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September 18, 2015
Workplace sleep issues can be a real nightmare: Health and safety implications examined

You know the feeling: It’s 3:00 p.m. and that heavy, drowsy sensation is banging at the door of your brain to get in. At some workplaces, yawning employees can retire to a napping room for a 20-minute refresher. But that’s the exception. Most sleepy workers have to reach for caffeine or just power through, with results that can range from uncomfortable to deadly.

This Compliance Report addresses workplace sleep issues and solutions. Learn about the personal and economic toll of employee sleepiness, the challenges of shiftwork, and how you can help your employees get the quality and quantity of sleep they need to perform safely.

A problem you can’t afford to ignore

Many businesses glorify the executive who logs 100-hour workweeks or the road warrior who lives out of a suitcase in multiple time zones. But Harvard Medical School Professor of Sleep Medicine Charles A. Czeisler says such behavior does not equate to top performance and, in fact, puts people and companies at risk. While businesses have polices designed to protect employees against smoking, sexual harassment, and other risks, they push employees to the brink by expecting them to work too long without enough sleep.

Writing in the Harvard Business Review, Czeisler noted, “We now know that 24 hours without sleep or a week of sleeping 4 or 5 hours a night induces an impairment equivalent to a blood alcohol level of .1 percent. We would never say, ‘This person is a great worker! He’s drunk all the time!’ yet we continue to celebrate people who sacrifice sleep for work.”

The cost of insomnia—just one sleep problem—is staggering. A study that appeared in the journal Sleep sampled more than 7,400 employed health plan subscribers and found an insomnia rate of 23.2 percent. One of the most significant results was presenteeism, which refers to being present on the job but not fully functioning. Workers with insomnia-related presenteeism lost an average of 11.3 days of work performance per year, with a price tag of more than $2,200. If those estimates were generalized to the U.S. workforce, the annual cost would be more than $63 billion.

Terry Cralle is a certified sleep educator and coauthor of the new book, Sleeping Your Way to the Top, which helps people understand the role of sleep in performance and how to overcome common sleep impediments. Cralle cites the Centers for Disease Control and Prevention (CDC), which has called lack of sleep a public health epidemic. Cralle says lack of sleep strips away resilience and emotional balance and, for many people, becomes a serious physical health issue. Research links inadequate sleep with conditions like diabetes, elevated blood pressure, heart disease, and depression, as well as cognitive and psychological problems.

“A need, not a luxury”

Like Professor Czeisler, Cralle frowns on a culture that extols lack of sleep and individuals who brag about how little they get. She explains that about 3 percent of the population are “short sleepers,” meaning they can get by on 5 or 6 hours a night. But 95 percent of us need an average of 8 hours. “It’s a biological need, not a luxury,” Cralle emphasizes.

Lack of sleep can impair the prefrontal cortex of the brain, which leads to a decline in cognitive performance. A problem noted by many experts is that individuals who are sleep-deprived don’t recognize their impairment. Cralle recalls one patient who was treated for sleep apnea in a sleep clinic Cralle ran. “It’s not just the physical issue of feeling tired,” she says. “This person turned into an irritable monster, her marriage was on the rocks, and she brought all of this into the workplace.”

Slowly getting the message

Cralle considers sleep a factor in many workplace issues like bullying, retention, and job satisfaction. She cites research that found on-the-job accidents are more than four times more likely among employees who are sleep-deprived than among those who use drugs or alcohol.

And while some employers are beginning to address these issues, society overall is slow to get the message. “I poll everyone I meet to see if their doctor asks them about sleep, and too many do not ask,” says Cralle. She believes sleep should be considered, along with diet and exercise, as a foundational element of health.

“The three are interconnected. If you don’t get enough sleep, you don’t have the energy to exercise. If you’re up all night with a baby, you’re not going to get exercise and will likely make horrible food choices because your hormone and other levels are out of whack.”

While employers are embracing wellness options like offering on-site Weight Watchers® meetings and subsidizing gym memberships, they’re not paying the same level of attention to employee sleep habits and practices, known as sleep hygiene. One promising development is that many wearable devices like FitBit and the Apple watch track sleep. Observes Cralle, “You can’t manage it if you can’t measure it.”


Sharing the facts about drowsy driving and other effects of sleepiness can be a powerful way to convey the importance of sleep to your employees. A National Sleep Foundation sleep poll found that 60 percent of adult drivers—about 168 million people—say they’ve driven while feeling drowsy in the past year. More than one-third have actually fallen asleep at the wheel.

