Sleep and recovery: a toolkit for employers

In association with Sponsored by 2

Contents

Introduction 2/ Understanding sleep deprivation 19 Appendices 33 Core statistics 3 Signs of sleep deprivation 20 Glossary of terms 34 Checklist of actions 4 Causes of sleep deprivation 21 A guide to sleep 35 Positive partnership 5 – Work-related causes 21 Clinical sleep conditions 36 SMEs 5 – Changes in health and wellbeing 22 Cognitive behavioural therapy 37 Toolkit development 5 – Personal and lifestyle factors 23 Resources for employers 38 Increasing awareness of sleep deprivation 6 – Sleep disorders 24 Taking a proactive approach 7 – Stress 25 Case studies 41 Foreword from Peter Simpson 8 Mental health and work life balance 26 Acknowledgements 51 Foreword from Dr Justin Varney and Sleep hygiene 27 Louise Aston 9 Impact of blue light 28 The business case for good sleep 10 Your legal responsibility as an employer 12 3/ Taking action to support good sleep 29 Prevention: creating the right 1/ Key issues to consider 13 culture and providing support 30 The importance of good job design 14 Early intervention: recognising Shift work 15 and addressing sleep deprivation 31 Travel and working across time zones 16 Recovery: helping employees Driving and road safety 17 to recuperate 32 Introduction

Introduction 3 Sleep in numbers Health risks:

We naturally feel Adults who sleep fewer <6 than 6 hours a night have annual cost tired at two different a 13% higher mortality times of the day: 13% risk than adults who sleep around of lost sleep at least 7 hrs1 £ to the UK1 30bn pm am Adults who sleep less 2 2 <7 than 7 hours a day are 30% more likely to be 200,000 working days lost 30% obese than those who sleep for 9 hours or more4 in UK every year to insufficient sleep1 Working night shifts Adults need has about a 25-30% between 1 in every 3 higher risk of injury 7 & 9 people in the UK are than working day shifts7 affected by insomnia3 hours of sleep a night2 3.2 night workers million in the UK5 Better sleep 1/3 We spend about is the biggest 1/3 of our single contributor And 1 in 9 workers lives sleeping to living better6 who work night shifts5

Sources: 1 RAND Europe • 2 NHS Livewell • 3 NHS Choices • 4 One You • 5 TUC • 6 Sainsbury’s Living Well Index • 7 IOSH Introduction

Introduction 4

Checklist of actions

Be prepared: Encourage sleep and recovery: Provide knowledge and training: U nderstand the importance of A sk employees what will help them I nclude training, information and sleep quality and recovery to and encourage them to take the lead guidance on sleep and recovery your employees on implementing change for managers and employees in your health and wellbeing strategy I nform employees that you recognise I dentify the threats to good sleep the impact of sleep deprivation in the workplace and the problems E nsure that training, information your employees face and guidance is evidence-based C onsult employees about their sleep and any problems they experience C onduct a workplace assessment E nsure that training and guidance with getting the right amount and for good lighting and ventilation is implemented quality of sleep S ignpost managers and employees C ollect feedback to ensure training, U nderstand your legal duty of to information about better sleep information and guidance meets care to employees and to the circumstances and recovery employees’ needs wider community K now how to access occupational health services

I dentify external resources you can use to support sleep and recovery among your employees For more detail on practical actions: Introduction

