Sleep Monsters - The Research

Let's face it... Sleep is important. I love sleep and am not afraid to admit that I am damn good at it.

I have confidence that I can run, ride and paddle for long periods of time but when it comes to the prospect of not sleeping, that confidence crawls into the fetal position and quietly cries itself to... you get the idea.. I will just put it out there up front that this is my biggest concern about the UntamedVA. Topping my list of the challenges to overcome in a 30hr AR is how to manage sleep or the lack thereof. I am not going to attempt to provide a concrete answer at this point but simply aim to collect and present some options for coping with this issue.

Over the past few weeks, I have been veraciously reading everything I can on the subject, from AR race reports to clinical research studies. It seems that sleep strategies for 24hr, 30hr and multi-day races seem to vary greatly and that the caliber athlete also greatly dictates the strategy employed.

The Effects of Sleep Deprivation:

The most promising resource I came across was a study by Duke University's medical program regarding the performance of their residents based on hours worked w/out sleep and outlining the effectiveness of different sleep strategies before, during and after those shifts. The study examined everything from the number of major errors performed during the shift to the percentage of car accidents on the way home from work. Here are some of the interesting conclusions from that study:

- The effects of going without sleep for a mere 24 hours are equivalent to having a blood alcohol level of .08% which is classified as intoxicated by most states. Lessened coordination, poorer decision making abilities, diminished self-awareness and lack of focus are all on the list of impairments caused by this (mild) sleep deprivation.

- Much the same as when consuming alcohol, as you tack on more sleepless hours, an individual continually looses his ability to diagnose himself as being tired and recognize the degree of his impairment. I can certainly attest to that finding as there have been countless occasions of me working late and being so tired that I couldn't make the decision to get up and go home long after I needed to so I just kept working.

- Hospital residents heading home from a 24hr shift are 6 times more likely to get in a car crash than someone who worked 16 hours or less.

So the writing is on the wall here and I bet no one is too terribly surprised. Lack of sleep impairs many of our abilities. The question I pose here is that if little or no sleep is possible, what activities or techniques can help minimize those impairments (at least on a temporary basis).

To Sleep or Not to Sleep:

Several endurance event bloggers feel that the best performance in 24 hour events is achieved by those individuals who paced themselves evenly through the entire event and that never slept. Of course they periodically stopped, took breaks, changed clothes and took small mental diversions but the best performers stayed up and kept moving, opting not to nap. The racers claimed this was much easier than taking a nap or lying down, building some "sleep inertia" and then trying to get going again.

Many Pro Adventure racers on multi-day courses reportedly shoot for 2 hours sleep for every 24 hours of the event. Even then, many report basically going clinically insane for periods of time to the point of not even recognizing their teammates, or falling asleep while riding a bike and crashing.

30 hr races fall somewhere in between.

The bottom line is that the individual racer or team must find a strategy that will work best for them. It is a tricky business trying to find the right balance but I am convinced that the strategy must be worked out and tested well in advance of the event because it is tough to have the mental capacity to reliably make the call to nap when necessary. It is also tough motivating to wake up in a reasonable amount of time without a set plan that everyone agrees upon.

Hoplites may only have one opportunity to test out sleep strategies before Untamed Virginia. We should formulate a sleep plan that theoretically seems the most sound and then try it out. The test will provide the feedback we need for designing a race specific sleep strategy.

Mitigating fatigue - Naps:

The Duke researchers looked specifically at some of the more common techniques for delaying or alleviating some degree of exhaustion. Here is their recommendation for effective use of naps and using caffeine.

- Brief (1-2 hours) napping prior to prolonged period of sleep loss, such as 24 hours on duty, can enhance alertness. Consider a two-hour nap prior to a 24-hour period of expected wakefulness.

- To be therapeutic during a wakeful period, naps should ideally be frequent (every 2-3 hours) and brief (15-30 minutes);

- Naps work best the “earlier” they are in a period of sleep deprivation. If you can pick just one nap, get it as early in the period of sleep deprivation as possible.. Better to “top off the tank early than wait till very fatigued.

- Time naps during circadian window of opportunity, between 2-5 a.m. and 2-5 p.m.

- Longer naps, such as those more than 30 minutes duration may be counter-productive in terms of “sleep inertia”. But probably better than “no nap”. Instead know how to counter sleep inertia. Get moving, get upright, bright lights, caffeine, etc ...

- Utilize quiet, environmentally comfortable locations for naps, ideally where there are no other interruptions such as colleagues dictating or using the computer. Hand over beepers and clinical responsibilities to another colleague when possible. (This one won't exactly be easy to pull off in an AR)

Mitigating fatigue - Caffine:

Using caffeine, a central nervous stimulant, “strategically” can help manage fatigue. It is not a sleep substitute. Tolerance quickly develops. If you intend to use caffeine to counteract fatigue, minimize the regular social use of caffeine so that it will be more effective when consumed. Caffeine may modulate symptoms but does not substitute for sleep. The effects of caffeine generally occur within 15-30 minutes. If you use it just before you drive home its stimulant effects may not kick in until you are home and ready to go to sleep. Avoid regular caffeine use (the social use of caffeine) if you plan to use to abate sleepiness. Instead use it for its “drug effect” when you are on duty only.

