Archive for the ‘performance’ category

The Critical Importance of Sleep for Firefighters

September 11, 2019

September 11 is a day we will never forget. I am forever thankful for the firefighters and others who step forward to watch over us all as first responders.

In honor of the day, here is a summary of what we know about firefighters’ sleep, and the costs they pay to provide 24/7 service.

It is critically important that firefighters are able to perform well when they are on duty, however, a large number are impaired by inadequate sleep. Many common concerns of firefighters such as cancer and cardiovascular disease risk, barriers to physical fitness, food culture, psychological stress from trauma and injuries (1), are related to or can be improved by sleep health.

Health and Safety:

The effects of inadequate sleep on human mental and physical health have been well documented. For firefighters the leading causes of death are heart attack and auto accidents (2).

  • 51.2% of firefighters report disturbed sleep, which contributes to psychological distress (3).
  • 37.2% of firefighters surveyed screen positive for sleep disorders: 28.4% obstructive sleep apnea, 9.1% shift work disorder, 6% insomnia, and 3.4% restless legs syndrome (3). Of these, the majority (80%) have not been diagnosed or treated.
  • Those who have sleep disorders are twice as likely to have an auto accident, and 2.4 times as likely to experience falling asleep while driving. They also are at increased risk of cardiovascular disease, diabetes, anxiety and depression (4).
  • Another study found that 17% have sleep problems, and as sleep hours decreased, so did physical quality of life (5).
  • Sleep deprivation among firefighters appears to increase high-risk behaviors such as alcohol consumption and decrease mental health and physical well-being (6).
  • Compared to firefighters with 8 hours of sleep, sleep deprived firefighters show changes in both their inflammatory cells and evening cortisol levels which has been shown to have adverse health effects (7).
  • Night and extended shifts increase the prevalence of cardiovascular and mental health disorders (8).

Shift Work and Performance:

Night shift and the extended shifts typical among firefighters are inherently difficult, though improved individual sleep plans and administrative policies can improve daytime sleep and alertness at night.

  • Response time by firefighters is slowest at 5am, twice as long as at 4pm (9).
  • The risk of a work related injury peaks at 2am (10).

Costs:

Firefighter injuries in the U.S. are estimated to cost $3.7 to 11.7 billion per year (11). Sleep deprivation is known to contribute to obesity via changes in appetite hormones, calorie intake and the insulin system. Obese firefighters miss five times as many work days as those of normal weight, at an annual cost of $1683 per employee (12), and those with BMI >30 have a three times increase in worker compensation claims due to injury (13).

Public safety personnel need to be able to perform well at all times of the day and night, however firefighters are not getting adequate sleep to perform well, make good judgments, or maintain their physical and mental health. Implementing wellness and fitness programs has been shown to improve cardiorespiratory endurance, experienced health and job satisfaction, while decreasing weight, high blood pressure and anxiety(14). Providing expert-led sleep and fatigue management education to firefighters will assist in achieving a higher level of sleep health(15) and safety on the job. A simple sleep education and screening program for firefighters resulted in a 46% decrease in disability days, and 24% decrease in injury reports (16).

The Cost of Workplace Fatigue

February 26, 2019

Last week, in Seattle, the National Safety Council put on their first Workplace Fatigue Conference, aimed at bringing fatigue experts and corporations together to solve the nation’s fatigue problem.

And no, it’s not overstating the case to say we have a fatigue problem. The costs we pay for being sleep deprived are staggering, here’s a look:

  • Untreated sleep disorders cost up to $3500/employee
  • Direct costs $14B, indirect costs $28B
  • Employees sleeping only 6-7 hours nightly cost employers 3.7 days of lost work
  • Costs come from absenteeism, presenteeism, accidents, injuries and healthcare

A large employer here in my hometown, Seattle, is Amazon. I put their data into the NSC Fatigue Cost Calculator *. Here’s the findings:

  • Fatigue is costing Amazon $47,393,505 per year
  • $6.2M in absent employees
  • $27.8M in decreased productivity
  • And $13.3M in increased health care costs

But this is not the true total cost. There are additional costs resulting from the way sleep deprivation impairs positive human interactions. When sleep deprived, leaders are more abusive and unable to see sleep deprivation in their employees, employees in turn are less satisfied with their jobs, leading to costly employee turnover. There are many other ways that sleep deprivation and sleep disorders raise costs on corporations.

I encourage you to complete the Fatigue Cost Calculator for your own corporation, then take steps by training employees on sleep health, and designing your shift schedule and other safety practices to decrease fatigue. And decrease costs will follow.

 

NSC Fatigue Cost Calculator

*(Assumptions were: 24,000 employees in Washington, computing sector, no shift work. Though of course we know that these employees do work long and sometimes irregular hours).

