Sleep
11(6):503-512, Raven Press, Ltd., New York
© 1988 Association of Professional Sleep Societies
Keynote Address
Sleepiness, Circadian Dysrhythmia, and
Fatigue in Transportation System Accidents
John K. Lauber and Phyllis J. Kay ten
Good morning, ladies and gentlemen. I am delighted to be here in San Diego to take
part in the second annual meeting of the Association of Professional Sleep Societies.
Although my small role in this meeting will soon be over, I intend to spend the next
couple of days here in order to learn more about sleep and sleep-related problems.
This is information badly needed. Although, as you will see in a few minutes, we have
investigated many accidents in which sleep loss, sleep disorders, fatigue, and circadian
factors are clearly implicated, I don't think we have the foggiest notion of the true
prevalence of these factors in transportation system accidents. One of the most perplexing problems our accident investigators face is how to determine what role, if any,
fatigue played in a specific accident. Unlike metal fatigue, human fatigue generally
leaves no telltale signs, and we can only infer its presence from circumstantial evidence. We need your help to develop better investigative techniques, which in turn
should lead to better ideas for preventive measures. And this would benefit everyone.
The total cost of transportation system accidents is difficult to estimate. The National
Safety Council (Accident Facts, 1987 edition) reported 47,900 deaths resulting from
highway accidents in 1986 and estimated $57.8 billion in lost wages, medical expenses,
insurance costs, and property damage. The Insurance Information Institute estimated
$76 billion "economic loss" resulting from 1985 highway accidents (Insurance Facts,
1986~7 Property/Casualty Fact Book). According to figures reported to the Federal
Railroad Administration by all railroads, in 1986, there were $167.5 million in "reportable damages" in that industry; but the Chase, MD Amtrak accident alone resulted in
$82.8 million in "reportable damages" plus insurance payouts, and according to some
figures I saw recently, $900 million in insurance payouts were made last year for
worldwide aviation accidents. One estimate indicates that a single major accident can
cost an airline as much as $500 million in total losses. It does not take sophisticated
economic analysis to realize that transportation system accidents pose a tremendous
economic burden on society, and it is impossible to quantify the personal suffering and
loss resulting from deaths and injuries.
It is widely recognized that most transportation system accidents are due to human
error. Depending on the specific mode of transportation and other considerations,
Presented by John K. Lauber to the Second Annual Meeting of the Association of Professional Sleep
Societies, San Diego, California, U.S.A., June 12, 1988.
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J. K. LAUBER AND P. J. KAYTEN
human error is responsible for on the order of 65-90% of all accidents. Boeing, for
example, in a study of jet transport accidents worldwide, identifies flight crew error as
responsible for 65.5% of all such accidents since the dawn of the jet age. In addition to
those caused by flight crew error, accidents caused by other personnel, such as air
traffic controllers, maintenance, dispatchers, and others, must be taken into account.
Similar rates of human error involvement are obtained in other modes of transportation
as well.
Obviously, determining that human error is responsible for accidents is easy-all too
easy some of our critics say-and in some sense I agree with them. The real challenge
facing us is to get behind the mere fact of human error in order to understand the
underlying problems that lead to the occurrence of the performance deficiency in the
first place. In recent years, investigators from the Board have delved increasingly into
the "why" of human error accidents. It has now become fairly routine for the human
performance investigator to dig deeply into individual "life-style" issues in order to
learn what may have affected the performance of a pilot or flight engineer or ship's
captain or truck driver.
Virtually always, an attempt is made to reconstruct the on-duty/off-duty/
rest/sleep/wake history of the key operational personnel involved in an accident. Frequently, we find horror stories, some of which I've illustrated below. But much more
frequently, what we find is ambiguous, inconclusive, and I'm sure in some cases,
downright misleading. As a result, the true incidence of fatigue as a causal or contributory factor is largely unknown.
Some people suggest that many more accidents which share the characteristics of (1)
long periods of inactivity and monitoring of equipment and (2) human errors attributed
to inattentiveness or poor jUdgment are due to fatigue. They are probablY correct.
Other people suggest that the empirical and theoretical foundations of sleep and fatigue
research are being diluted by the overeager attribution of sleep disorders and fatigue to
inappropriate accidents. They, too, are probably correct. You, the professional sleep
research community, can be of immense help to all of us by providing more concise
methods and theoretical formulations for determining the contribution of sleep factors
to accident causation. This, in turn, will lead to the development of more informed
public policy guiding the design and operation of our transportation system.
