Transcript Fatigue presentation - 2012x

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Don Arthur, MD
Emergency Medicine Physician
Rider
Endurance Rallying
The “Secrets”
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You can’t win without bagging the BIG points.
You can’t win without the REST BONUS.
You can’t win unless you ride a LOT.
Even if you ride a LOT, you can’t win unless you ride SMART.
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Sleep & Fatigue
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Sleep restores the brain’s chemical balance
Wakefulness develops a sleep ‘debt’
Computing
Power
Needs are individual and genetic
Cycle is normal and cannot be changed
Lack of sleep has a cumulative effect
Fatigue
Debt
We cannot ‘bank’ sleep
“More than any other factor, a winning ride almost
invariably correlates with total miles ridden.
“Never forget, however, that fatigue can easily
take it all back.”
Bob Higdon
Circadian Rhythm
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Our internal clock controls sleep-wakefulness cycle
Tries to keep us on a ‘normal’ 24 hour cycle
Synchronized to light (day) and dark (night) cycles
Mid day urge to sleep is normal and can help you
“Normal”
Sleep
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Sleep
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NOON
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Can You Change Your Cycle?
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• Yes… and everyone’s internal clock is unique
• Can easily adapt to sleep cycle shifts
• Adapts to three time zone shifts in as little as one day
• Need an additional day for each time zone shift over three
• Can adapt to work ‘shift’ changes – but slowly (days or weeks)
• But we cannot decrease our overall sleep need
“Normal”
Sleep
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Sleep
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NOON
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Disturbing the Rhythm
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• Sleeping less than normal results in
accumulation of a sleep debt
• Debt lasts until rest fulfills normal sleep
needs and repays the debt
Sleep
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Sleep
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Awaken early
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NOON
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Fatigue Effects
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• Gradual and insidious
• You may not be consciously aware – especially
if engaged in high skill or high tempo activity
• Effects are modified by:
• Individual task skill level
• Level of training/experience
Less experienced riders
are at greater risk!
Sleep
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NOON
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Microsleeps
You’ve had a microsleep if…
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Variable and unpredictable lapses in full consciousness
Can last a few seconds
Open-eyed sleep, paralysis, blurred vision, or other effects
Victim is unaware except for a vague feeling of missing time
May occur during periods of otherwise ‘normal’ functioning
At 70 mph, rider covers 103 feet every second!
“How did I get in this lane?”
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The Slowing Phenomenon
• Faulty appreciation for speed
• Decreasing ‘computing power’
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Riding speed slows
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“Ummmm… Hey Don, the speed limit here is 65.”
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Dangerous Mental Changes
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Decreased performance  slower thinking
Reduced vigilance
Loss of situational awareness
Impaired decision-making 
• Tend to choose uncomplicated options
• ‘Fill in’ perception gaps – especially at night
• Impaired long and short term memory
• Task fixation and slowed reaction time
You know you’re tired when you try to put drops in your eyes and miss.
You know you’re REALLY tired when it’s because you’re still wearing your glasses.
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Fatigue Manifestations
• Psychological changes
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Sleep becomes major subconscious focus
Mood slowly degrades and interferes with socialization
Motivation declines  faulty decisions
Eating and drinking tasks are ignored
Inhibitions wane  impatience, frustration, anger
Personal hygiene ignored
• Unexplained refusal to recognize sleep deprivation
• Impaired ability to take corrective action
• Deepens fatigue and increases danger
The greater the fatigue, the greater is our tendency to underestimate
the fatigue burden and magnitude of the drive to sleep.
This adds to the danger of unrecognized fatigue effects.
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Countermeasures
• Socialization and physical activity
• Enhances alertness while engaged in activity
• But… you will be more prone to sleep afterward
• Prescription medications
• Effects may be affected by other riding factors
• May increase susceptibility to problems while riding
• Consult your primary care provider
• Other drugs
• May improve wakefulness but only for very short periods
• Do not enhance long term (days) performance
• Significantly decrease performance after dose wears off
There is NO place in any sport for stimulant drugs.
PERIOD.
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Sleep Timing
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Normal circadian rhythm favors sleep at two times
Try to time sleep to coincide with circadian rhythm
Light and other cues lessened at night  increased risk
Fall asleep more quickly
Nap effectiveness will be enhanced
NAP
Sleep
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Nap
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NOON
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Sleep
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Sleeping or Napping
• Resting – naps v. prolonged sleep
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Repetitive ‘missed sleep’ has cumulative effect
Prolonged sleep is necessary to repay fatigue debt
Some sleep is better than no sleep
Naps provide significant recuperation but not as good as prolonged sleep
Any sleep longer than 5 minutes is beneficial
Waking after more than 45 minutes but less than 2 hours  sleep inertia
Two hours of continuous sleep ensures complete sleep cycle
Grogginess during sleep inertia is dangerous!
