Narrative:

I unintentionally flew fatigued during a trip. The following event could have resulted in a flight with a very tragic end. The trip consisted of a 4 day pairing with the first day flying 3 legs and late evening to the after sunrise. My sleep pattern consisted of a somewhat restless night of sleep in the hotel from after midnight to midmorning. After a somewhat unproductive day; I attempted to sleep beginning in the mid afternoon to be rested for the upcoming all-nighter. I believe I slept for about an hour and a half. I awoke; showered; ate; and reported for duty near midnight. This 2 segment turn went rather well. I was the pilot flying for the first leg. I believe I was alert for the entire duty period; with only a slight degradation in motor/thinking skill due to being tired. I then went into crew rest beginning at midmorning with an upcoming report time of shortly before midnight. I believe I slept off and on from approximately for about five hours. This was a restless sleep with many hotel type interruptions such as housekeepers banging around; noisy neighbors; light coming in the windows; etc. After waking; exercising; showering and eating; I reported on time. At this time I was feeling alert and ready to go to work. After a fairly uneventful first flight segment; followed by an hour thirty-five ground time; we departed for the return flight with me as the pilot flying. The first hour of the flight seemed to go well. It's the next 3 hours that were plagued with fatigue induced errors and safety violations. My first indication of fatigue was approximately one hour into the flight during cruise. I was reading; probably a company manual of some sort. During the middle of a sentence; my head bobbed down hard and my body jolted to attention. I remember the exact words I was reading; but I almost fell asleep in that instance. I looked over at the captain and informed him I was feeling rather tired. He shrugged his shoulders and went about his business as pilot not flying. I attempted to counter the affects of fatigue that I was feeling with caffeine; busy work; and concentration. However; these tactics were mostly futile. I remember at least one more head snap/body jolt during the flight. I missed radio calls and fell behind on navigating the airplane. The descent; approach and landing are pretty much a blur to me. One undesired aircraft state I got in was a high approach. The long continuous final approach down the glideslope began very stabilized. However; due to some wake turbulence issues; I disconnected the autopilot around 5;000 ft. This allowed me to fly a half dot high to stay out of the wake. I remember my hand flying was very jerky; not smooth; and sloppy. I watched the glideslope continue to go to one dot high; then a dot and a half; then two and so on. I was making an attempt to follow the glide slope; but with not much accuracy. Fortunately; the flight ended uneventfully. However; looking back at my performance; you might contribute that to a miracle. I went into crew rest at midmorning with an upcoming report time eleven hours later. I slept off and on for about three hours. After tossing and turning for another hour; I ended my attempt at sleep. I again reported for duty feeling ready to tackle the flight with alertness and gusto. However; it was again during the cruise phase that my fatigue; lack of sleep from the previous days; tiredness; or whatever you would like to call it set in. I was the pilot not flying during this one leg segment to our home domicile. I feel like I made many mistakes; most of them mental and having little outcome on the flight. I was sloppy and not very alert. I have not flown many flights during back of the clock duty periods; maybe just a handful during my six years here. I did not know; and still don't know how to predict when I will become fatigued during a flight. I figured if the trip was legal; it must be safe. This statement cannot be further from the truth. I believe the entire makeup of this 4 day pairing caused my fatigue which caused the undesired aircraft states. This pairing has non back of the clock duty periods; followed immediately by two back of the clock duty periods; followed immediately by a non back of the clock duty period. This body clock shifting is a recipe for disaster. Also; the built in sit time between the two flights is very dangerous. This increases the duty day and allows fatigue to set in faster due to the down time. Expecting the flight crew to get the needed rest while in a hotel during the day is crazy. My lack of sleep is mostly due to the hotel environment during the day. It is not conducive to sleep. Each day when I reported for duty; I did not feel fatigued. I felt alert and responsive. It was only much later into the duty period when I had adverse reactions to fatigue. I'm not sure how to utilize our fatigue policy in this circumstance. The bottom line is the trip is unsafe. This air carrier is creating a safety hazard with this pairing.

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Original NASA ASRS Text

Title: An Air Carrier First Officer describes a trip sequence with mixed back of the clock duty periods; and his fatigue as a result of insufficient sleep even with time periods scheduled for adequate rest.