Let's turn to some examples to illustrate the problems and difficulties I've discussed
above.
CHINA AIRLINES FLIGHT 006
On February 19, 1985, China Airlines flight 006, a Boeing 747 enroute to Los Angeles, California, from Taipei, Taiwan, suffered an inflight upset. The flight from Taipei
to about 300 nmi northwest of San Francisco was uneventful, and the airplane was
flying at about 41,000 ft mean sea level when the no. 4 engine lost power. During the
attempt to recover and restore normal power on the no. 4 engine, the airplane rolled to
the right, nosed over, and entered an uncontrollable descent. The captain was unable
to restore the airplane to stable flight until it had descended to 9,500 ft pulling more than
5 gs in the process. After the captain stabilized the airplane, he elected to divert to San
Francisco International Airport, where a safe landing was made. Although the airplane
suffered major structural damage during the upset, descent, and subsequent recovery,
only 2 persons among the 274 passengers and crew on board were injured seriously.
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The National Transportation Safety Board (NTSB) determined that the probable
cause of this accident was the captain's preoccupation with an inflight malfunction and
his failure to monitor properly the airplane's flight instruments, which resulted in his
losing control of the airplane. Contributing to the accident was the captain's overreliance on the autopilot after the loss of thrust on the no. 4 engine.
Flight 006 had departed Taipei at 0022 Pacific standard time (1622 Taipei local time)
and had been airborne 9 hand 46 min when the accident occurred (0214 Taipei time).
Because of the scheduled duration of the flight (11 h), an augmented flight crew was on
board. In addition to the three primary flight crew, an additional fully qualified captain
and flight engineer were on board.
At the time of the accident the three primary flight crew members were on duty. They
had been on duty during the takeoff, climb, and initial part of the flight. Thereafter, they
each went off duty at intervals ranging from 1.5 h to 4 h after takeoff, and were replaced
by the augmentee flight crew members, with the captain occupying the first officer's
seat during a portion of this period. The captain had been off duty 5 h during the flight
and returned to duty about 2 h before the accident. During his rest period, the captain
slept about 2 h in the bunk located in the rear of the cockpit. The first officer was off
duty about 3 h during the flight and returned to duty about 3 h before the accident. The
flight engineer was off duty about 5 h and returned to duty about 2 h before the accident.
The first officer's and flight engineer's activities during their rest periods were not
established.
The flight, which left Taiwan at 1622 local time, was due to arrive at Los Angeles at
0322 local Taiwan time the following morning. According to the captain, he had gone to
sleep fairly consistently at around 2100-2200 local Taiwan time for six nights prior to
the accident. As a result, the incident occurred some 4-5 h after the time that he had
been accustomed to going to sleep.
The captain of CI006 experienced alterations to his regular sleep cycle in the week
preceding the flight as a result of his return to Taipei (GMT + 8) from Jeddah, Saudi
Arabia (GMT + 3). In addition, the conditions of the flight caused him to stay awake
for a prolonged period. Although he slept for 2 h during the flight, discounting the
quality of sleep he experienced then, he still would have remained awake several hours
beyond the time that he would ordinarily be deeply asleep. For these reasons, there was
a high probability that he was affected by circadian desynchronosis at the time of the
accident.
Most of you will recognize that the long duration of flight 006, mostly conducted in
automatic flight, would certainly involve elements offatigue, boredom, and most probably a decrease in vigilance. You may also recognize that the quality of the crew's rest
in the cockpit of the aircraft could not fairly be equated to that which could have been
achieved at home or even in a hotel, and that the accident occurred at a time that was
later than the crew members' regular sleep periods. However, it is interesting to note
that no mention was made of fatigue or boredom in the probable cause determined by
the Safety Board.
If you read a copy of the Safety Board report on this accident, you will see a rather
lengthy discussion of the effects of monotony and fatigue on flightcrew performance.
