Motorcoach Industry Hours of Service and Fatigue Management Techniques (2005)

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CHAPTER 3 STRATEGIES AND TECHNIQUES TO COUNTER FATIGUE Transportation industries of all modes continue to search for ways to prevent or counter the effects of operator fatigue. Fatigue countermeasures are identified in one of three gen- eral approaches: (1) individual personal actions (e.g., care- fully monitoring one’s diet, obtaining plenty of rest, and avoiding some medications), (2) managerial (e.g., scheduling and assignments and company policies), and (3) technological (e.g., in-vehicle operator monitoring devices and road and highway design features). A fourth approach, of course, is reg- ulatory and pertains mostly to HOS considerations as briefly described earlier in this report. The McCallum et al. (2003) report addresses 20 fatigue countermeasures. The authors organized the 20 counter- measures into four categories based on the results of varied amounts of research. Some of the countermeasures are known to be effective; some might be effective but are still being studied; others require medical or other professional supervi- sion; and some simply do not work or may even have harmful health effects. A second major information source for this dis- cussion is TCRP Report 81: Toolbox for Transit Operator Fatigue (Gertler et al., 2002). COUNTERMEASURES THAT CLEARLY WORK The countermeasures described in this category are effec- tive as shown by research data and operational experience. They encompass both the prevention of fatigue by getting enough sleep and the mitigation of fatigue through counter- measures applied when one is getting tired. Individual countermeasures may need to be combined, based on spe- cific operational circumstances. Countermeasures included in this category are as follows: • Obtaining adequate sleep, • Napping, • Anchor sleep, • Caffeine, • Trip planning, and • Good sleeping environment. Obtaining Adequate Sleep Historically, the medical community believed the brain was inactive during sleep, but research over the past half cen- tury demonstrated sleep actually consists of several stages 10 and, in some of the stages, the brain is often very active. A typ- ical night’s sleep consists of cyclic sleep stages. The only way that the different stages are easily recognizable is through the use of electroencephalography (EEG), a physiological record- ing means that measures changes in the electrical brainwave potentials on the surface of the scalp. With the possible excep- tion of rapid eye movement (REM) sleep, merely observing an individual asleep will not identify the various sleep stages. Lengthy bouts of human sleep consist of several 90-minute cycles of brainwave stages. Each sleep cycle consists of sev- eral sleep stages, some deeper than others and not all of them conducive to dreaming. The basic stages of sleep are as fol- lows: • Stage 1 occurs as we drift off to sleep. This is a relaxed, half-awake state of “falling asleep” or light sleep. • Stage 2 sleep begins as relaxation proceeds and the heart rate slows. During this period, body movement ceases and muscle tension eases. • Stages 3 and 4, often referred to as slow-wave sleep, are characterized by different brain activity levels. These are deep states of sleep, which are more difficult to awaken from and, along with sleep, constitute the stages of sleep that are truly restful and restorative. • REM sleep, usually occurs last after a cycle or two of Stages 1 through 4 sleep have been obtained. REM sleep, as the name suggests, is characterized by rapid eye movements and generally occurs at the end of each 90- minute cycle. This part of the sleep cycle is character- ized by significant brain activity, electrophysiologically, almost as if the brain were actively awake, but only the eyes are moving behind the eyelids. During REM sleep there is a lack of muscle tone, thus preventing the indi- vidual from “acting out” dreams. During the night, sleep behavior may systematically alter- nate between the slow wave and REM stages. As the night pro- gresses, REM periods lengthen so that sometimes the last one before awakening may comprise almost one-half of the sleep cycle. Sleep specialists agree that adults need an average of 7.5 to 8 hours of sleep every night to perform in a maximally alert fashion on the job. However, there are exceptions. Some indi- viduals can function normally on as little as 6 hours of sleep, while others require 9 hours. To be most restful and recupera- tive, sleep stages should proceed through all the sleep cycles.

