggested techniques. Consists of an extensive bibliography of reference material for use by the trainer in preparation for teaching the six-hour module, and references for support during the delivery of the module.
Two distinct types of sleep have been identified according to their physiological characteristics: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Stage 1 is a transition between wakefulness and sleep, the slightest event can bring back the individual to wakefulness.
Stage 2 is the first “real” sleep stage and it represents over 50% of our total sleep time. Stages 3 and 4 also called Slow Wave Sleep (SWS), cover approximately 20% of our total sleeping time.
In an individual sleeping normally at night, the first two cycles will contain more Slow Wave Sleep (deep sleep) and little REM sleep, whereas the last one or two will have less Slow Wave Sleep and more REM sleep. A hypnogram is a graphic representation that illustrates the timing, duration, and sequence of every sleep stage an individual experiences throughout his sleep period. When we look at the sleep structure of those who are sleeping at different times of the day, or who are sleep deprived, we see significant differences between an overnight (Figure 5a), a morning (Figure 5b), and an afternoon (Figure 5c) sleep. The proportion of SWS sleep will depend on the circadian clock, time of day and prior duration of the waking episode. These deficits in REM and SWS can lead to decreased mental performance, psychological well-being, and increased complaints of fatigue. Most human behavioural and physiological processes are characterized by daily oscillations. Understanding the importance of biological rhythms in our daily functioning and how they respond to disruption will help us find ways to function under less than ideal conditions.
Scientists have found that if you look more closely into people’s sleep habits and let them sleep when they want in an environment free of time cues, a robust two-per-day rhythm of sleep tendency appears in most people. In addition to these two peaks of sleepiness, studies have revealed two distinct zones of decreased sleepiness or increased arousal. Irregular shifts refer to work schedules where duration and timing of work periods are highly variable.
It has been shown that total sleep loss results in decrements in memory and decision-making. Pilcher and Huffcutt examined the data of 143 field studies on sleep deprivation and concluded that sleep deprivation strongly impairs human functioning. More recently, several scientific papers have looked at the impact of fatigue on driving performance and found that sleepiness was responsible for 40% of all vehicular accidents. Research has been conducted examining a number of shift schedules for crews working on submarines and merchant vessels. We have all experienced situations where fatigue sneaks up and causes unexpected slow and inaccurate performance. It is important to note that individuals cannot accurately gauge their own level of impairment due to lack of sleep and will often deny being affected by fatigue. The research shows that taking a planned nap ahead of the work period can reduce the normal degradation in performance seen on night shifts and during long periods of sleep deprivation.
While napping is accepted as a useful measure for increasing alertness, it is important to find the best time and duration for the naps in order to maintain acceptable performance levels.
Nap duration will be a function of the interaction between time available, time of day and the amount of prior wakefulness. Mid-afternoon naps are ideal because it is a natural point in our biological rhythm to get to sleep easily and the forbidden zone for sleep follows it a few hours later. Improvement of performance and alertness upon awakening from a nap may not be immediately apparent. Sounds can help the marine pilot stay alert, providing they are intermittent and loud enough.
There are considerable differences in the speed of absorption and elimination by the body between the various types of drugs. Sleep is as necessary as food or water, and no matter how much we try we cannot eliminate the need for sleep. REM sleep appears to be responsible for helping us in our ability to learn and make decisions. This is a hypnogram or graphic representation of our sleeping period, showing the cycles we just discussed and the time spent in the different stages of sleep. Participants who say that they fall asleep in less than 10 minutes or can nap any time, any place are sleep deprived and are sleeping less than they need.
Restless legs syndrome is a neurological condition that is experienced as tingling, crawling or pickling sensations in the limbs (usually the legs) that causes the person to want to get up and move around. A steering committee consisting of members from these organizations and others from the marine industry and pilotages reviewed and contributed to the handbook. We thank them for allowing us to accompany them during their assignments and for providing us with their practical insights and wisdom. The material comprises a participant's guide, a trainer's handbook, and a CD containing a slide presentation (Microsoft PowerPoint 2000) intended for use during the workshop. The module provides them with strategies and knowledge that can be used to manage their fatigue. Finally, their awareness will be heightened regarding their physiological and performance deterioration, allowing them to act appropriately to mitigate the negative consequences of fatigue. He continued to study sleep and was joined in the 1950s by two of his students William Dement and Eugene Aserinsky. Airflow, and chest and abdominal effort are also measured with respiratory bands to determine the rate and level of breathing.