However, unlike rese:;lrch, an accident is unpredictable and uncontrolled. Flight 006's
crew was not monitored by electronic sensors. We could only infer the causes of the
crew's degraded performance from the Flight Data Recorder (FDR), which records
parameters of the airplane's flight path and pilot control inputs, and from personnel
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1. K. LAUBER AND P. 1. KAYTEN
records and interviews with the involved crew members and airline operations and
training staff. (In this case, we were fortunate to have access to a live crew; however,
communication was difficult because of the language difficulties.)
This accident, like virtually alLaccidents, was the result of multiple factors, including
issues such as the design of automated flight systems and pilot training. Although I
can't help but feel that fatigue, sleepiness, and circadian factors played a major role in
this accident, it is nonetheless very difficult to amass enough evidence to hold that
these are causal. It illustrates well the difficulties I referred to above.
RAILROAD ACCIDENTS
The railroad industry has had its share of accidents that the Safety Board has determined to involve fatigue. The Federal Railroad Safety Authorization Act of 1976 limits
the hours of service of railroad employees. For railroad employees in train and engine
service (locomotive engineers, firemen, conductors, trainmen, switchmen, switchtenders, and hostlers), the maximum work period is no more than 12 consecutive hours.
After working a full 12 consecutive hours, and employee must be given at least 10
consecutive hours off duty before being permitted to return to work. No employee may
be required or permitted to continue on duty or go on duty unless he has had at least
8 consecutive hours off duty within the preceding 24 h. Under the terms of these
limitations, (1) when an employee's work tour is broken or interrupted by a valid period
of interim release (4 h or more at a designated terminal), he may return to duty for the
balance of the total 12-h work tour during a 24-h period, and (2) after completing the 12
h of broken duty, or at the end of the 24-h period, whichever occurs first, the employee
may not be required or permitted to continue on duty or go on duty until he has had at
least 8 consecutive hours off duty.
These rules, when followed strictly, lead to some very creative schedules, and in
NTSB investigations of railroad accidents, we have seen some of the most creative
ones. In April 1984, the Safety Board investigated two accidents involving Burlington
Northern Railroad crews, in which it was determined that fatigue and irregular work
schedules played a causal role.
Wiggins, Colorado and Newcastle, Wyoming
About 3:58 a.m. mountain standard time, on April 13, 1984, Burlington Northern
freight trains Extra 6714 West and Extra 7820 East collided head-on on the single main
track about 1,027 ft west of the west turnout of the passing track at Wiggins, Colorado.
Seven locomotive units derailed and were destroyed in the collision and burning diesel
fuel was released from ruptured fuel tanks; 40 cars derailed, 26 of which were destroyed. Five train crew members were killed and two were injured. Total damage was
estimated to be $3,891,428.
About 4:56 a.m. mountain standard time, on April 22, 1984, eastbound Burlington
Northern freight train Extra 7843 East struck the rear of Burlington Northern freight
train Extra ATSF 8112 East on the main track at Pedro passing siding near Newcastle,
Wyoming. During the collision and subsequent derailment sequence, several cars of
another freight train which was standing unattended in the Pedro passing track were
also struck and derailed. As a result, 5 locomotive units, a caboose, and 21 cars
derailed. Two train crew members were killed, and two were injured. Total damage was
estimated to be $1,358,993.
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The NTSB determined that the probable cause of the Wiggins accident was the
engineer and other head-end crew members of Extra 6714 West falling asleep and failing
to comply with restrictive signal aspects. Contributing to the failure of the engineer and
fireman was their consumption of alcohol and fatigue resulting from their voluntary lack
of sleep during their off-duty time, aggravated by irregular work/rest cycles.
The NTSB determined that the probable cause of the Newcastle accident was the
failure of the engineer and head brakeman of Extra 7843 East to operate their train in
compliance with restrictive signal aspects because they were asleep or, in the case of
the engineer, otherwise impaired. Contributing to their failure was the use of marijuana
by the engineer, as well as fatigue of the engineer and head brakeman due to their
voluntary lack of sleep and unpredictable working hours.
Both accidents involved what was determined to be voluntary use of drugs or alcohol
and voluntary lack of sleep. As it is in the airline business, it is characteristic of a busy
railroad's extra, or in airline terms, reserve, list that it is staffed by the employees with
the least seniority, and if the "extra" list is cost effective (not too long), employees on
the list will usually get only minimal time off between work assignments. In the case of
these two accidents, the schedule was also unpredictable: employees had insufficient
information to determine when they would next go on duty, regardless of whether they
were waiting at home or at an away terminal, for the next call.