Introduction 5

Toolkit development SMEs Positive partnership This toolkit has been informed by an evidence This toolkit has advice that is review produced by the Public Health Your approach to supporting specifically aimed at small and England Library Team and the evidence was sleep and recovery will reap medium sized enterprises (SMEs). considered by a steering group made-up greater benefits if it has the SMEs can be disproportionately of practitioners, professionals and business affected by the loss of key staff for experts. It also draws on the experience of support of employees. any period of time because of illness, employers who have taken steps to support or when they are unable to perform sleep and recovery and signposts external E ngage with employees from the outset, ask to the best of their ability because organisations that offer advice and support them what will help them and encourage of fatigue. So, helping employees to to employers and employees. them to take the lead on implementing change maintain healthy sleep patterns and to recover fully after a period of sleep The case studies in this toolkit have been Y our employees might be aware of existing deprivation, is of vital importance. sourced and written following consultation support that can be improved or expanded with experts working in the sleep sector to have greater reach and impact This toolkit provides practical and through the contribution of employers information for all employers (small, A ppoint workplace champions who can help who are taking this topic seriously. They medium and large) on how you spread the word demonstrate a combination of employers can create an environment where sharing real-world examples of the initiatives R eport back regularly, test what is working employees understand the importance they have trialled to support employees and and what requires further development of sleep and recovery and are able personal stories from individuals who have to make healthier choices at work experienced situations which have impacted C reate channels of communication that reach and at home. as widely as possible on their sleep and work performance. Many of the points are simple to E ncourage employees to share their learning “I haven’t seen a specific resource for implement, supported by resources across the organisation so everybody can sleep and recovery like this before and that are free or inexpensive. The benefit I think it is brilliant. It’s really clear and crucial element is a commitment to accessible and I’m sure employers will A gree goals and the best way to measure support the health and wellbeing of find it very valuable.” achievements the organisation by fostering an open and inclusive culture. Janet Cummings Marketing and Health Coordinator, Amacus Introduction

Introduction 6

We spend about a third of our lives Increasing awareness of sleep deprivation asleep and the multiple risks of sleep Sleep has a number of critical Certain occupations are particularly deprivation are well documented. functions. It is essential for good at risk of impacted sleep (e.g. hospital This toolkit aims to provide health and wellbeing. It is also night workers, emergency services, essential for maintaining levels of police, 24/7 call centres). But it doesn’t information, resources and practical cognitive skills such as speech, just affect shift workers; stress at work actions that employers can take to memory and innovative and flexible is a significant cause of poor sleep, maximise employee energy through thinking. Lack of sleep has a profound so employees in any organisation, impact on our brain’s ability to function. whatever their working patterns, can effective sleep and recovery. The cumulative impact of successive experience sleep deprivation. All of nights of poor sleep is significant. these are reasons for employers to There is a strong relationship between understand the causes, possible sleep and physical and mental health. effects and solutions to poor sleep. This is why taking steps to prevent sleep deprivation or poor sleep is so important. “This toolkit is a great resource for employers, providing comprehensive Organisations are becoming and easy to navigate information on increasingly aware of the impact the importance of sleep and recovery. of sleep deprivation on the health As someone who provides advice and wellbeing of employees and and support to staff on areas such the implications for creativity, good as stress, sickness absence and decision making, safety, productivity case management – all of which can and competitiveness. Sleep deprivation tie into sleep issues – I found this is often associated with shift work, toolkit really helpful in providing clear, or work that takes place during practical steps to take to help benefit antisocial hours. our workforce.” Debs Ireland Occupational Health Adviser, Teesside University Introduction

Introduction 7

Taking a proactive approach This toolkit is designed to support “This toolkit has helped us with employers and line managers to some really practical actions to Working in partnership with create a workplace culture in which support our employees with sleep employees, employers can take the employer and the employee can and recovery. For us, the information a positive, proactive approach to openly and fairly discuss the need for on shift working, overseas travel and sleep and recovery and employees sleep assessment are all especially support sleep and recovery in the are able to get the sleep they need pertinent to our employees and we’ll workplace, with a strong emphasis to perform to the best of their ability. be embedding these elements into on the prevention of problems. This includes the importance of good our health and wellbeing programme.” job design and the need to remove Susan Wynn barriers in the workplace to good Occupational Health Manager, sleep and recovery. Sunderland University It sets out steps that are easy to follow and helps you choose the best free “This thorough toolkit will be a very resources for you and your team. Peer- useful resource for employers. I like reviewed evidence about what works that it encourages people to consider best to support sleep and recovery is how a lack of sleep could be to do still limited, so the toolkit also reflects with a range of issues and the links the experience of employers who are to further resources where employers beginning to respond to this emerging can find out more details about issue at work. particular areas are really helpful. I certainly feel better equipped to Taking action on sleep and deal with sleep and recovery in the recovery can make a real difference workplace having read the toolkit.” to your workforce and doesn’t have Ashley Lowe to involve a significant investment Health & Wellbeing Project Coordinator, of time or resources. Using this Newcastle United Foundation toolkit as guidance, you can develop an approach that suits your organisation, whatever its size or sector. Introduction