This is why eight 1-hour naps do not provide the restorative rest of a longer continuous sleep period. Understanding one’s individual sleep pattern is crucial for taking the steps to ensure sufficient restorative sleep. People can determine their optimum sleep amount by recording their sleep start and stop times on their third consecutive day off when they are not using an alarm clock to wake up. The amount of sleep needed should be enough to feel refreshed and healthy the next day, but not more—this will usually be between 7.5 and 8.5 hours. Based on the amount of sleep needed, people should establish a habitual time for going to sleep and waking up, and then maintain this sched- ule whether or not it is a workday. Additionally, daily exer- cise helps to promote sounder sleep. Getting good sleep depends on knowing what to avoid prior to sleeping. It is especially important to avoid caffeine, a widely used stimulant compound—it should be avoided within 4 to 6 hours of going to sleep, since caffeine effects can last that long. It is also important to avoid drinking alco- hol within 3 hours of bedtime, because alcohol fragments sleep and makes it less restorative. Cutting down or elimi- nating nicotine is important for promoting good sleep. Drink- ing fewer fluids before going to sleep will reduce awakenings to use the bathroom. Napping Napping is one of the most popular coping mechanisms for those working nontraditional hours. Although science is split as to the benefits and consequences of napping, there is signif- icant evidence of the value of supplementing the primary sleep period with a nap. In recent years both railroads and airlines have instituted policies that permit napping during work hours. An excellent description of the value and strategy of napping can be found in Gertler et al. (2002) and is quoted below. Research has shown that subjective sleepiness and sleep qual- ity seem to be a function of the total sleep over the course of the day, and not a function of the number or lengths of the naps. In other words, napping can be effective for meeting the daily sleep requirements, but the length of the nap determines whether or not it significantly adds to a short main sleep period. A nap of less than 90 minutes, or one that does not go through an entire sleep cycle of slow wave and REM sleep, will not sig- nificantly add to a short main sleep period and may not prevent the onset of fatigue. While a nap of up to 20 minutes may not compensate for inadequate daily sleep, it may eliminate the per- formance manifestations of fatigue for a short period of time. This type of nap is usually unscheduled and results from an uncontrollable sleep pressure or need to sleep. As such, this “emergency” nap should be reserved for infrequent use and not be a regular component of an individual’s sleep schedule. Scheduled naps of appropriate timing and duration, well inte- grated into the worker’s sleep management program are a bet- ter course of action. With all naps the issue of sleep inertia or hangover is a factor, just as it is with main sleep periods. Nap placement may be key to the consequences of nap- ping. The timing of a nap rather than its length has more of an effect on an individual’s alertness or performance fol- 11 lowing the nap. Research showing a benefit to napping placed the nap right before the work start time while research reporting a performance decrement due to napping allowed napping to occur throughout the day as desired. This illus- trates the complexity of napping. Both the length and timing of a nap are co-dependent on each other and may affect one’s performance and alertness differently depending upon their level. While many research questions still remain with regard to naps, when used appropriately napping is a viable strategy for supplementing an inadequate main sleep period and as such can improve on-the-job alertness. Since napping is a primary self-prescribed fatigue countermeasure, often without regard to appropriate usage and potential negative consequences, providing information on effective napping strategies can help the workforce to be more alert on the job. (Gertler et al., 2002, pp. 22–23) Anchor Sleep Anchor sleep refers to a regular sleep period of at least 4 hours’ duration, obtained at the same time each day. The anchor sleep period is supplemented by additional sleep peri- ods (e.g., naps) taken when the schedule allows. Employing an anchor sleep and taking supplemental naps should be used as a coping mechanism for situations where one cannot get a full continuous eight hours of normal sleep. While split sleep periods may give one a sufficient amount of sleep on a short-term basis, getting a full sleep allotment in a single episode is preferred. Anchor sleep periods have the advantage of