The original article appeared in WorkSafe BC Magazine. Article by Sarah Ripplinger
Fatigue is more than just a bad night’s sleep. Being in a chronic state of tiredness has adverse health effects from slow response times to increased vulnerability to disease. Employers can reduce the harm by creating a fatigue risk-management system.
Getting enough sleep is essential for our health, but it’s often easy to believe we can overcome fatigue with another cup of coffee or a splash of cold water to the face. In reality, the rise of digital technology and 24/7 workplaces is changing the way we work, and making it easier to work at any time of the day.
This comes with business benefits in terms of workplace productivity, flexible work schedules, and meeting growing consumer needs. But the flip side is that, according to a sleep review from Dalhousie University, only 26 percent of Canadians get a minimum seven hours of sleep per night. And an estimated 40 to 50 percent of workers are fatigued at work.
“Globally, fatigue has been identified as a contributory factor in many serious and fatal incidents spanning decades. It is having real impacts on workplace health and safety,” says Heather Kahle, a human factors specialist and ergonomist at WorkSafeBC. “Fatigue decreases one’s ability to perceive and process important information necessary for safety. It may also decrease one’s ability to adequately respond to workplace hazards.”
More than feeling drowsy or sleepy, fatigue is an acute or
chronic state of tiredness. Disruptions to our body’s natural circadian rhythms
— which affect our sleeping and waking cycles — from such things as shift work,
long shifts, and back-to-back shifts increase the risk
of workplace fatigue. If left unchecked, fatigue can contribute
to long-term health effects, such as a vulnerability to certain types of
cancers, heart disease, stroke, diabetes, dementia, and Alzheimer’s disease.
Putting workplace fatigue to bed WorkSafeBC held its inaugural Fatigue Risk Management Symposium on June 7, 2018, to raise awareness of the risks associated with fatigue in the workplace and the importance of addressing them. Nearly 200 professionals from a variety of industries heard from five leading experts on fatigue-related risk in the workplace.
Presentations and discussions covered topics ranging from
fatigue risk management to circadian rhythms and how fatigue influences workplace
performance. Presenter Mike Harnett, president of Solaris Fatigue Management,
emphasized why it’s important for employers to take an active role in
preventing fatigue. She notes that fatigue in the workplace only became part of
the broader risk assessment dialogue for employers in the past three to four
years, largely due to increased reporting on scientific findings that show fatigue
impairment is real. Before that, fatigue was often seen as an issue for workers,
not employers. Fatigue risk management is a shared responsibility. “We cannot
continue to blame the worker and classify the cause of incidents as ‘human
error.’” The challenge now, Harnett says, is to continue to raise the profile
of fatigue as a risk-management priority. “Management needs to see fatigue as a
business issue
and collect metrics to drive informed decision making,” says
Harnett. “Only through the collection of
objective data can management set targets that support KPIs [key performance
indicators]. As we often say in the safety world: What gets managed, gets
done.” Managing fatigue from the top down A fatigue risk-management system
(FRMS) is a highly useful framework employers can use to proactively identify
and evaluate hazards and risks that may result in harm or adverse outcomes. Critical
to this undertaking is establishing an integrated, consistent, and trustworthy
system-wide approach to identify, assess, and control for the risks that can
escalate in the presence of fatigue. Transparent reporting and evaluation
policies are also essential ingredients of a successful FRMS. “With fatigue
recognized as a key contributory factor in workplace health and safety, FRMS is
a solid framework used worldwide to measure, mitigate, and manage the risk of
fatigue,” says Kahle. “It can be used to set priorities and establish baseline
data to evaluate fatigue management strategies over time to ensure that
targets are being met and the appropriate interventions are
being used. “Employers will have fatigued workers in the workplace at some
point. It’s important to ask yourself if hazards in the workplace increase the
risk of harm or could lead to adverse safety outcomes when workers are
fatigued,” adds Kahle. “When workers miss changes or
important information in their environment because of fatigue, it affects
everything we do in the workplace. Addressing this can save businesses
countless dollars due to injury and lost productivity.” For more information
To assess the level of your daytime sleepiness, check out the Epworth Sleepiness Scale, which is easily searchable online.
Mike was interviewed for thefollowing article, published on the Business Insurance website in 2017.Author: Louise Esola
How
much sleep are employees getting at night? Workplace safety experts are calling
this one of the most frequently overlooked but critical questions to answer in
employer safety programs due to rising fatigue risks.
The
Park Ridge, Illinois-based American Society of Safety Engineers is funding an
ongoing study on fatigue through the University at Buffalo in Buffalo, New
York. The study, which began in August 2015, is surveying what workers think
about fatigue and whether they can recognize the signs in their everyday work
life, according to researcher Lora Cavuoto, an assistant professor in the
university’s Department of Industrial and System Engineering.
Fatigue
is often overlooked in safety programs because “it’s hard to pinpoint the
instant it happens,” Ms. Cavuoto said.
“If
we think about fall risk, a dominating injury, you can see those points; you
can see you have a worker at height and know the mechanism for solving that.
It’s fall protection,” she said. “Fatigue is a little more subtle and in the
background. Workers might not be aware they are feeling the consequences (of
fatigue).”
Michael
Trufant, an Asheville, North Carolina-based fatigue awareness program manager
for Aeroflow Healthcare Inc., which sells sleep apnea tests, called fatigue an
“epidemic.” “You can wear your eye protection, but (fatigue) is where it is,”
he said.