In addition, facilities for sleep and for recreation were inadequate at the away terminals. Some might say the environment at away terminals encouraged drug and alcohol consumption. There is ample evidence from many accident investigations pointing
to voluntary self-medication to control wakefulness and sleep.
Burlington Northern management was responsible for scheduling policies that made
it difficult for crew members to plan adequate rest periods. Although they are now
considering a research and education program concerning safe work-rest routine, at
the time of the accident, there was no management acknowledgment of the effects of
inadequate rest on performance. Crew members, even if they were aware of effects of
fatigue, alcohol, and drugs on performance, were very aware that they would not meet
any supervisory personnel at away terminals and knew they were unlikely to be supervised at night at all.
As evidenced by these accidents, the railroad industry, and the government, needs to
take steps to prevent situations such as these-this must include such broad-reaching
issues as management attitudes and philosophy.
MARINE ACCIDENTS
Grounding of the Panamanian-flag passenger carferry MN A. REGINA, Mona Island,
Puerto Rico, February 15, 1985
The Dominican Ferries Line MIV A. REGINA, a Panamanian-flag 330-ft, 3,658
gross-ton passenger carferry ran aground on the southeast coast of Mona Island, Puerto
Rico, at 0020 on February 15, 1985. After unsuccessful attempts to refloat the REGINA,
the 72 crew members and 143 passengers were landed by the vessel's lifeboats and
liferafts on Mona Island and subsequently flown back to Mayaguez. One crew member
was injured slightly when leaving the vessel. The stranded vessel, valued at $5 million,
was considered a total loss.
The NTSB determined that the probable cause of the grounding of the A. REGINA
was the failure of the master to monitor the vessel's progress along the charted course
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J. K. LAUBER AND P. J. KAYTEN
line by plotting navigation fixes so as to detect the vessel's set and drift. Contributing
.to the accident was the master's failure to make a leeway steering allowance for wind,
sea, and current effects when plotting a course line close to the island, his assuming a
watch while on medication and in a fatigued physical condition, and his failure to
maintain an adequate lookout.
There was evidence that the master was suffering from both chronic and acute
fatigue. He had not had a day off duty during the preceding 12 months. His daily
workload varied, depending on whether a trip was made or the vessel remained in port.
During the week of the accident, the company had instituted daily round-trips between
Puerto Rico and the Dominican Republic. This schedule allowed the master only about
3 h to himself each day, besides a typical allowance of 7-8 h for sleep. Insomnia and
operational reponsibilities had deprived the master of sleep for a period of about 42 h
at the time of the grounding. The accident occurred at 20 min after midnight.
Collision of the USS RICHARD L. PAGE arid the U.S. fishing vessel CHICKADEE in
the Atlantic Ocean east of Cape Henry, Virginia, April 21, 1987
About 1202 on April 21, 1987, the USS RICHARD L. PAGE collided with the fishing
vessel CHICKADEE, which was under tow by another fishing vessel. Six feet of the
bow of the CHICKADEE was severed and it immediately started to take on water. All
three crew members on the CHICKADEE abandoned the vessel just before it capsized
and sank. Crew members were rescued shortly afterward, and no one was injured. The
PAGE sustained only minor damage. The CHICAKDEE was a total loss. Damage was
estimated to be $112,000.
Although at the time of the collision, the visibility was limited, the captain of the
PAGE, a guided-missile frigate, decided to conduct a full power trial to test maximum
speed of the frigate. Neither the captain of the PAGE nor the CHICKADEE sounded
fog signals. The Officer ofthe Deck (OOD) on the PAGE reported intermittent contacts
on the radarscope, but since he could not identify the contact, decided that it was not
an actual vessel, and thus did not report the contact to the captain.
The Safety Board attributed the OOD's behavior the day of the accident partly to his
long working hours and disrupted sleep pattern during the several days before the
accident. There is a discussion in the NTSB report of this accident and of the nature of
military operations, which foster "almost stoic acceptance on the part of military
leaders and their subordinates of an arduous regimen that would be considered unacceptable in most nonmilitary environments," but the Board stopped short of issuing a
recommendation to the Navy on this matter.
