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Sleepless in Seattle . . . and Cincinnati and Syracuse
Vol. 57   No. 10
Sleep-deprived workers can cause injuries on the job, make costly mistakes and face lasting health problems. Public health specialists are sounding a wake-up call.

By Dori Meinert  10/1/2012
 

Last June, the National Transportation Safety Board cited driver fatigue as a main cause of a bus crash in New York that killed 15 people and injured 18 returning from a trip to a Connecticut casino.

It was one of several fatal bus crashes the board investigated last year—and one of the deadliest. Investigators found that the driver slept only for short periods of three hours or less in the three days prior to the crash.

"Fatigue and speed are an especially lethal combination," board Chairman Deborah Hersman said at the time. "In investigation after investigation, we are seeing the tragic results of fatigue, which can degrade every aspect of human performance."

While the consequences for sleep-deprived transportation workers and their passengers can be immediate, deadly and dramatic, a large portion of the U.S. workforce in many other industries is also getting insufficient sleep with surprisingly costly consequences, say researchers and public health specialists.

About 41 million U.S. workers get less than six hours of sleep each night, according to a study released earlier this year by the National Institute for Occupational Safety and Health (NIOSH). That means 30 percent of the U.S. workforce is getting less than the seven to nine hours a night recommended by the National Sleep Foundation.

Sleep-deprived workers are more likely to get injured on the job or make mistakes that injure others. Even in an office environment, they make mistakes that waste time and money. Productivity goes down. Absenteeism and presenteeism go up. In the long term, lack of sleep affects employees’ health, putting them at increased risk of cardiovascular disease, obesity, diabetes and depression, studies show.

Employers and employees can take steps "to increase the chances that the workers will get enough sleep," says Dr. Sara E. Luckhaupt, a medical epidemiologist and lead author of the NIOSH study.

Coupled with a significant increase in the use of sleep aids in recent years, the sleep-deficiency problem is only getting worse, sleep experts say.

"We’re kind of walking zombies at work," says James B. Maas, a social psychologist and author of Sleep for Success! (AuthorHouse, 2010). HR professionals should address the issue of sleep deprivation because it has physiological and cognitive consequences that affect the bottom line, he says.

Why So Weary?

Some theorize that workers aren’t getting enough sleep because the poor economy forces them to have two jobs or brings financial stress that keeps them awake. Others blame technology—and the psychological addictions that sometimes come with smartphone and social media use—that create the expectation that employees are "on call" any time.

Still others point to a culture where being too busy to sleep is a sign of importance, and an admission of fatigue may lead to a person being labeled lazy or wimpy. Some people may have medical problems such as sleep apnea, a condition that causes irregular breathing patterns that interrupt sleep.

At Fellowship Community, a retirement center in Whitehall, Pa., fatigue is often the first clue that a full-time employee is working extra hours elsewhere. Among its 280 full- and part-time employees, Jane Knepp, the company’s risk manager and HR administrator, is seeing more nurses, certified nursing assistants and personal care assistants take outside jobs with other employers.

The fatigue is particularly evident on the 11 p.m. to 7 a.m. shift. Dozing off is grounds for immediate dismissal, but tired workers who appear functional are hard to detect. They might show "just a lack of energy, really," she says. They might answer their own patients’ call lights but won’t help other employees who are busy.

Some are caring for children or aging parents during the day instead of resting up for their night shifts. "They think they can do it, but, from a business standpoint, they can’t. Nobody can," Knepp says.

How Do You Set a Body Clock?

Not surprisingly, employees who work nights are even less likely to be getting enough sleep. The NIOSH study found that about 44 percent of night-shift workers get too little sleep, compared with 29 percent of people working day shifts. Night-shift workers in the transportation and warehousing sector and in the health care and social assistance sector—which consists of social workers and counselors, for instance—top the list of the sleep-deprived.

"We are wondering if this has something to do with the way they are scheduled," Luckhaupt says.

It’s not just the length of time a person sleeps; time of day matters, too.

The human body has a daily cycle, called a circadian rhythm, that forces people to sleep. The urge to sleep is strongest late at night and reaches a peak in the early morning. Disrupting that rhythm can lead to sleepiness on the job—and, ultimately, health problems.

As an example, in 2007, the International Agency for Research on Cancer, a part of the World Health Organization, linked night-shift work to cancer. Other studies link working night shifts to diseases ranging from diabetes to heart disease.

