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July 16, 2021
Management of Sleep and Fatigue in Military Aviation
In recent years, Congress has expressed concernover the
effects of sleep deprivation on servicemember health and
military readiness, as well as its impact on military aviation
safety. Aviators in all military services of the Departnrnt of
Defense (DOD) with high operational demands and austere
work settings may experience sleep deprivation andfatigue.
To counter these effects, the military services use a variety
of mitigation strategies (i.e., non-pharmacological and
pharmacological meas ures) to enhance aviator s afety and
prevent aviation mishaps. This In Focus provides an
overview of those mitigation strategies and offers is sues for
congressional consideration.
Background
The U.S. Centers for Dis ease Control and Prevention
estimates 32.5% of adults do not meet the Healthy People
2020 (HP2020) criteria for sufficient sleep. In comparison,
the 2018 DOD Health Related Behaviors Survey estimated
54.6% of active duty servicemembers did not meet HP2020
criteria. HP2020 categorizes sufficient sleep as at least
seven hours in a 24-hourperiod. Research indicates a
variety of detrimentalhealth effects arisefromboth acute
and chronic sleep deprivation.
Sleep deprivation and fatigue are two distinct physiological
states. The National Institutes of Health defines sleep
deprivation as a conditionthat occurs when someone [does
not] get enough sleep. Sleep deprivationis acontributorto
fatigue. The National Institute for Occupational Safety and
Health defines fatigue as a feeling ofweariness, tiredness
or lack of energy. Sleep deprivation and fatigue can be
most apparent when an individual is awake counter to their
circadian rhythm(i.e., during the circadiantrough of
alertness), typically apparentduringtheearly morning
hours (see Figure 1).
Figure I. Relative Level of Alertness and Wakefulness
Based on Time of Day
High
a
<1-/
0
a
rt Low
Time of Dev
Source: CRS, Derived from Shappell, et al., Crew Rest and Duty
Restrictions for Commercial Space Flight, available at
https://rosap.ntl.bts.gov/view/dot/34244
Military aviators may experience sleep deprivation and
fatigue due to a variety of factors, including inhospitable
sleep environments, operational demands, unpredictable
schedules, long-duty days or flight durations, challenging
flight conditions, and circadian-rhythmdisruption due to
cros sing multiple time zones, known as chronodisruption.
In a March 2021 report to Congress, DOD stated sleep
deprivation has significant effects on the physical,
cognitive, and emotional functioning needed for readiness,
occupational, and operational mis s ion fulfillment. The
report also described the risk of accident in training,
operational, and combat environments significantly
increases if Service members are sleep deprived.
Fatigue Management in Military Aviation
Each military service is responsible for implementing its
own policies and procedures to mitigate aviator fatigue and
sleep deprivation. The military services use varied
approaches to mitigate aviator fatigue, including (1)
administrative and behavioral (i.e., non-pharmacological)
measures, and (2) the voluntary use of pharmacological
measures. Regulations for each service consistently
emphasize non-pharmacological meas ures as the primary
means ofmitigating fatigue.
Administrative and Behavioral Measu res
Adminis trative and behavioral meas ures can include limits
on the length of an aviator's duty day, or time spent flying,
and standards forrest and time available for sleep. The
military services also educate aviators on the impact of
sleep loss and the benefits of consistent sleep.
Pharmacological Measures
Historical Use of Pharmacological Measures. The U.S.
military historically has approved pharmacological
measures for aviators in certain mis s ion contexts. For
example, the Air Force and Navy have authorized the use of
pharmacological measures for selectmissions and aircrew
during combat operations, at least since theVietnamWar.
The operationalneeds for these measures havebeen
scrutinized and are an area ofreview. For example, the Air
Force suspended the use of stimulants between 1996 and
2001. After considering survey results frompilots flying
during Operation Desert Stormand four placebo-controlled
studies, theAirForce validated the need andutility ofthe
measures and rescinded the suspension.
Current Use. Longer flight durations, continuous
operations, improvements in night-vision technology and
the combat advantage of night operations have led to a
greater potential for fatigue and operating during a pilot's
circadian trough, increasing the need for pharmacological
measures. Thenmilitary services authorize aviation medicine
specialists (i.e., flight surgeons) to prescribe U.S. Food and
Drug Administration (FDA)-approved pharmacological
agents as a fatigue management measure when
administrative and behavioral measures are known or
expected to be insufficient. No DOD-wide policy
standardizes the situations or conditions for use of
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