Grounding of the Japanese Tankship MATSUKAZE in the Straits of Juan de Fuca,
April 28, 1988
Last month, we received notification of a grounding of a Japanese tankship in the
Straits of Juan de Fuca, about 70 nmi northwest of Seattle, Washington. According to
the Coast Guard investigator, the tankship was on a voyage from Long Beach, California, to Tacoma, Washington, and had been at sea for 3 or 4 days at the time of the
accident. The watch officer on duty at the time of the accident was the second mate,
who was standing his normal watch (midnight to 4:00 a.m. and noon to 4:00 p.m.) at the
time of the accident.
The second mate had awakened at 2345 on the evening of the accident and went on
duty at midnight. He had slept prior to that for 3 h. The master visited the ship's bridge
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a few times during the next 2 h, but after 0200, the second mate was alone in the
pilothouse. Sometime after 0215 the mate fell asleep, and he awoke about 0315, after
the vessel had run aground.
According to the Coast Guard investigator, the second mate said that he had not felt
tired while he was on watch, he had not been reading while on watch, and he had not
eaten anything just prior to assuming the watch or during the watch.
According to one of our NTSB marine investigators, "My first skipper had a solution. The watch officer was NEVER allowed to sit and seldom was allowed to come
inside out of the weather." While such practices may help to assure that people won't
fall asleep on the job, they are of dubious value in assuring long-term attention to duty.
HIGHWAY ACCIDENTS
The clearest instances of fatigue-related problems are seen in the major highway
accidents we investigate at the Board. The following accidents are illustrative of some
of the more flagrant abuses of physiology and prudence that have come to our attention.
(1) At about 4:15 a.m. on July 14, 1986, a Trailways Lines, Inc., intercity bus collided
with a Rising Fast Trucking Company truck on Interstate Highway 40 near Brinkley,
Arkansas. The busdriver and 27 bus passengers sustained injuries ranging in severity
from minor to serious. The truckdriver and his codriver were not injured. The truckdriver had only a 2-h nap in the 21 h before the accident. "The Safety Board concluded
that the combined effects of fatigue due to sleep deprivation, monotony, and vulnerability to attention lapses at that hour of the day combined to decrease the truckdriver's
vigilance and also adversely affected his judgment and contributed to his commission of
several errors before the collision." There was also evidence of marijuana and alcohol
involvement by the truckdriver.
(2) On May 30, 1986, an Intercity Tour Bus lost control and rolled over into the West
Walker River, Walker, California. As a result of the accident, 21 passengers died and
19 passengers and the driver were injured. The driver had been on duty on each of the
6 days before the trip to Reno, Nevada, accumulating as many as 88 h of duty time.
During those days, the driver was primarily engaged in driving shorter charter trips in
the L.A. area and I-day trips to nearby cities. The driver was accustomed to working
long days with limited rest. On May 27, 3 days before the accident, the driver was on
duty for 17 h and drove 11.5 h. The driver reported for duty that day at 5:00 a.m. and
went off duty at 10:00 p.m. During the next 2 days the driver was on duty 12 h a day,
but most of the time was spent relaxing between charter tour destinations. The day of
the accident, the driver began his duty day at 7:00 a.m., after having gone off duty at
9:00 p.m. the night before. According to Board staff, tl~e aggressive style of the driver
indicated that the driver was alert-but fatigue cannot be ruled out as a factor in this
accident (it was, however!).
(3) On May 31, 1985, a northbound tractor-semitrailer operated by Military Distributors of Virginia, Inc. (MDV) , collided with two southbound vehicles on a curve on
U.S. 13, about 2.3 miles south of Snow Hill, North Carolina. The first vehicle hit was
a schoolbus. Of the 27 schoolbus passengers (ages 5-13 years), 15 sustained minor or
moderate injuries, 10 sustained serious or severe injuries, and 2 received critical injuries. Six of the passengers died. The schoolbus driver sustained minor injuries; the
driver of the Military Distributors tractor which collided with the schoolbus sustained
fatal injuries. The NTSB determined that the probable cause was the failure of the
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J. K. LAUBER AND P. J. KAYTEN
driver of the Military Distributors of Virginia, Inc., truck to keep his vehicle to the right
of the highway centerline because of inattention due to a momentary lapse of alertness,
falling asleep, or an epileptic seizure.
