Mike was recently interviewed for the “Me Time Midlife Podcast”. Click here to listen!
This article recently appeared in OHS Canada
One of your top workers is rubbing his eyes, yawning and moving slowly. You know that “John” still has four more hours on shift in a safety-sensitive job. You ask him how he is and he responds: “I’m fine, just a little tired.” What do you do? Do you get him a cup of coffee? Make him take a break? Or do you tell John to just be safe out there? What actual written procedures do you have in place for your supervisors to follow?
Fatigue is not simply a state of feeling tired. Fatigue can be a hazard in and of itself, but what is often overlooked is how fatigue can elevate the risk of other hazards you’ve already identified. To prevent errors and incidents from happening, it takes more than just having a worker show up with eyes open.
While there are a number of personal reasons why a worker may be struggling with fatigue, at some point we have to start looking at the flaws in the system — not just the flaws in the worker.
The science is clear: workplaces need to understand their role in the promotion and mitigation of fatigue. The most important factor in their control comes down to the design of work schedules. There are two components to consider in a schedule design — the time of day that the work is being done (circadian factor) and the length of hours on and off duty (homeostasis factor).
Humans are not nocturnal
Based on our circadian rhythms, humans are a diurnal (day-oriented) species. This means we will always perform better and be more alert and safe when working during daylight hours, and get our best sleep during dark nighttime hours. We are at our worst between midnight and 6 a.m. when we are programmed for sleep, and suffer poor sleep when trying to sleep during daytime hours. There is also a dip in our rhythms in the early afternoon (the siesta period), which can also affect alertness and performance. Most importantly, research has demonstrated that less than three per cent of night workers show any physiological adaptation to night shifts. In other words, we have yet to figure out how to turn our species into nocturnal animals. So, while you may think you’ve adapted, the truth is, you’ve adapted to being in a state of impairment — it’s your new normal.
Recognizing that shift workers are at higher risk for fatigue and performance impairment, consider the following:
- Do one or more shifts exceed 12 hours in a 24-hour period?
- Do any shifts start or finish between the hours of midnight and 6 a.m.?
- Do changes to a roster, or posting of shift assignments occur with less than two weeks’ notice?
- Are complex or critical tasks scheduled during the high-risk zones?
The longer you’ve been awake, the more sleep pressure builds in the brain due to a depressant called adenosine. The result is that after being awake for 14 hours, sleepiness starts to set in. At 17 hours, you are the equivalent of .05 blood alcohol impairment (BAC). At 18 hours, you will be struggling to stay awake. At 20 hours, you are equivalent to .08 BAC, and your cognitive abilities drop by up to 40 per cent. Back to John. If he works a 12-hour shift, considerations would need to include when he woke up, length of his commute and any other factors that might influence how long he’s been awake, in addition to circadian factors.
If John’s on a night shift, that means a minimum of 12 hours off duty before his next shift. Ask yourself:
- Do some extended hour shifts exceed 12 hours?
- Are more than three consecutive 12-hour night shifts worked?
- Is there less than 12 hours undisturbed rest after a 12-hour night shift?
- Do employees work more than 60 hours in a seven-day period?
- Are there irregular and unplanned schedules as a result of call-outs?
- Is overtime unmonitored?
If you have identified flaws in the scheduling system, that doesn’t mean you have to throw it out. It does mean that you need to put a plan in place to mitigate the risk attached to those flaws.
Because being awake is not enough.
In my previous blog, we reviewed frequently asked questions I get at conferences, such as why we get up to pee in the middle of the night, what my dreams really mean, and how to reclaim sleep after bringing a baby into the mix. In Part 2, we delve into the impact of technology, sleep disorders, prescription meds and of course, non-prescription sleep aids.
1. I’ve heard looking at my smart phone can be bad for my sleep. How come?
All of our smart technology is driven by blue-enriched LED light. Within the full spectrum of light, there is a particular blue stream that has a direct effect on our ability to sleep by suppressing the production of Melatonin and affecting our circadian drive. Melatonin is our natural sleep hormone. It’s what helps us fall asleep and stay asleep.
During daytime hours, blue light exposure (including sunlight) is excellent. It can enhance our moods, improve focus and concentration, and actually help us sleep better at night. However, it’s all about timing and any night time exposure (after the sun has gone down) is strongly discouraged. Since the impact of light is affected by distance, small handheld devices like smart phones, e-readers, IPads, tablets and laptops are more damaging due to their proximity to your eyes than a big screen TV across the room.
While many devices have dimming features to ease eye strain, that is not the same as a blue light filter and will do nothing to prevent the suppression of melatonin. Most of our newer devices have built in blue-light filters to reduce this damaging effect. Check if your device has one. Go into settings, display, and then look for either “night shift” or “blue light filter” to activate it.
If you’re a day worker, use the automated “sunrise to sunset” feature. If you’re a shift worker, you may want to select specific times for it to activate. Your screen will turn a pink or orange-ish hue and greatly improve the chances of you getting a restful sleep. If your device doesn’t have a blue light filter, there are plenty of free blue light filter apps available online.
