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Lack of sleep

Fatigue called major foe in battle

ATLANTA — As U.S. troops with their high-tech equipment push deeper into Iraq, they face a problem that has plagued soldiers in combat for ages — lack of sleep.

The war with Iraq is little more than a week old, but many allied forces already are reportedly exhausted. With the threat of even more intense fighting still to come, sleep deprivation could take a serious toll on the battlefield.

"Paying attention to troops getting enough sleep may be more important in this war than ever before because of the high-tech equipment in use," said Dr. Paul Ragan, assistant professor of psychiatry at Vanderbilt University Medical Center in Nashville.

Days with little or no sleep lead to lapses in judgment and performance. An exhausted soldier could push the wrong button or misread a radar signal, causing a battlefield disaster. Some researchers fear that friendly fire incidents could increase if sleep deprivation becomes a big problem.

It already has afflicted some troops.

In the race across the desert that brought the Army's 3rd Infantry Division (Mechanized) and its 7,000 vehicles within 50 miles of Baghdad this week, many drivers fell asleep at the wheel and veered off their route.

The sandstorm that swept through the region this week allowed many troops a day of rest. But even then, some weren't able to sleep.

Some mechanics, under pressure to keep the vehicles rolling, have been getting only a couple of hours sleep a night. Incoming machine gun fire or artillery also forces soldiers from their sleeping bags and back on the move.

Studies show that most people need seven or eight hours of sleep per night to be at their peak mental and physical performance. Anything less than that and the body begins to suffer, said Dr. David Neubauer, associate director of the Johns Hopkins Sleep Disorders Center in Baltimore.

That's why the Federal Aviation Administration is so strict on limiting the number of hours that airline pilots can fly each week, he said.

Among the impacts of sleep loss: mood changes; irritability; and a reduction in concentration, memory, coordination and response to stimuli.

"A lot of us may feel some of this in a couple of weeks when we set our clocks one hour ahead because of daylight-saving time," Neubauer said. "We may feel crummy during the next few days after that as our bodies adjust to a new schedule."

Research shows that people who go without sleep for 24 hours lose about 25 percent of their ability to process information and respond to stimuli. That can be especially critical to sleep-deprived battlefield leaders and fighter pilots who must make quick life-or-death decisions in the heat of battle.

The power nap is one way to combat battle fatigue, Neubauer said. Even a 45-minute snooze can be refreshing.

Pilots, however, don't have the luxury of taking naps. Instead, what many of them do, with their commanders' approval, is swallow dextroamphetamines, a form of "speed," to keep them refreshed after losing sleep.

Researchers, though, say those drugs are not the answer for sleep-deprived ground troops.

Military leaders and generals say they are well aware of the perils of sleep deprivation during combat. Researchers are studying numerous methods to overcome sleep loss.

Some research focuses on a new drug called monafinil, which has been licensed for use for the treatment of narcolepsy under the brand name Provigil. According to sleep researcher Michel Jouvet of Claude Bernard University in Lyon, France, "monafinil could keep an army on its feet and fighting for three days and nights with no major side effects."