PARIS (AP) — One sailor used sandpaper to gingerly file down his broken molar before capping the aching stump with epoxy resin. But no one — at least not yet — has had to stitch their own tongue back together or crawl with a broken leg the length of their yacht tossed by raging seas, as in previous years.

The doctor of the around-the-world Vendee Globe solo sailing race has learned to be grateful for such small mercies. Experience has taught Jean-Yves Chauve that when the telephone rings in his surgery in France, it can only be bad news. His patients, utterly alone in the tormented oceans of the southern hemisphere, are as tough as old boots. They have to be to survive three months away from home, comfort and human contact. They're not the type to consult the doctor for mere aches and scrapes.

"These are very resistant people, so generally when they do call it's because there really is a serious problem," Chauve said. "I often say that I'm a doctor who lives in his waiting room. Because I have to be patient, I have to wait for people to call me."

They say the Tour de France is grueling. Ironman triathlons look aptly named, too. But the Vendee Globe might be the toughest race of any sport, almost lunatic and most certainly dangerous in the pounding day-after-day demands it puts on sailors and their boats.

Little more than one third of the way into the race from France, around Antarctica and back again, one third of the 20 starters have already given up. The remaining 13 skippers are scattered over 3,700 nautical miles (6,850 kilometers) of ocean from Cape of Good Hope on the southern tip of Africa to Cape Leeuwin on the southwestern tip of Australia. Ahead lies the Pacific Ocean, Cape Horn, the long sprint northward back up the Atlantic Ocean, and who knows how many icebergs, whales, storms and potential disasters to avoid.

It may be another 50 days or more before the winner sees the western coast of France and the harbor at Les Sables d'Olonne. That is the start-finish point of this race that bills itself as "the Everest of the seas" — although far more people have scaled the roof of the world or even stayed aboard the International Space Station than completed the six previous editions of the Vendee Globe.

Those that make it, never touching land or getting assistance, as the rules dictate, will doubtless return with more tales of having hallucinated from exhaustion, of seeing pink elephants or imaginary cats. Being able to sleep in short, sharp bursts or surviving on the briefest of power naps is a vital part of competing effectively.

"I often say Vendee Globe racers are elite-level sleepers," Chauve said in a phone interview. He's been the race doctor since its first edition in 1989. "If you sleep badly, if you sleep too much or have low quality sleep then it affects your intellectual performance and physical performance and that can be very bad over three months."

Being an accomplished sailor, single-handedly navigating giant yachts with a spread of sail, isn't enough. Vendee Globe competitors must also be mechanics, electricians and doctors, able to fix a broken diesel engine, debug a malfunctioning computer or stabilize a broken bone, always one of their own. They must know how to pace themselves, be their own coaches, insisting not only that they go fast but sleep and eat enough, too.

The muscular effort, alone, of keeping one's balance on such a yacht burns 800 calories a day, Chauve said. The sailors need daily to wolf down 5,000 calories, mostly dried foods, pasta and other carbohydrates, often over five meals. The galleys are minimalist: a water heater, a stove and a fork, the doctor said.

Stripped down to save weight, the sparse cabins amplify the thump of waves on the hull, a sound that can grow as loud as a rock concert, 120 decibels, Chauve said. Imagine how that wears on nerves and sleep. The constant damp makes the skin fragile. Salt gets into cuts; they can easily get infected. Unlike in other sports, there is no hot shower to reward aching muscles — just a cold flannel wash, more sea, more pounding, more missed sleep.

Bernard Stamm's tooth sheared off this week when he was eating. Even breathing became uncomfortable for the Swiss-born yachtsman, with cold air making the exposed nerve ache. Worried the broken molar's sharp edges would cut and infect Stamm's tongue, Chauve said he asked him "to file it down a bit, very gently of course," with sandpaper.

"We didn't ask him to file down the tooth completely, just the edge of the break. It only took a few seconds," Chauve said. "It is a bit painful but there was a risk of infection in the mouth."

Holding a small dental mirror, Stamm dried the stump as best he could with a cotton bud, wincing from pain. Being jolted around by the waves, he then dolloped resin on it, forming a hardened cap Chauve hopes will hold for two months until Stamm sees a dentist.

"In such conditions, it's always a bit do-it-yourself really, we have to make things up as we go along," the doctor said.

In the 2008 race, Yann Elies broke his femur in the ocean south of Australia, roughly where the race is now, when his boat hit a wave, tossing him backward.

"At the speed he was sailing, the water is as hard as a wall," Chauve said. "He had to drag himself with his broken leg from the front to the back of the boat, over a lot of obstacles."

Australian rescuers got to Elies after two days of suffering.

In 1992, competitors didn't have satellite phones like now. So Bertrand de Broc sent the doctor a fax: "'I've cut my tongue. What should I do?' It put me in a spot of bother, because it was really quite an original injury," Chauve recalled.

Chauve first practiced on himself — "I stood myself in front of the mirror and pretended I was doing the surgery on myself" — and then faxed his instructions back to the French skipper.

"He sewed his own tongue together with a needle and thread," the doctor said. Two stitches, "in just the same way that he would have sewn the sails on his boat."

That surely would be pain enough for most people.

De Broc is back again this year.

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John Leicester is an international sports columnist for The Associated Press. Write to him at jleicester(at)ap.org or follow him at http://twitter.com/johnleicester