2. I’ve heard you can buy Melatonin. Do you recommend it?
Here’s what we know. It has been heavily marketed in recent years as a safe way to help get sleep, but synthetic melatonin is not the same as what your body produces, and does not take you through the sleep cycle like natural melatonin. Many side effects have been noted, including excessive grogginess the next day after you use it, upset stomach, and very vivid, horrific nightmares. It is also not recommended for people who have a history of depression, as it can enhance these feelings, or a history of seizures.
Recent scientific literature is advising that you restrict the use of Melatonin on a temporary basis, such as when you’re travelling across time zones, to help offset jetlag, but not to use it on a regular basis as a sleep aid. Not everybody produces, or requires, the same amount of melatonin, and the timing of taking it is just as important as the amount. For example, some need it earlier in the day than others. As for parents giving it to children, there simply isn’t enough long term research on the effects of children, but given what we know about the effects on adults, why take the risk of giving them nightmares or affecting the quality of their sleep.
If you suspect your lacking melatonin, a safer and gentler alternative is the natural supplement called L-Tryphtophan. It is the precursor needed for the body to produce serotonin in the gut, which ultimately is synthesized into our own natural version of melatonin.
3. How do I know if I have a sleep disorder?
Very simply, if you wake up unrefreshed and struggle to stay alert throughout the day, you could have a sleep disorder. If it takes you longer than 30 minutes to fall asleep, and you wake up several times during the night and can’t fall back asleep, you could have a sleep disorder. Most importantly, if someone tells you that you snore loudly, or has heard you gasp or choke during the night, you could have a sleep disorder. In this case, you may be suffering from Obstructive Sleep Apnea (OSA).
OSA is becoming more and more prevalent and is probably the most dangerous. It’s the result of something blocking our airway while we sleep. We literally stop breathing. When it repeatedly lasts for more than 10 seconds, you officially have OSA. This means we starve both the heart and the brain of oxygen, and this leads to all kinds of other significant health issues including cardiovascular disease and stroke. It also means we don’t get through all of the sleep stages that we need to because every time we gasp for air, it wakes us up and kicks us out of the sleep cycle, thus preventing us from getting the recuperative sleep we need. You’ll be constantly exhausted, unable to focus, and emotionally drained.
While obesity is a prime contributor to the onset of OSA (a size 17 neck for men and 16 for women is a primary risk factor), that doesn’t mean other people can’t have airway obstructions. Adults and kids alike can have enlarged tonsils or adenoids that block the airway. A narrow palette with a wide tongue could collapse back into the throat during sleep. Sleeping on your back is also a known cause. Heavy smokers, drinkers and those using sedatives are at high risk, as they all cause the muscles of the throat and tongue to relax and collapse on themselves.
It has been reported that 1 in 4 Canadian adults have symptoms of OSA. If you think this may be you, book an appointment at a sleep clinic to get checked out. Depending on the severity, you may be outfitted with either a dental appliance (minor OSA) or a CPAP machine (severe OSA). A CPAP machine is one that provides continuous positive air pressure to ensure the airway stays open while you sleep and is the most effective method for combatting OSA. Check if your benefit plan covers the cost of these devices.
4. What sleep medication would you recommend?
In short? None. And not only because I’m not a Doctor. Both prescription and non-prescriptions medications (including melatonin) disrupt your natural sleep cycle so they don’t replicate normal sleep patterns. Alcohol needs to be included here, as many people turn to is as a sleep aid.
Prescriptive medications (benzodiazepenes) are highly addictive and their use should be limited to being a last resort and only under the strict guidance of your doctor. However, even over-the-counter meds can create high tolerances and come with other side-effects. More importantly, taking medication only treats the symptoms, not the problem. Stress is a common cause of sleep disturbance, in addition to those previously mentioned. You need to address the heart of the matter for the best results!
Mike was recently interviewed for the “Me Time Midlife Podcast”. Click here to listen!
A new report from the US Department of Transportation has been released that examines the relationship between accidents and incidents amongst US rail industry maintenance-of-way employees and their corresponding work schedules.
Ten U.S. railroads participated in the study by providing MOW data. Study methodology consisted of using a biomathematical fatigue model to review work schedules to determine if they exceeded thresholds of acceptability on 12 factors that are known to be related to impaired performance due to fatigue. Participating railroads provided 10-day schedules to facilitate modeling of fatigue prior to the accident or incident. Exceeding the fatigue risk threshold on any of the 12 factors indicates elevated risk due to fatigue accumulation and subsequent impairment of performance. Results indicate that portions of the work schedules exceeded fatigue risk threshold levels for almost all 12 factors measured and in some cases, there were multiple factors that contributed to exceeding the fatigue risk threshold. This understanding can inform efforts to optimize MOW worker schedules to reduce fatigue and related human performance errors. The results may also support changes to safety standards regarding regulations for MOW work/rest periods to be consistent with other railroad employee work/rest regulations.
Read the full report here.