The MDV truckdriver had had 1.5 h sleep the night before the accident. At the time
of the accident, the truckdriver had been on duty about 12 h, 7 of which were actually
spent driving. Based on the available evidence, the truckdriver had had 1.5 h sleep
during the 36 h before the accident. There is no evidence to indicate that officials at
MDV were aware of the truckdriver's seizure disorder or that they were failing to
exercise adequate supervision ofthe MDV truckdriver's hours of service. Based on the
reconstruction of the truckdriver's activities on the day of the accident, it appears that
the truckdriver was not driving in violation of any Department of Transportation (DOT)
hours of service rules at the time of the accident. Assuming that he was driving to
Norfolk to go off duty for a minimum of 8 consecutive hours when he arrived there, the
trip he was driving at the time of the accident could have been completed within the
maximum time permitted by DOT hours of service rules.
(4) On April 29, 1985, a Bell Creek, Inc., tractor-semitrailer collided in the rear end
of a Tuba City School District Schoolbus near Tuba City, Arizona. Of the 32 schoolbus
passengers (ages 5-21 years), 2 were fatally injured, 4 sustained serious injuries, 4
received moderate injuries, 18 sustained minor injuries, and 4 were not injured. The
truckdriver and the schoolbus driver received minor injuries. The NTSB determined
that the probable cause of this accident was the truckdriver's chronic fatigue, which
adversely affected his ability to avoid a collision with the stationary schoolbus; his
chronic fatigue developed from a loss of sleep due to a combination of excessive duty
time and a prolonged irregular duty pattern. Contributing to the accident was the failure
of Bell Creek, Inc., to properly monitor the truckdriver's activities to prevent excessive
hours of service.
The truckdriver was found to have kept two sets of logs-one for the company and
one for himself-with conflicting entries for time worked. Fuel receipts conflicted with
entries in the driver's logs.
According to interviews, the truckdriver had slept poorly the night of the 27th due to
a cough, for which he was taking over-the-counter cough medicine. The night before
the accident, the truckdriver had slept on the floor in a motel room he shared with other
truckdrivers from around 10:00 p.m. until 3:30 a.m. The accident occurred about 3:15
in the afternoon.
According to Bell Creek, the truck company, the driver had been on duty a total of
88.25 h during the 8 consecutive days before the accident. He was in violation of the
Federal 70-h, 8-day rule. He was also in violation of the 10- or 15-h rules, or both, on
April 23, 25, 26, 27, and 28. His consumption of a large quantity of sweets several hours
before the accident, with the resultant initial elevation of the body sugar level, may
have led to a rapid depletion of body sugar level, resulting in even further fatigue.
NTSB safety recommendations related to driver fatigue, medical factors, and duty time
The Safety Board has issued several recommendations related to fatigue and work
duty time issues, including asking Office of Motor Carrier Safety (OMCS) to issue "On
Guard Notices" warning drivers of the problems of fatigue and recommending that
OMCS find methods and means to prevent or to minimize dozing at the wheel by
drivers of carriers in interstate commerce. Several recommendations specifically related to work and duty time limitations and record keeping have been issued.
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KEYNOTE ADDRESS
With regard to methods to minimize dozing, OMeS continues to say that existing
devices are too expensive, that research to develop better devices is not feasible given
today's funding, and that proper rest and sane scheduling would take care of the
problem. NTSB recommendations for dozing-prevention devices to individual bus
companies have met with little success.
NTSB special study on heavy truck accidents
This year the Safety Board is completing a year-long study of accidents involving
heavy trucks. The study will include independent drivers and large and small trucking
companies. An expanded accident report form is being used that will include items
aimed at exploring sleep and fatigue problems, as well as the impact of drug and alcohol
use on truck safety. Many of the data items have been developed with the assistance of
members of the Professional Sleep Societies. We are just beginning now to collate the
data.
CONCLUDING REMARKS
As we have seen, there are clearly some serious deficiencies in our understanding
and application of knowledge about sleep, circadian factors, and fatigue as they affect
human operator performance in transportation systems-or for that matter, in any
technologically complex system. Although it is true that we don't really have a sufficient understanding of the role these factors play in transportation system safety, it is
also proven, by example, that there are some serious shortcomings in our public policy,
as reflected, for example, in the substance and enforcement of regulations governing
operator duty and rest.