Although the National Highway Traffic Safety Administration estimates that 100,000 police-reported crashes and 1,500 deaths are the direct cause of driver fatigue each year, the numbers may represent just the tip of the iceberg. One reason is that there is no test to determine sleepiness in the way a breathalyzer can test for intoxication. Another reason is that self-reporting is unreliable, and drowsiness may play a role in crashes attributed to other causes, including alcohol.

Review and share other important facts about drowsy driving with your employees:

  • Adults ages 18–29 are more likely to drive while drowsy compared to other age groups.
  • Adults with children in the home are more likely to drive drowsy.
  • Men are almost twice as likely as women to fall asleep at the wheel.
  • People who sleep 6 to 7 hours a night are twice as likely to be involved in a sleep-related crash, compared to those who sleep 8 hours or more.
  • Those who sleep less than 5 hours are four to five times more likely to be involved in a crash.

Conduct your own sleep survey to find out if employees are concerned about this issue. If necessary, bring in an expert, consult your employee assistance program or insurance provider, and develop a plan to help your workers get the rest they need.

Cralle believes sleep education should be taught in schools and encourages school systems to better respect the needs of children, especially teens. Waking before 6:00 a.m. to get on a school bus by 7:00 a.m. is “horrible for their health and safety,” she says, and can lead to depression, increased risk-taking, self-medication with energy drinks, and use of alcohol and drugs.

New hire orientation is an excellent opportunity to introduce sleep awareness to workers, according to Cralle. Employees need to know the facts about sleep hygiene—from avoiding stimuli like alcohol and digital devices before bed, to the potential benefit of napping, to the uselessness of opening the car window if you’re driving sleepy. But beyond that, employees need to be able to acknowledge impairment. An employee should feel comfortable telling a manager, “I was up with my 2-year-old all night and I don’t feel I can drive my truck safely today,” without fear of recrimination.

At this workplace, sleep gets respect

At Dartmouth Hitchcock Medical Center, where Dr. Adam Sorscher is an assistant professor of community and family medicine, sleep gets the respect it deserves. Sorscher also serves as the medical director of the Sleep Health Center at Alice Peck Day Hospital in Lebanon, New Hampshire.

Dartmouth Hitchcock employees with sleep-related concerns can complete a sleep survey as part of the hospital’s Live Well/Work Well initiative. Health coaches, who work with employees on issues like diet, weight, exercise, mental health, and more, use the findings to advise them, with Sorscher’s help, on sleep.

Although insomnia is the most common sleep complaint in the general population, Sorscher has been surprised to learn that more employee complaints are related to sleep apnea. This potentially serious health condition is characterized by pauses in breathing during sleep.

Dartmouth Hitchcock offers cognitive/behavioral therapy for insomnia, as well as sleep testing and other treatment for those suffering from sleep apnea. In addition to working with coaches, employees keep sleep logs to identify patterns and problems.

Fatal implications

Like Cralle, Sorscher is concerned about the prevalence and impact of tired workers. He cites a study in the Journal of Occupational and Environmental Medicine that looked at the top 10 causes of employer healthcare costs. Sleepiness was third and fatigue was fifth, with costs tied to absenteeism, presenteeism, drug prescription costs, and medical appointments. Sorscher also cites statistics linking more than 100,000 motor vehicle accidents and 1,500 deaths each year to sleepiness at the wheel.

Among the many reasons for workplace tiredness is the fact that we treat sleep as a “negotiable element in planning,” assigning it a lower priority compared to other tasks and responsibilities. And there’s the fact that, as a society, we are getting less and less sleep. Sorscher explains that before the advent of electric light bulbs, American adults got about 9.1 hours of sleep on average per night. More recently, that figure is 6.8 hours during the workweek and 7.4 hours on weekends.

Adds Sorscher, “Although people can make choices about sleep, there is a certain biological reality that your brain needs it. You can choose to be sleep-deprived, but that will have consequences in terms of alertness and cognitive function.” That being said, Sorscher and other specialists acknowledge that there are considerable variations in how individuals tolerate sleep deprivation.

Nurse group responds to need

A member-needs survey by the American Association of Occupational Health Nurses (AAOHN) revealed an interest in sleep disorders and shift work and the resulting safety impact on workers. Injury prevention and sleep researcher Karen Heaton was asked to lead a panel to develop an online sleep education program.