An estimated 20 percent of the working population in developed countries work night shifts. Some of these individuals can retrain their so-called body clocks by adjusting environmental factors, such as keeping their bedrooms dark when they sleep in daylight. Others can’t adjust and develop shift-work disorder, a treatable medical condition that occurs when an individual’s internal sleep-wake clock is out of sync with his work schedule.

What Are the Consequences?

In lost productivity alone, insomnia costs the nation
$63.2 billion a year, primarily due to presenteeism, according to a study published in September 2011 in the journal Sleep. On average, a U.S. worker who is too sleepy to function fully at work costs his employer 11.3 days in lost productivity, or $2,280 a year, researchers estimate.

Those estimates surprise people because sleeplessness often isn’t viewed as a medical problem, says the study’s author, Ronald C. Kessler, a Harvard Medical School professor.

"People aren’t getting treated because they don’t see themselves as sick," he says. "People who have sleep apnea just slowly get weaker, and they don’t notice." Day after day, they wake up tired, grab coffee and drag themselves to work.

Fatigue shows up in careless mistakes. In the health care setting, "when workers make a mistake, it may not be a typo. It could be someone’s life," says Francesca Williams, regional HR manager for Nueterra, with responsibility for five Houston-area hospitals.

In the 24-hour restaurant business, "when people are tired and having to count cash and take inventory, there can be big financial implications," says Debby Carreau, president of Inspired HR. She provides HR services to small and medium-sized companies from offices in Canada and California.

Fatigue also makes people moody and irritable, increasing problems with co-workers. Fellowship Community’s Knepp recalls a recent blowup between two certified nursing assistants during the 3 p.m. to 11 p.m. shift regarding the proper way to transfer a resident.

Their disagreement was blown out of proportion because "all they had to do was ask a nurse supervisor," Knepp says. When she discussed the problem with them, she learned one had an outside job and the other was facing financial stress.

Numerous studies show that fatigue slows reaction time, reduces alertness and reduces decision-making ability. In a study published last year, researchers at Virginia Tech University and Michigan State University found that lack of sleep caused workers to behave less ethically. Another study last year led a researcher at Temple University to conclude that sleep deprivation causes individuals to make riskier economic decisions.

The repercussions of weary workers go beyond worksites. The National Highway Traffic Safety Administration reports that at least 100,000 crashes a year are due to driver fatigue, causing 1,550 deaths, 71,000 injuries and $12.5 billion in damage.

Why Is Sleep So Critical?

Scientists can’t fully explain the restorative powers of sleep, but many say it’s as important for living as food and water, maintains Claire Caruso, a research health scientist at NIOSH. In a laboratory study, rodents kept awake for a few weeks died of sleep deprivation. It took just a little longer than death from starvation, she says.

"We don’t think of it as being that fundamental to health and safety," she says. "One of the theories is that sleep and the immune system are working together to fend off pathogens." During sleep, people’s bodies repair wear and tear and their brains form memories of new information learned.

Because many studies confirming that poor sleep leads to health problems have appeared only recently, many health care providers didn’t learn about the problem in their medical training and thus aren’t focused on it, Caruso says.

However, that’s starting to change. The federal government includes sleep health in its Healthy People 2020 program, the nation’s 10-year goals for health promotion and disease prevention. The goals include increasing the proportion of adults and teens who get sufficient sleep, increasing the proportion of people with symptoms of obstructive sleep apnea who seek medical evaluation, and reducing the rate of vehicular crashes due to drowsy driving.

Employer Solutions

Some employers, such as EE Technologies Inc. in Reno, Nev., are now offering sleep education, or sleep hygiene, as part of their wellness programs.

In every industry, "people aren’t getting enough sleep. We are all just trying to do too much," says Laura Anderson, HR supervisor. During two shifts, 132 workers at the Reno site make electronic printed circuit boards.

Last May, employees were encouraged to participate in a "Chill Out Challenge," committing to eat one cup of fruit or vegetables a day, exercise and get seven hours of sleep daily. They each won points toward monthly $100 discounts on health insurance. Still, some workers told Anderson they had trouble getting enough sleep.

Sarah E. Cannon-Foster, western regional director of human resources at Starwood Hotels and Resorts Worldwide Inc., brought in sleep expert Maas to speak first to 40 hotel general managers and then separately to 100 HR professionals. The company purchased a copy of his book for each attendee.

