SLEEP AND SAFETYwcfsa.org/Archive/2019/2019-10/Sleep and Safety.pdfFalse Memories/Poor Decisions A sleep-starved brain may not encode memories correctly and bring misinformation into

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Marietta B. Bibbs, BA, RPSGT, CCSH, FAASTSystem Manager

BayCare Sleep Disorders Centers

SLEEP AND SAFETY

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Objectives

• Review importance of Sleep

• Discuss Consequences of Sleep Loss

• Recognize Symptoms of a Sleep Disorder

• Review Safety Issues Related to Sleep Loss

• Tips to Sleep Better

• What Employers Can Do

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Importance of Good Sleep

• Key to health, performance, safety and quality of life

• Essential to cognitive and physical tasks

• Supports productivity and safety

• Stabilizes Blood Sugar

• Reduces Stress

• Builds Muscles

• Contributes to Weight Loss

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Facts About Sleep and Health

Sleep is necessary for healing and recovery

Poor sleep can lead to psychological and physical illness and even death

Treating sleep disorders improves physical well-being and is instrumental in managing medical and psychiatric illness

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Institute of Medicine Report

▪ Lack of good sleep is “An Unmet Public Health Problem”

▪ “The cumulative effects of sleep loss and sleep disorders represent an under-recognized public health problem and is associated with a wide range of increased health consequences (hypertension, diabetes, obesity, depression, heart attack, and stroke).”

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Sleep is Not a Priority

▪ Lifestyle (work, children, social life, eating and exercising late)

▪ Poor sleep habits▪ Circadian factors (shift work)▪ Environmental disruptions (TV,

phone, computers in bedroom)▪ Untreated sleep disorders

▪ Sleep is not taken seriously!!!

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How Much Sleep Do You Need?Enough to maintain alertness to avoid building a sleep debt

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Effects of Sleep Debt

• Sleep debt increases the likelihood of microsleeps

• Brief unintentional episodes of loss of attention—such as a blank stare, head snapping, or prolonged eye closure

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The Brain and Sleep Loss Connection

▪ Researchers found that sleep deprivation makes it difficult for brain cells to communicate effectively

▪ Causes temporary mental lapses that affect memory and visual perception

▪ Offers clues why a sleepless night makes it difficult to think and concentrate the next day

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Sleep Loss and Conscious Thought

• A lack of sleep interferes with the ability of brain neurons to encode information and translate visual input into conscious thought

• When a sleep-deprived driver sees a person in front of his car, it may take longer for the driver to realize what he or she is seeing because "the act of seeing the person slows down in the driver's overtired brain”

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What Happens When The Brain Doesn’t Sleep?

• Hippocampus -Lose sleep, lose

long-term memory

▪ Sensory Overload: a well-rested brain prevents sensory overload

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The Sleepless Brain

False Memories/Poor Decisions

▪ A sleep-starved brain may not encode memories correctly and bring misinformation into memory

▪ Sleep loss causes changes in the frontal lobe which dulls judgment, increases desire and leads to poor decisions

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The Sleepless Brain• Cerebral Shrinkage: Poor

sleep in healthy adults causes loss of brain volume in the frontal,temporal and parietal lobes

• Risky Decisions: Sleep loss causes the prefrontal cortex (brain’s reward center) to light up and leads to poor decisions, like overspending at the casino

• Brain Damage: Pulling an all-nighter kills brain cells in the brain stem

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Effects of Sleep Disturbance and Sleep Loss

DAYTIME FATIGUE, TIREDNESS AND

SLEEPINESS

IRRITABILITY AND INABILITY TO

TOLERATE STRESS

MEMORY PROBLEMS --INABILITY TO THINK

CLEARLY

DECREASED IMMUNITY TO COLDS

AND INFECTION

DEPRESSION AND ANXIETY

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Sleep Deprivation impacts workplace safety, productivity and individual health

• Insufficient sleep and working while fatigued is commonplace in the modern 24/7 workforce

• 37% of workers sleep-deprived

• Over-worked and over-tired employees have cognitive declines

• Sleepy workers present employers with heightened safety risks and increased economic costs

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What are Sleepy Workers Doing?

