Page 99 - Journal of Special Operations Medicine - Spring 2016

performance and may even increase resilience and facili- effects, length of continued wakefulness, time of day, and
tate recovery after these periods. 40 cumulative effects of sleep loss. Research suggests that al-
though no person can go without sleep for extended peri-
Table 2 presents how sleep deprivation within groups (or ods of time, some individuals are more impacted by sleep
teams) can inhibit group performance over and above loss than others. In addition, cognitive and performance
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sleep loss effects for individuals. These group decre- decrements are greatest after 12 hours of continuous
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ments result from a reduced ability to pay attention, work and injury rates triple after 16 hours. 57,58 Moreover,
decreased communication, and increased distraction. working between midnight and 0600 is not the same as
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In addition, sleep-deprived individuals are less empathic, working during the day, especially during the “circadian
have a reduced capacity for conflict resolution, and are trough” (0300–0500), which is a critical period for per-
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more sensitive and emotionally driven. These disrup- formance and alertness decrements. 42,59, Changes in time
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tions will likely reduce the effectiveness of the group and zone should also be considered when planning for peri-
negatively impact mission success. Furthermore, sleep ods of extended wakefulness, because they disrupt inter-
deprivation can impact moral decision-making and in- nal circadian rhythms (i.e., cyclic changes that occur in
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crease unethical behavior 50,51 and deception. For situ- the body every 24 hours based on light and dark envi-
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ations like combat, where intact moral reasoning and ronmental exposures). Finally, cognitive and performance
decision making are crucial both to mission success and decrements get worse the longer an individual goes with-
maintaining honor and integrity, going without sleep out sleep, and the longer it will take to recover from that
may make an Operator’s job even more difficult. “sleep debt.” For every one night without sleep, it takes
at least two nights of 7–8 hours of sleep to return to opti-
Table 2 Compounding Effects of Sleep Deprivation in Groups mal levels of performance. 40,42,58
Decreases group performance 45
For additional strategies when planning for periods of
Reduces ability to pay attention sleep loss, the type and quality of sleep one gets may be
Decreases communication just as important as the amount of sleep each night. Sleep
Increases distraction 46 is typically separated into two categories—nonrapid eye
movement sleep (NREM) and rapid eye movement sleep
Lessens empathy and reduces capacity for conflict
resolution 47 (REM)—based on different brain-wave patterns, which
are characterized by measuring the electrical activity
More sensitive and emotionally driven 48
of the brain via an electroencephalogram. Individuals
Interferes with moral decision-making 49 cycle through NREM and REM sleep throughout the
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Increases unethical behavior 50,51 and deception 52 night in about 90-minute increments. Greater propor-
tions of NREM sleep are achieved earlier in the night
(2200–0300) and that ratio switches to greater REM as
What Is Considered Optimal Sleep?
the night goes on. This cycling is related to circadian
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Given the extreme effects of sleep loss, is there a mini- rhythms. Disruption of this system (e.g., shift work,
mum amount of sleep necessary to sustain performance? exposure to artificial light) can have consequences for
According to the National Sleep Foundation, most sleep patterns. Important processes, like the formation
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healthy adults need 7–9 hours of sleep each night. Of and retention of new memories, and regeneration, res-
course, this sounds outrageous to any Special Opera- toration, and repair of the brain and the body from the
tions Forces Operator who is deployed, sleep is a lux- previous day’s insults all occur during NREM or deep
ury, and getting enough sleep is rarely, if ever, an option. sleep. Therefore, ideally, most of the sleep period would
High operational tempo and activity 24 hours per day, be the restorative NREM, but that is not always the
noise, and austere environments are not conducive to case. Having only NREM sleep is not optimal either, as
sleep. 54–56 However, given the potential negative impact there is a biological drive for REM. Ongoing research is
insufficient sleep can have on readiness and mission suc- focused on understanding how brain-wave patterns at
cess, more emphasis should be placed on good rest and night can inform optimization of sleep.
sleep habits and practices.
How to Get the Most Out of Sleep
Since operators are unlikely to get the recommended
amount of sleep each night, it may be more useful to focus Is it actually possible to enhance sleep? Simple behav-
on planning for periods of sleep loss or extended wake- ioral changes can have great impacts on improving sleep.
fulness, and getting optimal sleep when the opportunity Table 3 provides simple solutions to promoting optimal
presents itself. The following factors should be considered sleep. For example, regular exercise makes it easier to
when devising strategies and planning for limited sleep in fall asleep, get more sleep, delay the onset of REM, re-
operational settings: individual differences in sleep loss duce REM, and enhance deep/NREM sleep. Sleep can
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Optimizing Performance With Sleep 83