Narrative: I unintentionally flew fatigued during a trip. The following event could have resulted in a flight with a very tragic end. The trip consisted of a 4 day pairing with the first day flying 3 legs and late evening to the after sunrise. My sleep pattern consisted of a somewhat restless night of sleep in the hotel from after midnight to midmorning. After a somewhat unproductive day; I attempted to sleep beginning in the mid afternoon to be rested for the upcoming all-nighter. I believe I slept for about an hour and a half. I awoke; showered; ate; and reported for duty near midnight. This 2 segment turn went rather well. I was the pilot flying for the first leg. I believe I was alert for the entire duty period; with only a slight degradation in motor/thinking skill due to being tired. I then went into crew rest beginning at midmorning with an upcoming report time of shortly before midnight. I believe I slept off and on from approximately for about five hours. This was a restless sleep with many hotel type interruptions such as housekeepers banging around; noisy neighbors; light coming in the windows; etc. After waking; exercising; showering and eating; I reported on time. At this time I was feeling alert and ready to go to work. After a fairly uneventful first flight segment; followed by an hour thirty-five ground time; we departed for the return flight with me as the pilot flying. The first hour of the flight seemed to go well. It's the next 3 hours that were plagued with fatigue induced errors and safety violations. My first indication of fatigue was approximately one hour into the flight during cruise. I was reading; probably a company manual of some sort. During the middle of a sentence; my head bobbed down hard and my body jolted to attention. I remember the exact words I was reading; but I almost fell asleep in that instance. I looked over at the Captain and informed him I was feeling rather tired. He shrugged his shoulders and went about his business as pilot not flying. I attempted to counter the affects of fatigue that I was feeling with caffeine; busy work; and concentration. However; these tactics were mostly futile. I remember at least one more head snap/body jolt during the flight. I missed radio calls and fell behind on navigating the airplane. The descent; approach and landing are pretty much a blur to me. One undesired aircraft state I got in was a high approach. The long continuous final approach down the glideslope began very stabilized. However; due to some wake turbulence issues; I disconnected the autopilot around 5;000 FT. This allowed me to fly a half dot high to stay out of the wake. I remember my hand flying was very jerky; not smooth; and sloppy. I watched the glideslope continue to go to one dot high; then a dot and a half; then two and so on. I was making an attempt to follow the glide slope; but with not much accuracy. Fortunately; the flight ended uneventfully. However; looking back at my performance; you might contribute that to a miracle. I went into crew rest at midmorning with an upcoming report time eleven hours later. I slept off and on for about three hours. After tossing and turning for another hour; I ended my attempt at sleep. I again reported for duty feeling ready to tackle the flight with alertness and gusto. However; it was again during the cruise phase that my fatigue; lack of sleep from the previous days; tiredness; or whatever you would like to call it set in. I was the pilot not flying during this one leg segment to our home domicile. I feel like I made many mistakes; most of them mental and having little outcome on the flight. I was sloppy and not very alert. I have not flown many flights during back of the clock duty periods; maybe just a handful during my six years here. I did not know; and still don't know how to predict when I will become fatigued during a flight. I figured if the trip was legal; it must be safe. This statement cannot be further from the truth. I believe the entire makeup of this 4 day pairing caused my fatigue which caused the undesired aircraft states. This pairing has non back of the clock duty periods; followed immediately by two back of the clock duty periods; followed immediately by a non back of the clock duty period. This body clock shifting is a recipe for disaster. Also; the built in sit time between the two flights is very dangerous. This increases the duty day and allows fatigue to set in faster due to the down time. Expecting the flight crew to get the needed rest while in a hotel during the day is crazy. My lack of sleep is mostly due to the hotel environment during the day. It is not conducive to sleep. Each day when I reported for duty; I did not feel fatigued. I felt alert and responsive. It was only much later into the duty period when I had adverse reactions to fatigue. I'm not sure how to utilize our fatigue policy in this circumstance. The bottom line is the trip is unsafe. This Air Carrier is creating a safety hazard with this pairing.

Data retrieved from NASA's ASRS site as of April 2012 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.