Prophylactic naps help
• Sleep timing
• Combine with gas/food stops… or not?
• Rest without sleep does not pay fatigue debt
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The Sleep Cycle
• Light sleep
• Jerky movement
• Easily awakened
• Moderately deep sleep
• Dreaming phase
• Erratic heart rate and
breathing
• Easily awakened
“DON’T WAKE ME UP”
Stages of Sleep
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90-120
MINUTE
SLEEP
CYCLE
STAGES 3 & 4
Deep sleep phases
Brain function very slow
Difficult to awaken
Inertia if interrupted
REM = Rapid Eye Movement – the stage of sleep where dreams occur
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40-50% of sleep time
No eye movement
Brain function slows
Easily awakened
Nap for 5-45 minutes to
avoid sleep inertia.
Sleeping more than 2 hours
provides a full sleep cycle.
Where to Sleep
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Be physically and mentally comfortable
Shelter is better than open air
Police guarded rest stops are best
Company is good
Use a ground cloth or pad to keep dry
Stay away from pet walking areas
Beware of ants and other creatures
Leave your helmet and riding suit on
Remove your ear plugs
Don’t wake others with your Screamin’ Meanie®
Yes, you can sleep while resting on your tank bag
There is no substitute for sleep.
“REST TO GO FARTHER.”
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The Iron Butt Hotel
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How to Sleep the Night Before
Overcoming Pre-Rally Excitement
• Clear your mind
• Don’t keep planning your ride
• If something is bothering you, fix it!
• Develop a bedtime routine and stick to it
• Yoga, meditation, reading
• Train your mind to anticipate sleep
• Avoid activities which require complex thought
• Have everything packed and ready to go when you awaken
• Turn your phone off
• Pay your bill ahead of time
• Set your alarm and ask for a wake-up call
• Have your bike gassed up and ready to ride
• Have something to eat and drink ready for the morning
• Sleep where and how you’re comfortable and fall asleep easily
• Roommate? Find one with similar/complementary habits
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Preparing for the Ride
• Carefully consider potential riding impact
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Chronic illnesses
Predisposing conditions
• Carry a card with emergency information
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Name, address, phone numbers
Next of kin and how to contact
Significant health history
Medications and allergies
Health insurance information
Vehicle insurance and towing information
Make an ICE entry in your cell phone contacts
Put a sticker on the back of your driver’s license
Take extra medication (in safe and dry place)
Prevention is better than treatment
When in doubt, talk with your primary care provider
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Personal Preparation
• Begin well rested
• Maintain physical fitness
• Eat properly
• Small, balanced meals
• Easily digested, low bulk foods
• Afternoon snack to counter circadian dip
• Avoid caffeine, alcohol, and tobacco
• Participate in several small rallies
before “the big one” to develop a
successful routine and confidence.
Can you find your gear…
In the dark?
In the rain?
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Bike Preparation
Prepare your bike to eliminate variability
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Consistent systematic packing
Communication equipment (phone cards, too)
Ergonomics – form and function
Comfortable seat that fits YOU
If you’re worried about your tires, change them!
Tools and tire repair kit – know how to use them!
Can you pick it up?
“SKERT”
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Eliminate Riding Stressors
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Severe time constraints
Bad weather
Excessive heat or cold
Unfamiliar roads
Monotonous scenery
Extended night riding
Increased threats – wildlife and traffic
Riding conditions beyond the rider’s ability
Complex tasks required while riding
Distractions – mechanical or personal problems
YOU’RE
LATE!
Know your limits ahead of time and stick to them.
PLAN YOUR RIDE. RIDE YOUR PLAN.
