Chronic Fatigue in Aviation: Causes, Risks, and Prevention

Introduction to Fatigue and Aviation

Fatigue is the mental and/or physical state of being weak and tired. Mental and physical fatigue differ from each other, but the two will often exist together. A person becomes mentally tired if they are physically exhausted for a long period, while physical fatigue manifests as an inability to function at normal levels (Jackson & Earl, 2006).

Mental fatigue manifests as a sleepy feeling and an inability to concentrate properly. In medical terminology, fatigue is not a sign but rather a symptom, meaning that a person suffering from fatigue is able to feel and describe the condition. Experts have indicated that around 10% of people globally suffer from persistent tiredness at any one time, and females are more prone to persistent tiredness than males. It is not easy to define fatigue in humans because of its large variability of causes, which range from circadian rhythm disruption and boredom to heavy physical exertion (Caldwell, 2005).

In nonprofessional terms, fatigue is defined as weariness. More precisely, fatigue is a condition characterized by increased discomfort leading to loss of power, a lessened capacity to work, reduced capacity to respond to stimulation, and diminished efficiency—normally accompanied by a feeling of tiredness and weariness.

The consequences of fatigue are relatively minor for an average person, but for those working in safety-critical environments—such as piloting an aircraft, operating a motor vehicle, running a nuclear reactor, or performing surgery—the consequences can be disastrous. In the aviation industry, fatigue is an important factor associated with shift work and loss of sleep. Long duty cycles can cause flight crews to become careless, inefficient, and inattentive (Jackson & Earl, 2006).

According to Caldwell et al. (2009), aircrews suffer from fatigue due to irregular work-rest cycles, transmeridian flights, and other work-related factors. The frequent loss or disturbance of sleep experienced by flight crews also leads to fatigue. Fatigue has led to errors, incidents, and other problems in the aviation industry. According to NASA, fatigue contributed to 21% of reported aviation incidents. Crews flying aircraft of all sizes face fatigue problems, and this remains a continuing concern.

Causes of Fatigue in Aviation Workers

There has been significant evolution in operational demands and aviation technology, yet the need for sleep by human operators has remained constant. No amount of technology can counter the need for sleep, especially when the technology requires a human operator. Fatigue can degrade many aspects of performance, including decision-making, judgment, reaction time, memory, selective attention, fixation, concentration, and mood. Avers and Johnson (2011) posit that the low arousal produced by sleep loss is accompanied by greater performance decrements on simple tasks. The simplification of aviation processes through technology has, in turn, contributed to this performance decrement.

The amount of sleep required by individuals differs, but studies suggest that most people need around eight to nine hours of sleep per night. Non-shift workers generally sleep more than shift workers. Pilots claim they need at least 7.5 hours of sleep per night. Sleep timing influences the duration of sleep, meaning that crossing time zones can lead to cumulative sleep deprivation. People have the capacity to cope with small amounts of fatigue, and catching up on sleep will help work it out of their system. However, the continuous accumulation of fatigue can lead to potentially dangerous effects. Circadian rhythms and sleep debt are the two main causes of fatigue.

Circadian Rhythms and Shift Work

A person's body temperature, human error rate, alertness, and sleep tendency follow a 24-hour pattern. The body maintains a steady 24-hour biochemical, behavioral, and psychological rhythm — these are known as circadian rhythms. Human beings are diurnal creatures, meaning they are awake during the day and sleep at night. Exposure to light, especially early morning light, affects the human body clock. A person's circadian rhythms are so reliable that even if the person is removed from their normal 24-hour cycle of day and night, the rhythms continue to run. Circadian rhythms affect aviation workers particularly those working the night shift. Even with enough sleep during the day, these workers still experience fatigue while working — not because they have not slept enough, but because of their natural circadian rhythms.