Introduction 8

Foreword from Peter Simpson Chief Executive Officer, Anglian Water

Long before the term ‘24/7 economy’ delivered. These days, poor sleep has workplace, with demonstrably positive entered our language, utilities like an impact across society, affecting outcomes. Anglian Water were working around millions of people. Stress at work, the clock to ensure that our customers or poor job design, can cause sleep Sleep and recovery is a new topic, so enjoyed uninterrupted essential services deprivation or affect the quality of sleep. our understanding of what works best like water. Occasionally, incidents And because people spend so much to support employees is still evolving. happen that require our teams to make time at work, the workplace is an ideal Our health and wellbeing programme emergency deployments that can take place to begin to offer the support they is focussing on the impact of sleep several days to resolve. I have first-hand need to address these issues. deprivation across the organisation and experience of working 12-hour days for how we can support all employees to Click the links two weeks or so, under intense pressure At Anglian Water, we understand that understand the importance of good sleep below to view and I understand the toll it takes on body employees are the lifeblood of our and effective recovery after periods of Anglian Water’s and mind if you are unable to make the organisation. Their health and wellbeing intense work. We are adopting a holistic videos on sleep time to rest and recover. are central to the sustainability of the approach, recognising that where sleep and recovery: business. As many employers now has become a problem it cannot be Working in those conditions has recognise, we have a responsibility solved in isolation. As an organisation, The importance consequences for the individual, but as business leaders and managers we need to understand the root causes, of sleep health also for the organisation. The cumulative to provide the support our employees provide support and information and in the workplace effect has an inevitable impact on need to stay fit and well for as long make the necessary adjustments in the the quality of decisions. But when as possible. It is the right thing to do, workplace. It is also about encouraging Legal a community is depending on you, but it also makes good business senior managers to lead by example responsibilities it can be difficult for somebody who sense, for a healthy workforce will be and creating high performing teams of the employers is focussed on getting the job done, more engaged and make a positive that harness individual resilience. as quickly as possible, to admit that contribution to sustainable growth. How to sleep better fatigue is affecting their ability to work. We are committed to sharing our and sleep hygiene We have deep experience of working learning across our supply chain The impact of sleep deprivation is with our employees to embed practices to ensure that as many people as not only felt by teams on emergency that support physical and mental health possible benefit. Workplace health deployment, or even by the men and across the organisation. Our “Fit for the and wellbeing are of vital importance women who work during the night Future” programme has transformed the for the whole community. to make sure that vital services are way that we think about wellbeing in the Introduction

Introduction 9

Foreword from Dr Justin Varney, National Lead for Adult Health and Wellbeing, Public Health England and Louise Aston, Wellbeing Director, Business in the Community

Sleep is essential to a healthy life. is estimated to cost the UK economy no sleep as something to be admired Deprivation of it increases the risk over £30 billion a year, equivalent to need to be challenged. Sleep deprivation of premature death, mental health almost 2% of GDP. is a huge organisational risk that can problems, disease and disability. result in poor decision making, affecting Nobody can perform at their best if All employers have a responsibility the lives of thousands of people and they do not have good quality sleep. to support the health and wellbeing even potentially causing fatalities. of their staff as part of their health and The World Health Organisation safety duties and, at a national level, We hope that businesses can use this estimates that two thirds of adults in we want to see more people leading toolkit in conjunction with the suite of developed countries globally do not healthy, productive lives. Public Health England and Business get the recommended seven to nine in the Community toolkits to safeguard hours of sleep each night. The 24/7 Responsible employers are beginning their employees and ensure that they digital economy has brought us to consider the implications of sleep are getting the right wellbeing support many good things, creating jobs and deprivation and how it can be addressed. they need to remain in good health and prosperity. But the downside is that Their challenge is to understand and fulfil their potential. we are on the go, all the time. The respond to the underlying reasons why dividing line between our work and employees may be suffering from poor our life outside work has blurred. In sleep. Their reflections must extend a connected society, we are always beyond shift workers. In a global switched on. Modern lifestyles leave economy, employees increasingly less time for sleep and when we do work across international time zones, sleep, it is often interrupted or cut short. or remain connected to work during hours supposedly set aside for home Evidence shows that sleep matters life or rest. We need to raise awareness to individuals but it also matters to and encourage wider discussions about business. Poor sleep leads to poor sleep deprivation and its impact at interpersonal interactions and dynamics, work and across society. Conversations poor customer service, mistakes and about sleep need reframing and cultures accidents. As a result, sleep deprivation which hold that getting by with little or Introduction

