TERRY PRONE: A wake-up call on the dangers of closing our eyes to sleep deprivation

HE had one hour’s sleep the night before.

Only one. One hour’s sleep before stepping into the cockpit of a passenger jet as captain of the crew flying it from South America to Europe.

He said so himself, on the black box recording retrieved long after the plane went down in the Atlantic, killing three Irish doctors and 225 other passengers. The crash happened in 2009, on an overnight flight to Paris from Rio de Janeiro.

“I didn’t sleep enough last night,” the captain, a 58-year-old named Marc Debois, is heard to say on the recording before the disaster happened. “One hour. It’s not enough.”

If he had been the only sleep-deprived crew member in the cockpit, that would have been bad enough. But, apparently, all of the pilots theoretically in charge that night had under-slept, due (according to reports) to having been in Rio with their wives and girlfriends the previous night — the implication being that they were not with their wives and girlfriends in hotel beds, tucked up getting the sleep they needed, but instead, perhaps, out on the town.

When things began to go wrong on the flight, all cockpit crew demonstrated the effects of lack of sleep. First of all, the captain, who was on a break when the plane’s electronics began to yell a stall warning, took more than a minute to respond to calls from his colleagues to take over and solve the problem. When he eventually did take over, the other crew members couldn’t explain to him, clearly and succinctly, what had happened, because they, too, were groggy. The end result was that the crew took precisely the wrong action, pulling the plane’s nose up, failing to realise that this was exacerbating the problem even as the Airbus A330 headed for the ocean.

It was not simply pilot error; conflicting and fluctuating information was presented to them by the plane’s data feeds. The odds were stacked against them, but in the three and a half minutes before the jet hit the water , they failed to get on top of the issue enough to rescue themselves and their passengers.

People died, not because the pilots were drunk, but because they were tired. The crash constitutes one more potent piece of evidence that sleep deprivation can be as lethal, when the unexpected happens, as can intoxication. One more piece of evidence in a chain that goes right back to the Second World War, when the Allies experienced disaster in Aug 1942 close to Guadalcanal. A small Japanese flotilla of warships made bits of a much larger American fleet, not just due to surprise, but because the crews on the American ships were exhausted. On each of the US ships, crucial mistakes were made, including by one captain who ordered the guns and torpedo launchers stopped because he believed — wrongly — that they might be aimed at other US vessels.

He had this belief because, when he had, shortly beforehand, gone to get some overdue sleep, the mindset shared by those in command was that any attack would come from the skies. Waking up to a quite different situation, neither he nor his colleagues could comprehend what was happening.

They fumbled, made contradictory decisions, failed to notify other ships or, when receiving such notification, misread it and took astonishingly inappropriate actions. Four massive ships went down, 1,000 men died and 700 were grievously injured.

IT took 50 years for a navy psychologist, analysing the data, to work out that sleep deprivation had been at the root of the tragedy. Scanning the skies had been their task, and sleep deprivation locked their brains onto continuing that task long after its relevance ceased.

They simply could not get their heads around a situation that was radically and self-evidently different.

The same process resulted in a quarter of the American casualties during the Gulf War. One in four Americans in that conflict lost their lives as a result of “friendly fire;” rockets and other missiles aimed in error by Americans at other Americans.

David Randall’s recent study of the importance of sleep, entitled ‘Dreamland’, examines research into friendly-fire incidents conducted, post factum, by the US Army, involving interviews with those who had fired rounds at their own colleagues and those who had been at the receiving end.

“After all of their digging,” he writes about the researchers, “one truth stared at them, a conclusion that was as obvious as it was radical: Soldiers simply weren’t getting enough sleep. The skills and training built up over hundreds of hours of preparation were lost on the battlefield amid the sleep deprivation of combat. The effects of sleep deprivation were strong enough that they threatened to derail the greatest military organisation in the world.

“The needs of the human body, and the vital role that sleep plays in how the brain makes rational decisions, were trumping the top-secret technology and hardware that should have given US forces total dominance over their enemies.”

We now know the lethal impact sleep deprivation has on our reactions and on the capacity of our brains to process incoming information. The data and the significance of the data have had remarkably little effect in several important areas, for a number of reasons. For example, it’s much easier for a pilot to be spotted as having ingested alcohol than it is for them to be spotted as suffering from sleep-deprivation, and a pilot pitching up in front of a Michael O’Leary or his equivalent (which is not to say that any airline in the world has the equivalent of Michael O’Leary) claiming to have had a bit of insomnia the night before would probably get a dusty answer.

The “we went through it and it never did us any harm” school of thought, articulated by older doctors, has positioned sleep deprivation as a rite of passage which leaves the young doctor stronger, wiser, and more competent. Only recently has it become accepted that young doctors after 36 hours of wakefulness are likely to make grave errors and gain nothing from the process other than the trauma of losing a patient, perhaps their first, and knowing they contributed to the death.

Another problem, articulated by Randall, is that “a thicket of studies have shown that humans, as a rule, do a terrible job of judging not only how they slept on any particular night but also what goes into making them sleep better. Accurately estimating how long it took to fall asleep and contrasting one night of sleep with another are two skills that are simply beyond our capacity.”

Our inability to disconnect from smartphones and iPads undoubtedly contributes to sleep deprivation, as do our sedentary lives. The old rules still apply, when it comes to getting enough sleep to ensure you can cope with anything the following day throws at you: Take enough exercise, have a warm milky drink before going to bed, turn off the TV an hour before you hit the sack, and read a book.


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