The course, Wake Up to Worker Sleep Issues (available at, was created to help safety and medical professionals recognize signs and symptoms of shiftwork disorders, impaired sleep, and other sleep problems, and to provide appropriate referral or treatment.

Six modules cover sleep hygiene (e.g., no TV in the bedroom, no strenuous activity before bedtime, no texting in bed); signs of conditions like insomnia and obstructive sleep apnea; the impact of medications on sleep; lifestyle choices that impair sleep; legal implications for workers in safety-sensitive positions; and testing, treatment, and diagnosis.

Shiftwork is a critically important concern for the healthcare profession. The actions of sleep-deprived personnel have been linked to patient treatment errors. Furthermore, exhausted medical residents are often involved in vehicle crashes as they make their way home after dozens of hours on duty.


Ryan Holmes, CEO at the social media management company Hootsuite, is all about the benefits of employee napping. “Burning the midnight oil and skipping sleep to gain a competitive advantage is something I’ve struggled with, especially back when Hootsuite was still a startup,” he wrote in a blog post.

Holmes cites the advantages of 10- to 20-minute power naps, including longer life expectancy, more happiness, less stress, and increased creativity. Hootsuite has established napping rooms and sleeping pods and encourages employees to “catch a few winks on the job to avoid burnout.”

Other ways Hootsuite helps employees stay healthy and well are:

  • Honoring the lunch hour by encouraging employees to eat healthy food and get exercise.
  • Finding ways to get outside, even if it’s just a quick break.
  • Permitting employees to bring their dogs to work.
  • Promoting snacking, including fresh produce from the company’s rooftop garden.

Humans are physiologically predisposed to sleep when it’s dark outside. Workers who report at 7:00 p.m. for a 12-hour shift must force themselves to stay alert despite the natural desire to sleep after the sun goes down. Heaton is especially interested in ongoing research that may one day permit employers to know which workers are genetically better able to tolerate this disruption. Having access to such information could help managers schedule employees to be on duty when their bodies are functioning at their best.

“In the absence of that information, we do know that there are certain rotations that are better for shift workers,” adds Heaton. “For example, it’s better not to rotate shifts but, if you do have to rotate, it’s better to do a forward rotation than a backward one.” This means starting out on the day shift, then rotating to evenings, then to nights rather than the other way around. Research by Heaton and others points to the role of the family in successful shiftwork. Heaton helps employees and families balance the demands placed on shiftworkers (like “honey-do lists” or participating in daytime activities) with the need for uninterrupted sleep.

According to Heaton, the trucking industry is making progress in addressing the complex issues of how to best meet the needs of customers and maintain profit margins while providing employees with safe workplaces. For example, Schneider, a multinational provider of truckload and intermodal services, launched an initiative that focuses on sleep apnea. The company says the program, which pays for employee screening, diagnosis, and treatment, has been highly successful in identifying and treating disease and saving money.

Tips for safer shiftwork

Shiftwork has been linked to accidents blamed at least in part on sleepiness. Notorious examples are the Three Mile Island nuclear plant accident in 1979, the Chernobyl nuclear plant disaster in 1986, and the Exxon Valdez oil spill in 1989.

According to healthcare provider UCLA Health, shiftworkers tend to be consistently sleep-deprived because they can rarely get enough sleep during the day, typically logging 2 to 4 fewer hours of sleep than others. Shiftworkers tend to be easily awakened and have trouble falling asleep during the day and, as a result, can develop insomnia.

UCLA Health recommends taking a nap—ideally about 90 minutes—just before reporting for a night shift to boost alertness. Naps during the night shift lunch hour can help, though this may not work well in high-pressure jobs that demand instant reactions.

Stomach problems are common among shiftworkers, according to UCLA Health, as shiftworkers eat poorly and at odd times. The recommendation is to try to eat three regular meals spaced evenly over the course of the day. This helps cue your body clock to know when to get sleepy. A balanced, low-fat diet with plenty of fruits and vegetables is advised.

Other advice for making shiftwork work:

  • Avoid sleeping pills. While sleeping aides are often used by shiftworkers to help them get to sleep during the day, they should not be seen as a long-term solution. Sleeping medication becomes less effective over time and can have negative side effects.
  • Monitor caffeine. Stimulants such as caffeine may increase alertness on a nightshift, but it’s important to avoid caffeine within 4 hours of bedtime.
  • Work environment. A bright, cool workplace environment can keep workers more alert on the job and help prevent accidents. Shiftworkers should discuss other desired workplace changes with their managers who may not be aware of what the overnight shift is really like.
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