An important step forward to address fatigue risk in Federal Aviation Administration air traffic operations

Recent incidents at John F. Kennedy International Airport in New York, and at Ronald Reagan Washington National Airport, are among a long list of near-miss air traffic safety incidents.¹ But these incidents are not new. The American Academy of Sleep Medicine has addressed the high prevalence of fatigue-related risks to safety among air traffic controllers (ATCs) in prior communications.^2,3 The National Transportation Safety Board, the organization charged with investigating major transportation safety incidents and issuing recommendations to enhance safety, has also long been concerned about the problem of fatigue-related safety incidents. In its 2019–2020 Most Wanted List of transportation safety improvements, the National Transportation Safety Board specifically included the reduction of fatigue-related accidents as a goal, along with specific recommendations to the Federal Aviation Administration to address fatigue-related mistakes among ATCs.⁴

In December 2023, the Federal Aviation Administration commissioned an independent panel of fatigue science experts to review the data and offer mitigation strategies. In April 2024, Federal Aviation Administration Administrator Michael G. Whitaker, after reviewing the expert panel’s recommendations,⁵ issued his intention⁶ to pursue key changes in the current system of duty hours rules for ATCs⁷—some immediately, and others in the longer term.

Faced with acute shortages in the workforce, ATCs are known to work prolonged shifts without sufficient rest opportunities. A particularly exhausting schedule, known as a “rattler,” compresses 5 shifts into a 4-day span, in which an ATC might work a day shift followed by a night shift on the same night. Individuals working such shifts only achieve 2–3 hours of sleep before the night shift.⁸ Work hours like these result in a fatigued worker, whose ability to perform the job is compromised. This practice should not continue.

Second, in addition to long work hours, the need for round-the-clock operations requires workers to be on duty during nontraditional hours (late nights, early mornings, rotating shifts), which includes their circadian low period of the day, when the drive for sleep can be most powerful. This innate biological drive to fall asleep may be even more prominent when it occurs in the background of chronic insufficient sleep over days, weeks, or months. The sleepier a worker is, the more likely they are to make a serious mistake.

Third, the nature of the work itself leaves this situation particularly vulnerable to fatigue-related errors: the need for sustained cognitive attention; the monotony of the task, which is continuous surveillance; the need to scan multiple screens simultaneously (such as weather and radar information); and the physical conditions—a sedentary position in a location that is quiet, cool, and dark (if during nighttime hours). Taken together, these conditions create the “perfect storm” for major safety incidents.

Sleep science has shown that a healthy adult who gets 6 or less hours of sleep at night over 14 nights experiences cognitive impairment equivalent to what is seen after up to 2 full nights of complete sleep deprivation.⁹ To make matters worse, affected individuals may be unable to recognize their own impairment and may instead have a false sense of confidence.^9,10 The combination of insufficient sleep, misaligned sleep, and the difficulty of assessing one’s own impairment with accuracy can therefore increase the rates of safety incidents, errors, do-overs, misses, near-misses, and outright accidents.

Given this large burden of scientific evidence, we unequivocally applaud Mr. Whitaker for offering prompt directives to address public safety. Among the initial steps, to become effective in 90 days, is the requirement for 10 hours off between shifts, and 12 hours off before a midnight shift. The importance of this step cannot be overemphasized, for it acknowledges that sleep is an essential biological need that cannot be circumvented. His plan to monitor for adherence with this directive will also be a crucial component of ensuring that this plan is implemented successfully.

He also suggests that rotating shifts be scheduled in a forward-rotating manner, a practice better suited for workers’ circadian biology than backward-rotating shifts. This requirement is critical, because humans as a rule are better at delaying sleep rather than advancing sleep hours.¹¹

We also concur with his broad-based approach to not only offer rest breaks, but to increase the number of workers over the long run. Adequate staffing can help relieve the need for overtime, allow days off between consecutive series of shifts, and reduce workload while on duty. This approach would allow not only more rest between shifts but also reduce the cognitive demand while on duty, which can help slow the accumulation of fatigue over a shift.

Moreover, the plan includes attention to sleep disorders such as obstructive sleep apnea, which are common, yet often unidentified or untreated.¹² Education and awareness about the role of sleep and sleep disorders in alertness, safety, performance, and health is crucial in mitigating the downstream effects of fatigue.

Finally, we are in strong support of implementing these strategies in a nonpunitive way, as he proposes. Work in the commercial trucking industry shows that entity-wide fatigue management programs can indeed be implemented successfully.¹³

Sleep is a basic biological need. Inadequate sleep can have chronic, long-term consequences on health and safety for the worker, including increased risk for cardiovascular disease, diabetes, obesity, mood disorders, cognitive decline, infection, and cancer, as well as driving accidents. While addressing public safety, ATCs, by working in an environment that promotes healthy sleep, also have the opportunity to achieve tremendous personal health gains.

DISCLOSURE STATEMENT

The authors submitted this letter on behalf of the Public Safety Committee of the American Academy of Sleep Medicine. The authors report no conflicts of interest.