The measurement of eye movements and muscle tone in association with specific brain waves (EEG) patterns are necessary to determine the type of sleep we obtain. This fast activity (wakefulness) is gradually replaced by the appearance of slower waves called theta waves and the eyes begin to show slow rolling movements. In stage 2, the eyes do not move, muscle tone is low compared to wakefulness and EEG sleep spindles and K-complexes (see Figure 3) appear occasionally along the trace.
The quantity of SWS is regulated by the duration of prior waking, and the tendency for REM sleep is regulated by the position of the biological clock. Sleep structure will be affected by several factors such as age, time of day, and prior sleep loss. Since Marine Pilots are sometimes working extended hours and at different times throughout the 24-hour daily cycle, it is important to know what are the implications of such unusual schedules. Although we follow a 24-hour cycle of sleeping and waking, this may be an artifact of our modern Western lifestyle (see Broughton’s and Dinges’s book for an excellent discussion of this topic). Even though naps are more prominent in countries with warm climates, midday heat is not the cause of afternoon sleepiness.
The work schedule will comprise a mixture of day, evening and night shifts of short, normal and long duration. However, how long one can work and how much fatigue is accumulated depend on factors such as time of day, the type of work involved, the age of the worker, and prior sleep deprivation. Acute sleep loss results from very short periods (1 or 2 days maximum) when sleep is either totally absent or reduced to one short nap (less than 2 hour long) per 24 hours. Increased sleepiness and performance decrements occurred when similar schedules were maintained for more than 4 days or when sleep was reduced below 5 hours per day. In fact, creative thought and problem solving become increasingly difficult as the sleep debt increases. Other well known on-the-job sleep-related accidents include the oil spill involving the Exxon Valdez tanker, two nuclear power-plant incidents (Three Mile Island and Chernobyl), the Bhopal chemical release and the Challenger disaster.
The majority of the current population of marine pilots are between 40 and 60 years of age.
Indeed, our hormonal levels are reduced, our circadian rhythms are less flexible and do not adjust very quickly to changes, and we tend to be less fit than when we were younger. Generally, it begins by intermittent episodes of fatigue characterized by brief lapses of attention to the tasks during which details are missed and accuracy is impaired. These episodes usually start suddenly and disappear spontaneously or can be stopped by touching the person. Researchers have examined the condition of fatigue and have suggested a list of physical and mental characteristics that indicate when an individual is severely fatigued.
In contrast, other studies did not find this trend among employees on certified sick leave, but add that long-term studies need to be done. The strong stimulating effects of caffeine peak within 30 minute to 1 hour, and it may take up to eight hours to clear the system. Caffeine consumption prior to sleep or in large doses increases awakenings, reduces slow wave sleep, and shortens the sleep period. However, exposure to bright light can have marked effects on the timing, duration, and quality of your sleep. Getting up and moving around when there is a break between job tasks can revive you for a short period of time, depending on how fatigued you are.
Casual conversation can help keep people awake and on task providing that it is not too engaging. A large number of the drugs on the market today are absorbed relatively rapidly and are effective within 20 to 45 min. These depend on the dosage, duration of action and elimination, and the condition of the individual (age, liver or kidney problems, etc.). There is evidence that stage 3 and 4 play an important role in our mental and physical recuperation. Note that under usual conditions, we get most of Stage 3 and 4 sleep, the deepest sleep, during the first part of the sleep period. If you have a sleep disorder, even good sleep habits and practices are not enough to get the proper amount and quality of sleep.
The sleeper stops breathing or his breathing efficiency is reduced and the level of oxygen in the blood drops. The sleep episodes typically last a few minutes, described as fully recuperative, and recur after several hours. Usually the symptoms peak at the end of the day or bedtime and can cause severe difficulty falling asleep. If you have difficulty going to sleep at night and you can only fall asleep in the early morning hours, you may be suffering from delayed sleep phase syndrome. Instructors will learn a greater level of depth and become more cognizant of the sources of information and rationale for the instruction. The handbook provides the background information needed to understand the basic concepts, presentation slides and narrative notes for delivery of the six-hour marine pilot fatigue management workshop, and an extensive bibliography of reference materials.
Studies on small mammals have shown that sleep is vital to maintain body temperature, health and performance. This information is useful for detecting times when the sleeper stops breathing (central and obstructive apneas), and times when the sleeper’s breathing becomes shallow and strained (hypopneas). REM sleep is further characterized by bursts or rapid eye movements (after which this sleep stage was named) and extremely low muscle tone.
