By K. Thorald. Dawson College. 2018.

In addition purchase 25 mg phenergan visa, a further factor that can create sleep loss is a prolonged period of continuous wakefulness buy phenergan 25 mg otc. It is clear that a protracted duty period can create fatigue by extending wakefulness and decreasing sleep and may also involve circadian disruption generic phenergan 25mg with mastercard. However, in continuous operations, boredom may also be a factor and when an individual is acting as a passive monitor, particularly of relatively rare events in highly automated aircraft, there is the possibility that these elements will increase the likelihood for physiological sleepiness to emerge. In many flight operations, the time available for sleep is constrained by a number of factors and, if an individual’s physiological timing for sleep does not coincide with the scheduled sleep opportunity, then a cumulative sleep debt can result. It is clearly important for this to be considered when an individual is planning their sleep and rest schedule before, during and after a trip to ensure that there is adequate opportunity for sleep in order to avoid the inevitable effects of both sleepiness and impaired performance. It is estimated that sleep-related vehicle accidents account for up to 20% of all road traffic accidents and drowsy driving is as important a factor in accidents as drunk driving. If the crew member commutes by car they should be reminded that they may be driving after lengthy periods of time on duty. In addition, they may have crossed several time zones or their circadian rhythm for alertness may be at a low point. Good practice dictates that where possible an individual should sleep when tired and crew may wish to make use of quiet areas in their crew report buildings to nap before embarking on the drive home. In general, there is some evidence that taking a caffeine containing beverage followed by a 20 minute nap will improve alertness for 1-2 hours. However, these are only recommendations and should be tailored to the individual crew member’s needs and activities bearing in mind that the best effects are likely to come from combining strategies rather than relying on any one alone. They focus on the underlying physiology and are aimed at reducing the adverse effects of fatigue, sleep loss and circadian disruption resulting from flight operations. Sleep Scheduling Crew members who are sleep deprived before the start of a duty period will experience more difficulties than those who are well rested. Indeed, if they commence a tour of duty with an existing sleep debt, then generally this will only worsen during the trip schedule. Therefore, in addition to getting the best sleep possible before starting a trip, crew members should obtain at least as much sleep during each 24 hour period away as they would during a normal 24 hour period at home. Understanding the circadian and other factors will help them to maximise the sleep opportunities. If they are struggling to stay awake, then sleepiness should be taken as a clear sign to get some sleep. Conversely, if they wake spontaneously and are unable to return to sleep within 15-30 minutes, then they should get out of bed. In other words, if the brain is giving clear signals that the individual is sleepy, then sleep. However, if the individual wakes up and is alert and unable to sleep, they should get up. Key Points _____________________________________________________________________ At Home Get the best possible sleep before starting a trip On a Trip Try to get as much sleep in every 24 hours away as in a normal 24 period at home Trust your own Physiology If the crew member feels sleepy and circumstances permit, then they should sleep If the crew member wakes spontaneously and cannot get back to sleep in 15-30 minutes, they should get up _______________________________________________________________________________ Napping Napping has been shown scientifically to improve subsequent alertness and performance. However, it is important when taking a nap just before a duty period to minimise the chances of going into the deeper phases of sleep. This will help to avoid the condition known as sleep inertia which produces a disorientated sensation which can persist for 10-15 minutes after waking from deep sleep. Limiting the duration of a nap to 45 minutes or less will minimise the chances of having significant amounts of deep sleep but will nonetheless help to decrease the period of continuous wakefulness. If the crew member is able to nap at times other than immediately before a duty period, then the nap can be longer. In these circumstances, a nap of 2 hours or more will enable them to have at least one full cycle of deep and dreaming sleep. At other times, naps can be longer Remember, some sleep is better than none _______________________________________________________________________________ Good Sleep Habits The following recommendations are important and applicable to everyone. It can be useful to establish a pre-sleep routine to help teach the mind and body that it is time to relax and fall asleep. As part of this, a set of cues can then be developed which will assist the individual to relax in preparation for sleep anywhere and anytime. Paying attention to the sleep environment and trying to ensure that the room is dark (by the use of eye shades if necessary) and quiet (by turning off the telephone and using ear plugs) is also important. The bed should, of course, also be comfortable, although in a hotel this is outside the individual’s control and what is comfortable for one person, may not be ideal for another. At all times they should avoid going to bed hungry, as this will delay sleep, but conversely, eating a heavy meal will also disrupt sleep. Therefore, if they are hungry at bed time, the individual should eat a light snack or have something to drink, but avoid alcohol as this has a significant influence on sleep. Caffeine is known to prevent sleep onset and disrupt subsequent sleep in susceptible people.