- 400-600 mg (3-4 cups of brewed coffee) is a usual dose, but some individuals may be overly sensitive to this amount.

Substance Caffeine content
12 ounce cola 36 mg
12 ounces diet cola 47 mg
8 ounces brewed Coffee 133 mg
12 ounces ice tea 26 mg
1.45 ounce dark chocolate 31 mg
Excedrin, 2 tablets 130 mg
No Doz maximum strength 1 tablet 200 mg

- Consider using caffeine 30 minutes prior to drive home following night call. (In an AR application, caffeine should be used 30 minutes prior to those hard hours of the morning when it is still dark.)

- Useful only for temporary relief of sleepiness. The benefit typically lasts 3-5 hours (Again, caffeine should only be used one time in the middle of the night/morning for coverage until the sun takes over in waking the body up.)

- Adverse effects include disruption in sleep quality, tolerance, diuresis and irritability (Before using caffeine, we must be aware of the possible irritability it could cause. It may just not be worth it in an already intense environment.)

- Can minimize sleep inertia symptoms. (It could be useful to help us get started again after a late night nap)

Conclusions:

5/2/2008 - When discussing this issue with my friend Jason H., a fellow AR junkie, he said not to worry because the excitement and adrenaline would carry us through the race w/out need for sleep. I am eager to test this theory.

8/10/2008 - Empirical Evidence! (24hr) - After racing the Odyssey One Day AR, June 26th, and finishing in 23 hours and 55 minutes I can confidently report that sleep/rest appears to be unnecessary in a 24 hour race. Without naps, supplemental caffeine (other than found in a Gu pack here and there) and few if any breaks in action, we knocked out the course and I yawned a grand total of 4 times. J. Heron was right in that the action is enough to keep you going through the night and the sunrise will take care of the "rest" of the race. One caveat to this is that my experience was from the navigator's seat. While I did experience a low period in motivation between 2-2:30am, constantly having something to think about kept me mentally engaged when other racers were getting sleepy. I know that my partner in crime, Jason Smith, was feeling vulnerable on the bike between 7-7:30am as he attempted to maintain a pace line back to the race HQ. The only time I felt sleepiness starting to creep in was when we were in long sections on the same trail with few navigation decisions to make. Once in the passenger’s seat on the car ride home, less than an hour after the race finish, I could barely keep my eyes open between 10th of a mile markers while Jason powered out the 30 miles back to his mom’s.

9/23/2008 – Empirical Evidence (30hr) – During the Untamed Virginia 30hr AR, September 12th, team Kaizen (Our new name) had the strategy to keep racing the whole event without sleep/rest but to keep in touch with one another and stop if any of us felt it was necessary to rest for safety’s sake. I knew this would be tough since most all three of us had a terrible week leading up to the race in the sleep department due to travel, sick kids, nervousness, ..etc. While team morale rose and fell at different times, no one felt the need to take a nap. This time around, I did dump a “big ass Coke” into my bike water bottle at a McDonalds around 11:30PM and one of the other guys drank one of those 5 hour energy drinks in the wee hours of the morning. It seems that a 30 hr race is just a 24 with “a little extra” tacked onto the end.

My conclusion so far is that for endurance events up to 30 hours, the best sleep strategy is to plan to go without but be willing to take a break should someone be at the end of their rope. There are times that physical breaks are obtained when pausing to take care of feet issues or plotting points on the clock but our philosophy is to roll with the tortoise and maintain a pace we can keep for the duration. Our bodies have proven themselves capable of staying awake for 30 hours of exercise with few breaks in action so unless there are special circumstances, that’s what we’ll plan to do!

Eyes on the Prize - Untamed Virginia 30hr Adventure Race

The Back Story:

Two and a half years ago, some friends and I hatched a plan to get into the best shape of our lives and start Adventure Racing. Our half baked idea was to one day be able to complete a 24hr Adventure Race. Team "Hoplites" was born and we set our eyes on a 4hr sport level AR in the spring of 2007, The Impossible Panther. The Impossible Panther was held in the totally unknown (to us) Uwharrie National Forest near Cary, NC. That race was a wonderful experience and our ideas of how fun it would be were surpassed by leaps and bounds. In the fall, we upped the ante and threw down in the Gold Nugget AR (8hr) put on by the same folks, partially in Morrow Mountain State Park and the Uwharrie National Forest. The middle of the pack finish in each of these races had little effects on the unbelievably fulfilling feeling to overcome each challenge and to have worked as a team to get to each finish in style.

The Beat Goes On:

With two races under our belts and a many learned lessons later, we are ambitiously setting our sites on a 30 hr race in September of 2008 called Untamed Virginia. I have another blog to record workouts so this one will be primarily dedicated to identifying and solving the problems that a race 22 hours longer than our best effort to date will entail.