Rest for the Weary

the overlay, MAJ Eisen fails to mark an important road junction with a checkpoint control measure.

There’s no time to double-check his overlay, for the OPORD is due to begin in five minutes and graphics must be ready right now.

Meanwhile, TF personnel are sluggishly finishing their prep-for-combat checks before moving out. Though the morning sun is already blazing hot, the soldiers’ bodies tell them it’s still nighttime. Tank commanders, worn out and irritable, forget to make sure their crews are drinking water. The first heat casualties begin to occur. By the time the tanks start rolling, the task force has been without rest for over 48 hours. On the road march out, a Bradley driver falls asleep at his controls, plunging his vehicle over a cliff. All aboard are killed or badly injured.

Then real disaster strikes. A young platoon leader, bewildered by stress, fatigue and the featureless terrain around him, makes a wrong turn at the critical crossroads. The rest of the task force follows his tank directly into a dug-in regiment of enemy armor. The annihilation is total. Army trainers examine the results of this disaster and finally rally support for sleep management programs behind the slogan “No More Task Force Buzzsaws!”

Future battlefields “are likely to be chaotic, intense, and highly destructive” places.2 New technologies, combined with adoption of the AirLand Battle doctrine, have greatly increased the tempo of modern warfare. Advances in target acquisition, communications and sensor systems mean our forces can fight longer, harder, and faster than ever before. The U. S.-led coalition proved how deadly this combination can be when it crushed Iraq’s military forces after a 100-hour ground campaign in 1991.

The relatively short duration of recent operations such as DESERT STORM or the 1989 invasion of Panama can be deceiving, however. There is no guarantee that the next conflict involving American troops will be equally brief. It remains imperative that units continue to train for extended periods of time.

Army doctrine recognizes this need. FM 22-9, Soldier Performance in Continuous Operations, defines two distinct stages of combat with respect to sleep management:3 Continuous Operations (CONOPS). Combat continuing at high-intensity levels for extended periods. Individuals within a unit may have some opportunity for sleep, though this sleep may be brief or fragmented. Rest for the Weary The Role of Sleep Management in Combat Operations by Captain Patrick J. Chaisson Sustained Operations (SUSOPS). Unrelenting combat where soldiers have little or no opportunity for sleep. Within any CONOPS there are likely to be periods of SUSOPS.

Units practice CONOPS and SUSOPS regularly at Combined Arms Training Centers like the NTC or JRTC. Unfortunately, the average Active Duty heavy maneuver battalion rotates to NTC only once every three years. Reserve Component forces get to experience the pressures of prolonged combat operations even less often. The average two-week Annual Training tour might leave six days of field time once time is set aside for travel, equipment draw/turn-in and maintenance activities. Therefore, the experience level of our soldiers, leaders, and planners regarding sleep-deprivation and its countermeasures is not where it should be.

Scaling the Wall of Sleep What is the body’s reaction to sleep loss? More important, how can leaders maintain their soldiers’ ability to fight when forced to operate for long periods without rest? Before we can address these questions, a few words are necessary about the nature of sleep. The Circadian Cycle. Humans operate on an “internal clock,” known as the Circadian or Diurnal Cycle, that influences behavior such as the desire to sleep.

Since most people are used to working during the day and sleeping at night, performance tends to be lowest from 0300-0700.4 It is during this “Circadian Trough” that alertness most suffers, as any TOC night-shift veteran can attest. (See Figure 1) Jet Lag. This occurs when individuals rapidly cross time zones. Their circadian cycles are not in synch with the actual time, leading to low energy, sleepiness during the day, and poor job performance. One study indicates that jet lag can reduce total unit effectiveness by up to 15 percent.5 Those who expect to begin combat operations immediately after deployment should pay heed to these findings.

Sleep

Inertia.

Humans normally awaken gradually. The state of disorientation and sluggishness upon arousal is called sleep inertia, and usually lasts 5-15 minutes. Personnel who have just risen will not be fully alert, so leaders must consider sleep inertia in deciding when and for how long troops may sleep.

Sleep Deprivation. Just how long can individuals go without sleep?

