Fatigue and the modern sailor

The quality of sleep can be as important as the amount in reducing fatigue and the quality of sleep can be affected by sleep disorders. Should owners and crew leaders take a closer look at the diagnosis of sleep apnea and the available therapeutic responses? The answer seems to be a resounding yes!

As is well documented, "fatigue degrades a person's cognitive abilities by slowing reaction time, reducing alertness and negatively affecting decision-making, all the skills necessary for effective navigation and system diagnosis. vascular. Research has shown that people need about eight hours of sleep a day and that they receive less than that can result in degraded performance through fatigue. Accident investigations have linked seafarers' mistakes to their fatigue. (Barry Strauch, ScienceDirect, 2015).

Fatigue-related accidents today pose a problem as important as in 2002, when the Gard first published an Insight article on the subject: are we fed up with it? 39, hear about fatigue-related victims?

Fatigue is caused by a variety of factors such as stress and excessive workload, but is also strongly influenced by a person's ability to "sleep well". In addition to environmental factors such as noise and vibration, the quality, quantity and continuity of seafarers' sleep are greatly influenced by the usual working hours on board. As a result, fatigue management strategies typically begin with the identification of operational workload requirements and on-board manpower and shore support resources, coupled with effective workload and time management. job.

However, a variety of sleep disorders is also known to disrupt the quality of sleep and make it impossible to get a restful sleep, even when individuals spend enough time trying to sleep. The most common sleep disorders are sleep apnea, insomnia, restless leg syndrome, sleep disorder and narcolepsy. Sleep disorders pose a particular risk to seafarers, as maritime operations already expose seafarers to limited sleep.

Since studies have concluded that fatigue plays an important role in marine accidents, it is not surprising that the shipping industry is looking for an action plan based on evidence. Here we discuss sleep apnea – a disorder often undetected and therefore untreated – to the detriment of individual crew members and, inevitably, to a safe use of the ship.

Sleep Disorder Respiration (SDB) describes two major disorders:

• Obstructive sleep apnea (OSA), characterized by repeated episodes of obstruction of the upper respiratory tract during sleep.
• Central sleep apnea (ACS), characterized by a lack of respiratory drive, causes respiratory instability and breaks. CSA is associated with patients with existing cardiovascular or neurological diseases.

We will focus on the first disorder, OSA, because it is by far the most common. As is well documented in medical journals, the OSA presents a significant causal correlation with high blood pressure, cardiovascular disease, coronary heart disease and an independent risk factor for stroke. Additional medical research indicates possible links with atrial fibrillation, heart failure and diabetes (other studies are ongoing). All these diseases are serious, leading to a very significant disability and premature death.

Diagnosis, treatment and prevention of losses

A correct diagnosis of AOS is simple, involving only a night's sleep connected to sensory medical equipment. Once the diagnosis is made, the treatment is also simple and effective. The C-PAP machine is the main medical tool available worldwide. The C-PAP is a mask worn at night connected to a machine that sucks air, pushes it into the connection tube and places it in the mask. The resulting increase in atmospheric pressure forces the opening of the patient's airway and keeps it open as long as the machine detects blockage in the throat (which is done by measuring the relative pressure of breaths and breaths).

Another tool for treating sleep apnea is a custom-designed dental retainer that forces the lower jaw bone up and away from the throat, thereby increasing the radius of the airways and minimizing the closing during sleep. Both tools have been shown to reduce obstructive airways when they are used properly. Both are easy to carry when a sailor is moving to and from the ship.

It should also be noted that the IMO Subcommittee on the Human Element, Training and Intelligence has finalized a series of revised guidelines on fatigue which, subject to the approval of the Maritime Safety Committee during its next meeting in December 2018 to help shipowners and operators adapt their fatigue management strategy. A copy of the draft MSC circular describing the revised guidelines is available here. When workforce adjustment, operational workload requirements and rest periods do not reduce fatigue in a particular case, we recommend that the employer consider doing an apnea test of sleep and, if disorder. The treatment of sleep apnea will not only improve the quality of life of the sailor. It will also make ship operations safer for everyone on board and hopefully reduce the number of casualties due to human error.
Source: GARD (http://www.gard.no/web/updates/content/26300677/fatigue-and-the-modern-seafarer)