"HR leaders, by nature, are many times caretakers for the team," she says. "We felt this was going to help equip them to take care of themselves as well, through understanding the correlation between sleep and optimal performance."

One solution to workplace drowsiness is for employers to allow—even encourage—naps, says Maas, who coined the term "power nap" more than 30 years ago.

"Rather than taking a coffee or cola break, which is going to disturb your sleep at night, why not take a power nap?" he asks. He recommends a 10- to 15-minute snooze in the afternoon, when the body’s circadian rhythm takes its second dip. (The first dip occurs in late evening to signal that it’s time for bed.) Any nap longer than 15 minutes will leave employees feeling groggy.

Maas acknowledges that a stigma of laziness prevents some employers from promoting naps. Only 6 percent of employers offer onsite nap rooms, according to the 2012 Employee Benefits research report by the Society for Human Resource Management.

At Northwestern Memorial Hospital in Chicago, computer software won’t allow nurses to sign up for more than 60 hours a week or more than three 12-hour shifts in a row, says Ann Schramm, director of women’s health, who oversees about 440 nurses. Self-scheduling gives workers more flexibility and control of their work schedules.

The hospital recently adopted a policy supporting planned napping by nurses on breaks, and administrators are identifying quiet rooms.

The hospital has implemented a "Take a Break" program, asking nurses to document breaks to make them more aware of the breaks’ importance. Many get busy and forget to take breaks or are reluctant to turn patients over to someone else, Schramm says. She is discussing with HR how to transfer some of these ideas from nursing to other departments.

In tackling worker fatigue in a health care setting, HR professionals should review staff-to-patient ratios to ensure that employees aren’t overworked, advises Williams of Nueterra. They also should create a culture where employees feel comfortable speaking up if they need a break, she adds.

While federal agencies set minimum standards for time off for certain workers, such as truck drivers and airline pilots, sleep and safety experts say that approach alone won’t solve the problem.

Looking for a way to improve its safety record, Schneider National Inc., a trucking company based in Green Bay, Wis., began screening drivers for sleep apnea in a 2004 pilot. A company nurse noted that many drivers fell into the at-risk category of overweight aging males with sedentary lifestyles. That year, 339 drivers were diagnosed with sleep apnea and treated. The results were a 30 percent drop in preventable crashes, a 48 percent drop in the cost of crashes and $539 monthly savings in health care costs per driver. The savings were so dramatic that Schneider began testing all drivers.

Today, Schneider treats about 2,000 of its 11,500 drivers for sleep apnea. Even with treatment cost at $3,500 per driver, paid from a self-funded health plan, the return on investment has been positive, says Don Osterberg, the company’s vice president of safety and security. Drivers have access to a network of 30 sleep clinics while on the road and receive training on sleep hygiene.

"We viewed it as an investment that was going to improve benefits, reduce health care costs and improve safety costs," Osterberg says.

One unanticipated benefit was a 60 percent reduction in turnover among treated drivers—a significant advantage in an industry known for high turnover.

Better yet: "We’ve gotten testimonials from drivers who say, ‘You’ve saved my life.’ "

The author is a senior writer for HR Magazine.

Are your workers sleep-deprived? How do you know? How are you addressing the issue?

Web Extras

Online Sidebar:  Night Shift Creates Stress, Health Concerns

SHRM article: Shift Workers More Likely to Be Injured (Safety and Security Discipline)

Study: Short Sleep Duration Among Workers—United States, 2010 (Centers for Disease Control and Prevention)

Study: Insomnia and the Performance of U.S. Workers: Results from the America Insomnia Survey (Sleep journal)

Study: Sleep Deprivation Biases the Neural Mechanisms Underlying Economic Preferences (The Journal of Neuroscience)

Study: Lack of sleep and unethical conduct (Organizational Behavior and Human Decision Processes)

Guidance statement: Fatigue Management in the Workplace (Journal of Occupational and Environmental Medicine)

Study: Sleep: A Health Imperative (Sleep journal)

Report: Evolution of Fatigue Risk Management Systems (Circadian Technologies Inc.)

Video: Sleep and Health (Harvard Medical School and WGBH Educational Foundation)

Blog post: Sleep and Work (National Institute for Occupational Safety and Health)

Blog post: NIOSH Research on Work Schedules and Work-related Sleep Loss (National Institute for Occupational Safety and Health)

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