About an hour before sunrise on August 27, 2006, Comair Flight 5191 was approaching 120 miles per hour on its takeoff from the Blue Grass Airport in Lexington, Kentucky, when co-pilot James Polehinke noticed something strange about the runway.
“That is weird,” he said in a conversation captured by the flight recorder. “No lights.”
“Yeah,” said Capt. Jeffrey Clay.
Sixteen seconds later, their 50-seat commuter jet ran out of runway. Polehinke just managed to get airborne but not enough. The plane hit an earthen berm, clipped a fence and a clump of trees, and went down in a ball of flames.
The pilots had gone down the wrong runway, a secondary, general-aviation strip 244 feet too short for the nearly full jet’s liftoff. Forty-nine of the 50 souls perished. Only Polehinke survived.
Eleven months later, the National Transportation Safety Board ruled the crash was caused by pilot error. By a 3-2 vote, the board declined to blame the flight controller, who was busy with administrative work as the plane taxied and took off.
Greg Belenky, a research professor and director of WSU Spokane’s Sleep and Performance Research Center, has yet another suspect: fatigue.
In the previous 24 hours, the flight controller had only two hours of what he called “not real good” sleep. He was at the tail end of his fifth shift in four days.
Belenky didn’t have sleep records for the pilots, but they acted tired. They started the day boarding and powering up the wrong airplane and did an incomplete pre-flight briefing. They overlooked various clues that they were going the wrong way. Rested people tend to see a problem and look for a way around it; tired people tend to blow past the problem and persevere, redialing the wrong number, pushing the wrong button harder or, perhaps, continuing on the wrong runway.
Using a model that weighs one’s performance against sleep cycles and circadian rhythms, Belenky estimated the air traffic controller was operating at 71 percent of his maximum effectiveness.
If he had had more sleep and been less fatigued, Belenky testified to a U.S. Senate subcommittee in 2011, “he might have detected the error in runway choice prior to the attempted takeoff and in time to avert the disaster.”
Few of us have 50 lives at stake as the claws of fatigue tear at our minds and bodies. But it’s safe to say a lack of sleep is making us less than our full selves.
On average, Americans get six and a half hours of sleep a night, significantly less than the recommended seven to nine. Between 50 and 70 million Americans “chronically suffer from a disorder of sleep and wakefulness,” according to the Institute of Medicine of the National Academies. The institute estimates the lost productivity and mishaps of fatigue are a $150 billion-a-year drain on the economy.
The Centers for Disease Control and Prevention calls our lack of sleep “a public health epidemic.” Well over one-third of people surveyed report falling asleep at work at least once in the past month. Nearly one in twenty say they’ve nodded off while driving just as often.
Sleeping at the wheel alone accounts for an estimated 1,550 fatalities a year and 40,000 injuries. But sleep loss and fatigue exact other costs as well: increased hypertension, diabetes, obesity, depression, heart attack, and stroke, as well as the more immediate woes of broken concentration, weaker memories, and greater difficulties keeping up with hobbies, financial affairs, and work.
“Even mild sleep loss affects conscious experience and working memory,” says Belenky, who spent 29 years as a psychiatrist and sleep expert at the Walter Reed Army Institute of Research before starting the WSU sleep center in 2004.
When he arrived, the center was anchored by a $4.5 million appropriation secured by then-Congressman George Nethercutt, Jr. ’67. In the last five years, the center has raised another $32 million. It now has nearly a dozen principal investigators and associated laboratories.
It is the rare soup-to-nuts operation, ranging from basic, molecular-level science to real-world simulations and policy. In one lab, James Krueger can see sleepiness triggered by the release of ATP, or adenosine triphosphate, a finding that Discover magazine listed among its “top 100 stories of 2010.” Across East Spokane Falls Boulevard, Hans Van Dongen can study the brain waves of sleeping and awake lab subjects, or juggle billions of data points pulled off truck drivers and rigs as they go through a two-week field study.
In the Deadly Force Judgment and Decision Making Simulator, Bryan Vila, a former Los Angeles County sheriff’s deputy, can watch a tired cop weigh a split-second decision Vila knows only too well: to shoot a suspect, risking a faulty rush to judgment, or wait for just a little more information, risking your own demise and the lives of bystanders.
The center is guided by a principle that Belenky discovered in his earliest days of psychiatry. If you can help people with their sleep, you will clear the way for them to make good judgments, to better help themselves.
“‘Lifting the fog of fatigue,’ we call it,” he says. “The art and science of antifogmatics.”
I’m surrounded by people in white coats and blue nitrile gloves. There’s Mike Winser, a research assistant, four Spokane-area college students, and Amy Bender. She’s a registered polysomnographic technologist, trained and certified in attaching wires to sleep subjects and recording and interpreting changes in their physiology as they sleep.