Introduction 10

The business case for good sleep The number of hours the average There are many reasons why people are person sleeps has been in decline for unable to sleep, or to get the hours of As a society, we sleep less than we the past few decades, but its impact on sleep they need, which are discussed in used to and less than we should. economic performance has received this toolkit. The causes are often outside Although the optimum amount varies little attention. Yet we know that sleep the workplace but the effects are felt at quality has an important influence on our work and may impair an employee’s from person to person, most of us cognitive functions. Not getting enough ability to carry out their duties. Work can need between seven and nine hours sleep is likely to affect our performance also cause excessive stress, which may a night. Around four in 10 people at work. lead to sleep deprivation or poor sleep. In some sectors, this can present a risk do not get enough sleep. One in One of the most comprehensive studies to the safety of colleagues or members five suffer poor sleep most nights, on the economic impact of sleep was of the public. carried out by Rand Europe, a not-for- representing the second most profit research organisation. It used common health complaint after pain. data from 62,000 people in five major “We know from our wellbeing economies (the United Kingdom, the work with our staff and the work United States, Canada, Japan and that we do as a charity, that the Germany). The study concluded that the most important thing is to start the economic cost of tired employees being conversation – making people feel less productive or absent from work comfortable to start talking about altogether amounted to almost two per sleep issues they are having which cent of GDP. In the United Kingdom, are either caused by or impacting on this equates to around a £30 billion a work. This toolkit is a great resource year loss, attributed to lower productivity for employers to help people start levels and higher mortality rates. talking about this issue.” Separately, a study published by the Kate Upshall Davis London School of Economics Centre Wellbeing and Mental Health for Economic Performance in 2017 Manager, Crisis found that a one-hour reduction in sleep duration adversely affects the number of hours worked and household income. Introduction

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Sleep deprivation takes a toll over a The challenge for employers and line “Our health and wellbeing app Bupa Boost shows long period of time, which means that managers is to understand the cause that sleep is among the top three issues of concern employees are often unable to judge of sleeplessness to be able to consider to employees. In fact, among users of the app who for themselves how they are affected. what the best response is. The good set personal wellbeing goals, sleep is consistently That’s why line managers play an news is that small changes to sleep number one. Wellbeing is individual and what is important role. They must understand duration and quality can have a positive important for one person may not work for another. the importance of good sleep and impact and there are simple steps that Our sleep habits are particularly personal and be able to spot the symptoms of employers can take to achieve this. it can be difficult to have a conversation about sleep deprivation. Employers should sleep in a workplace setting. But it is critical for also consider this when designing organisations to understand the impact of sleep their health and wellbeing strategy. and recovery for the health and wellbeing of employees and the implications for productivity. Sleep deprivation is often where “That is why this toolkit is so important. We know physical and mental health intersect. there is an unmet need for advice and support and Sleep deprivation itself can be a as employers we have a responsibility to ensure symptom of mental health problems that employees have access to the information they and can increase the risk of developing need to make healthier choices and to understand mental health problems. There is also what steps they can take to improve the quality of a growing understanding of the link their sleep. We also can ensure that the workplace between lack of sleep and hypertension, does not become a barrier to a good night’s sleep heart disease and diabetes. After and we can support employees to recover to just a short period of reduced sleep, reduce the risk of fatigue.” people are more vulnerable to infection. Brain function deteriorates, drastically Patrick Watt increasing the risk of accident and Corporate Director, Bupa UK injury. Longer periods of sleep loss can significantly impair learning and cognitive processing, particularly in older people. Those sleeping fewer than six hours a night have a 13 per cent higher mortality risk than those getting seven to nine hours. Introduction

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Your legal responsibility as an employer