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ENVIRONMENATL
EFFECTS
Environmental Stressors
• Sun
• Wind
• Dryness
• Moisture
• Temperature
• Vibration
• Noise
Courtesy: Paige Ortiz
• Helmet – proper fit, full face, liner
• Windshield – laminar flow
• Eye protection
• UV filtering sunglasses
• Prescription lenses/bifocal inserts
• Hearing protection
• Skin and lip protection
• Powder to prevent chaffing
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Clothing
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Full body protection of your choice
Waterproofing – including gloves and boots
Ballistic contact point pads
Make sure everything is ‘broken in’
Heated clothing – vest at least
Evaporative cooling garments
The perennial undergarment debate…
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Dehydration
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Water loss from heat exposure – primarily sweating
Normal vapor loss from lungs
Normal ‘insensible’ water loss from skin
Increased water loss during heat exposure
• Keep skin covered
• Use cooling methods
• Significantly affects mental and physical functions
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Can accelerate development of fatigue
Accentuates fatigue effects
Many symptoms mimic fatigue
Dry mouth, headache  nausea, muscle weakness
• Increases risk for heart and circulation problems
• Especially when taking some medications
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Rehydration
• Stay ahead… DRINK before you need to
• Water AND electrolyte (salt) solution
• Sweating causes loss of water and electrolytes
• Need to replenish BOTH
• Low salt levels can be harmful
• Read the labels
• Amounts of electrolytes vary
• May contain carbohydrates (sugar)
• Avoid caffeine or alcohol for hydration
• Both cause water loss by increasing urination
• And this can accelerate dehydration
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For Diabetics
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• Carbohydrate (sugar) in drinks can be
dangerous for diabetics
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Can raise blood sugar level acutely
May result in rebound decreased blood sugar
May increase water output through urine
Most athlete supplements contain sugar
+ Sugar
No Sugar
• Contains necessary
electrolytes
• No carbohydrates/sugars
• Add to your water bottle
Caffeine
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• Caffeine is not a substitute for rest!
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Should be avoided prior to an event – habituation
Can be used ‘strategically’ to improve alertness
Mental awareness improved by 100-200 mg
Peak effect seen in 30 minutes, lasts 3-4 hours
Don’t consume prior to anticipated rest – disturbs sleep
Will increase urine output!
• The ‘Caffeine Nap’
• Drink a caffeinated beverage just before a nap
• The caffeine will be absorbed during the nap
• Caffeine effects will manifest upon awakening
Caffeine is a drug – use it wisely!
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Caffeine Sources
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Effective dose = 100-200 mg
Grande
330mg
10 ounce
130mg
12 ounce
30-45mg
12 ounce
55mg*
12 ounce
140mg
8 ounce
60mg
400mg/
Packet
200mg/
Tablet
12mg/
Piece
2 ounce
207mg
8 ounce
80mg
9mg/
Piece
8 ounce
5-25mg
Remember, caffeine is a diuretic!
* NOT IN CANADA
5-hour Energy Drink
“Regain the feeling of energy and mental
alertness with 5-Hour Energy Drinks. It’s
better because you can actually feel it
working. It starts with a tingle, a sudden
rush, then KAPOW. Grogginess is gone
and you’re running on all cylinders. Your
mind is alert and focused. Your body is
ready for action.
“5-Hour Energy Drinks provides a boost of
energy and mental alertness that lasts for
hours – with no crash. That’s because 5Hour Energy is packed with B-Vitamins,
enzymes and amino acids.”
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5-hour Energy Drink
Supplemental Facts
Serving Size 1.93 fl. oz.
Amount Per Serving
% Daily Value
Niacin (as Niacinamide) 30mg
150%
Vitamin B6 (as Pyridoxine Hydrochloride) 40mg 2000%
Folic Acid 400mcg
100%
Vitamin B12 (as Cyanocobalamine) 500mcg
8333%
Sodium 18mg
<1%
Energy Blend
1870mg *
Taurine, Glucuronic acid (as or from gucuronolactone),
Malic Acid, N-Acetyl L-Tyrosine, L-Phenylalanine,
Caffeine, Citicoline
* Daily value not established.
Other Ingredients: Purified Water; Natural and
Artificial Flavors; Sucralose; Potassium Sorbate,
Sodium Benzoate and EDTA (to protect freshness).
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• Contains 207mg of caffeine.
(“…as much as a cup of coffee”)
• … and a whopping dose of Niacin
(Vitamin B3) which causes dilation of
blood vessels and a flushed feeling,
giving the impression “It’s working.”
• These effects may increase water and
heat loss due to blood vessel dilation.
• Side effects include nausea,
vomiting, dizziness, insomnia, arm
and leg numbness, rapid heart beat.
Ride Safely
• Know when to stop.
• Stop before you need to
• Stop to go farther!
• Have a routine for stops.
• Gas… log?
• Food
• Et cetera
• Get gas before you need to.
• Separate gas from rest stops?
• Avoid high speeds.
• Greatly increases fatigue
• Greatly increases risk
• Consistency wins!
• Stay away from trucks!
NO RIDE IS WORTH YOUR LIFE!
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Be On The Lookout!
Distracted drivers
…are out to kill you!
You’re four times
It’s hard to
more likely to have
concentrate on
a road accident
two things
when you’re on
at the same time.
a mobile phone.
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Enjoy the Ride!
[email protected]
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