Page 100 - Journal of Special Operations Medicine - Spring 2016

Table 3 General Recommendations to Maximize Sleep avoided in situations when regular sleep at night is pos-
Recommendation Caveat sible. Additionally, during restricted sleep opportunities
Minimize light and None (e.g., 4 hours of sleep), napping alone may not restore
cognitive function following overnight periods of sus-
noise in sleeping area tained wakefulness. When combined with appropriate
Refrain from alcohol More than two drinks within a doses of caffeine during the overnight periods, however,
within several hours few hours of bedtime will disturb 66
of bedtime sleep cognitive performance may be effectively sustained.
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Avoid caffeine This is most important in caffeine- Rest, or “time off task,” is also an important strategy for
(>200mg) up to 6 sensitive individuals 63
hours before bedtime recovery. After a prolonged period of time on task, an in-
Most exercise factors (e.g., mode, dividual may experience fatigue and a decrease in various
67
duration, intensity, timing) have abilities that require much effort ; these likely result in per-
Exercise regularly 68
not been sufficiently studied to formance decrements. After prolonged or repeated tasks,
make specific recommendations 73 depending on the cognitive load (amount of mental effort
Identify stress- Individual preferences and required for working memory), task difficulty, and/or time
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reduction strategies to situations will influence the use on task, rest may be needed. Both sleep loss and fatigue
use before bedtime of stress management strategies decrease performance, but they affect the body differently:
(e.g., mindfulness, mental imagery, fatigue can be reversed by rest, whereas the effects of sleep
relaxation, etc.) 73 loss can only be reversed with sleep. Although sleep and
rest are both important strategies for recovery, sleep-loss
be also optimized by setting up an environment that en- effects and fatigue should be managed separately to plan
sures successful sleeping. This would include having a for periods requiring sustained performance.
dark, quiet room, refraining from more than two drinks
of alcohol several hours before bedtime , prepping for Tools Available to Enhance Sleep
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going to bed (e.g., having a routine), and paying atten- and Performance
tion to how diet and exercise affect sleep. Of note is
the role of alcohol in disturbing sleep, affecting both the A few tools are available to aid in the management of
quality and quantity of sleep. Importantly, caffeine in sleep and ensure performance will be minimally affected
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excess of 200mg in any form (e.g., coffee, tea, energy during periods of sleep loss (see the Human Performance
drinks) should be avoided for a minimum of 6 hours Resource Center blog at http://hprc-online.org/blog/sleep
prior to bedtime. Insufficient sleep and caffeine use/ -and-the-warfighter). Actigraphy, a noninvasive method
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abuse go hand in hand, especially for military personnel, to distinguish between sleep and wake, can be useful
but caffeine will be a topic for a future article. Addi- for monitoring amount of sleep achieved or lost. Ac-
tionally, avoiding artificial light prior to and after falling tigraphy is best used when paired with a program like
sleep may improve sleep quality, as these exposures may Alertness Management for Military Operations (https://
disrupt circadian rhythms and the brain’s sleep promot- flyawake.org/login.aspx?ReturnUrl=%2f), which uses
ing hormone melatonin. For a comprehensive list of an algorithm to predict “mental effectiveness” based on
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ways to improve sleep hygiene visit the National Sleep the amount of sleep an individual gets and a few other
Foundation’s website https://sleepfoundation.org. parameters (e.g., time since last sleep period). 70

A growing body of sleep research is focusing on how to Finally, smart phone applications are available to assist
improve deep sleep by augmenting slow-wave activity in the management of jet lag for people who frequently
via medications and electrical stimulation (e.g., transcra- travel across time zones and for shift workers (e.g., “En-
nial direct stimulation), but no treatments are currently train” from the University of Michigan [https://itunes
available. At the heart of this research is understanding .apple.com/au/app/entrain/id844197986?mt=8]). 71
brain patterns during sleep, according to the notion that
less sleep might be needed if it is better or more efficient Conclusion
sleep.
Special Operations missions do not allow for optimal rest
or sleep. However, the impact of reduced rest and sleep on
What About Naps?
readiness and mission success may be minimized by ap-
A review of the literature related to napping concludes propriate preparation and planning. Preparation includes
that short, infrequent naps, lasting between 10 and 30 periods of “banking” or extending sleep opportunities
minutes, can restore wakefulness and promote learning prior to periods of loss, monitoring sleep and mental ef-
and performance. However, taking longer naps on a fectiveness by using tools like actigraphy to measure sleep
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regular basis can disrupt nighttime sleep and should be and activity, exploiting strategic sleep opportunities, and

84 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016