The practical applications of such technologies are being explored in various situations, such as military deployments and long-haul trucking (Paul et al., 2007). Paul and his Canadian colleagues have successfully countered jet lag and shift lag by timing light treatments in conjunction with timing ingestion of sustained-release melatonin. Light treatments are also being used in the treatment of seasonal affective disorder. The physiologic mechanisms are still being explored (Boivin and James, 2005; James et al., 2004). A combination of the technologies with pharmacologic agents, such as caffeine or melatonin, and structured changes in sleep patterns can assist people who must move between time zones (Piérard et al., 2001).
Most fatigue researchers point out that the solutions to worker fatigue include the participation of workers’ organizations, managers, and supervisors. Fatigue is difficult for people to manage successfully apart from their work environments. Enormous strides have been made in the design, development, and implementation of fatigue-risk management systems (FRMSs). Regulations and laws have been passed that require FRMSs, as discussed in the comprehensive FRMS guidance statement published by the American College of Occupational and Environmental Medicine (Lerman et al., 2012).
Interestingly, some people are naturally fatigue-resistant (Aeschbach et al., 2003; He et al., 2009; King et al., 2009). There might be an identifiable genetic component of that attribute that has not yet been discovered. If such a genetic component is identified, it might be a useful target for experimentation to help workers or soldiers to become fatigue-resistant.
Knowledge about the nature of fatigue associated with many kinds of specific jobs may be used to optimize operational plans. International working-time regulations may affect military or contractor duty periods during training. The accident and incident risks associated with fatigue may be documented and quantified, and the results may inform operational planning. In the next 5 years, 12-hour shifts may come to dominate 24/7 operations because of the flexibility they provide workers to structure their off-duty time. Technologies for ambient light treatment in the nighttime workplace have been deployed commercially and may be used to enhance nighttime work performance. Readiness-for-duty testing technologies have been deployed minimally in the commercial world (Axelsson et al., 1998; Bloodworth et al., 2001; Campolo et al., 1998; Dwyer et al., 2007; Laundry and Lees, 1991; McGettrick and O’Neill, 2006; Richardson et al., 2007; Smith et al., 1998; Tucker et al., 1998; Williamson et al., 1994).
In the next 5-10 years, fatigue-risk modeling will become common in 24/7 operations. Modafinil may be approved as an over-the-counter stimulant to be used somewhat like caffeine. Top-down FRMSs will be common in 24/7 operations, and the practice of removing sleep debt before critical operations will also be common. In the next 10-15 years, pretravel adjustment of the circadian rhythm will become common, and on-duty napping during 24/7 and nighttime operations will become an accepted practice. In the next 15-20 years, rapidly rotating and flexible shift plans will be used in support of 24/7 operations, and more care will be taken to ensure that enough personnel will be available to support four- and five-crew solutions to meet 24/7 work demand (Axelsson et al., 1998; Bloodworth et al., 2001; Campolo et al., 1998; Dwyer et al., 2007; Laundry and Lees, 1991; McGettrick and O’Neill, 2006; Richardson et al., 2007; Smith et al., 1998; Tucker et al., 1998; Williamson et al., 1994).
There are some indications that physiological stimulation of the human body can interfere with sleep biology (De Groen, 1979). At the crudest level, such stimulation might be a physical nudge. At the most sophisticated level, it might be brain stimulation (Dimitrov and Ralev, 2009). It is well within the realm of imagination to consider the potential of implants, such as electrodes, that might provide such stimulation if a series of warning indicators were detected. Alerts based on measurement of ocular movements and blinks have been used successfully to reduce impairment caused by drowsiness in real time in equipment-operating tasks (Johns et al., 2007).4
4Fletcher, Adam. 2012. “Technologies for Fatigue Detection and Management.” Presentation to the committee, March 8.