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The long-term health effects of fatigue: burnout

by Emma Chisholm Programme Director

Following on from our blog post on the effects of long-term fatigue on mental health, we continue to examine the pilot lifestyle and the effects of fatigue by taking a look at the damaging effects of burnout.


‘Burnout’ is the term used to describe a chronic state of physical, emotional and mental exhaustion combined with doubts about your competence and the value of your work. Burnout is more common in high-achievers who, with their ‘I can do everything’ attitude, can ignore the fact that they are working exceptionally long hours and putting enormous pressure on themselves to ‘cope’.

We don’t yet have quantitative evidence of the burnout rate of pilots, but looking at the medical profession as a comparator, one study estimates 27% of physicians in the UK suffer from burnout and it’s a phenomenon that is on the rise across professions. We are certainly hearing of more cases across the Association and we hear of ‘burnout’ clinics for pilots that have been set up in Portugal and Switzerland.

Clearly preventing and reducing work-related burnout is of great importance to pilots as individuals but also to prevent the economic losses for airlines which are a result of long-term sickness and potential loss of highly experienced workers. The business case for ‘pilot well-being’ is another angle from which this issue can be tackled.


Of course, pilot roster construction is critical in reducing the risk of sleep deprivation, and BALPA’s work in this area is ongoing. But what can pilots as individuals do to better cope with the demands of their roster? Good physical fitness can be helpful for increasing tolerance for sleep disruption by lessening fatigue and improving recovery mechanisms.

Good sleep ‘hygiene’, including tightly scheduled sleeping hours, sleep routines, use of naps and arrangements to avoid disturbances. Access to natural light can help, although the role of light is complex. If the light is bright enough it can promote phase adjustment of the body clock but at a lower intensity, it can have a more general positive effect through general activation of the nervous system.

Healthy and regular meals are important. Those with late duties should have their main meal in the middle of the day instead of during the shift. Those on night duties should eat lightly during the shift and have a moderate breakfast before their sleep to minimise digestive discomfort. Pay careful attention to high carbohydrate foods and high sugar snacks as these can encourage sleepiness

The use of stimulant substances, such as caffeine, can be used to temporarily counteract sleepiness when alertness is required but this does not address the underlying sleep deficit, and taking caffeine within four hours of sleep is likely to disrupt the sleep you get. However, it will assist in nap recovery so it can be beneficial to save caffeine use for the times in which it is really needed.

Further information on the contributors to sleepiness and fatigue can be found in the BALPA fatigue reporting guide that all members should have.


It may be that despite your best efforts to stay fit and manage your sleep you, or your family, notice that sleep is becoming a problem and/or other aspects of your mental health are suffering. You are a pilot who needs a Class 1 medical and if you don’t have that, you can’t work so there may be reluctance to take steps to address this medical issue.

Your first point of contact is your AME but if the AME is not immediately available and if you are in any doubt about your fitness you should not fly.

The AME will ask questions mainly around safety performance effects – any daytime sleepiness, symptoms of depression, difficulty in concentrating, etc. The AME will want to establish the potent contributors to your symptoms (domestic vs work stress for example) to make a judgement about how far down the route of medical investigation to go. Once a diagnosis is made a pilot might be referred to a sleep clinic or towards a range of psychological and psychiatric therapies. Selected pilots can fly while taking antidepressants and referral to see a CAA consultant psychiatrist should not be feared. Pilot feedback after these consultations is excellent.

BALPA is currently working with a renowned sleep centre to create a ‘care pathway’ for pilots with a sleep disorder which will include a specialist sleep disorder clinic for pilots.



Our sense is that the current known cases of longer-term mental health issues related to fatigue are just the tip of the iceberg. Recent membership polling told us that 90% of pilots have known other pilots to fly when unfit to do so. And of those who have flown unfit, 12% cite stress and 3% cite depression/anxiety as the reason they are unfit. The majority (77%) cite fatigue as the reason, but given the inter-relationship between long-term fatigue and mood disorders, and the fact that pilots may not recognise (or be willing to admit) a mental health issue, we might expect the problem to be bigger than we think.

Working hours are just one contributing factor to these health problems, but with pilot hours
increasing (and the recovery periods decreasing), it is conceivable that a cadet pilot today will retire having flown 40,000 hours by retirement, almost double what the average retiree today will have flown. If we are seeing problems now, what will this look like in 10 or 20 years? So while we continue our Focus on Fatigue programme to challenge rosters, improve reporting and support pilots we must not ignore this less obvious but insidious problem that will face pilots and our profession.

Have you been affected by any of the issues raised in this article? Would you be prepared to anonymously share your story to raise awareness of this issue? If so, please email fatiguegroup@balpa.org.