stabilizing a person’s circadian physiological rhythm to a 24-hour period, so that a motorcoach operator does not constantly feel “out of synch” with the clock. He or she can time the anchor sleep period so that the circadian rhythm high and low points correspond to work and sleep periods. Research data indicate that it is important to have the anchor sleep period occur at a constant time every day. If a driver is going to use anchor sleep, the driver and the company must make sure his or her schedule allows this. (Minors and Waterhouse, 1981, 1983) Anchor sleep is not a substitute for getting a full 8 hours’ sleep during any 24-hour period. Instead, it is a coping mech- anism meant to keep one’s circadian rhythm synchronized to a daily schedule. It is important to supplement anchor sleep with naps that are sufficient to provide the complete sleep allotment that we need on a daily basis. This countermeasure anchors the sleep cycle. Caffeine Our bodies gradually build up a tolerance to repeated con- sumption of high levels of caffeine (e.g., 5+ cups of coffee per day). A frequent coffee drinker may need a higher dose of caf- feine to obtain the same “boost” effect of the more casual cof- fee drinker. Therefore, workers who wish to benefit from the alerting effects of caffeine should consume caffeine sparingly and “save the boost effect” until they really need it (e.g., during

two known physiological lull points of every day: 1–4 PM and 1–4 AM). Caffeine, a mild stimulant, is one of the most commonly used fatigue countermeasures, usually through drinking coffee. Other popular drinks and foods contain a lot of caf- feine, including cola drinks, chocolate, and tea. Caffeine is widely available and can have the advantage of break- ing up a fatiguing work routine (e.g., a long, monotonous drive). Caffeine affects the nervous system within 15 to 20 minutes. The effects include a more rapid heartbeat and increased alertness that may last for 4 to 5 hours. In especially sensitive individuals the effects may last up to 10 hours (De Valck and Cluydts, 2001). Coffee has the highest caffeine level, followed by tea, cola drinks, and chocolate. Over-the-counter cold medica- tions also contain caffeine, as do “alertness aids” such as NoDoz and Vivarin. The caffeine content of coffee may vary substantially depending on preparation. The irony of caffeine is that although it can aid alertness when a motor- coach driver is on duty, it may hinder his or her ability to sleep once off duty. And large amounts of caffeine raise one’s blood pressure for the period of time the caffeine is still in the bloodstream. Trip Planning Trip planning is using knowledge of the length and structure of a trip to plan rest intervals at particular times and places en route. The limitations on trip planning involve factors that are often outside of a driver’s immediate control, such as when his or her work shift starts, the availability of rest areas, and the pace of operations. In general, trip planning is an effective approach to start- ing work more refreshed, and alleviating fatigue while on the job. The primary advantage of trip planning is that motor- coach operators can anticipate those times at which they will be feeling fatigued and do something about it before it low- ers performance to unsafe levels. It also provides some struc- ture along the route so drivers will be less likely to overextend themselves. Proper use of trip planning and the associated rest intervals will keep drivers from getting dangerously fatigued and also allow them to plan where and when to sleep for their main sleep period during multiple-day trips. Trip planning can be considered both a preventive countermeasure, as well as an operational approach (Rosekind et al., 1995). The difficulty of trip planning for motorcoach operators lies in the pre-determined schedules within which they must operate. Itineraries are seldom built with the coach driver in mind. Passenger needs, whether individuals traveling point to point or tour groups, determine the basic schedule for the motorcoach operator. He or she must be able to identify places to rest and break while meeting the scheduling demands of the passengers. Motorcoach company managers should be 12 encouraged to fold the resting needs of their drivers into the scheduling equation. Good Sleeping Environment The sleep environment should be quiet and dark, using room-darkening shades if necessary. Earplugs can be helpful if there is noise. The temperature of the sleeping room should be around 65°F, and the bed should be used only for sleeping— not for activities such as reading or television watching (Zarcone, 2000). One clear advantage for motorcoach operators in com- bating fatigue is their access to hotel and motel rooms on a regular basis. The McCallum