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)!
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!
For some workers, going to work chronically fatigued might be more dangerous than being at work drunk, according to a sleep expert speaking at the IAM141 2017 Safety Conference this week.
Airline union activists, managers, and safety advocates learned a surprising fact this week. Working with chronic, accumulative fatigue is more dangerous than working while moderately intoxicated – a lot more dangerous.
Mike Harnett, a featured speaker at the Conference, knows just how harmful a lack of sleep can be. She is an expert on the subject of fatigue management and sleep deprivation, and her research on the topic has provided valuable guidance to groups and organizations such as NASA, airports, transportation companies and labor groups such as the IAM.
“BEING AWAKE IS NOT ENOUGH”
With news reports of baggage handlers falling asleep in the underbellies of the planes they are working, only to awaken after take-off, sleeplessness has already become a severe issue for air carriers. Airport workers need high levels of physical athleticism, mental focus, and situational awareness to do their jobs safely. And, when the safety of the flying public is also taken into account, the need to avoid the kinds of impairments that come with knocking back a few beers before work is a no-brainer.
Yet, unlike being a little tipsy at work, it can be hard for employers and even workers to wake up to the dangers of chronic sleep deprivation. Nevertheless, the problem should be taken seriously, according to Harnett. Especially in the case of airport workers, who are uniquely vulnerable to the damage that can be caused by the effects of fatigue.
“IMPAIRED IS IMPAIRED”
Meanwhile, the symptoms of sleep deprivation are almost identical to intoxication. Loss of situational awareness, underestimation of risk, hindered visual perception, and reduced reaction times are all symptomatic of both drunkenness and fatigue.
Peer-reviewed studies have consistently demonstrated that a person who has been awake for only 17 hours has the equivalent impairment of a person with a blood-alcohol level of .05%. (In many states, a blood-alcohol level of .08% is enough to result in a DUI arrest.) Those who have stayed awake from 5:00 AM to 2:00 in the morning without sleeping will have reached a .08% blood alcohol level of impairment, and those who have gone without rest for 24 hours can expect an equivalent impairment of .1%. ??“Impaired is impaired,” Mike Harnett told the crowd of some 120 union activists and company managers. “If you are impaired because you’re drunk, or if you have these same impairments due to fatigue, you are creating the same hazard.”
Fatigue is one of the most common causes of airline accidents, with most airport injuries happening early in the morning and late at night when workers are the most tired.
BETTER UNDERSTANDING IS NEEDED
Fixing the problem will require more than a nap. Harnett says that those suffering from chronic fatigue cannot accurately determine if they have reached a dangerous level of sleep deprivation. Even worse, the problem is rampant, with strong majorities of Americans completely unaware of the danger of chronic fatigue. Airport workers who must work sleep-defying shifts late at night or very early in the morning, and who get hit with mandatory overtime and inconsistent days off on a regular basis may be even more at risk than the overall population.
Harnett suggests that the solution to accidents caused by chronic fatigue will require a long-term partnership between workers and companies. Companies will need to begin understanding that fatigue can be a real threat and not merely a discipline issue. Company managers often think of sleep as a personal issue that shouldn’t be factored into the work environment. In many cases, travel times to and from work are not factored into the space between work shifts. At many airlines, workers are severely punished for napping at the workplace before or after shifts. These policies need to change, Harnett says.
But, a lot of the burden is going to fall on the shoulders of airline workers themselves. There are real dangers associated with chronic fatigue, and most of these problems can be solved with better sleep.
This article was published by WSPS (Workplace Safety & Prevention Services). Link to their website here.
Sleep-related fatigue has reached epidemic proportions in Canada, says Mike Harnett, President of Solaris Fatigue Management.* “Three quarters of the population are not getting the minimum required amount of sleep. Employees are showing up for work cognitively or physically unable to do the job to the extent that you expect.”
This may translate directly into injuries and incidents. “The reality is that what gets labelled human error is often a consequence of fatigue,” says Mike. “If you’ve been awake for 17 hours straight, you have an impairment equivalent to .05% blood alcohol content. If you’re awake for 20 hours, you’re at .08%.”
While we may not be able to eliminate fatigue, implementing a fatigue management system or plan can help reduce the related risks. Mike offers seven strategies for managing employee fatigue.
Educate senior leadership and managers on the cost and consequences of employee fatigue and build a strong business case. Management may not have considered that office workers face fewer fatigue-related hazards than someone on the factory floor, and may not correlate fatigue with organizational performance and employee safety. Here’s a key statistic for your business case: research shows 13% of workplace injuries can be attributed to fatigue.** Work with senior leaders to establish targets and metrics for managing fatigue.
Determine whether your workplace has a fatigue problem by conducting an employee survey. If your workplace has a culture in which employees may not feel comfortable talking about their experience with fatigue, invite them to respond anonymously.
If you determine fatigue is a concern, consider the following steps.
Review your safety management systems through a fatigue lens and start incorporating fatigue into your workplace’s health and safety policies and procedures. For instance, set out rules and responsibilities for supervisors for managing someone who is tired. Are they allowed to let an employee have a nap? Do they have the authority and means to temporarily assign the employee to a task posing less risk? What is the process when someone consistently shows up fatigue impaired?
Review your hazard assessments through the same lens. Start with high-risk tasks. How much risk could fatigue add and how could you mitigate it?
Consider the work schedule from a hazard or fatigue perspective, especially if your workplace has shift assignments. “For example,” says Mike, “early morning activities (before 6 a.m.) are high risk because these workers are at ‘the window of circadian low’ — the worst possible time cognitively and physically for us to be functioning because it’s when our bodies are programmed for optimal sleep.” Implement strategies to offset or mitigate the risks, such as moving critical tasks away from the hours between 3 a.m. and 6 a.m., or double-checking any work performed at that time.
Screen employees for sleep disorders and incorporate solutions into wellness and benefits programs. “One in four Canadians are at a high risk for obstructive sleep apnea, which can be a killer. If your screening identifies people at high risk for sleep apnea, arrange for proper diagnosis and treatment.” Also, consider offering benefits that promote quality sleep, such as blackout drapes, white noise devices and CPAP machines — the preferred treatment for obstructive sleep apnea.
Provide employees with strategies that improve sleep and alertness, such as what foods to eat on nightshift, when is the best time to exercise, how to manage family and social schedules, etc. “Share information on how to achieve good sleep, how to manage fatigue, and how to live a shiftwork lifestyle. Shiftwork isn’t about a schedule, shiftwork is a lifestyle and they need to adapt to accommodate that lifestyle,” says Mike.
How WSPS can help
Our ergonomic specialists — part of WSPS’ team of technical consultants — can help your workplace explore options for managing fatigue and reducing the risk of fatigue-related incidents. Examples include cognitive demands analysis, shift schedule design, ergonomic assessments to reduce musculoskeletal loading fatigue and more.
* Solaris Fatigue Management works with human factors and fatigue management specialists to provide a comprehensive suite of fatigue related services. Mike Harnett is a frequent speaker at symposia and conferences, including WSPS’ Partners in Prevention 2019 Health & Safety Conference & Trade Show. Find out more about Solaris Fatigue Management.
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