How to Manage stress & fatigue of flight?

STRESS:

Stress is defined as a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.

Stress is a physical, mental, or emotional factor that causes bodily or mental tension.

Stresses can be external (from the environment, psychological, situational (physical situation flight), social situations or internal (illness, or from a medical procedure).

The body responds to stress by releasing hormones that increase the heart and breathing rates and ready your muscles to respond. Stress hormones affect your respiratory and cardiovascular systems. If you already have a breathing problem like asthma or emphysema, stress can make it even harder to breathe.

Under stress, your heart also pumps faster. Stress hormones cause your blood vessels to constrict and raise your blood pressure. As a result, frequent or chronic stress will make your heart work too hard for too long. When your blood pressure rises, so do your risks for having a stroke or heart attack.

STRESSES OF FLIGHT

1. Pre-flight Stresses:

a. Anxiety to reach airport on time

b. Carrying baggage & walking briskly long distances-Airport Angina c. Rush & Confusion at the airport

2. In-flight Stresses:

a. Altered atmospheric pressure of the cabin at high altitude resulting into less oxygen availability to body.

b. Reduced atmospheric pressure in the cabin resulting into expansion of gases trapped in the body cavities

c. Low Humidity (10 TO20%) in the cabin leads to drying effect of airway passage (causing dry cough), cornea (under contact lenses) and the skin.

d. Noise, Vibration, Turbulence and uncomfortable cabin Temperature. e. Cramped seating and lack of movement during long flight hours. (may lead to Deep Vein Thrombosis).

f. In a closed, cabin environment; one is exposed to infectious diseases.

3. Post-flight Stresses:

a. Jets lag or body circadian de-synchronization, i.e. mismatch between the body clock and the local time due to rapid travel across time zones.

b. Fatigue.

Jet Lag

Jet lag or circadian de-synchronization results from mismatch between the body clock and the local time. It is caused by rapid travel across time zones. Crossing the International Date Line can cause confusion about on what date you'll arrive, e.g.:

∙ Starting a 12–15 hour flight from the U.S. west coast to Japan or Hong Kong in late evening can land you there in the morning two calendar days later.

∙ If starting the reverse course by midday, you may well arrive but a few clock hours more or less on the same calendar day.

Jet lag is also compounded by the fact that long hours spent on a plane may lead to sleep too much, or not enough, possibly at the wrong time of day relative to where the passenger departed from. The fatigue from travelling plus the mismatch with local time can leave the passenger ready to fall asleep in the afternoon, or being wide awake in the middle of the night, knowing that dawn is still several hours away.

The main symptoms associated with jet lag are tiredness and sleeping difficulties resulting from de-synchronization between the individual’s internal clock and the external environment. However, being temporary in nature, healthy passengers easily endure these stresses. Judicious use of hypnotics helps control sleep loss but does not re-entrain the circadian cycle. Alcohol should not be used as a hypnotic because it disturbs sleep patterns and will sometimes provoke sleep apnea.

It can be minimized by:

⮚ taking short flights;

⮚ taking transit breaks;

⮚ Exposure to sunlight on arrival.

In general, passengers should allow a reasonable period (1 to 2 days) for adjustment prior to engaging in serious business.

Circadian Rhythm - A circadian rhythm is a roughly 24 hour cycle in the physiological processes of living beings. Circadian Rhythms (or body-clock) are endogenously generated and are influenced by external cues such as sunlight and temperature. These external cues are called zeitgebers.

FATIGUE MANAGEMENT

Fatigue: Fatigue refers to mental or physical exhaustion that stops a person from being able to function normally. It is more than simply feeling tired or drowsy. Fatigue is caused by prolonged periods of physical and/or mental exertion without enough time to rest and recover.

Fatigue can be a major source of stress among employees, and fatigue can significantly affect an employee’s capacity to function. It can impact on an employee’s performance and productivity, and increase the potential for workplace injuries and/or accidents to occur.

1. Fatigue is generally caused by:

• spending long periods of time awake

• having an inadequate amount and/or quality of sleep over an extended period. 2. Factors both in and outside of the workplace can be a source of fatigue.

3. How to manage fatigue?

Employer’s perspective:

There are a number of actions that employers can take to help manage the factors that influence fatigue, especially in work-related circumstances.

Identify the contributing factors and take corrective measures:

a. If overtime is necessary, plan for it so employees can schedule their activities around it Limit overtime to ensure staff are getting sufficient breaks between shifts. b. Ensure the roster provides for a continuous seven to eight hours of sleep in each 24 hours, and at least 50 hours sleep for every seven days

c. Ensure roster allows for at least two full nights’ sleep after the last night shift. d. Have a room for workers to sleep in before commuting home.

e. Provide access to healthy food options at work, for example, healthy vending machine options.

f. Avoid safety-critical tasks during the early hours of the morning as low alertness on night shift between 3-5 am presents increased accident risk

Employee’s perspective:

a. Be prepared and organize beforehand-bring healthy meals and snacks to night shift. Avoid large meals one to two hours before sleeping.

b. Have an afternoon nap before the first night shift.

c. Avoid excessive alcohol as this can disturb your sleep. Avoid caffeine after midnight when on night shift.

d. Get into a routine for going to sleep (e.g. take a warm shower or relaxing bath before going to bed, listen to soothing music).

e. Plan your social activities and ensure you get sufficient sleep before starting work. f. Include exercise/walking/yoga in your daily routine.

If fatigue is not relieved by enough sleep, and by addressing contributing factors such as good nutrition and a low-stress environment, the person should seek professional help.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.