Battle Of The Bulge

Regular periods of sitting wide awake in a hotel room have become a routine part of my long-haul existence.

While I do sleep, I just don’t seem to be able to get the longer blocks that I sometimes crave and need. I do have one advantage. I’m a power napper and I can get short bursts of sleep almost anywhere when I need them, including transits on crew buses or through shorter, controlled inflight naps. This has been crucial in optimising my performance for the more critical phases of flight such as departure and arrival segments.

While it’s great that our airline puts significant effort into the application of fatigue science, which has resulted in some very positive changes to our schedules, it still has a large impact on me when I’m wide awake in the early hours and unable to get back to sleep.

My challenge right now is the hotel mini-bar, which is stocked with a nice array of chocolates, flavoursome European beers and some good quality wines. I’ve been thinking about them for 30-odd minutes, reminding myself of the commitment I made to improve my diet and to cut down my alcohol intake.

It’s all too much. “Bugger it”.

I’m overcome by temptation and just need one cold, tasty beer to relax. Anyway, I have a full day off prior to the next flight.

It’s a fancy Belgium beer I’ve not tried before and it’s tasting great. I’m feeling much better, a more relaxed headspace, a simple pleasure and reward at the end of what has been a long flight. I finish the first one a little too quickly so I opt for another, which I’ve promised myself I will drink more slowly. After that, feeling even more relaxed, it’s time for a red wine, the final nightcap (or so I think) before I try to get back to sleep. At this stage I’m still craving sugar and hey, one chocolate bar isn’t all that bad is it? I promise myself I will go for a run in the morning to burn off the calories.

‘I’ve never truly adapted to the routines and the ongoing disruption to my sleep’

Unfortunately, the next morning I’m feeling disappointed with myself.

Combined with the ‘flat’ feeling and low motivation I opt for a large breakfast in a good-looking café instead of the run, enjoying the ‘white noise’, the hustle and bustle of other locals going about their daily business. I take a relaxed stroll around the local sights and then opt to head back to the hotel room to rest prior to the late evening departure back to home. I think to myself “perhaps next time” about meeting my own goals for maintaining a healthier lifestyle.

How many times have I had this conversation with myself? I just don’t seem to be able to break the habit.

What’s more, my partner – who I still have a desperate need to feel closer to since we’ve been drifting apart – let me know recently that my waistline is getting bigger and that perhaps I need to do more exercise.

While the comment was made with genuine concern for my wellbeing, with everything else going on it has further exacerbated the distance between myself and my partner. Since that comment, I almost feel down and flat, and rather than exercising I’ve started to further increase those other rewards: more beer, wine, grabbing a small chocolate bar. And yes, my belt buckle has been adjusted out by a notch. My inner voice is tending to tell me “I’m hopeless” and I’m questioning why my partner would want to be with a fat person like me.

The sleep diet: battle of the bulge

Leveraging on the extensive application of clinical sleep science by Dr Carmel Harrington, author of The Sleep Diet and The Complete Guide to a Good Night’s Sleep, I’m keen to provide some insights into Carmel’s work and the true impact of sleep disruption.

While this article cannot cover all the factors, I highly recommend Carmel’s books to anyone interested in learning more about successful techniques to enhance sleep.

In order to have good health we need to focus on three things: good nutrition, good exercise and good sleep, yet research indicates that more than 35 per cent of adults suffer sleeplessness symptoms annually.

One of the very important aspects of sleep is energy conservation and it is during sleep that both our brain and our muscles get the opportunity to rest and repair. But it’s not only our brain and muscles that need downtime; our biological systems also needs a rest period.

So what do these studies tell us? Basically, we now know that when we are chronically sleep-deprived we suffer serious negative consequences in all sorts of ways. Without proper sleep our brain does not work as well, causing poor mood state, poor thinking processes and sometimes unpredictable behaviour. Our metabolic system is put under stress, reducing our body’s ability to control our metabolism and appetite, and our body’s ability to protect us from infection and disease is impaired.

For those attempting to lose weight all these effects have a direct impact the ability to diet. Have you ever tried dieting when in a poor mood, sick, or extremely hungry? If you have, you will be able to remember just how hard it was to stay on the diet and how, in most instances, the diet was abandoned until you felt happier, healthier or not so hungry.