Start School Later meets with the Dept. of Health

July 17, 2012

Tomorrow, July 18, the leaders of the national Start School Later initiative will be meeting with directors at the Substance Abuse and Mental Health Services Administration of the Department of Health. There is a connection between early school start times and depression and suicidal thoughts that needs to be addressed.

The full press release is below, and I’ll post the update from the meeting in the next few days. If you’d like to weigh in with your support of later school start times you can sign the petition at http://www.startschoollater.net
RELEASE: July 16, 2012: GRASSROOTS GROUP ASKS FEDERAL AGENCY TO ADDRESS LINK BETWEEN EARLY HIGH SCHOOL START TIMES, MENTAL HEALTH, AND TEEN SUICIDES:

Contact: Heather Macintosh, 410-279-4569 heathermac@verizon.net
Dr. Terra Ziporyn Snider, Co-Director, 410-262-6616

Start School Later, a national coalition advocating for sane, humane high school start times, is meeting with Dr. Anne Mathews-Younes, Director of the Division of Prevention, Traumatic Stress and Special Programs, and Dr. Richard McKeon, Director of the Suicide Prevention Resource Center, at the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the US Dept of Health and Human Services (HHS), Wednesday, July 18, in Rockville, MD.

Compelling scientific research shows that adolescents’ sleep needs are being dangerously compromised by the extremely early school schedules of many US high schools. Waking at 5:30 to catch a bus and begin school in the 7 o’clock hour is incompatible with adolescent sleep needs and causing teens to miss out on the crucial sleep they need for physical and mental health and development and optimum academic achievement. Sleep deprivation is strongly linked to anxiety, depression, and suicidal ideation, among other health effects.

SAMHSA is an agency of the U.S. Department of Health and Human Services (HHS), which, in turn, is increasingly recognizing the importance sleep plays in the health and wellness of young people.

“We’re looking forward to discussing ways federal agencies might be helpful in raising awareness and facilitating policies to ensure safe, healthy school hours for all children,” says Terra Ziporyn Snider, PhD, Start School Later’s Co-Director. “This has been impossible to achieve in many local school systems, where all too often politics and myth trump student health and well-being.”

Start School Later is an all-volunteer, national coalition working to ensure that all public schools can set hours compatible with health, safety, equity, and learning. Coalition members attending the SAMHSA meeting include Dr. Terra Ziporyn Snider and Kari Oakes, PA-C, both from Maryland, as well as Terry Cralle, RN, of Virginia, and Debbie Coleman, MBA, faculty member at the Miami University (Ohio).

Sleepy Transportation Workers – Scary!

March 15, 2012

Last week was National Sleep Awareness Week, and the time each year that the annual Sleep in America Poll is unveiled. This year it is all about sleep health in the transportation industry. This data raises concerns about public safety, and the health of the transportation workers. Here’s what pilots, train operators, and professional drivers of all types reported about their sleep.

Sleepiness and Safety
When asked about sleepiness, 1 in 4 pilots and train operators said that sleepiness has impacted their job performance once a week. Even more concerning is the number of professionals who say that sleepiness caused safety issues: 20% of pilots, 18% of train operators, and 14% of truck drivers.

These safety issues persist during transportation employees personal time: 6% were in an auto accident due to sleepiness compared to 1% of those who work in other industries.

The Sleep Schedule
Almost half of transportation workers are dis-satisfied with their sleep. Many say their work schedule does not allow enough time for sleep (44% train operators, 37% pilots). This compares to 27% of non-transportation workers.

Transportation professionals tend to work longer shifts, with less time off between shifts. They also tend to have longer commute times, and irregular shiftwork type schedules.

Adequate Sleep for Transportation Professionals
It’s been a pleasure in my office to help transportation professionals get healthy, natural sleep. This is primarily about strategically using our body’s sleep systems to promote alertness during work hours and sleep during sleep times.

First, create a window of time for sleep that can be as consistent as possible. Also put into place a routine of meal times, exercise, activity – all those things that signal time to the body. Second, reduce the commute as much as possible. Third, use precisely timed melatonin and light therapy to promote sleep at sleep times and increase alertness during the work day. This is a very individualized approach which takes into account the irregular work schedule, commute time, sleep environment, and lifestyle.

Summary

“The margin of error in these professions is extremely small. Transportation professionals need to manage sleep to perform at their best,” said David Cloud, leader of the National Sleep Foundation.  His comment really sums this up, that sleep health is so important for transportation professionals and the safety of the public they serve.