“A person who sleeps only four to five hours a day is the same as a (person with a) 0.08 blood alcohol level,” said Mr. Trufant, touting research that’s been echoed over the years by many safety organizations — from the U.S. Occupational Safety and Health Administration to the American College of Occupational and Environmental Medicine.
The
Itasca, Illinois-based National Safety Council put the issue on the forefront
of its agenda recently. In 2016, the nonprofit tackling workplace safety issues
launched a fatigue initiative, providing statistics on how prevalent the issue
is becoming in a report issued in July. And this fall, it is launching a
fatigue calculator for employers to gauge how tired their employees are and
what risks are created as a result of fatigue.
“The
tired employees are increasing safety risk,” said Emily Whitcomb, an
Itasca-based senior program manager with the fatigue initiative. “Employers are
becoming more interested in this issue (because) of the major consequences it
leads to.”
The
statistics are alarming, she said, listing some of what she called the most
eye-opening in the council’s national survey of 2,000 employees across several
industries: 43% of those surveyed reported not getting enough sleep every day;
16% reported falling asleep while driving; and 27% reported falling asleep on
the job in the past month.
“That’s scary if you are doing a safety-critical job,” she added. The council also narrowed down a list of nine risk factors that contribute to the likelihood of an accident occurring at work — a list that includes long shifts, demanding jobs and long commutes. “Nearly everyone (at 97%) reported at least one risk factor, and 80% reported at least two. With that, your risk factor increases,” Ms. Whitcomb said.
Experts
have long pointed to such high-profile incidences as the Chernobyl nuclear
disaster in Russia, the Three Mile Island nuclear accident in Pennsylvania, the
Exxon Valdez oil spill off Alaska and even the most recent string of collisions
at sea involving U.S. naval vessels.
“When
we look at the largest incidents in the world, all of them are fatigue-related,”
said Mike Harnett, Calgary, Alberta-based vice president of human factors for
Six Safety Systems Inc., which delivers solutions in the United States and
Canada to reduce worker fit-for-duty risks associated with drugs, alcohol and
fatigue in the workplace.
“We
constantly blamed the operator, but it’s the flaws in the system we have to
look for,” said Ms. Harnett. “That’s not human error; they fell asleep because
they were not getting enough sleep.”
The
council’s research found that 16% of workers surveyed reported at least one
near miss or safety incident because of fatigue.
Ms.
Whitcomb said much of the problem exists in current employment culture, which
is shifting slowly.
“The
hard thing with fatigue is we always see that pushing ourselves, putting sleep
to the side, is seen as a badge of honor,” she said. “If you lose sleep and put
in your overtime, people think it will pay off in the end.”
Ms.
Harnett said corporate policymakers and executives are often behind the curve,
as many have “gone through” fatigue to find success. “The harder and the longer
they worked, the better it was for promotions,” she said. “We have to convince
management they have a problem.”
The
latest interventions can be as simple as a questionnaire for workers on sleep
habits, both before or after an incident, Ms. Harnett said. Another solution is
to train employees on the importance of sleep and to limit longer shifts, she
added.
Experts
say a burgeoning area is in research and testing for sleep apnea and other
conditions that can cause a person to be tired during a workday.
“What we are trying to do is get employers to push sleep health programs and sleep screening,” said Ms. Whitcomb. “We found that 90% of sleep disorders are untreated.”
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)!
In December of 2016, I was thrilled to be invited to the National Safety Council’s (NSC) first Blue Ribbon Panel on Fatigue held in Chicago. It was an excellent opportunity to meet and collaborate with icons in the fields of fatigue and sleep research as we broke into workshops to discuss the status of fatigue and how it is being managed (or not managed) at the worksite.
Rubbing shoulders with the likes of Dr. David Lombardi, Dr. Charles Czeisler, Dr. Mary Caskadon, Dr. Mark Rosekind, Dr. Steven Higgins, Dr. Imelda Wong, and so many more reaffirmed the need for tackling the issue of fatigue from a position of science and evidenced-based research.
2016 Blue Ribbon Panel on Fatigue (Can you spot me?)
This inaugural event led to the development of tools and guidance documents issued by the NSC and which are readily available to both the public and private industry sectors. Many of these resources were introduced to us at the NSC’s 2019 Workplace Fatigue Conference in Seattle, an outcome of the efforts in Chicago. This event once again drew world-class researchers but more importantly, it drew industry leaders who came to learn and share.
One of the many resources introduced at the event is the NSC’s Fatigue Cost Calculator. Led by Dr. Charles Czeilser and The Brigham and Women’s Hospital Sleep Matters Initiative, this tool helps organizations build a business case around the development of fatigue management initiatives. After inputting workforce size, industry and location, this information is used to predict the prevalence of sleep deficiency and common sleep disorders among employees in geographical regions. Most importantly, the algorithms are based on the findings of 55 peer-reviewed studies.
It must be noted that this is a US based tool on American figures of sleep deficiency and sleep disorders. It does not directly equate to Canadian sleep or cost factors (perhaps it’s time to develop our own?).
There are numerous resources available on the NSC website including videos and an excellent white paper that looks at the causes and effects of fatigue entitled Tired at Work: How Fatigue Affects our Bodies.
As fatigue hits the radar of more and more companies, it’s important to make informed decisions using the latest science available. A big shout out to Emily Whitcomb and the rest of the fatigue management team at the NSC for continuing to drive this important conversation forward!
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