Over the next hour and 39 minutes, the team takes turns measuring, marking, and attaching 13 electrodes to my head and collar bone. When Winser at last leads me into the dimly lit, apartment-like suite of the center’s Human Sleep and Cognition Laboratory, I sport a ponytail of fine, colored wires that meet in a purse-like junction box. Winser shows me how to snap the box to a printer cable, at which point the lab’s machinery can record some of the fundamental workings of my sleeping mind and body. Then it’s lights out.
For decades, researchers have for the most part been in the dark about the inner workings of sleep. Van Dongen, the head of the sleep lab, compares the science of sleep to astrophysics, his original field of study. Just as we can’t visit deep space to look at a massive, dying star, we can’t look directly at a sleeping human brain.
“We have really advanced technologies,” he says one day in his office, “but they’re all indirect measurements. There’s nothing that you can just directly observe.”
In the ’90s, as a doctoral student in a Dutch physiology lab, Van Dongen sought to figure out what makes an early-rising morning person versus a late-rising night owl. At the time, they were considered personality traits with moral implications, the morning people being industrious and the evening people being lazy.
Van Dongen placed subjects in a “constant routine” environment in which they were kept semi-recumbent and awake and fed small meals every hour. He then monitored changes in their body temperature.
Over 24 hours, one’s temperature can swing three degrees Fahrenheit, peaking in the late afternoon and hitting a trough in the early morning hours. It’s the circadian cycle, or biological clock, and it turned out that morning and evening people, in effect, live two or three time zones apart.
“That changes the whole debate about whether people should get up early or stay up late,” Van Dongen says. “If it’s a biological trait and you’re an evening type, you don’t want to have these people get up early to be more productive, because they’re not going to be more productive.”
While at the University of Pennsylvania between 1998 and 2005, Van Dongen restricted the sleep of several dozen young adults to four, six, and eight hours a day for two weeks. Another group didn’t sleep for three days.
Those who had six hours a night or less had cognitive problems as severe as those up two nights. It was as if sleep was a daily medicine with very specific dosing requirements to avoid cumulative cognitive shortcomings.
“So the less sleep that you got,” says Van Dongen, “the worse it got, but also the more days in a row you got less sleep, the worse it got.”
Moreover, subjects short on sleep were largely unaware of their mental shortcomings, suggesting that chronically sleep-deprived people might think they’re operating on all cylinders when they’re not. Their baseline of acceptable performance has shifted, says Van Dongen.
“You’re performing worse overall, but it’s stable,” he says. “That becomes the new norm. It’s similar to people who are in chronic pain. They don’t notice it anymore and it takes a pain reliever for them to recognize what it was like to be normal.”
Around the same time, work by Belenky and colleagues at the Walter Reed Army Institute of Research found that shortening a good night’s sleep by just 40 minutes could affect one’s performance, and as Van Dongen saw, the less sleep one got, the worse things get. It also takes more than a weekend of sleeping in to recover.
“Even after three days of recovery sleep,” says Belenky, “with a normal eight hours in bed, people were still not back up to their baseline level.”
One of the key ways to measure a sleepy subject’s cognitive decline is the Psychomotor Vigilance Test. In the sleep lab, it involves little more than pushing a button as fast as I can when a stopwatch readout appears at random intervals on a computer screen. It looks super easy. Devon Grant, the center’s senior study coordinator, knows better.
“You won’t want to do it for more than 10 minutes,” she says, smiling mysteriously.
As the numbers roll and I hit buttons, the screen reports my speed, which is typically less than three-tenths of a second. I manage to hold this through the exercise, but Grant proves to be right. Near the end of the 10-minute session, it grows exceedingly, almost painfully boring. That’s the “vigilance” part of the exercise being tested. It takes a lot of effort, but I hang on and keep my times low.
That’s typical for well-rested subjects, says Grant.
“All bets are off when they’re sleep deprived,” she adds.
My eight-hour night in the lab is uneventful save for the quarter-million data points streaming from my head into the lab’s computers every second. I sleep self-consciously, and lie awake for what seems like 45 minutes after an early-morning bathroom break.
The following week, Bender says it took me 12 minutes to get to sleep, that I awoke 34 minutes later, and after being awake eight minutes, I had a long, deep short-wave sleep, the deepest, most impenetrable phase. My early-morning sleepless spell lasted nearly an hour. I then slept on and off until Samantha Riedy, another research assistant, woke me around 6:20.
I slept a total of 6.5 hours: 11 percent in Stage 1; 65 percent in Stage 2; 9 percent in the slow-wave stage, or Stage 3; and 15 percent in the rapid-eye-movement, or REM, phase.