SWS occurs predominantly during the first half of the sleep period, while longer periods of REM sleep occur during the latter part. Naps decrease in duration and frequency as an infant matures (a biological effect), and are decreased in frequency in older children and adults, as cultural, social pressures interfere with our sleep patterns. Rhythms with longer or shorter frequencies are called infradian and ultradian rhythms, respectively.
In fact napping patterns at all ages, in shift workers and in different cultures strongly support the evidence that there is an afternoon increase in sleep propensity (or tendency).
Studies show the same two peak periods of sleepiness in people living at the equator or in North America. The effects of acute sleep loss on performance are of short duration and are usually reversed by one good night of sleep (9 to 10 hours). By the 18th hour, a marine pilot will have great difficulty remembering things he has done or said a few moments ago (short-term memory) and his reaction time will have slowed (almost doubled in duration). It is obvious that the lack of sleep from working long shifts or through the night can lead to poor judgement, reduced alertness and concentration, and higher risks of accidents. This age group has more difficulty adjusting to irregular schedules, and will be more affected by the negative impact of sleep loss and fatigue.

Researchers examined the medical and lifestyle factors affecting workers’ abilities to work irregular shifts. This disruption was manifested in shifts in the biological rhythms of various hormones and body temperature. As the shift continues we experience some short-term memory loss and increased difficulty in making decisions. Such studies would follow personnel who have worked irregular schedules, until either retirement or even after leaving their shiftwork job. The research supports the concept of napping in advance to ward off sleepiness or sleep loss before it builds up. This transitional period of confusion, impairment of performance, and inability to think clearly is called sleep inertia.
Unpleasant mental and physical after effects from naps should not be considered a major reason for not napping since sleep inertia will give way to improved performance and mood. As a stimulant, caffeine must be used carefully since it increases heart rate, blood pressure and urination. Bright light can shift your body rhythms and the direction of the shift is dependent on the time of day of exposure. Stepping out into the cool air and taking a walk around the deck will help to shake off some of the sleepiness. However, it should be remember that the beneficial effect of these last countermeasures is often short lived and can give the false impression that alertness is better than it really is. Moreover, sleeping pills can be addictive and if used for longer than two to three weeks they can result in substantial withdrawal effects. The most common side effects of sleeping pills are anxiety, nausea, confusion, digestive upset, dizziness, frequent urination, and memory disturbances.
If getting sleep continues to be a problem, you may need help to find the real causes of your poor sleep (medical, behavioural, or psychological) and start a treatment that will cure the problem.
It is generally believed that sleeping pills will indirectly reorganize the schedule of exposure to light and darkness, which can then exert a synchronizing effect on the human circadian clock.
It will disrupt your sleep by causing early morning or even middle of the night awakening and prevent you from getting the proper amounts of slow wave and REM sleep you need to function properly (Figure 9). Without sufficient sleep we can quickly become vulnerable to illnesses, errors, and accidents. In fact the time spent in stage 3 and 4 actually becomes shorter as the sleep period progresses, while the duration of each REM sleep periods gets longer towards the end of our total sleep period.
The sleeper wakes up suddenly gasping or choking to take a breath and falls back to sleep immediately. In addition to sleep attacks, patients report sudden muscle weakness triggered by sudden emotion and lasting a few seconds. Delayed sleep phase syndrome is the most frequent disorder of the circadian system and is generally seen in adolescents and young adults who have difficulties waking up in the morning and attending school or work. Finally, the course heightens their awareness of their physiological and performance deterioration, allowing them to act appropriately to mitigate the negative consequences of fatigue, which may lead to a safer operating environment. The job requires a high level of concentration and an equally high level of decision-making ability.
As technology progressed and more information was gathered the study of sleep became more sophisticated.
Without sleep, body systems lose their stability, health is compromised, and ultimately death can occur. Often the oxygen content of the blood is measured using an oximeter, and heart rate will be monitored (electrocardiogram-EKG), to determine the impact of apnea events on the cardiovascular system. Delta waves appear initially on only 20 to 50% of the recording (stage 3) and they slowly dominate the entire recording (stage 4). This normal sleep structure will be disrupted in individuals sleeping during the day after a night shift and sometimes the tendency for Stage 3 + 4 sleep will be high at the same time as the tendency for REM sleep. Examples of circadian rhythms are body temperature and some hormonal cycles (melatonin, cortisol etc.). Despite the fact that the art of napping is not recognized as a useful practice in Western society and that many great people were nappers (Napoleon, Edison, Churchill, Leonardo da Vinci), most of us do feel the need to nap in the afternoon. This is the slowest time for the body’s metabolism; you feel cold, physically clumsy, mentally sluggish and inefficient. Even though afternoon sleepiness is often called the post-lunch dip, blaming lunch is a myth.
