Winning, but Really Feeling Beat

Almost three weeks into the U.S.-led war in Iraq, sleep is in dangerously short supply.

Averaging well under four hours of slumber a day, some soldiers in convoys are nodding off at the controls of their trucks and tanks -- falling asleep, in some cases, standing up. Sentries on the perimeters of U.S. camps say they cannot keep their eyes open in the dark. And the radios of units driving forward are crackling with the sounds of chronic sleep deficit, as comrades snap and curse at one another and -- even worse -- fall into sullen or somnolent silence.

As the troops prosecute what might be the final phases of the war in Iraq, the weeks of brief and broken sleep could prove a potent adversary. For most people, even youthful warriors, eight hours a day remains the minimum needed for peak performance. Much less, new studies show, and an individual’s performance will degrade slowly but surely over time.

“We don’t ever want to go down the road of no sleep,” says Air Force sleep researcher John Caldwell.

“There is simply no substitute for it,” adds Col. Gregory Belenky, the Army’s chief scientist.

Brain scans show that a missed night of sleep will cause a metabolic drop of 12% to 14% in the prefrontal cortex -- the section responsible for higher-order reasoning and judgment. That is a rate nearly twice as high as for the brain overall.

For soldiers and pilots, that means the part of the brain that discerns friend from foe, chooses targets and navigates through a battlefield is truly addled by sleep loss. And that’s a major problem for this force. Already, sleep researchers surmise that friendly fire incidents, errant convoys and operating accidents will be found to have been caused partly by fatigue.

“We like to call this Army ‘the objective force,’ ” Belenky says. “If you’re counting on people to think on the fly, and to respond to problems by coming up with new solutions, that’s prefrontal cortex.”

Even as scientists such as Caldwell and Belenky measure the perils of missing sleep, they are looking for ways to allow a person to forestall or skip sleep for long periods without paying the price.

For now, Navy and Air Force fliers are permitted to pop “go pills” -- dextroamphetamines, or speed, issued by flight surgeons as “fatigue countermeasures.” By contrast, pity the lowly ground-pounders, whose second (and third, fourth and fifth) wind comes only from the caffeine in a packet of freeze-dried Tasters’ Choice instant coffee, frequently poured directly into the mouth.

The U.S. military is seeking more creative solutions. Already available, but not in official use, is an anti-narcolepsy drug called modafinil, which can give a sleep-deprived person lengthy stretches of alertness without the jitters or the crash. The Army and Air Force have tested the drug, approved by the Food and Drug Administration in 1998, and found some benefits.

In development by the Army is a “sleep watch” -- a tiny monitor worn by each soldier. The watch would track sleep and activity levels, take into account circadian rhythms, which govern sleep-and-wake cycles, and provide troops and their commanders with an instant assessment of a soldier’s level of sleepiness. In deciding which soldier should stand guard or whether to press forward or stop to rest, a unit commander could check the data from the watches and make better-informed decisions.

Further out, scientists hope that certain animals will yield some of their secrets to combating fatigue and overcoming the need for sleep. One project funded by the Defense Advanced Research Projects Agency proposes to study dolphins, which never fall fully asleep, in a search for alternative ways of sleeping. Because of their need to surface at short intervals for air, these marine mammals appear to fall asleep in one-half of their brains at any given time, leaving the other awake to stand guard against predators and oxygen deprivation. Birds may also offer clues, since many remain awake over lengthy migrations.

The effect of such work on civilians could be enormous. In the last century, Americans have shortened their time sleeping, on average, by 20%. Long-haul truckers, shift-work employees and parents with young children are thought to operate with chronic sleep shortages, and about one in five automobile accidents in the United States is linked to driver fatigue.

The armed forces have long been driving powers in the international sleep-research community, and with good reason: Throughout history, fatigue has been a soldier’s constant companion. In June 1944, U.S. paratroopers landing in Normandy were pummeled by exhaustion as much as by a dug-in defender, according to historian S.L.A. Marshall.

“They were so beat they could not understand words even if an order was clearly expressed,” one Army captain told Marshall afterward. “I was too tired to talk straight. Nothing I heard made a firm impression on me.”

Now that technology has made war a round-the-clock enterprise, the challenge of sleep has become even greater.

In the Persian Gulf theater, rapid advances, unforeseen resistance and the general chaos of war have made sleep shortages epidemic. When several hours of sack time are impossible, the troops try to put together enough sleep in short intervals. But in many cases, they are clearly not coming close to the eight-hour mark.

“There’s good news and there’s bad news,” says the Army’s Belenky. Troops deprived of sleep for long enough will sleep anywhere, and some sleep -- a 45-minute catnap in the mud, for instance -- is better than no sleep at all, he says. They know they must “nap early, nap often.” And that is exactly what they have done in cramped tanks, in raging sandstorms and amid the thunder of artillery.

But that too is the bad news, Belenky says. With little sleep, troops can doze off during chemical attacks, while on watch or while operating dangerous equipment -- and in war, it is all dangerous equipment.

Recently, after a five-day sprint across the desert, soldiers of the 3rd Infantry Division described scenes in which columns of tanks and armored vehicles would idle in gigantic bottlenecks behind a sleeping driver. Crew members from a nearby vehicle would scramble out to awaken the stalled driver. By the time the column started moving, someone farther back would have fallen asleep, and the process would start all over again.

Lt. Col. Jim Chartier, commander of the Marine 1st Tank Battalion, recently called sleep deprivation “our biggest enemy. It makes easy tasks difficult.”

“We’re not at the breaking point yet,” he told USA Today after almost two weeks on the march. “But we’re closer than I’ve ever seen.”

For Iraq’s troops and its civilian population, the bombing and advance of U.S.-led forces have certainly made sleep fitful and short. Among Iraqi units still intact, that may help dissolve the will to fight. But some of the sleep-deprived may become more impulsive, taking greater-than-usual risks. Whether they are civilians approaching U.S.-manned checkpoints or potential suicide bombers, their responses to exhaustion can pose a new dimension of danger for civilians and troops alike.

And as a recent pair of studies showed, a shortage of sleep over time is every bit as debilitating as a two- or three-day marathon of wakefulness.

In separate studies, Belenky and University of Pennsylvania sleep researcher David Dinges found that a night without sleep -- or a fortnight on just four hours a day -- can render a subject slow to react, easy to distract and very forgetful. The sleepless subject becomes impulsive, irritable and unable to respond to complex problems with any but the most rote of responses. He responds worst under time pressures and has no grasp on the extent of his impairment.

In recent days as U.S. and British forces have consolidated their gains and awaited the catch-up of supplies, many units have slowed their pace, allowing troops a little extra time to refit, refuel, rearm -- and rest.

That should help. With three days of “recovery sleep” -- in studies, eight hours of uninterrupted sack time in a real bed -- the performance of experimental subjects did improve after two weeks of reduced shut-eye. But none of the sleep-restricted groups studied -- those who had slept three-, four- and seven-hour nights -- bounced back fully, even with three full nights of sleep. And though pauses in their drives forward have given many units time to rest, it is unlikely that soldiers’ sleep schedules have returned to anything near normal.

For the troops driving now for almost three weeks in the Persian Gulf, there can be no victory in a war against sleep, warns Dr. Clete Kushida, director of Stanford University’s Center for Human Sleep Research. Sure, he says, for the young, the trained, the adrenaline-pumped, performance can limp along gamely for some time. But whether their rest comes with victory or with reinforcements, “eventually, they’ll reach a point where they just need sleep.”