FALLS CHURCH, Va. (Army News Service, Dec. 17, 2015) -- Sgt. 1st Class Alonzo Howard said he has but one regret: that he didn't know the effects sleep deprivation have on combat effectiveness.

Howard spoke at the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit, Dec. 9.

During the second battle of Fallujah in Iraq in 2004, Howard went for more than a week with very little sleep. The combat engineer succeeded in closing off a bridge to prevent the enemy from escaping.

While the mission was a success, Howard said his performance could have improved even more had he known about sleep banking, a technique he could have used to mitigate some of the negative effects of staying awake for long periods of time. Sleep banking means sleeping longer than the recommended eight hours a night for one or more nights before going without sleep or very little sleep.

As a platoon sergeant, one of the important things Howard did was to coach his squad leaders on ways to stay alive and win in combat. That meant such things as tactics, weapons proficiency, physical fitness and proper nutrition.

But sleep, he said, was never one of them.

During the battle, one of his corporals did exceptionally well, and Howard said he succeeded in recommending him for a field promotion to sergeant. That sergeant was killed later during a subsequent deployment to Afghanistan.

Howard said he doesn't know the factors that contributed to the sergeant's death, but he said he passed along all of the knowledge of warfare he knew to that sergeant, except for the effects of going without sleep. He said he wishes he'd known then what he knows now about sleep.

One of the suggestions Howard offered at the Sleep Summit was producing small, plastic Performance Triad cards so Soldiers in the field can have guidance to follow regarding risk management and the tradeoffs between sleep and performance. His suggestion was well received.

One of the participants at the Sleep Summit noticed Howard's Ranger Tab and asked what he thought about going without sleep during the grueling training at Ranger School.

Howard responded that the benefit of that is knowing how far you can push yourself and experience the effects of sleeplessness on performance to gain a greater appreciation for understanding the importance of sleep firsthand. In other words, he suggested leaving the training as it is.

EFFECTS ON PERFORMANCE

Dr. Thomas J. Balkin, a scientist at Walter Reed Army Institute of Research in Silver Spring, Maryland, described findings from his research on sleep deprivation.

Participants were divided into groups, with some getting nine hours of sleep, others seven, five and three over a seven-day period. Participants were then given psychomotor vigilance tests each day to determine their reaction time to visual stimulus, he said.

An accompanying chart within this article shows marked declines for the five- and three-hour groups each day. After the seven-day trial period, the participants in all groups were allowed eight hours of sleep and tested again each day. Performance for all groups shot back up very quickly, especially on the first day. However, performance didn't recover to pre-trial levels, except for those who banked sleep, or had nine hours of sleep the week before the deprivation.

Balkin noted that other studies from Department of Defense research laboratories have "demonstrated the significant effects of sleep deprivation and fatigue on cognition, attention, reaction time, and moral reasoning, all of which are critically important for operational effectiveness."

Research also suggests, he said, that "more is better" when it comes to sleep and that getting more than eight hours of sleep a night establishes a sleep reserve in case sleep is lost one or more nights in the future.

SUGGESTED REMEDIES

Balkin then offered the idea that if mission allows, everyone in the Army should be able to come to work at 8 a.m. "If the boss comes in at 7 a.m., workers typically follow that example." Same for working late.

Another suggestion, he offered, is instructing all personnel to not text or email during off-duty hours unless it's an emergency. Too many people, he said, sleep with their cell phone beside them.

Maj. Scott Williams, chief of the sleep clinic at Walter Reed National Military Medical Center said some trucking companies require drivers to be hooked up to a Continuous Positive Airway Pressure, or CPAP, device when they're sleeping.

A CPAP is normally used to pump oxygen into the nasal passage for people who have obstructive sleep apnea. But CPAP can also be used to monitor the amount of time a person is sleeping, he said. The device can transmit that data from wherever the person is located back to the trucking company headquarters. That way, employers have a way to verify if their drivers are sleeping.

Using a CPAP, or perhaps a sleep sensor device to monitor Soldiers' sleep might be a good idea, particularly for jobs where alertness is important, he said.

Editor's note: A third sleep article will explain the types of sleep problems Soldiers face and medical treatments for those problems. Balkan's study, "Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: A sleep dose-response study," was published in the 12th edition of the 2003 Journal of Sleep Research. Co-authors were: Gregory Belenky, Nancy Wesenten, David Thorne, Maria Thomas, Helen Sing, Daniel Redmond and Michael Russo.