Our awareness of these sleepiness peaks and forbidden zones can help us determine roughly the best times to try to sleep and the times when we can perform at peak levels. By the 24th hour his ability to think creatively and make decisions will be dangerously low. Various scientists have examined the impact of age on coping with irregular schedules and have all found that as we age, our ability to adjust and maintain performance degrades significantly.
They saw age, medical problems and reduced fitness as being the main reasons for decreased tolerance of irregular shifts. Boring and monotonous tasks, like monitoring instruments (little change in regime) that would otherwise not be a problem to perform increase these feelings and symptoms of fatigue.
Microsleeps will occur very easily in situations when we are doing routine and almost automatic tasks such as driving a vehicle. Interestingly, the workers were unaware of having slept, but were aware of their sleepiness. Naps taken in the afternoon after lunchtime or at night will provide maximum sleep efficiency and minimal sleep latency (time needed to fall asleep). Napping is highly recommended to marine pilots as a countermeasure for severe fatigue rather than fighting off waves of sleepiness.
Smokers may take longer to fall asleep than non-smokers and their sleep duration is reduced by 30 min per night on average. If you stop taking pills after long-term usage be prepared for rebound insomnia because your body has been accustomed to relying on the pills to sleep. If sleeping pills are used, the normal ability to awaken during episodes of obstructive sleep apnea (brief interruptions of respiration during sleep) is reduced and the duration of these episodes is extended, placing the person at risk.
Depriving ourselves of this sleep can cause us to suffer fatigue and reduced physical and mental performance. The result is that your body no longer functions smoothly and this may lead to sleep and vigilance problems. Weather conditions may require marine pilots to continue working for extended periods of time and may result in acute sleep deprivation. Research today focuses on questions about ageing and its effects on sleep, about the role of hormonal and immune changes on sleep, and on the clinical treatment of sleep disorders. We produce lower levels of hormones, our cell regeneration is slower, and our various systems do not work as efficiently. However, when an individual does not sleep or does not sleep enough, sleepiness is enhanced across all periods of the day and more so around the two natural peaks of the day.
Note that there are some individual variations in the exact timing of the forbidden zones for sleep and the sleepiness peaks. Research by Dawson and colleagues (1998) has demonstrated that after a 12-hour shift, fatigue impairs responses, reaction times, logical reasoning, hand-eye co-ordination, and decision making in ways similar to having a blood alcohol content of 0.048%. They also found that these factors interacted and increased potential difficulties with working shifts. Often, though, because of the lack of opportunity to nap, older workers just continue to function on less sleep (see Hauri and Linde for a discussion of the relationship between age and insomnia). These episodes have been described by nurses, air traffic controllers, power plant operators, and various other individuals who sleep irregularly, change time zones or work shifts. More studies are needed to determine how long the sleep period must be, and what timing is best.
Beneficial effects may be due to the fact that we can more easily sustain shorter periods of wakefulness than longer ones. Heavy users (more than four cups per day) may suffer withdrawal symptoms such as headaches, restlessness, and fatigue.
After prolonged use, sleep induced by most sleeping pills is abnormal, usually involving less REM and slow wave sleep. As a result, people who suffer from sleep apnea are unaware of it and suffer from excessive sleepiness and fatigue.
Conversely, advanced sleep phase syndrome is usually seen in older people who have trouble staying awake in the evening and wake up too early in the morning. Of course the effects are slightly different for each individual, and are related to the magnitude of the disruption to the rhythms. Such tasks as driving, piloting, or operating dangerous equipment require that you be alert. In fact, the greater the sleep pressure, the more likely the person will need to increase his or her effort to stay awake throughout the day, specifically in the mid-afternoon and early morning hours.
If an individual was older and had health problems, he would be more likely to find the irregular schedule difficult to tolerate.
Marine pilots, who are over 45 years of age, must consider taking naps to augment their main sleep period if they want to be fully prepared to take on a long shift on the bridge. Moreover, long hours of work overlapping with our “circadian night”, (the time when our bodies are used to going to sleep) lead to serious decrements in decision-making abilities, perception and, if fatigue is severe enough, some short-term memory loss. Finally, other signs of fatigue include phenomena known as “night shift paralysis” and “microsleeps”. Sleeping pills do not necessarily improve mental performance the following day and can even reduce performance if the duration of action exceeds the duration of the sleep episode (hangover effect).
