To Sleep: Perchance to Dream - in the Flight Levels

Going to sleep in flight can be a big problem. If you are the Pilot Flying going to sleep is really bad. If you're a long haul relief pilot, not going to sleep can spell trouble. A number of the airline pilots we see have difficulty sleeping in flight on trans-oceanic runs. If you're part of the cockpit crew or flying first class you at least have the option of lying down. That's a big help. Our pilots seem to prefer the newer Boeing 787's or Airbus 380's flight crew rest compartments that provide a modicum of privacy and quiet. If however, you're sitting bolt upright with three hundred of your newest acquaintances in a turbulent, noisy, dry, odorous aluminum cylinder, the challenge to sleep increases.

So what's a guy to do to get twenty winks? Dr. Jamie Zeitzer is a Professor of Psychiatry and Behavioral Sciences at Stanford. He's written quite a bit about the psychology of sleep. He points out that although the physical discomforts of the airline cabin make it hard to sleep, two big barriers to sleep are within our control: stress and anxiety.

Lack of privacy creates social stress. Compression into the ever-shrinking airplane seat creates physical stress. Anxiety can come from various sources, fear of flying being one. Hopefully that isn't too big an issue for the readers of Minnesota Flyer. Another source of anxiety is the pressure to fall asleep. Ironically you can bet on that keeping you awake. Zeitzer admits that there is no universal method for dozing off but suggests two strategies. First of all try not to think about falling asleep. Second, zone out and imagine yourself elsewhere. Walking along a warm Caribbean beach hand in hand with my Lovely Bride is a favorite of mine. Margaritas anyone?

In addition to the mind-games, an eye-mask, noise canceling headphones, pillows and blankets can create real or imagined breathing room.

A couple of drinks before conking out are helpful for many folks. However, there is some evidence that ethanol may heighten the effect of jet lag for some people.

If none of these measures do the trick, one can always retreat into the world of drugs. A favorite over-the-counter sleep aid for some folks is melatonin. It's a naturally occurring hormone involved in sleep. There is a problem with it however. It's an unregulated substance, so you have no guarantee of potency or purity.

You might look for a product manufactured within the European Union. They actually regulate production of supplements over there. Also there are few reliable studies on melatonin's effects. Another favorite is Benadryl (diphenhydramine). It is a USP regulated antihistamine with a substantial sedative effect for many people. You can buy it over-the-counter and be confident you're getting the real thing in the advertised dosage. The down-side with Benadryl is it absolutely prohibits you from acting as PIC. Also rather than getting sleepy some folks get buzzed by it. It's called "paradoxical excitation." So you might want to try a dose before you fly as a passenger. If you really are having trouble, you can of course consult your physician regarding prescription sleep aids. In general it's best to use one of the short acting sleeping pills such as Sonata (zaleplon). Even with it, however the FAA requires a six hour wait before resuming pilot duties. If you are flying and using drugs as sleep aids, a word of caution. To quote the AME Guide, "Occasional or limited use of sleep aids, such as for circadian rhythm disruption in commercial air operations, is allowable for pilots. Daily/nightly use of sleep aids is not allowed regardless of the underlying cause or reason." Furthermore, do not mix any of these drugs with alcohol. Folks with a belly full of booze and pills have been known to do strange and disruptive things on airliners. You might become the Air Marshall's next best friend.

These helpful hints may minimize the effects of a bad night's sleep and a lapse of eleven time zones, but they won't completely eliminate them. Therefore once you arrive listen to your body. Be sure that you've had enough time to recover from sleep deprivation and jet lag before you hop back into the cockpit.

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com