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!
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.
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.”
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