et al. (2003) report makes the following recommendations to drivers seeking restful sleep: To ensure quiet, you should remove any noise sources, espe- cially those that are unpredictable (e.g., pets in the bedroom). Use of earplugs to reduce traffic noise or other external sounds helps many people, as does use of a constant low- level noise source such as a fan. Reducing the amount of light in your sleeping area can be done by using black out shades over windows, heavy dark fabric for curtains, or “hurricane shutters” over windows. Some people also use eye shades in areas where there is substantial light leakage (p. 4–14). COUNTERMEASURES IN THE RESEARCH PHASE The countermeasures described in this category show promise for reducing fatigue, but generally they are some dis- tance from practical application and are not available for implementation without the assistance of fatigue research pro- fessionals. The countermeasures included in this category are, for the most part, technological or medical. Carroll (2004) reports on an FMCSA-sponsored fatigue management technology (FMT) pilot study conducted in partnership with Transport Canada and the American Trans- portation Research Institute. Although the study focused on the operators of commercial trucks, the findings could rea- sonably be applied to motorcoach operations as well. This most recent study looked at a combination of four dif- ferent technologies that tested four different kinds of fatigue management. One device was a wristwatch activity monitor that, based on objective information regarding the driver’s recent sleep history, informs him or her of his or her state of readiness to continue to perform well before requiring addi- tional sleep. The second device, called PERCLOS (PERcent of the Time Eyelids are CLOSed), is a system for infrared camera monitoring of driver drowsiness. The study was to determine if providing objective information about the amount of eye- lid drooping could improve driver alertness (Dinges and Mallis, 1998).

The third device, a lane-tracking device, provided a sec- ond measure that presumably also measured driver alertness by monitoring the driver’s performance in keeping the vehi- cle in the center of the driving lane. The fourth technology was a power steering system for reducing driver workload in controlling the truck in tough driving circumstances such as driving in cross winds. The results of the study indicate that drivers who are informed frequently about their sleep status will take steps to get more sleep; in the study, those drivers who were pro- vided with feedback from the wristwatch device increased their sleep duration by 26 minutes a day. The FMCSA study elicited encouragement from the drivers for researchers and engineers to continue development of such technologies; and the drivers recommended many improvements to the design of the prototype devices tested to make them more user-friendly. At least two viable lane-tracking systems designed to mon- itor and inform drivers about their driving performance are being offered to commercial drivers and marketed to auto- motive original equipment manufacturers (OEMs). Addition- ally, in other exploratory research, technologies such as driver head movement monitoring have also shown promising results. Companies in Japan have had success in monitoring driver inputs (i.e., steering, brakes, and throttle) to assess fatigue. Much R&D has been accomplished and now selecting which driver monitoring technologies to employ and further devel- oping them begins to focus on driver-vehicle interface, pack- aging, and generating cost/benefit data that are compelling to fleet buyers. COUNTERMEASURES THAT REQUIRE SUPERVISION The countermeasures described in this section either require a prescription by a physician (e.g., drugs such as stimulants or hypnotics) or require guidance by a person trained in circadian physiology for best application (e.g., melatonin). Drivers must be careful about countermeasures in this category, because side effects and dependencies can develop from the use of many chemical substances. The countermeasures included in this category are • Stimulants, • Sedatives/hypnotics, • Melatonin, and • Bright light. Stimulants Stimulants exert a physiological effect on the nervous sys- tem so that the effects of sleep loss can be temporarily reduced. Caffeine (discussed in a separate entry) is an example of a stimulant—one that does not require a prescription and that 13 does not have adverse side effects unless consumed in very large quantities (Babkoff and Krueger, 1992). Even under the guidance of a physician, many stimulant compounds can have unwanted and even dangerous side effects that can affect one’s performance and health. These effects may include changes in blood pressure