 You can read the report here: http://www.sleepfoundation.org//article/press-release/sleepy-pilots-train-operators-and-drivers

Sleep Health in ‘Whole Living’

September 27, 2011

Recently I spoke with journalists at ‘Whole Living’ along with other sleep specialists. It’s a great article, filled with information and skills that adults need to sleep well. Here’s a few highlights:
– Go to bed at your ideal bedtime
– Create a great place to sleep
– Avoid alcohol, the snooze button and oversleeping
– Learn to calm yourself back to sleep
More information on the many ways sleep impacts your health (think weight gain, heart disease, and wrinkles) can be found in the full article in the October issue. http://www.wholeliving.com/

Sleep Health in the News

March 30, 2011

It’s been fun the last week to talk with several folks in the media, both here in Seattle and on the web.  Here’s the links:

Interview about sleep & social skills with Linda Thomas of KIRO news
radio will air Weds, 5-8am, 97.3 fm
http://www.mynorthwest.com/category/news_chick_blog/20110328/Lack-of-sleep-impairs-teen-social-life/#comments

Interview on sleep needs & performance with Michael Harthorne of KOMO
community news
http://ballard.komonews.com/news/health/specialist-ballard-students-suffering-sleep-they-arent-getting/630340

Interview about insomnia with Myrna Sandbrand, RN on BlogTalkRadio

http://www.blogtalkradio.com/ezsleep/2011/03/25/interview-with-dr-darley

I love to talk to people about sleep health, the may ways it impacts their well-being, and what to do to improve sleep.  If you’d like a speaker for your group let me know, drdarley@naturalsleepmedicine.net.

Sleep In America Poll – Using Technology

March 7, 2011

The new Sleep In America Poll came out today, the first day of National Sleep Awareness Week 2011.

This poll was all about our use of technology during the hour before bed, our nightly sleep, and daytime function. Here are some of the highlights:
– 63% say that during the week their sleep needs are not met
– 60% say they have a sleep problem almost every night
– 95% of us use technology during the hour before bed a few nights a week or more
– 20% of 13-29 year olds say they are awoken by a text, phone call or email several nights a week
-22% of 13-18 year olds are clinically sleepy
– About 10% of 13-45 year olds say they drive drowsy 1-2 times a week

Even the light from your TV or laptop is enough to suppress melatonin. During the hour before bed your melatonin should be increasing, allowing you to become sleepy and fall to sleep easily. The time for bright light is in the morning to get energized.

Want a Better Social Life? Then Sleep Well

March 2, 2011

So, what has to happen to have a good social life? People need to think you are somewhat attractive, you need to be able to read others’ emotions, and you need to be a pretty good person.

All these aspects of a good social life are impacted negatively if you don’t sleep well. Research this last year has shown that when people are sleep deprived they:
A) are considered less attractive than when they are well rested
B) are less able to discern happy and angry emotions from anothers’ facial expression
C) are more likely to put their own interests above others when making moral or ethical decisions.

So, we already knew the many ways poor sleep or sleep deprivation impacts our physical health and performance. Now we’re starting to learn how our social abilities are impacted too.

My next thought is about the high number of children who are sleep deprived (80% of highschool students). Since this is a time when they are learning social skills, what is the long-term impact of being sleep deprived at this critical time?

Getting your ‘Beauty Sleep’ really matters!

January 3, 2011

When a patient first sits down for their return appointment, I frequently can anticipate whether their sleep improved or not.  All this before they say a word.  How do I know?

For years I’ve thought it was because of the way their face looks – skin tone, color, skin around the eyes, and general ‘sparkle’ in the facial expression.  New research from the British Medical Journal (http://bit.ly/eWOZPc) has shown that the amount of sleep we’ve had is reflected in our face, and impacts how others see us.  In this study participants were sleep deprived 31 hours then photographed.  They were also photographed after a regular 8 hour night of sleep. 

When untrained observers looked at the photos, the sleep deprived people were rated as less healthy, less attractive, and more tired.  The authors conclude that “This suggests that humans are sensitive to sleep related facial cues, with potential implications for social and clinical judgments and behaviour.”  Think relationship success and job performance reviews. 

Just another great reason to get enough hours of sleep each night, and to address any sleep problems that interfere with this.

Are you an Owl or Lark?

October 25, 2010

An ‘Owl’ is someone whose body clock is set to sleep later than average, and a ‘Lark’ is someone whose set to sleep earlier than average. It is your inherent melatonin rhythm and temperature rhythm that determine when you sleep.

Being an Owl or Lark can impact how well you do with different schedules. Generally speaking, Owls do better with later schedules and shift work like graveyard. Larks are the ones you’d want to open the shop in the morning. It’s important to know that alertness fluctuates over the 24 hours in almost the same curve as temperature. As your temperature drops you are less alert and more sleepy.   If you get into bed and try to sleep before your body is ready, you may experience this as insomnia.  About 10% of chronic insomniacs actually are Owls, and if they go to bed later have no problem sleeping.

To determine if you are an Owl or Lark you can do the Horne-Ostberg Morningness-Eveningness questionnaire, which was developed in 1976. You can find a modified version of it online at http://web.ukonline.co.uk/bjlogie/test.htm.

This information can help you develop a lifestyle that best suits your circadian rhythm.  If you are not able to shift the time of your commitments, a sleep specialist may be able to help shift your circadian rhythm.