Mike was recently interviewed for the “Me Time Midlife Podcast”. Click here to listen!
Very proud to have this report released! Thank you to all who contributed to our efforts, and a huge thank you to the CSA Group for tackling this issue. We are one step closer to providing all Canadian workplaces, both large and small, with a national standard on how to address fatigue. – Mike
With unprecedented levels of workplace fatigue attributed to modern day work, a national standard could help address the issue and improve workplaces in Canada
(Toronto, November 20, 2019) – Professional burnout is affecting a wide range of jobs, workplaces and industries, and there is no standard definition or management practice in place to address this issue. That’s the key finding from CSA Group’s latest research report Workplace Fatigue: Current Landscape and Future Considerations which was released today and finds that a common definition of workplace fatigue is currently lacking in Canada.
In 2019, for the first time, the World Health Organization recognized burnout as a medical diagnosis. However, without a standard definition of what workplace fatigue means in Canada, it’s difficult to say how pervasive the problem is.
CSA Group’s research finds that while a number of industries in Canada, including aviation, rail, marine, nuclear, oil and gas, healthcare and defense do recognize fatigue as an issue for workers, there is no comprehensive definition of workplace fatigue, what causes it or how it may affect performance.
“Our research has identified that there is certainly an opportunity for standards that address workplace fatigue to make a real and positive difference to workers in this country,” said Mary Cianchetti, President of Standards, CSA Group. “What we’ve found is there is a need to support the management of workplace fatigue in Canada for the health and safety of Canadian workers. CSA Group could help to address this gap with a national standard.”
In some workplaces, the potential consequences of fatigue can be a matter of life and death. Workers in paramedic services face unique health and safety issues on a daily basis such as shift work and extended work days, as well as periods of intense psychological stress or trauma. That’s why the Paramedic Association of Canada is currently working with CSA Group to develop a national standard on fatigue risk management for first responders, in parallel with this new research.
“Paramedics do a job that can be grueling both physically and emotionally, and workplace fatigue is an issue we cannot ignore. We know that the impact of fatigue on first responders can affect neurocognitive performance, which in turn can endanger not only their own personal health and safety, but also the health and safety of their fellow responders and the public they serve,” said Pierre Poirier, Executive Director, Paramedic Association of Canada. “This research identifies that a gap does exist in Canada when it comes to how fatigue is being addressed in the workplace. We are pleased to already be working with CSA Group to develop a standard for fatigue risk management for first responders aimed at reducing exposure to fatigue-related hazards and protecting both paramedics and the people they help every day.”
In 2018, CSA Group introduced a psychological health and safety standard to address the specific needs of paramedic service organizations. The creation of a standard for workplace fatigue could address gaps in the existing legislation to protect the health and livelihood of all Canadian workers, regardless of where they work.
For more information on the Workplace Fatigue: Current Landscape and Future Considerations research report, click here.
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!
I have the pleasure of speaking at various conferences and industry events on the subject of workplace fatigue. Regardless of the direction of my speech, there is inevitably a number of individuals waiting patiently to ask me questions about their own personal struggle with sleep.
It’s not surprising. Sleep was a mystery to us for centuries. It’s only been the last few years that science is beginning to unravel what is truly going on when we sleep, and why it’s not simply a waste of 8 hours in bed. Here are some frequently asked questions concerning why we don’t get the sleep we need.
1. Is it true we need less sleep as we get older?
For the most part, this is a myth. All adults require somewhere between 7-9 hours of sleep. As we age, we have a shift in how much time we spend in the different stages of sleep, with older workers getting less deep sleep (meaning less human growth hormone production) as well as REM sleep, reducing the overall length in the process. We also see a shift in our chronotype, meaning that as we get older, we tend to become more “morning larks”, getting up earlier in the day, often at the expense of not sleeping as long. It’s not uncommon for older adults to make up for their shorter night sleep by having a nap during the day, getting them closer to that minimum requirement of 7 hours.
2. It seems like every night I have to get up and go to the bathroom, and then I have difficulty falling asleep. What can I do?
There are medical and non-medical reasons why you’re waking up to pee in the middle of your sleep period. Urination at night (known as nocturia) can range from 1 or 2 episodes to as many as 5-6 times per night. The more frequent, the more we need to be concerned.