I believe these shortcomings in large part result from ignorance and misunderstanding on the part of the public, including our public policy makers. There are some
common misperceptions, or myths if you prefer, about sleep and fatigue factors that
may be largely responsible for this state of affairs. For example, "an hour of sleep is an
hour of sleep ... ," and, "an hour of duty is an hour of duty ... " How else can one
rationalize flight and duty time regulations for pilots operating on international routes
which fail to account for time-of-day effects on the quantity and quality of sleep?
Another too widely held misperception is the notion that overcoming the effects of
insufficient sleep and rest is simply a matter of motivation. The many physicians in this
audience ought to be highly familiar with the phrase, "When I was a resident ... ,"
which is always followed by some heroic tale of marathon sessions in the ER (or
someplace). I recently actually heard a former Federal Air Surgeon make such a statement during a discussion of flight and duty time issues.
Or consider the following excerpt from an article in the Washington Post (1987),
"The [Nuclear Regulatory Commission] said it found a pattern of sleeping or inattentive operators [at the Peach Bottom Nuclear Power Plant] ... especially on the 11 pm to 7 am shift,
when the control room is staffed by a skeleton crew . . .
"Running a nuclear power plant at full power is largely an automatic operation, but workers
are expected to continually monitor gauges . .. and they must be alert to abnormal 'trends' on
gauges . .. and they must be prepared to handle sudden emergencies . .. " (emphasis added).
Clearly, this reporter (and probably most of his readers) is unaware of the extensive
body of research on vigilance and human operator performance. So, too, is the author
of an editorial that appeared last fall in the San Francisco Chronicle on the subject of
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1. K. LAUBER AND P. 1. KAYTEN
"cockpit napping." The concluding statement in the editorial states, "The public has
an imperative right to protection against laxity on the flight deck" (San Francisco
Chronicle, October 9, 1987). This level of understanding, unfortunately all too often, is
the basis of much of our public policy guiding and regulating these system safety issues.
I believe there are several ways that sleep researchers can affect relevant public
policy. I want to close my address to you this morning by suggesting some activities
that could be of great benefit in this regard.
First, you need to assist in the development of better investigative techniques and
unifying concepts that can be used to improve our understanding of the role that
sleepiness, fatigue, and circadian factors play in manned system accidents and incidents. We need better accident investigation methods so that we can do a better job of
determining the involvement of these factors in system catastrophes.
Second, you must help to provide a realistic assessment of the validity of claims of
fatigue-, sleepiness-, and circadian-caused accidents and incidents. Apparently, there
are some individuals in the sleep research community who feel that the more frequently
and dramatically sleep issues can be implicated in incidents and accidents, the better.
Perhaps they feel they can improve their prospects for securing public support (read
"money") for their programs by doing so. But besides being unethical, in the long run,
such dramatic tactics will be harmful-in a self-perpetuating cycle, support will only
continue so long as there is a problem, so why focus on solution-oriented research?
Third, research efforts to develop countermeasures must be intensified. Shift work,
all night aircraft, train, and truck operations, and trans meridian flights are facts of
modern life. Accordingly, we must develop ways to help people cope with the unique
biological and psychological demands of such operations.
Fourth, you must help educate the public about these issues. In addition to some of
the myths and misperceptions I mentioned earlier, consider a couple others: "A few
beers, and I sleep like a baby ... ," or, "I know my limits, I know when it's time to
pull over and sleep ... " These are widely held beliefs which many people use to make
practical decisions about their own coping strategies. Strategy founded on ignorance all
too often ends in tragedy.
Finally, you must take an active, direct role in the formulation of public policy
affecting sleep and fatigue and circadian issues. I know that some of you have been
quite active in lobbying activities, and I want to strongly encourage you to continue and
even step up those activities. Too few people really understand the political process
well enough to realize what a practical, fundamental role can be played by researchers
and other specialists in the development of public policy and in the enactment of
appropriate legislation.
The academic purist's disdain for "applied" research, or the closely related cynicism
within the intellecutal community regarding the political process, interfere with the
search for practical solutions to problems that often have tragic consequences. We all
share a responsibility to apply our talents for our mutual benefit. I know you will do
your part, and I look forward to working with you on these problems.
John K. Lauber
Phyllis J. Kayten
National Transportation Safety Board
Washington, D.C.
Sleep, Vol. 11, No.6, 1988
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