What has become crystal clear from all these studies is that if you have short sleep or poor quality sleep, you are nearly twice as likely to have Type 2 diabetes or to develop Type 2 diabetes over a given period of time compared to someone who has good sleep.

It was only 10 years ago that the first clinical study into what effect short sleep had on our glucose metabolism was undertaken – the result of population studies showing a link between poor sleep and Type 2 diabetes. Researchers took a group of healthy young people and restricted their sleep to just four hours a day for six days before allowing sleep for up to 10 hours a day for the next six days.

At the end of each six-day period they were tested for ability to metabolise glucose – in other words, how much insulin could the body produce, and how quickly, in order to reduce the amount of glucose in the blood as fast as possible.

After just six nights of restricted sleep their ability to metabolise their glucose had decreased by 40 per cent compared with their ability in the fully-rested state, and many of them in the sleep-deprived state were displaying the characteristics of someone with a high risk of developing Type 2 diabetes (or in the pre-diabetic state).

Sickness and sleep

Early to bed, early to rise, makes a person healthy, wealthy and wise. While it would appear that generations past understood the worth of sleep in all aspects of our lives, it seems that today this wisdom has been lost – so much so in fact that our current generation often views sleep as an optional extra, something to be indulged when there is nothing else to do.

However, we do this at our own cost and expose ourselves to acute infections.

The role of sleep in recovery from illness has been well recognised for millennia. Night after night when we sleep, our immune system gets to work to detect and eliminate from our system any foreign bodies or potential infections such as viruses. Key to this activity are our natural killer cells which, as the name suggests, eliminate cells that have become infected by a virus or have become cancerous. What has been found is that our natural killer cell activity is reduced by as much as 50 per cent in conditions of sleep deprivation.

It would appear to follow logically that a decrease in our killer cell activity will leave us more vulnerable to develop an overt infection (as in a cold or flu). In clinical studies it has been shown that people who have fewer than seven hours sleep a night, or who have disturbed sleep, are three to five times more likely to develop a cold when exposed to the virus than people who sleep more than eight hours or who have consolidated sleep.

Disrupted sleep and metabolic efficiency

Our metabolism is managed by the hormonal and central nervous systems. In times of sleep deprivation the production of certain hormones is substantially reduced. Research now shows that this direct link affects the ease with which we gain weight and the difficulty with which we lose it. Research has found that when people are deprived of sleep, the body decreases resting metabolic rate by as much as 10 per cent because it needs to ensure that there is enough energy to maintain other basic processes. As a result, you must substantially increase your physical activity and/or decrease your food intake just to remain the same weight. The outcomes of insufficient sleep: >> Hormones increase our sense of hunger and our desire for carbohydrate-dense foods (such as ice-cream and hamburgers).

‘Early to bed, early to rise, makes a person healthy, wealthy and wise’

>> Our increase in appetite – a direct consequence of the disruption of the hormonal cycles – translates to an approximate increase in consumption of between 350 and 500 calories per day, which over time results in significant weight gain.

>> Our bodies go into an energyconservation mode, and although we may feel hungrier and eat more food, our ability to burn calories is decreased by up to 10 per cent.

When our body goes into this mode, it also prefers to burn lean muscle tissue instead of fat.

>> We do not think very well and our ability to make good decisions and to plan well is affected. If we do not plan options for healthy food, it often means we will end up eating the foods that are readily available (which are frequently high-fat/high-sugar).

>> We lose the motivation to eat the proper food, to exercise and even to diet. We often develop a negative mood – we feel down and might be annoyed more easily.

If sleep deprivation continues for long enough, we may even develop depression.

>> These negative mood states make dieting very difficult as, in an attempt to improve our mood, we will more readily seek out comfort food such as chocolate, biscuits or ice-cream.

Disrupted sleep – the vicious cycle

Many personnel within the aviation industry not only experience regular circadian disruptions (where the body is aligned with the time at home but has not yet adjusted to the time zone in another country), but are also exposed to several other stressors (as per the factors discussed in the previous two Australian Aviation ‘Out of the Blue’ articles) that must be carefully managed. If this leads to a failure to deal with stressors during awake time, you may find you have to deal with them in the night hours when you want to sleep. All this is made worse by the time zone changes and the vicious cycle of increased use of caffeine, alcohol and/or poor food choices.