“It’s really unclear what the significance of the stages mean,” says Bender. For overall recuperation, she adds, “a lot of people think it’s the total amount of sleep that matters.”
Indeed, as the following day unfolded in a drive to Seattle, I encountered one of the chief byproducts of sleep deprivation. For all the ten-dollar words experts have at their disposal, they call it “sleepiness.” And after a light lunch on Capitol Hill, I sought out the elegantly named antidote to sleepiness: a nap.
It’s the early ’70s and Bryan Vila, on patrol for the Los Angeles sheriff’s department, is approached one morning by a newspaper carrier in South Central LA.
“There’s a crazy man around the street with a gun on the porch,” he says. “Third house.”
Vila unlocks his shotgun, radios a dispatcher to say where he’s going, and pulls around the corner.
He finds a large man in a bathrobe. He is holding a very large handgun. Vila figures it’s a Ruger .44 Magnum single-action revolver, “the seven- or eight-inch barrel version.” As handguns go, it’s a cannon.
“Drop it,” Vila says.
The man turns towards the officers, bringing the gun almost directly in line with them.
Vila repeats the command, with added emphasis.
“Put … the … gun … down. Now!”
The man really doesn’t want to put the gun down. He seems alert but perplexed, not angry or delusional, but he says nothing and does not comply.
Vila carefully aims at him. He’s on the edge of shooting and well in the zone of being justified, but something doesn’t add up.
“‘I’m going to kill you,” he says, “if you don’t put that gun down.’”
At last the man puts the gun down.
For years, Vila second-guesses himself. If the man decided to shoot, he almost surely would have gotten a round off before Vila could have processed and acted on a decision to fire in self-defense.
It turns out the man was a postal worker who was coming off a night shift and lying in bed when he heard two men breaking into his house. Threatening them with his gun, he held them against the wall of his entry way and shouted for a neighbor to call the police.
Vila did not know this. What’s worse, in the tunnel vision of a deadly confrontation, he did not hear a voice to the side saying, “Don’t shoot him. It’s his house. I called you.”
Vila got lucky. Now, armed with a doctorate and years of research, he wonders how the tunnel vision and adrenaline of that moment would have mixed with a serious case of fatigue. Tired people can feel threatened more readily. They’re less open to new information or solutions. They have trouble making sense of complicated sensory information, and may be more likely to act, not wait.
With state-of-the-art driving and shooting simulators, Vila is trying to get as good a view as possible of fatigue in the field.
“We don’t know anything about arousal and fatigue really to speak of,” he says, “especially in an operational environment, especially in people who are used to dealing with things when they’re tired.”
Vila often voices the untested assumption that one never falls asleep in combat. But even if that’s true, there’s a lot to suggest much of the brain can be notably absent.
While at Walter Reed, Belenky helped with a study in which researchers did brain scans of sleep-deprived people while they performed a series of rapid-fire addition and subtraction problems. As the subjects endured 24, 48, and 72 sleepless hours, the researchers saw decreasing levels of activity in the thalamus, which controls attention and alertness, and the prefrontal cortex and the parietal association areas, which combine to make our working memory.
“This is the basis of anticipation, planning, doing things,” Belenky says. “It’s the core of the perception-action cycle and it is slammed by sleep loss.”
This time, I have the gun.
It is a standard-issue semi-automatic handgun with the firing mechanism modified and the barrel replaced with a laser. If I fire at an image projected on the wall, sensors will detect where I was aiming and when I fired. There will also be a loud bang.
I’m in the Deadly Force Judgment and Decision Making Simulator. I’ve already seen Vila go through one scenario. Steve James—a former British Army officer turned doctoral student in criminal justice—has given me a crash course in acting like a cop in a potentially deadly encounter. Basically, use clear, strong, simple commands, much like you do with a dog.
There are times to use a soft voice, like trying to calm a drunk down, says Vila, “But when you use the command voice, it brings you right into it and you’re focused on what you’re doing.”
This is no county fair shooting gallery. Decades after being a cop, Vila will be so engrossed in a tactical simulation that his heart rate will double. One of the scores of working police officers to go through the simulator had his heart rate triple in the span of one beat.
I’m called to a domestic disturbance call from a distraught person who says their spouse is being abusive. There are weapons in the house.
The room gets loud with the sounds of a man and woman screaming and swearing at each other. I see a man and woman in a narrow kitchen. The man is holding the woman in his outstretched hand.
The moment I say, “This is the police,” the man turns and fires. In less than two seconds, I fire back, hitting him first in the groin—“you probably got the femoral artery,” says Vila—followed by the chest and the head.