Understanding circadian rhythms is vital in the aviation industry. Managers who are aware of what their employees experience can develop strategies to mitigate the risks associated with circadian rhythm disruption. Circadian rhythms play a vital role in the regulation of sleep. There are chemical changes that occur naturally in the body when it is preparing to sleep, and this typically takes place between 8 pm and midnight. At around 3 am, a person's body temperature reaches its lowest point and then begins to rise steadily as the body prepares for the day ahead, often well before most people are awake.

Managers need to recognize that the most critical time for shift workers is between 2 am and 5 am — the window of circadian low. A person's body temperature is at its lowest and mental alertness is at its poorest during this period, making the likelihood of errors highest. Aviation workers also experience this circadian low, and flight crews are most likely to cause incidents during this window. Sleepiness reaches its peak at this time. If piloting an aircraft, a pilot who begins to doze may interfere with flying instruments unknowingly or may be unable to respond quickly to any developing problem.

Another peak in sleepiness occurs between 3 pm and 5 pm — the afternoon nap window for most people. A person whose sleep was disturbed or restricted the previous night will find it particularly hard to stay awake during this window the next day. Taneja (2007) argues that employees affected by circadian rhythm disruption who nonetheless maintain a "can-do" attitude will struggle to stay awake and continue performing their tasks normally. This is dangerous, as the employee will have a slower reaction speed, be more prone to errors, and exhibit poor decision-making. Employees need to understand their circadian low periods and avoid performing safety-critical work during those times. While this may reduce the number of ground incidents, pilots and flight crews face additional risk because they must remain alert at all times — any loss of consciousness in the air can have severe consequences.

Sleep Debt and Its Accumulation

Adults need around seven to eight hours of sleep per night, though this need varies between individuals (Caldwell Jr., 1997). A century ago, before the widespread use of electric lighting, people slept approximately nine hours per night. Today, work commitments, television viewing habits, and family demands combine to limit the amount of sleep a person gets each night. In the busy aviation industry, many people suffer from sleep deprivation without being aware of it. Extreme sleep deprivation can have severe health consequences, but even mild sleep deprivation can affect an employee's health and ability to perform simple tasks both at work and in their personal lives (Signal, Ratieta, & Gander, 2006).

Sleep debt builds up every time a person obtains less sleep than needed. With each successive night of inadequate sleep, a person adds to their sleep debt. Reducing sleep by only one hour per night over several nights can measurably reduce a person's mental capacity.

Shift workers who work at night must sleep during daylight hours, which causes sleep debt to accumulate. Daytime sleep tends to be shorter and of poorer quality compared to night sleep. Providing shift workers with alternating schedules following a full day off will help ensure they can clear their sleep debt (Caldwell, 2012). Because the aviation industry operates 24 hours a day, night shifts are unavoidable. To reduce sleep debt, night-shift workers should ensure that their bedrooms are kept dark during the day, as light affects sleep patterns and its reduction increases sleep duration. Research has shown that shift workers experience one to two hours of sleep loss per 24-hour period.

Family commitments and the nature of the work can also deny a person adequate sleep, further increasing sleep debt. Other contributing factors include drugs, alcohol, and medical conditions. Insomnia, restless legs syndrome, sleep apnoea, and periodic limb movements are all medical conditions that can interfere with a person's sleep patterns and total sleep time.

Conclusion

Receiving enough sleep is the only way to resolve and prevent fatigue. Sleep provides the body with a period of recuperation and rest that reduces tiredness and restores performance capacity. Fatigue can affect all workers in the aviation industry — not only flight crews — and accepting this reality gives organizations the opportunity to mitigate risks proactively rather than reactively.

Fatigue management is critical in aviation. Because fatigue is not well understood by many employees, educating them on what fatigue is and advising them to avoid handling sensitive equipment when fatigued will meaningfully improve aviation safety. Some operators claim not to need fatigue management systems, insisting that common sense is sufficient. However, fatigue is not employee-induced — it results from a complex combination of work-related and personal factors. If operators do not provide employees with adequate rest after night shifts, those employees will return to work carrying sleep debt and will be prone to errors on even simple tasks. A systemic, management-driven approach to fatigue risk management is therefore essential to the safety of the aviation industry.

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