British studies found that a platoon of light infantry kept alert with no opportunity for rest becomes militarily ineffective after only three days.6 Certain tasks degrade more quickly than others, with mental functions affected most by sleep deprivation. Experiments conducted by the Walter Reed Army Institute of Research concluded that soldiers receiving six to eight hours of sleep nightly can function indefinitely.

Four to five hours of sleep will maintain acceptable levels of performance for five to six days. However, less than four hours leads to a rapid decline in performance, rendering individuals ineffective in two to three days.7 Thus, if soldiers go without rest for more than three days, or get less than four hours of sleep a night, they are in real danger of collapse after the first 72 hours of CONOPS.

Sleep loss is cumulative. Soldiers may possess asleep debt even after several hours’ sleep. If an individual receives five hours of sleep on one night but only two the night before, he is still sleep-deficient and must get more rest.

We must note here that people respond to sleep deprivation in very different ways. Some soldiers’ performance may degrade significantly after as little as 18 hours awake. On the other hand, we have all heard stories of that crusty old first sergeant who could seemingly go without sleep for a week, provided he had his coffee and cigarettes. Other factors, such as climate, MOPP level, and even age also may affect the individual’s tolerance to sleep loss.

The Effects of Sleep Deprivation Officers and NCOs need to recognize the physical signs of serious sleep loss. Among these symptoms are the following:8

•Vacant stare - “glazed” eyes (the classic “1000-meter stare”)

•Bloodshot eyes

•Pale skin

•Body sways upon standing; sudden dropping of chin upon sitting

•Walking into obstacles and ditches

•Poor personal hygiene

•Very slow heart rate

•Loss of interest in surroundings

•Slurred speech As mentioned before, sleep deprivation takes its heaviest toll on the mind’s ability to process and evaluate information. Those most affected by sleep deficiency, then, are soldiers who think for a living — fire direction center crews, radar operators, leaders at all levels. See Figure 2 for a summary of effects.

Mood and Motivational Changes. Insufficient sleep can cause unit members to feel less energetic, less alert, more irritable, increasingly negative Figure 1. Circadian Cycle from CACDA, Continuous Operations Study (CONOPS). and sleepy. Prolonged sleep loss will see a shift from negativism and irritability to a sense of dullness and weariness.

Impaired Attention. Soldiers’ attention spans shorten as they continue to go without sleep. Vigilance decreases rapidly, resulting in the individual missing or misidentifying critical signals.

Short-term Memory Loss. Those who are experiencing sleep loss find they cannot recall what they just saw, heard, or read. This makes it difficult (if not impossible) to learn new information, follow instructions or remember recent decisions.

Failed

Verbal Communication.

Weariness, impatience, and limited attention spans can cause conversations to wander. The sleep-deficient individual has difficulty understanding or articulating messages.

He frequently misinterprets information. Lack of Insight. Asleep-deprived person often is unaware that his performance is inadequate. He may think he is doing his job well, and angrily denies criticism of his poor work. Judgment and self-awareness suffer. This false sense of self-confidence is increased when units repeatedly use the same scenarios and terrain in their training exercises.

Safety. Tired soldiers make careless mistakes.

They seek shortcuts to proper procedures or skip them altogether. Lack of initiative caused by fatigue keeps leaders from checking their troops’ work. After 72 hours without sleep, accident rates increase by 50 percent.

Impaired Task Performance. Uninteresting, repetitive, or complex tasks are seriously affected by sleep loss. The ability to encode and decode information becomes severely degraded. Soldiers need more time to perform cognitive tasks, like plotting grid coordinates. Individuals have difficulty reasoning logically and respond more slowly to changing conditions. They seem as if in a daze.

Other

Symptoms.

Some people may experience visual hallucinations after extended sleeplessness. Others begin to neglect such routines as changing socks or filling canteens when water is available. Personal hygiene deteriorates in sleep-deficient units.9 Historical Perspectives The crippling effects of sleep deprivation can be made clearer through a few historical examples.