What I don’t know is if he shot me first. Were this a full-bore simulation, my assailant’s bullet would have been in the form of a 10-millimeter nylon ball fired from above the screen at half the speed of a paint ball. The actual simulations are also using real Northwest police undergoing driving situations and vigilance tests after a full work week, then again after three days off. Forehead sensors measure their brain activity.
In a chapter for the book Holding Police Accountable, Vila notes just how much they lose to long hours, disrupted circadian cycles, and poor sleep. The hand-eye coordination and motor speed of someone awake for only 17 hours is similar to a person with a .05 percent blood-alcohol level. After 24 hours, the equivalent level jumps to .10 percent, above the U.S. standard for drunk driving.
Officer discretion is built into many of their decisions, from arresting people to driving in emergencies to using deadly force, but a lack of sleep can compromise the prefrontal cortex’s capacity to make such decisions.
However, writes Vila: “Officers whose frontal lobes are out of service even though they themselves are on duty are less likely to think about consequences or to be able to analyze a situation correctly and apply complex rules to their behavior. They are also less able to manage the anger and frustration that often accompany confrontations in the field.”
Meanwhile, he says, “Almost no police agencies have comprehensive policies and procedures in place to manage fatigue.”
Two years ago, you would have thought an epidemic of narcolepsy was sweeping across the nation’s airport control towers. Air traffic controllers were caught dozing at Seattle’s Boeing Field, at Reagan National Airport, and in Knoxville, Reno, and Miami. The head of the air traffic control system resigned.
Belenky, testifying to a Senate subcommittee chaired by Maria Cantwell, D-Wash., said the problem was a systemic shortcoming of night-shift work, of “trying to work when one should be asleep and trying to sleep when one should be awake.”
He described the Comair 5191 disaster, noted the problem of the fatigued Lexington air traffic controller, and offered a suggestion: “I expect that an effective way to sustain operational performance and well-being in air traffic controllers working the night shift is sanctioned, scheduled on-shift napping.”
It was a suggestion backed by science, including a study of cross-Pacific pilots and the general knowledge that naps count on the daily ledger of sleep needed to recuperate.
The proposal did not fly. The White House reportedly said it failed “the Leno test,” implying that the suggestion was too ripe for ridicule on late-night television. Then-Transportation Secretary Ray LaHood vowed to add an hour to the time between shifts but made no allowance for naps.
“We expect controllers to come to work rested and ready to work and take personal responsibility for safety in the control towers,” he said in a widely quoted statement. “We have zero tolerance for sleeping on the job.”
“‘Zero understanding,’” says Belenky, “is usually the basis for ‘zero tolerance.’”
But WSU sleep researchers are seeing movement in other areas. Van Dongen is in the middle of an extensive study that could more closely align pilot schedules with periods when they’re less likely to be fatigued. An FAA regulation in effect early next year sets pilot hours by factors like how many trips they take in a day but also leaves open the possibility of a new schedule-specific rule if researchers can provide data justifying it.
“That’s the sort of enlightened rule-making that we’ve been hoping for,” says Van Dongen, “and that’s starting to happen now.”
Vila talks of developing a “risk metric” with which policy makers and administrators can weigh the real costs of fatigue-inducing practices like overtime. Paying time and a half is often seen as a good deal because non-payroll costs, like training and equipment, remain stable. But if the sleep lab can calibrate the added cost brought on by fatigue—crashed equipment, lost work hours, property damage, civil liabilities—it will have gone a long way in underscoring the value of a good night’s sleep, and the occasional snooze.
A traveler’s guide to the land of ZZZs
Greg Belenky, director of WSU Spokane’s Sleep and Performance Research Center, has no trouble sleeping.
“I usually take a book to bed and sort of hold it in my hand and say,
‘I’m too tired’ and put it aside,” he says. “I don’t even crack it.”
But he knows well the struggle of those who can’t sleep and offers the following bits of advice:
- If you don’t exercise regularly, don’t do it right before bedtime. But if you are used to it, exercising before bed can raise your core body temperature, prompting sleep. A more leisurely alternative: a warm bath.
- Avoid caffeine after noon, especially if you are older.
- Avoid a big meal before bed.
- Alcohol may help you get to sleep, but its sleep-inducing effects wear off, leading to a rebound in the form of disturbed sleep.
- Many insomniacs lie in bed ruminating on why they can’t sleep. In the process, the bed can become a trigger for insomnia. Get out of bed and do something else until you’re tired. Some sleep clinics also offer cognitive behavioral therapy that can decouple the association between being in bed and being unable to sleep.
- Be consistent about when you go to bed and get up to maintain the light exposure of your circadian rhythms.
- Avoid television and electronic devices, whose light can signal the brain that it’s sunset, shifting circadian rhythms and making sleep more difficult.
- Have a calming ritual before bed, even if it means holding a book and saying you’re too tired to read it.