▪ Falling asleep at inappropriate times

▪ Failing to perform safely

▪Working with a bad mood

▪Using poor judgement

▪ Failing to pay attention

▪Working with poor vigilance, vision, and motivation

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Sleep-Deprived Workers

• Impaired reaction time

• Problems processing information

• Short-term memory problems

• Decreased productivity

• Increased moodiness and aggressive behavior

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Sleepy Workers Have Difficulty

▪Concentration-68%

▪Handling stress-65%

▪ Listening-57%

▪Solving problems-57%

▪Decision making-56%

▪Relating to others-38%

Source: NSF Sleep In America Poll

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Workplace Attendance Related to Sleep Loss

▪Make errors—19%

▪ Late to work—14%

▪ Fall asleep at work—7%

▪Stay home from work—4%

▪Get injured—2%

Source: NSF Sleep In America Poll

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Catastrophes Attributed to Fatigue-Related Performance Failures, Sleep Loss, and Night Shift Work

▪ Union Carbide Chemical Plant Explosion

▪ Chernobyl Nuclear Disaster

▪ Three Mile Island Nuclear Disaster

▪ Exxon-Valdez Oil Spill

▪ Colgan Air Flight 3407 Crash

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The Cost of Sleep Loss

▪ Over 20% of all serious car crash injuries associated with sleepy drivers

▪ Hundreds of billions of dollars a year spent on direct medical costs related to sleep disorders:

▪ Doctor visits

▪ Hospital services

▪ Prescriptions

▪ Over-the-counter medications

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Sleepy Drivers

• Sleepiness impacts safety for those who drive as part of their job or commute to and from work

• The National Transportation Safety Board (NTSB) estimates that fatigue has been a contributing factor in 20% of its investigations over the last two decades

• NTSB included “reduce fatigue-related accidents” as a goal on its 2017 – 2018 “Most Wanted List” of transportation safety improvements

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Sleep Loss and Work-Related Injuries

▪Highly fatigued workers are 70% more likely to be involved in accidents

▪Chronic insomniacs have higher rates of accidents

▪Workers with chronic sleep disturbance are nearly twice as likely to die in a work–related accident

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Traffic Fatalities

• In February, the AAA Foundation for Traffic Safety released research estimating that drowsy driving is involved in up to 9.5 percent of all motor vehicle crashes

• The Foundation projected that drowsy driving causes an average of 328,000 motor vehicle accidents in the U.S. each year, including 6,400 fatal crashes

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Direct Cost of a Sleepy Workforce

• According to the National Safety Council, fatigued workers cost employers about $1,200 to $3,100 per employee in declining job performance each year

• Sleepy workers are estimated to cost US Employers $136 billion a year in health-related lost productivity and $411 billion in total costs

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Sleepless Nights Hurt Everyone

• US workforce is conditioned to just power through fatigue

• Worker health and safety on the job are compromised when they don't get the sleep they need

• Doing nothing to address fatigue costs employers a lot more than they think

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Impact of Sleepiness on Safety

Sleepiness causes decreased performance capacity

Tired workers become slower, more error prone and less productive

Fatigue impairs employees’ ability to function properly and puts them at a greater risk of a safety incident

About 13% of work injuries can be attributed to sleep deprivation

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Shift Work or Night Work—Higher Risk for Workplace Injuries and Accidents

MEMORY LAPSES DIFFICULTY CONCENTRATING

ERRORS IN JUDGMENT

SLOWER REACTION TIMES

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Sleep Health and Shift Work

• Chronic sleepiness pose a constant struggle for night shift and rotating shift workers and those who work long hours or have an early morning start time

• The U.S. Bureau of Labor statistics found about 15% of full-time US employees perform shift work

• Many shift workers suffer from chronic sleep loss caused due to disturbed circadian rhythm or an untreated sleep disorder

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Sleep Loss and Chronic Disease Nearly 70 million Americans suffer from a

sleep problem, and nearly 60 percent of them have a chronic disease that can harm their overall health

Lack of sleep and sleep disorders, including sleep apnea, excessive daytime sleepiness (narcolepsy), restless legs syndrome, and insomnia, are increasingly recognized as linked to chronic disease, including obesity, high blood pressure, and cancer

Chronic sleep deprivation is

associated with increased risk of

depression, obesity,

cardiovascular disease and other

illnesses that negatively impact a

worker’s well-being and long-term

health

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RECOGNIZE THE SIGNS AND SYMPTOMS OF

SLEEP DISORDERS

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Sleep Disorders are Chronic Conditions

“Proper treatment for most sleep disorders requires a period of time for fine-tuning, extended follow-up, and lifestyle changes”

IOM Report on Sleep and Sleep Deprivation 2006

▪Requires:▪Evaluation/promotion of Sleep Health

▪Life Style Management

▪Education

▪Person-Centered Care

▪Identification/treatment/follow-up care

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The Most Common Sleep Disorders

▪Obstructive Sleep Apnea

▪Narcolepsy

▪Movement Disorders▪ Periodic Limb Movements

▪ Bruxism

▪ REM Sleep Behavior Disorder

▪ Insomnia

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Other Sleep Disorders Often Unrecognized

▪Circadian Rhythm Sleep Disorders

▪Shift Work Disorder

▪ Jet Lag Disorder

▪Hypersomnia

▪Advanced Sleep Phase Syndrome

▪Delayed Sleep Phase Syndrome

▪Parasomnias

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Sleep Apnea Affects Sleep Quality

Performance during the day is directly

related to quantity and quality of sleep

Sleep loss accumulates over time

Poor quality sleep leads to “sleep debt”

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Sleep Apnea Statistics Are Alarming!!!!