In The Heights of Courage, Israeli Brigadier General Avigdor Kahalani describes one incident that occurred during the 1973 Yom Kippur War. He had fallen asleep next to his tank’s exhaust pipe and awoke the next morning with third-degree burns on his thigh. Kaha-lani’s exhaustion was so complete that he never felt the heat blistering his skin.10 When combined with other combat stresses, lack of sleep can ruin a unit in short order. While fighting on New Georgia in 1943, the U. S. 169th Infantry Regiment “cracked” after enduring three days and nights of relentless harassment by a handful of Japanese infiltrators. Unit members shot and grenaded each other in alarming numbers until the regiment was finally judged combat-ineffective and sent to the rear for a rest. Sleeplessness also contributed to the evacuation of 360 troops from the New Georgia theater on July 10, 1943, due to “war nerves”

— or combat fatigue.11 Leaders are especially vulnerable to fatigue, as is evident in this example from the American Civil War. During the Bermuda Hundred campaign of May 1864, Confederate Major General Chase Whiting discovered a prime opportunity to strike the rear guard of Major General Benjamin Butler’s Army of the James as it opened the Battle of Drewry’s Bluff. Whiting’s force of 5,300 veterans found itself opposed by just two understrength Federal regiments, yet the Rebel general failed to press his attack and crush the enemy. Observers thought Whiting was drunk; in reality he had not slept for three days and was unable to think clearly enough to assess the situation correctly.12 Implementing a Sleep Management Plan Sleep discipline used to mean going without sleep for as long as possible.13 Research has proved this theory obsolete, as has experience at training centers such as the NTC. We now realize that humans need sufficient sleep if they are to remain effective in combat.

Sleep management plans are especially critical for those involved in command and control functions, namely leaders. In a combat maneuver Effects on Mental Processes Tasks More Adversely Affected Lack of concentration Sustained Lapses of attention Unstimulating Reduced vigilance Work-paced activity Slowing of action Surveillance Impaired short-term memory Inadequately learned Loss of insight High workload Misinterpretation Complex decision-making Visual illusions Disorientation Mood Effects Countermeasures Fatigue Rest periods Depression Short naps Irritability Shorter work periods Loss of interest in surroundings Rotation of duties and events High state of training Increasingly dominating Realistic training desire to sleep Mental stimulation Cross-checking Clear and simple orders Written instructions UK’s Army Personnel Research Establishment, 1986

An effective sleep management plan begins well in advance of the operation. The following hints can be used in preparing soldiers for CONOPS/ SUSOPS as well as maintaining their ability to fight once deployed.14 Pre-Deployment Phase: Units should train on complex tasks to the point of “over-learning.” If responses become almost automatic, they are more resistant to stressful, fatiguing conditions. Cross-train personnel to take over other crew members’ tasks; rotation can give some troops a rest. A high degree of physical fitness will lessen the feelings of fatigue associated with sleep deprivation. Exercising frequently-used muscle groups is especially helpful. Thus, tank loaders should develop the upper body while infantrymen need to march with packs frequently.

In general, the higher the state of training prior to sleep loss, the longer performance deterioration can be staved off (but it is still difficult to go beyond 2-3 days without sleep).

Training for extended, intensive periods allows personnel to recognize the effects of sleep loss and their response to it. However, an individual’s tolerance of sleep deprivation cannot be increased by keeping that person awake.

Troops must learn to sleep in MOPP IV if operations in a chemical environment are likely. When soldiers practice sleeping in such unusual conditions prior to deployment, the experience will reduce stress. Personnel who expect to work mostly at night should convert to a night-work/day-sleep schedule (relative to the destination time zone) for some time before departure.

Although sleep can not be stored up, unit members should rest as much as possible before deployment.

While this is typically a time of intense preparation, the alternative is to arrive in a combat zone already exhausted.

Deployment/Pre-combat

Phases: Sleep quality can be reduced during the deployment phase by time pressures, traveling in uncomfortable vehicles and changes in time zone and climate. Adopt asleep plan and follow it as closely as possible so soldiers remain fully combat effective. When a delay of several days exists between arrival and actual combat, personnel can adjust to the new time zone of their surroundings. If there is no delay, it may be best to stay with the work/sleep-rest pattern of the home station. In that case, unit members will not try to adjust their circadian rhythms to local time. They may be sleeping during the day and working at night.