Try to get most of your hydration during the daytime hours and cut back at night, with no liquids a couple of hours before you go to bed. Alcohol, coffee and tea are all diuretics and will increase the need to wake up and visit the bathroom.
Keep in mind that as we get older, our bladders lose their “holding capacity”. We also have less of an anti-diuretic hormone that allows us to retain more fluid before we need to run to the bathroom! Older adults are at higher risk for certain medical disorders, or may be on medications that directly affect the bladder. Urinary tract infections, diabetes, and liver conditions could be culprits. Nocturia is also a warning sign for the development of something more sinister such as cancer of the bladder or prostate. Frequent urination isn’t always due to a full bladder.
Finally, shift workers may experience a body clock disorder that makes the body think it’s daytime when it’s nighttime and vice versa, and upset the natural timing of when we’re supposed to urinate.
If you can’t attribute your nocturia to consuming liquids too close to bedtime or some other cause, then please consult with your physician. Keep a daily drinking diary to help them determine what is going on.
3. I never dream. Is there something wrong with me?
Whether you know it or not, you are in fact drifting in and out of dreaming throughout your sleep, but if you don’t wake up while it’s happening, chances are that you won’t recognize it. For example, most of our vivid dreaming occurs during REM sleep, but if you wake up during a different stage of sleep, you may not notice the dragon chasing you through the woods. If you wake up and remember your dream, it often reflects a more gentle form of waking up, as opposed to an alarm clock blasting you awake or your kids jumping on top of you.
A sudden awakening typically causes a spike in noradrenalin being released, which quickly washes away your ability to recall the dream.
There are many theories as to why we dream, but academics are leaning towards the memory consolidation process, meaning that it reflects the brain trying to figure out what information is important to keep, and what can be removed. Think of it like a file cabinet where you have to weed out the old information to make space for the new.
4. I have very vivid dreams. Most don’t make any sense. Should I be worried?
One of the things that happens when we enter into our dream state is a heightening of emotions, creativity, and imaginings. This is due to a quieting of the frontal lobe of our brain, which is responsible for things like logic, problem solving, reasoning and self-control, and an increase in activity in our amygdala, which is responsible for our “fight or flight” hormones. As a result, our dreams are often incredulous, or make no sense at all. Don’t worry. You’re normal.
5. I’m a new parent. I am chronically sleep deprived. Please help!
A recent 2019 study examining new parents and sleep found that sleep deprivation lasted for the first 4-6 years after the birth of the first child. The first three months were the worst, with mothers receiving about 60 minutes less sleep, but improved to 40 minutes less sleep for the rest of the first year. The effect on fathers was less pronounced at only 13 minutes less sleep even during the first three months.
What’s worse is that not only are you getting less sleep, but you have more interruptions throughout the sleep period, with one survey indicating new moms getting only 1-3 hours of undisturbed sleep at a time. This interrupts our sleep cycle and you may miss out on critical stages of sleep.
The act of breastfeeding is a known sleep enhancer, making it easier for mom to fall asleep while feeding as opposed to bottle-feeding which causes the baby to move about more and disrupt the quietness of the situation. More controversial but often promoted is the notion of breastfeeding and sleeping in bed with the infant to minimize awakenings to both mom and the baby. If it means less sleep disturbances, it might be in your best interest.
Napping is a tired parent’s best friend. It can supplement the sleep you’re not getting. To effectively nap during daytime hours, be sure you have blackout drapery with no TV or lights on around you. Use a white noise device to block out daytime sounds from outside. And most importantly, lie flat. We fall asleep quickly when we’re lying down, but not so when simply reclining on the couch or in a chair. Try to always nap in the same location. Our bodies thrive on routine and as soon as you enter into your sleep space, it will help you to fall asleep quicker.
Still, every once in a while, you need a good solid night of sleep. Have your mother-in-law, siblings, or someone else who owes you a favour, take care of the kids for a night every couple of weeks so you can escape into deep, undisturbed sleep.
Finally, give yourself a break. The housekeeping police won’t be coming by to see if you made the bed, dusted the shelves, and vacuumed the carpet. Time is your most important commodity. Make sure your older children keep up with the chore list. If cost isn’t a huge factor, hire somebody to mow the lawn, clean the house, or pick up your groceries. And with all the options now available, ordering in food has became a lot more nutritious (and less clean up required)!