Employers have a legal duty to manage risks from workers health assessments – although they don’t have to fatigue and sleep deprivation, irrespective of any of their accept. If a decision involving work equipment, processes or workers’ willingness to work extra hours or preference for organisation could potentially affect the health and safety of certain shift patterns. Under the law, employers have a duty employees, such as any proposed changes to shift working of care to protect not just the health, safety and welfare of arrangements, the employer must give the employees their workers but any other people who might be affected (or their representatives) information about the proposals by their business. The following general principles apply. and time to consider it. The employer must also give the employees (or their representatives) the chance to express Health and safety law requires employers to consult with their views on the proposed changes. Then the employer their employees on all matters of health, safety and welfare. must take account of these views before reaching a decision. They can do this either directly or, if there are health and safety representatives, through them. Employees also have a duty to take reasonable care of their own health and safety and that of others at work who may be The Working Time Regulations 1998 (as amended) affected by their activities. Employers should take positive (“WTR”) lay down the minimum legal requirements on how steps to help staff understand potential causes and to organise working time. Employers are required not just to risks of fatigue at work. They should make staff aware satisfy the provisions of the WTR, but to proactively consider of relevant safety rules, policies and procedures. fatigue a risk factor in their business like any other health and safety risk. Whether the business involves major hazards or not, employers are required to set up appropriate systems to control potential causes of fatigue, such as shift patterns and excessive overtime. Some sectors (such as aviation) For further information, see the following resource links have specific regulations to guard against fatigue. below from the Health and Safety Executive website:

Note that some employees may prefer certain shift patterns that are unhealthy and likely to cause fatigue. Develop a policy that specifically addresses and sets limits on working hours, overtime and shift-swapping to guard against fatigue. The WTR require employers to offer night 1/ Key issues to consider

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1/ Key issues to consider 1/ Key issues to consider

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The importance of good job design A job that is well designed also health and performance levels and enables an employee to accomplish thereby reduce ill health. Periodic Good job design helps to reduce what is required in a safe and healthy assessment of the job or tasks is the risk of physical and emotional manner and thereby reduce physical preferable as it should be able to stress. Good work for employees and psychological strain. Further, it identify if changes or adjustments helps with the organisation of work are needed to the way in which incorporates elements which make (identifying issues such as work employees carry out their duties. that job worthwhile to the individual, overload, repetitiveness and limited such as job security, the ability to control over work) and supports occupational safety and health within Click on the useful resources below use and develop skills and clear organisations. A well designed job which help explain the importance responsibilities. results in more engaged, healthy of good work and job design: and productive employees and these outcomes benefit both employees and organisations.

The work environment is changing, due to a move to a stronger service economy, the increasing number of women in the workforce and the large “Sleep is a basic human need and number of older workers who remain equally important to health as good in employment. Good work design diet and exercise. Health and wellbeing must also evolve to retain productive, policies should promote good sleep safe and healthy employees. hygiene. There may also be health and safety issues arising from shift Work and job design should occur working, particularly at night and within organisations when a new job sleep apnoea, which may make the is created or when the work and jobs employee unfit to drive. Employers no longer fit the worker or exceed the need the support of good occupational capacity of an individual employee. health advice.” Effective organisations should have monitoring procedures in place to Professor Diana Kloss continuously assess workers’ safety, Chair, Council for Work and Health 1/ Key issues to consider

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Shift work Millions of people work in HSE guidance on shift work includes: shifts, at night or on split, rotating or varying schedules.  Plan an appropriate and  Consider the needs of vulnerable varied workload workers, such as young or ageing workers and new and expectant Shift work can take a toll on employees’ minds  Offer a choice of permanent mothers and bodies. Shift workers are at increased risk or rotating shifts and try to of chronic illnesses such as heart disease and avoid permanent night shifts  Limit consecutive work days to a gastrointestinal diseases. Although the link maximum of five to seven days and between disrupted sleep patterns and the  Either rotate shifts every two to restrict long shifts, night shifts and increased risk of disease has not been proven, three days or every three to four early morning shifts to two to three employers should recognise the duty of care weeks – otherwise adopt forward consecutive shifts they owe to shift workers. rotating shifts  Allow two nights of full sleep when Shift workers are also at increased risk of fatigue,  Avoid early morning starts and switching from day to night shifts which in turn elevates the possibility of errors, try to fit shift times in with the and vice versa accidents and injuries. The risk is found to be availability of public transport higher on night shifts and rises with increasing  Build regular free weekends into shift lengths over eight hours, across successive  Limit shifts to 12 hours including the shift schedule shifts and when there are not enough breaks. overtime, or to eight hours if they are night shifts and/or the work  Consider increasing supervision The Health and Safety Executive (HSE) has is demanding, monotonous, during periods of low alertness developed good practice guidelines on shift dangerous and/or safety-critical design, as well as general guidance on shift  Control overtime, shift swapping work and fatigue. Encourage workers to take regular and on-call duties and discourage breaks and allow some choice as workers from taking second jobs to when they are taken

