COL. DAVID ROMINE, DO, MPH
Command Surgeon
U.S. Army Combat Readiness Center/HQDA Safety
Fort Rucker, Alabama

It was a quiet morning with the mist of daybreak broken gently by the early light of dawn and a small group of cadenced Soldiers marching along a roadway. For the Soldiers and their NCOs, it had been a rigorous couple of days of training starting early in the morning and stretching into evening.

This particular day started as the previous mornings had, with physical readiness training. Afterward, the Soldiers headed to the range for weapon qualification and a foot march back to the unit area. This training task was not foreign to the Soldiers and NCOs; they completed it a few days prior. Today, however, disaster struck.

A truck following the Soldiers with water and other support accelerated into the group, killing two and injuring five. In a split second, what began as a routine day of training ended in tragedy. The driver was a seasoned leader, committed to the 24/7 care and training of Soldiers. This is what the he lived for – to the point where he and his peers neglected their sleep hygiene. The deadly result: falling asleep while driving a truck and accidentally running through a formation of troops from behind.

Human performance while sleep-deprived is a lot like being under the influence of alcohol. Driving after being awake for 18 hours is equal to a blood alcohol concentration of 0.08 percent – e.g. legally drunk – and leaves you at equal risk for a crash. According to Williamson and Feyer, in the journal Occupational and Environmental Medicine, “the fatigue of sleep deprivation is an important factor likely to compromise performance of speed and accuracy of the kind needed for safety on the road and in other industrial settings,” with corresponding degradation of performance due to fatigue when compared to that of alcohol – and, that it was often even worse.1 The National Sleep Foundation reports 100,000 crashes each year are caused by fatigued drivers and that 55 percent of drowsy driving crashes are caused by drivers less than 25 years old.2,3

There’s an increased likelihood that the macho pronouncement, “I’ll sleep when I’m dead,” will certainly self-fulfill, should the lie rear its ugly presence in a unit, either for the one making the statement or for an unwitting victim or victims of this willful, deadly carelessness. While attitudes are shifting, there remains an entrenched disregard for the negative effects of sleep deprivation-related fatigue and the damaging effects on performance and safety.

However, there’s a notable exception: Aviation as a whole has made great advances over the past 50 years by implementing (among other safety policies) clearly and intentionally defined “crew rest” time into battle rhythms and flight schedules. Translating these safety successes into non-aviation settings has proven difficult but must be pursued aggressively, by a modern fighting force that wants to increase readiness and success in battle.

There are, however, signs that attitudes overall are changing. Many folks in and out of the military are proclaiming sleep to be “a new miracle drug” and believe proper amounts and quality of sleep provide whole-body restoration and detoxing. But there’s nothing really new about this. Additionally, there are marked human performance benefits with increased sleep, as Dr. Murali Doraiswamy of Duke University Medical Center and chair of the Global Agenda Council on Brain Research reports. As an example, elite athletes experience enhanced performance when increasing their time spent sleeping.4

Also, just ask anyone who has recently received successful treatment for obstructive sleep apnea or other sleep disorders and note the life-changing benefits they report from finally getting a good night’s sleep. The popular and scientific press has had a lot to say about the importance of proper sleep for a long time. Military writers and wellness advocates, notably via the Army’s Performance Triad, also have weighed in on the topic, all promoting awareness of the relationship of good sleep habits and safety to service members and military civilians. Yet, sustained rates of fatigue-related accidents in the military population persist, both on and off duty.

Leaders and safety professionals (that’s everyone in the military) face the challenge of questioning why messaging and methods promoting restorative sleep are met with limited success. The fact that properly resting personnel has multiple benefits across the spectrum of human performance and military readiness is undisputed. The challenge remains thwarting the myth that there is any honor at all in sleep deprivation and for establishing a culture of healthy and timely rest into the battle rhythm of the force, one where witnessed sleep deprivation elicits the same response as drunk driving, leaving a child in a parked car on a hot day, etc. The proven potential for serious injury or death is just as real.

Like elite athletes, warrior athletes across the Army benefit from adopting a lifestyle of nurturing restorative sleep hygiene and guarding proper personal and group rest and recovery, even as many Soldiers, Airmen, Sailors and Marines guard their workout routines, fitness supplements, nutrition, professional training, etc. Sleep is cheap. It costs nothing to rest troops properly, with proven, immediately realized returns on investment of improved readiness and reduced loss. The trust built among warriors is built on certain assumptions. Let’s add the confidence of knowing a battle buddy is rested and ready to our list of vital tactics, techniques and procedures.


Footnotes:
1 Williamson, AM, Feyer, Anne-Marie. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med 2000;57:649–655.

2 Drowsy Driving Prevention Week, National Sleep Foundation: http://drowsydriving.org/about/detection-and-prevention.

3 Ibid.

4 Grenoble, R Finance Industry’s ‘Macho Attitude’ About Sleep Has Serious Consequences. HuffPost online, 01/21/2016: https://www.huffingtonpost.com/entry/high-finance-sleep-athletes-davos_us_56a14306e4b0404eb8f0c59d.