Combat

Phase: The purpose of sleep management is to avoid a situation where all personnel are physically and mentally exhausted at the same time.

Ideally, every soldier should get 6-8 hours of uninterrupted sleep a night. Operational demands will certainly reduce this figure. There are, however, ways to counter the degrading effects of sleep loss on unit members.

The first and most obvious countermeasure is napping. Soldiers should take naps at every opportunity, as even ten minutes’ sleep may restore alertness for a time. Leaders must nap, setting the example for their troops. Keep in mind that individuals need more sleep if they get it by napping than if the sleep is uninterrupted. Also be aware of the risk of sleep inertia when soldiers nap during lulls in combat.

Some people work better at night. Consider their preferences when making shift schedules. Others can take sleep loss in stride for long periods. The use of backup personnel and the Second in Command (2IC) concept is essential in CONOPS. Key leaders need a chance to rest.

As sleep deprivation progresses, allow more time to accomplish tasks. Take care to make communications clear and simple. Make a habit of repeating back verbal orders. When possible, have a second person check decisions and calculations for accuracy and completeness.

Soldiers should take breaks from their duties or rotate jobs. Mild physical activity (for example, walking around) can temporarily relieve fatigue from sleep loss. To maintain CONOPS capability, proper nutrition and water discipline is essential. Hungry, dehydrated soldiers tire more easily. The same is true of personal hygiene.

Leaders must make sure their troops maintain good personal habits to ward off disease and preserve morale. Post-combat Phase: The only remedy for sleep loss is sleep. Rest is not the same as sleep. Immediately following a period of SUSOPS give soldiers an opportunity to “sleep off” their deficit. Figure 3 shows what is necessary to fully recuperate from the effects of sleep deprivation. Soldiers recovering from long periods of sleeplessness should not be awakened until they have received adequate rest. Otherwise, low performance will result. Not everyone requires the same amount of recovery sleep. Some troops’ restlessness may keep others from getting the rest they ARMOR — 17 Minimum Cumulative Restorative Hours of Sleep Usual Sleep/Rest Loss Sleep/Rest Requirement Day 1 - 24 hrs 8 hrs 4 hrs Day 2 - 48 hrs 16 hrs 8 hrs Day 3 - 72 hrs 24 hrs 12 hrs (10 sleep, 2 rest) FM 22-9, Soldier Performance in Continuous Operations, 1991

Commanders must consider this side-effect if troops need to be ready for combat on short notice.15 The Role of Drugs Soldiers receive mixed messages about the use of drugs to sustain alertness. For years, drill sergeants have warned recruits that those who take pep pills will “crash” once the effects of those stimulants wear off. Yet what command post is complete without a coffee-maker constantly brewing? Coffee and other warming beverages can raise morale and improve short-term alertness. Using over-the-counter drugs to counteract sleep loss, however, will lead to rebound fatigue and impaired judgment. German fallschir-mjager (paratroops) discovered this when they took benzedrine, a stimulant, to stay awake during sustained operations on the Eastern Front in World War II.16 Laboratory studies of drugs that help maintain alertness during SUSOPS are currently underway. Also in development is a short-acting sleep-inducing drug for use during deployments and lulls in combat. This sleep aid will be used in combination with a reawakening drug that allows soldiers to return to full alertness quickly.17 Maintaining the Initiative Effective sleep management is a combat multiplier. A commander who can apply unrelenting pressure to a weary foe will have the advantage. Well-rested, mentally alert soldiers fight better than troops who are exhausted.

Sleep management begins with command emphasis — leaders must set the example!

Those who regularly deny themselves sleep in misguided attempts to prove their endurance will fail. The smart field leader recognizes his limitations and those of his men. Techniques such as those described above will allow our maneuver forces to maintain the initiative even after weeks and months of intensive combat. In conclusion, remember that the ultimate objective of sleep management is to let us fight smarter so we can fight harder.