1 in 5 adults suffer from some form of sleep apnea

Nearly 8 of every 10 persons with sleep apnea have are undiagnosed

50% of diagnosed patients are not compliant with their treatment

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Sleep Apnea in the Population

90%

5%

3%2%

Obstructive

Central

Mixed

Complex

▪ 22 million Americans estimated

to suffer from sleep apnea

▪ 80% of cases are moderate to

severe and undiagnosed

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Risks of Untreated Obstructive Sleep Apnea

Risk of Dying

OSA affects 4% of US

Population (22 million adults)

Percent Undiagnosed

46%

90%

▪ Patients with severe OSA have a 46% chance of dying

▪ 90% remain undiagnosed and untreated

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What is Obstructive Sleep Apnea?

▪ Involuntary pause in breathing

during sleep lasting 10-20 seconds

but can be much longer

▪May occur hundreds of times during

sleep:

▪ Sleep interruption (arousals)

▪ Decreased Oxygen/Increased Carbon Dioxide

▪ Snoring

▪ Heart Arrhythmias

▪ Mostly caused by a mechanical problem

▪ tongue falls back against soft palate

▪ soft palate and uvula fall back against the

back of the throat closing the airway

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Obstructive Sleep Apnea is a Vicious Cycle

▪Occurs more frequently in supine sleepers, middle-aged, overweight, and males

▪Occurs in both sexes, all ages, body types and sleeping positions

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Nighttime Symptoms of Sleep Apnea

• Nasal obstruction

• Frequent loud snoring

• Pauses in breathing

• Waking with choking sensation

• Frequent arousals from sleep

• Restless sleep with difficulty Breathing

• Morning headaches

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Untreated OSA

Increased Risk of……

▪ Hypertension and stroke

▪ Diabetes and obesity

▪ Atrial fibrillation and myocardial infarction

▪ Coronary artery disease, arrhythmias, heart failure

▪ Poor concentration

▪ Risk of accidents

▪ Excessive daytime sleepiness, chronic fatigue

▪ Death from complications of untreated OSA

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Other Types of Apnea

Central Sleep Apnea

▪ Less common (about 5% of sleep apnea cases)

▪ The signal to the brain that controls breathing muscles is lost

▪Snoring is less common but insomnia is prevalent

▪Common in heart failure, stroke, high altitude

Mixed Sleep Apnea

▪A combination of both central and obstructive sleep apnea

▪Begins as central apnea and develops into obstructive

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Complex Sleep Apnea

• Combination of both obstructive and central apnea

• Obstructive sleep apnea appears first, but central apnea appears when patient is placed on CPAP (continuous airway pressure)

• Sleep is fragmented due to frequent pauses in breathing leading to Insomnia

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Circadian Rhythm Sleep Disorders

▪ Shift Work Disorder

▪ Jet Lag Disorder

▪ Delayed Sleep-Phase Syndrome ▪ Sleep period is delayed until the early morning

hours—typically 2:00-6:00 AM

▪ Advanced Sleep-Phase Syndrome▪ Goes to sleep significantly earlier than the

average adult, with difficulty sleeping in the early morning

▪ Often wakes up between 2:00-5:00 AM

Misalignment of the biological clock

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Insomnia

• Most common sleep disorder

• Causes, symptoms and severity varies from person to person

• Complaints of difficulty:• Falling asleep

• Staying asleep

• Waking up early with trouble returning to sleep

• Waking up tired in the morning

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Prevalence of Insomnia

▪ One-third of Americans have occasional insomnia (40%)

▪ 10-15% have chronic insomnia

▪ Highest risk for insomnia:

▪ Women

▪ Older Adults and poor population

▪ Depression

▪Higher in people over age 65 (60%)

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Symptoms of Insomnia

▪ Insufficient sleep

▪ Light or unrefreshing sleep

▪ Unable to sleep without taking a sleeping pill or drinking alcohol

▪ Sleep is unpredictable

▪ Perception of inadequate or poor sleep

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Effects of Insomnia

▪ Impacts nearly every aspect of one’s life

▪ Affects performance at work, cognitive skills, family relationships, etc.