Otherwise cheap phenergan 25mg mastercard, you may find that you experience a reduction of fear for only that one den- tist or procedure trusted 25mg phenergan. In addition to scheduling dentist appointments 25mg phenergan otc, you can also make a point of watching vid- eos showing dental treatment and role-play simple dental procedures with your helper. If you experience uncomfortable symptoms, such as faintness, a racing heart, or sweating, just let them pass without actively fighting them. As long as you continue to experience significant fear, the possibility of your fear worsening again will be elevated, particularly if you don’t have the opportunity to encounter the feared situation for an extended period of time. However, note that it’s perfectly normal to be ner- vous before certain types of medical or dental procedures. Remember, the goal of treatment is to reduce your fear to a normal level so that it no longer interferes with your life; the goal is not to eliminate all fear of medical or dental situations. Each case confronting your fear 85 example describes the specific treatment program that was used, which should make it easier for you to develop a pro- gram for overcoming your fear, based on your own hierarchy. Roxy—needles, injections, and blood tests Roxy’s fear of needles began when she was about ten years old. When it came time to have blood taken, her mother mentioned to Roxy that she could look away if she wanted to. Although her mother’s intention was to comfort Roxy, her comment had the opposite effect. A few years later, Roxy needed stitches after cutting her hand with a kitchen knife. Over the next few years, Roxy fainted several more times during routine blood tests, vaccinations, and other procedures involving nee- dles. Lying down seemed to reduce her faintness, and it usually prevented her from losing consciousness as well. At the dentist’s, she insisted on having all dental work done without an anesthetic. Fortunately, her health was good, and there was little need for her to confront needles. However, by the time she turned thirty, Roxy was beginning to think it was time to overcome her fear. She and her husband had recently decided to have a baby, and she was terrified to have the blood work she would need during pregnancy. Also, she was considering taking a new job that required her to receive several vaccina- tions and a full physical exam, including blood work. Her fear was beginning to interfere with her life, and it was time to do something about it. At her first therapy session, Roxy’s therapist con- ducted a thorough assessment and worked with Roxy to develop an exposure hierarchy. Given her history of faint- ing, Roxy and her therapist decided that exposure with applied muscle tension (to prevent fainting) would be the most appropriate treatment for her fear (see chapter 6 for a full description of applied muscle tension procedures). In that first session, Roxy was taught how to tense all the muscles in her body to raise her blood pressure. During the first week, she practiced the exercises for about five or ten minutes at a time several times per day, at home and in her office at work. At her next treatment session, Roxy and her thera- pist introduced exposure practices. Before each practice, confronting your fear 87 Roxy used the applied tension exercises, and she contin- ued to use them during the exposure practices, particu- larly when she noticed feelings of faintness. That session focused on exposure to photos of people getting injec- tions, as well as watching a videotape of someone having blood drawn. During the first thirty minutes she felt quitefaint,butthefeelingsubsidedbytheendofthe hour, until she was able to watch it with minimal anxiety or faintness. Over the next week, Roxy practiced watching the video at home for about an hour each day. For the first few days, she included the applied tension exercises to mini- mize any feelings of faintness that might occur. At her next therapy session, her therapist had everything needed to expose Roxy to the types of things she might encoun- ter during an injection or blood test. The session took place in a medical exam room, and the therapist was wearing a lab coat. Roxy repeatedly practiced having her arm tied with a tourniquet, followed each time by her therapist disinfecting the inside of her elbow with an alcohol swab. Next, Roxy practiced holding a sterilized needle to a vein on the inside of her elbow (without breaking the skin). When she was comfortable with this step, she allowed her therapist to hold the needle to her 88 overcoming medical phobias arm. Through the first part of the session, Roxy used the applied tension exercises to combat her faintness, but by the end of the session she was able to do the exposure exercises without applied tension. For homework, Roxy practiced exposure to the tourniquet and alcohol swabs for about thirty minutes each day (with her husband’s assistance).