For example, if you suffer from sleep-maintenance insomnia (difficulty staying asleep) there are two things that are particularly relevant to your sleep practice. Firstly, caffeine is a big culprit in the inability to stay asleep. All too often people who have poor sleep use caffeine to counterbalance both their anxiety and tiredness. While it might seem that caffeine is helping, it is not. Caffeine has a long half-life and can stay in our system for up to seven hours.

This is especially so if you are over 45 because, as we age, our metabolism slows and it takes our body longer to process the caffeine. Many people who have trouble staying asleep do not recognise that their caffeine consumption may be an issue. This is because they have no trouble falling asleep – indeed many can fall asleep almost immediately and so think that their inflight coffee is not to blame. If this is you, then take heed. If we are still under the effects of caffeine when we go to bed we may, because we are so very tired, be able to get to sleep fairly quickly.

Once our need for sleep reduces a little (which it will do while we are actually sleeping) and we go through a normal period of transiting through wakefulness, the presence of caffeine in our system will immediately stimulate wakefulness.

We will then have trouble getting back to sleep.

Secondly, alcohol could also be causing our sleeping problems. If you are experiencing any difficulty sleeping then alcohol is definitely not recommended. People are often surprised by this as they associate drinking alcohol with sleepiness.

Indeed, while alcohol has an initial sedating effect, it is rapidly metabolised and after four to five hours there is minimal blood alcohol remaining. After this time the person experiences what is known as ‘rebound wakefulness’ which can mean periods of shallow sleep and multiple awakenings, sweating, increased heart rate and overall general activation (as opposed to the normal quietness associated with sleep). So rather than increasing sleep, alcohol actually reduces total sleep time.

After getting too little sleep for a few days we begin to feel excessively tired, cranky, depressed, unmotivated, indecisive and unable to learn or process information well.

We also invariably feel disinclined to exercise or participate in activity.

When we do not get enough sleep there is a deregulation of our appetite hormones so we are also very hungry and have a strong desire to eat all the wrong types of food.

Habit patterns for high performance

So how do you break the cycle? First and foremost, if you’ve read the two previous Australian Aviation articles from the ‘Out of the Blue’ series, and you’re experiencing multiple factors that feel out of your control, then it’s time to get specialist support (eg make an appointment with your local doctor, sleep specialist or a psychologist).

Good sleep practices, some more applicable when back at home, include: >> When possible maintain a regular bedtime and awakening time.

>> Unless necessary, do not nap during the day if it will disrupt your ability to get a normal night’s sleep.

>> If having trouble sleeping, avoid alcohol.

>> Avoid caffeinated beverages after midday.

>> Do not smoke before bedtime.

>> Do not exercise within three hours of bedtime.

>> Finish eating two to three hours before bedtime.

>> Adopt a regular going to bed routine, which could involve any or all the following: • Dim the lights at least one hour before bed.

• At the same time switch off any computers or other devices.

• If the day has presented many stressors, write down the problems that are concerning you the most and, if time, note possible solutions.

Don’t spend more than 30 minutes on this exercise.

• Take a hot shower 30 minutes before bed.

• Go to bed and practice a relaxation technique (see link below).

• Do not use the bedroom for anything other than sleep or sexual activity! • Keep the bedroom cool, dark, quiet and comfortable.

You started this career being the best you can, both professionally as a pilot and as a parent, spouse, partner or friend within your home life. In any high-performance team (eg the Red Bull Air Race) using specialists to help keep your ‘head’ in the game is just as important as using a fitness trainer for physical strength conditioning and recovery.

Furthermore, having reviewed the many challenges of disrupted sleep, it is essential to develop skills to manage any anxiety: the increased stress that’s preventing you from getting to sleep. We’ve provided a link to a simple questionnaire to determine whether anxiety is one of the causes for your sleep issues, as well as a relaxation technique that Carmel has found successful in training personnel from all industries to enhance their sleep.

www. sleepforhealth. com. au In the next article I will provide further insights into techniques known to reduce ‘brain fog’, including some newer insights into diet. Until then, try practising and integrating the relaxation technique offered by Dr Harrington as one further means to establish new habit patterns for high performance. And if you haven’t done so already it might be time to pass the articles to your partner to ensure they too gain insights into the challenges confronting you within your aviation workplace.

‘It is essential to develop skills to manage any anxiety: the increased stress that’s preventing you from getting to sleep’