▪ Insomniacs have poor overall quality of life

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Narcolepsy

• A neurological disorder

• Symptoms:

• excessive daytime sleepiness

• uncontrollable sleep attacks

• Sleep attacks sometimes accompanied by hallucinations and sleep paralysis

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Narcolepsy Symptoms

▪ Excessive Daytime Sleepiness

▪ Cataplexy

▪ Hypnagogic Hallucinations

▪ Sleep Paralysis

▪ Automatic Behavior

▪ Disturbed Nighttime Sleep

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Sleep-Related Movement Disorders

▪ Periodic Limb Movements Disorder

▪ Restless Legs Syndrome

▪ Bruxism (teeth grinding)

▪ REM Sleep Behavior Disorder

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Partners: American Academy of Sleep Medicine (AASM), Centers for Disease Control and Prevention (CDC), Sleep Research Society (SRS) and National Safety Council (NSC)

• Launched the “Sleep Works for You” campaign

• Encourages employers to help workers avoid fatigue and develop healthy sleep habits for long-term success and well-being

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Encourages Employers to Promote Sleep Health in the Workplace with three steps:

Investigate

Investigate the causes of fatigue in the workplace and implement fatigue risk management as part of a safety management system

Educate

Educate employees on fatigue, sleep health and sleep disorders, as well as strategies to improve alertness on the job, as part of a comprehensive employee wellness program

LearnLearn about sleepiness in the workplace, its costs, its causes and how fatigue can lead to a higher rate of safety incidents

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Findings from The Sleep Works for You Campaign

Working long hours and sleeping less

than the recommended seven or more

hours has become a badge of honor in

many industries

Evidence proves that a lack of sleep hurts productivity, safety and overall

health

It is essential for employers to

promote health and safety by creating a workplace culture

that values the importance of sleep

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Sleep Works for You Campaign

• Employers can help shift workers fight fatigue by implementing the following strategies:

• Avoid assigning permanent night-shift schedules

• Assign regular, predictable schedules

• Avoid long shift lengths

• Give employees a voice in their schedules

• Rotate shifts forward when regularly changing shifts

• Provide frequent breaks within shifts

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How much is fatigue costing the workplace?

• The National Safety Council teamed with Brigham & Women's Hospital to develop this online tool

• Employers receive a tailored estimate of how much fatigue is costing their bottom line

• The calculator estimates how much of the burden can be avoided with programs implemented in the workplace

https://www.nsc.org/forms/real-costs-of-

fatigue-calculator

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Employers Can Reduce Sleepiness in

the Workplace

▪Create work schedules with sleep requirements in mind:

▪ Work hours that give workers time for restful sleep

▪ Work schedules that allow for consistent sleep patterns

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Employers Can Reduce the Risk

▪ Businesses with long shifts or frequent overtime can provide amenities to lighten the burden this places on employees

▪ Prepared meals

▪ On-site accommodations for workers to recharge before driving home

▪ Napping areas to boost morale and efficiency

▪ Recharge time to reduce risk of substance abuse to stay alert

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Employee and Employer Responsibilities

▪ Sleep disorders can be categorized as a disability

▪ Can qualify for on-the-job accommodations

▪ Employees must explain their condition and provide supporting medical evidence

▪ Employers must follow EEOC regulations

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Encourage Good Sleep

Habits

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Difficulty Sleeping

▪ Limit time in bed

▪Use your bed only for sleep and sex

▪Avoid watching the clock

▪ Limit naps

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MAKE SLEEP A PRIORITY

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Workplace ScreeningCan Help

Sleep disorders are often overlooked because individuals fail to receive proper treatment when a legitimate

diagnosis can be beneficial

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QUESTIONS???

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Screening Tools

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The Berlin Questionnaire

▪ Screening Tool for Sleep Apnea

▪ Can help identify patients with sleep

apnea in general population

▪ primary care and sleep clinic settings

▪ Elderly people

▪ Commercial drivers

▪ People with coronary artery disease,

chronic kidney disease, diabetes, stroke,

migraine, atrial fibrillation

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Epworth Sleepiness Scale

• Measures likelihood of falling asleep during eight normal, low activity situations

• Can determine if sleep disorders may be the cause of the problem

• Questions rated on a scale of 0-3, with 0="no chance of dozing" and 3="high chance of dozing“

• 0-5 Lower Normal Daytime Sleepiness

• 6-10 Higher Normal Daytime Sleepiness

• 11-12 Mild Excessive Daytime Sleepiness

• 13-15 Moderate Excessive Daytime Sleepiness

• 16-24 Severe Excessive Daytime Sleepiness

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Assessments for Shift Work Disorder

Sleep diary: Taking notes daily about sleep patterns to determine if sleep problems are caused by a disorder or another underlying problem

Sleepiness scales: Questions to determine level of sleepiness when one wants to be awake (a main symptom of shift work disorder). The National Sleep Foundation Sleepiness Test or similar scale can be used

Sleep studies: a noninvasive test that records several body functions during sleep, (brain waves, heart rate, breathing patterns, oxygen levels). Tests are conducted overnight in a sleep center or can be done at home with portable equipment