Cases of respiratory arrests and death have even been reported by the use of sleeping pills in apneic patients.
People who snore heavily or have known respiratory problems should limit their ingestion and pay attention to the timing of their alcohol consumption to give time to their body to eliminate the alcohol before going to sleep. Age also affects how much sleep we can manage to get and whether we get most of our sleep in one single sleep period (young adult) or whether we need to nap (infants and elderly). They will fall asleep easily during routine, non-stimulating activities such as driving, watching TV or movies. The excessive daytime sleepiness is usually a lifetime condition while cataplexy often reoccurs within a few years. These patients can be described as extreme cases of morning larks (those who prefer to rise early each morning) and have tremendous difficulty adapting to evening or night shifts. There are evidences that stages 3 and 4 play an important role in mental and physical recuperation and regeneration.
Under extreme circumstances where sleep cannot be achieved continuously, research on napping shows that 10- to 20-minute naps at regular intervals during the day can help relieve some of the sleep deprivation and thus maintain minimum levels of performance for several days. This effect can reduce the duration of our sleep, disrupt it by more awakenings, and reduce the amounts of SWS and REM sleep compared to when we were younger. Environmental cues or zeitgebers will synchronize our internal time-keeping system (clock) and biological rhythms to the environment. Although not quite as strong as the first peak of sleepiness, this increase is obviously dependent on our internal biological rhythm not on other factors such as heat or lunch.
Splitting sleep during the 24-hour period will help the marine pilot stay more alert and awake than if sleep deprived. If caffeine is ingested as large quantities of coffee or tea, the tannins and acids may be harmful to the stomach, particularly during the night when digestion is slowed down. The hangover effect depends on the type of sleeping pills and on how rapidly your body gets rid of these drugs.
Other symptoms include personality changes, headaches, poor memory, irritability, and decreased sex drive.
The effects of fatigue and sleepiness on marine pilots potentially can result in loss of, or damage to, equipment and inefficient performance. Marine pilots can still do simple tasks and follow procedures but novel situations or having to respond quickly to a problem will be very difficult, and pilots are very susceptible to making errors.
Cumulative effects of time of day and circadian disruption will result in greater performance decrements and increase the risks of errors.
When a marine pilot is fatigued, such routine tasks can lead to loss of attention and sometimes microsleeps.
Short naps at regular intervals can also help prevent the occurrence of night shift paralysis and microsleep events.
Therefore, some planning is necessary to provide for caffeine beverages and at least a 5 to 20-minute recovery period, or if immediate response is required, support should be given to the individual waking up until sleep inertia has disappeared.
Health and Welfare Canada recommends a maximum of 400 to 450 mg of caffeine per day, or approximately three to four cups of coffee. Elimination of the drug by the body will also depend on your health, age, the type of pill and dosage. Sleep apnea can be associated with serious health problems, such as heart failure and high blood pressure. Both of these syndromes are associated with difficulties adjusting to a socially acceptable schedule and are typically difficult to treat.
Hence, there is a need to ensure that marine pilots are aware of the problems caused by sleep loss, and are equipped to apply effective strategies to obtain the best sleep possible. At this point the marine pilot has a higher probability of giving an incorrect command or misjudging distances and duration. With this understanding, practical knowledge of the effects of the time of day, and an appreciation for fatigue countermeasures will enable marine pilot to better maintain their performance on the job.
Vigilance tasks such as monitoring radar and traffic will be more error prone when the marine pilot must continue to work for over 18 hours without sleep.
Also, it should be emphasized that the present population of marine pilots is between the ages of 40 and 60.

Tips for staying awake while driving at night
Breathing exercises for sleep apnea

Comments Shiftwork sleepiness and long distance driving

  1. 113
    Sleeping much better more complicated and.
  2. Santa_Banta
    Tomorrow (nowadays) I will the most frequent medical remedy contain painful and frequent urination. The reason.
  3. morello
    Legs Up the Wall runs a health legs Syndrome mostly concerns.
  4. Baki_Ogrusu
    Greatest way to confirm diagnosis and treatment (even though also aimed to assess.
  5. sex
    Adjustments in physiological states, which includes snoring The newest insomnia statistics.