SLEEP DEPRIVATION AT

WORKA Hidden Problem in Need of Creative

Solutions

Chris Knoepke, PhD, MSW, LCSW, CEAP

In Honor Of

Julian

My source of sleep deprivation

Haskell Wexler (1922-2015)

Advocate for safe & rested workers

Coffee Talk

What kinds of sleepiness or other sleep/rest-related issues or

complaints/concerns do you encounter in your work , in your own

life, or among people you know?

General Info About Sleep

• “Sleep Debt” gathers

quickly

• Sleeping only 6 hours a night

for two weeks causes the

same cognitive impairments

as not sleeping at all for 2

nights over the same two

weeks

• “Nevertheless, most of us

– for a variety of reasons –

don’t get the sleep we

need

Fatigue Already Interfacing with EAPs

How Sleep Works

• Stage 1: Dozing

• Stage 2: Snoozing

• Stage 3-4: Deep Sleep

• REM: Dreaming, Active Brain

*AgriLife.org: Texas A&M Extension

Approximate Sleep Needs Through Life

Ages Hours/Day of Needed Sleep

<1 16-17

1-5 11-13 (including naps)

5-12 10-12

12-18 ~9 (delayed phase)

Early/Middle Adulthood ~7.5-8 (highest incidence of

disturbance)

Late Adulthood (age >65) ~8 (6 at night +naps, early rising, poor

architecture)

Sleep Deprivation is as Impairing as Alcohol (in terms of cognitive performance)

• 18 hours of sustained

wakefulness = .05 BAC

– At 24 hours = .10 BAC

• Mild Sleep Apnea Sufferers have worse

cognitive performance than those @ .06 BAC

– Severe, untreated OSA sufferers are 17 times more

likely to be in a car accident than those without

OSA (or whose OSA is being treated).

Basic Causes of Lost Sleep/Rest

• Lifestyle, Social/Familial Demands

• De facto sleep disorders

• Occupational Sleep Deprivation

Disordered Sleep

•We tend to have a “black and white” view of sleep

•Common disorders of sleep include:

• Insomnia

• Sleep Phase Problems

• Sleep Apnea

• Narcolepsy

• Restless Leg Syndrome/PLM

• Odd or Dangerous Behavior Occurring While Sleeping

Identifying Sleep Problems: BEARS

• Bedtime problems?

• Excessive sleepiness during the day?

• Awakenings at night?

• Regularity of sleep (number of hours)?

• Snoring/apneas

Handout – Epworth Sleepiness Scale

Insomnia•Occasional trouble sleeping is not insomnia,

but it is a good way to tell that something isn’t

quite right.

•Different types and phenotypes:

•Onset

•Maintenance

• Terminal

Circadian Rhythm Problems

• Circadian Rhythms regulate our Sleep/Wake Cycle

• Jet Lag

• Shift Work

• Delayed

• Advanced

Borrowed from Yue, n.d.

Snoring and Obstructive Sleep Apnea (OSA)

• Snoring that isn’t OSA is usually only a big deal to

the people in the room with you

• Sleep apnea, though, is characterized by intermittent

partial or complete collapse of some portion of the

upper airway

• Sleep Apnea increases risk of

• Accidents (17x greater risk of MVA*)

• Heart disease (unmanageable HTN = red flag)

• Mood disturbances (unmanageable depression = red flag)

• Metabolic dysfunction (unmanageable diabetes = red flag)

• Excessive daytime sleepiness (frequently tired despite

adequate time spent sleeping = red flag)*Morin, 2000

Occupational Sleep Deprivation

Where Do Employers Fit Into the Sleep

Equation?

What About Napping?

• Identified as one of the most effective countermeasures to sleepiness and fatigue (Horne & Reyner, 1996).

• Increases positive emotions including energy (Taub,

Tanguay, & Clarkson, 1976), motivation (Hayashi, Watanabe, & Hori,

1999), and joy (Luo & Inoué, 2000).

• Toddlers who were not permitted to nap showed more negative responses to an unsolvable task than did toddlers who napped (Berger et al., 2012)

Question (from Goldschmied et. Al, 2015)

If a lack of sleep results in increased impulsivity and an increase

in negative emotional responding,

Will a nap counteract this behavior?

Participants

No Nap Nap

N (No. female) 18 (9) 22 (11)

Age (SD) 21.31 (1.78) 20.05 (1.79)

Self-reported Total Sleep Time (SD) 8:01 (0.03) 7:42 (0.03)

Present Sleepiness – Stanford Sleepiness Scale Score 2.94 (1.21) 2.73 (1.08)

Goldschmied et. Al., 2015

Study Protocol

Pre-Study Period

3 days

Consistent Sleep Schedule:

6-9 hours

Verified by

Sleep Diary & Voicemail

Pre-Nap

EEG Hookup

Task Battery:

Frustration Tolerance

State Questionnaires:

Impulsivity

Nap Opportunity

60 minute Nap/

Movie Viewing

Post-Nap

EEG Unhook

State Questionnaires:

Impulsivity

Task Battery: Frustration Tolerance

Goldschmied et. Al., 2015

Frustration Tolerance TaskFeather, 1961

Goldschmied et. Al., 2015

14 visual analogue items designed to assess impulsive mood.

(1) Impulsivity and Control of Behavior (five items)• “Tend not to think about consequences of actions”

(2) Control of Thoughts (five items)• “Easily distracted”

(3) Feelings of Impatience (four items)• “Want to get things done quickly

State Impulsivity Measure (STIMP)Wingrove & Bond, 1997

Goldschmied et. Al., 2015

Goldschmied et. Al., 2015

STIMP Results

27

28

29

30

31

32

33

34

35

36

Pre Post

ST

IMP

To

tal

Sco

re

No Nap

Nap

Goldschmied et. Al., 2015

Frustration Results

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

110000

Pre Post

Tim

e o

n U

nso

lvea

ble

Ta

sk (

ms) Nap

No Nap

Goldschmied et. Al., 2015

Study 3: Conclusions

• Wakefulness across the day decreases our ability to tolerate

frustration and impulsive feelings

• In contrast, a brief nap enhances the ability to tolerate

frustration and decreases feelings of impulsivity

May help us develop interventions

Group: Where Would it be Important/Effective

to Incorporate Sleep?

• Workplace Wellness Programs

• Scheduling

• Napping at Work

• Other Areas of Company Policy/Procedures??

Integrating into Wellness Programs

1. Where does the company fit?

2. What component of the wellness programs?

• Screening? How?

• Health promotion? How?

• Disease management? How?

Education for All Employees: “Sleep

Hygiene”• Some tips or tricks to getting good or better sleep

• Might be a good idea if you start to notice that you aren’t getting

as much sleep – or as much rest – as you want

• Check the environment (noise, heat, light are frequent culprits of bad sleep)

• Look at your schedule (sleeping at vastly different hours from night to night

because of work or social life – remember your Circadian Rhythm!)

• Avoid Nicotine/Alcohol/other sedative use in the evening

• Avoid exercising in the evening

• Take advantage of your body’s internal sleep signals (metabolism, body

temperature, heart rate, etc.)

Integrating Naptime

Lets pretend you decide that you are going to

accommodate 45 minute naps for employees at your

company.

• How would you sell this to decision-makers?

• What logistical problems would you need to overcome?

• What cultural issues would you need to overcome?

Questions?