and pulse, headaches, irritability, appetite loss, insomnia, nervousness, talkativeness, and sweating. Herbal stimulants are unregu- lated, and the effects of many are unknown because of lack of proper evaluation. However, it is known that ephedra in particular is associated with heart attack and stroke and is likely to soon be controlled (Gyllenhaal et al., 2000). Most stimulants, except caffeine, are not permitted in oper- ation of public transportation vehicles in the United States and many other industrialized nations. Many stimulants have a high potential for addiction and abuse because of the rapid euphoria that results from high doses. The use of stimulants can lead to a cycle of binging and crashing, and long-term abuse can lead to mental and behavioral disorders. Possession and use of controlled substances without a proper physician’s prescription is illegal and can result in fines and jail time. All motorcoach operators are subject to regulations ban- ning use of illegal substances while operating a motor vehi- cle. Random drug testing is regularly carried out to cut down on the use of most known stimulants. Sedatives/Hypnotics Depending on the specific type of drug class, sedatives can cause changes in the nature of a person’s sleep. Generally, the use of sedatives does not change the overall amount of sleep for an individual. Although some sleeping pills (used only while under a physician’s prescription) can help a driver to obtain needed sleep, they often are accompanied by unwanted side effects. Sedatives and hypnotics have the advantage of being applicable to a number of situations that might interfere with sleep, such as shift changes, jet lag, or stress-related short- term insomnia. The drugs can help to alleviate these short- term problems and be discontinued to preclude the risk of dependency. Under no circumstances should anyone use these medications without the close supervision of a physician. If hypnotics are used for a long period of time, the user may develop a dependence on them, and there often is a “rebound insomnia” in which sleep is slightly worse for 1 or 2 nights after discontinuing the drug even if it was used for only short periods of time. If the drug is a particularly long- acting one, or if the user has high sensitivity, there may be a sleep inertia “hangover” effect the next day in which a per- son will feel sluggish after awakening from the drug-induced sleep (Roehrs and Roth, 2000). Herbal remedies such as Valerian root, chamomile, kava, and lavender are promoted as sleep aids, but the evidence for their effectiveness is much less clear.

The significance of the physiological changes associated with sleeping pills make it difficult to recommend use of most commercially available pharmaceutical products at this time. Melatonin Melatonin is a natural sleep sedative hormone produced by the pineal gland in the brain. Melatonin levels increase in the blood stream during hours of darkness. Commercially avail- able synthetic melatonin sold in health food stores is often used in attempts to induce sleepiness and to help one adjust the circadian rhythm to new schedules (e.g., to overcome jet lag after transmeridian travel). However, the production of synthetic melatonin is not regulated by the Food and Drug Administration, so the quality and purity of individual pack- ages of the product is inconsistent. If one can obtain good quality synthetic melatonin and a proper use regimen can be worked out, use of melatonin offers good promise to assist drivers in stabilizing their sleep schedules. Because melatonin naturally dissipates in the blood stream in bright light, its use as a sleep sedative is effective only in a darkened room, or a blackened-out truck sleeper berth. Many drivers report successfully using mela- tonin to induce sleep during their required down time when they ordinarily might not have gotten to sleep without it. The sleep inducing properties of synthetic melatonin are short term. Although potentially helping an individual fall asleep more quickly, the use of melatonin will not neces- sarily lead to longer sleep periods. Those who successfully use melatonin as a sedative take it in a pill form in hopes it will help them fall asleep quickly at times when they might otherwise have trouble sleeping (e.g., during daylight hours). Individual experiences with commercially sold synthetic melatonin vary widely, perhaps partly because the actual con- tents of pill form melatonin are not clearly identified by the manufacturers and very likely because no recommended plan of use regimens have been succinctly worked out as of yet. Medical research continues in numerous government and university research laboratories to determine the potentially promising use of synthetic melatonin as a sedative and to identify any as-yet-unknown side effects. If commercial drivers plan to use synthetic melatonin over a period of time, it is recommended they consult with a physician to determine what the latest research findings are on repeated use (National Sleep Foundation, 1997). Bright Light The use of bright light as an operational fatigue counter- measure refers to timing the exposure to outside or bright indoor light in order to shift the circadian rhythm to corre- spond to a new work schedule or to enhance alertness. Use of light exposure for resetting the circadian rhythm is a 14 complex undertaking and should be guided by a person knowledgeable in circadian physiology. Additionally, the benefits of resetting the circadian rhythm can be maintained only through fairly rigid adherence to the procedure and ensuring that other time cues (e.g., daylight) are minimized (McCallum et al., 2003). The idea is to use bright light exposure to shift circadian rhythm toward work schedule requirements, so that the oper- ator will obtain more sleep and be more alert when on the job. The required light is in the range of 3000 to 10000 lux— much beyond that obtained simply from indoor lights. Special equipment is required to generate this level of illu- mination, and some evidence suggests that the green wave- length is especially effective. Using light exposure for several hours over a several-day period is usually most effective in shifting the circadian rhythm, although periods as short as 30 minutes have been shown to have an effect (Wright and Lack, 2001). This countermeasure has been particularly useful for pilots and other transport workers who either rapidly shift through multiple time zones or who work on a forward rotating sched- ule that changes by one shift each rotation (e.g., day shift, afternoon, night). Given that motorcoach operators do not quickly transit across multiple time zones, it is unlikely that they will find this countermeasure to be very practical in their work situation. COUNTERMEASURES THAT HAVE MINIMAL EFFECTS OR MAY CAUSE HEALTH PROBLEMS The following fatigue countermeasures are not supported sufficiently by scientific data demonstrating their effective- ness (e.g., diet or aromatherapy) or they may cause health problems (use of tobacco and/or nicotine). Other countermeasures that have been commonly reported, such as exercise, diet, or listening to the radio have minimal or no lasting impact on driver fatigue, even though people think they do. The countermeasures included in this category are as follows: • Nicotine (not an effective stimulant for maintaining alertness); • Ventilation and temperature (effects are fleeting and temporary); • Exercise (taking rest breaks and exercising energizes one for a short while, but then onset of driver drowsiness returns quickly); • Diet (longer term solution to health, wellness, and fit- ness helps to a point); • Sound (noise-induced alertness gets old and tends to be aggravating to a tired driver); and • Odor/Fragrance (fleeting effects are not very helpful in maintaining alertness).

COUNTERMEASURES SPECIFICALLY USED BY THE OVER-THE-ROAD BUS INDUSTRY The focus groups from the 1999 study (Arrowhead Space & Telecommunications, Inc.,1999) also recommended a set of countermeasures specifically to offset bus operator fatigue. The study report lists the following countermea- sures: 1. Increase minimum off-duty time for drivers to at least 10 hours between trips and improve opportunities for drivers to get better rest during long and overnight trips. 2. Minimize inverted duty sleep cycles for drivers during extended tours and trips. 3. Establish “first in/first out” dispatch protocols to mini- mize stress and fatigue-producing situations associated with dispatch. 4. Enhance total compensation packages for drivers to attract more quality drivers to the motorcoach indus- try and to retain them. 15 5. Provide training on fatigue causes and countermeasures for bus drivers on a regular basis. 6. Provide bus drivers with skill training in areas such as passenger management and conflict resolution to reduce daily stress factors. 7. Provide effective outreach and education for tour group organizations and the general bus riding public regard- ing regulatory and operational limitations and bus driver fatigue. 8. Encourage the federal government to regulate the motorcoach industry as a separate entity in terms of operations and situations related to driver fatigue. 9. Compile relevant data specific to the motorcoach industry determining the number of units in operation, miles driven, accidents, and so forth. 10. Increase and enhance motorcoach federal regulation enforcement. 11. Include tour group operators as responsible parties for compliance with regulations by motorcoach opera- tors and drivers.