Remember that some employees who are not officially night workers will be affected by ‘night shift’ patterns (e.g. those who get up at 4 a.m. for a 6 a.m. shift). 1/ Key issues to consider

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Travel and working across time zones The globalised nature of today’s Minimising the effects of jet lag business world means that employees Encourage employees to do the following: are increasingly likely to work across time zones.  Select a flight that allows early  Upon arrival at a destination, evening arrival and stay up until avoid heavy meals 10 pm local time International travel is an integral part of many  Bring earplugs and blindfolds occupations, while many other employees  If the employee must sleep to help dampen noise and block work outside normal office hours to support during the day, take a short nap out unwanted light while sleeping colleagues or customers in other parts of the in the early afternoon, but no world. In such cases, the demands of work longer than two hours, setting an  Try to get outside in the sunlight can disrupt healthy sleep and become a alarm to be sure not to oversleep whenever possible because barrier to recovery. daylight is a powerful stimulant  Anticipate the time change for for regulating the biological clock, Jet lag is one of the most common issues trips by getting up and going while staying indoors worsens impacting sleep. Typical consequences of to bed earlier several days prior jet lag jet lag include disturbed sleep, decreased to an eastward trip and later alertness, general malaise and impaired for a westward trip  Although it is always important to daytime function. In addition, gastrointestinal eat healthily, the type of foods we distress is common and occurs when travellers  Upon boarding the plane, eat have no effect on minimising eat at irregular hours. change your watch to the jet lag destination time zone  If you are only ‘in country’ for a When it is necessary for employees to travel  Avoid alcohol or caffeine at short time, it might be easier on across time zones, there are some simple least three to four hours before your body to avoid adjusting to behavioural adjustments that can be made bedtime, because both act as the new time zone before, during and after arrival to help stimulants and prevent sleep minimise some of the side effects of jet lag. 1/ Key issues to consider

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Driving and road safety Driving while fatigued is an offence road drivers as they are more likely to under road traffic law and may result drive in fatiguing situations, undertaking Managing the risk of fatigue and in prosecution leading to imprisonment long journeys, under time pressure sleep deprivation for employees who and other penalties. Every week around and after long working hours. In the drive can save lives. Driver fatigue 150 British road deaths and serious rail industry, work-related road traffic injuries involve someone using the road accidents and incidents and CIRAS is a serious problem that results in for work purposes. The Royal Society staff reports show that many workers thousands of serious injuries and for the Prevention of Accidents names are exposed to similar crash risk factors. deaths on Britain’s roads every year. driving as the most dangerous work activity that most people do. Around Increasingly, drivers are self-employed It is estimated that fatigue may be 40 per cent of sleep-related accidents and may hide sleep problems through a factor in up to 20 per cent of all involve drivers of commercial vehicles. a fear of losing work. Responsible road accidents and up to a quarter organisations should work closely with Employers should consider not only the contractors to prioritise safe driving. of fatal and serious accidents. risk to those whose primary occupation is driving, but also those who routinely drive long distances for work and those who commute to and from work by road.

Long working hours, irregular shifts, work schedules and night driving are factors that increase crash risk. Business drivers with high work-related mileage have over 50 per cent more injury accidents than non-business 1/ Key issues to consider

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“Fatigue is known to contribute to one in five UK road deaths, more than Safe driving 80% of inflight procedural errors and to increase the risk of accidents four-fold. Measures for reducing risk in this regard include: It is linked to longer-term health risks such as obesity, diabetes, depression,  Working practices, journey schedules, appointments and routes should enable drivers suicide, heart disease and cancer. to stay within the law “As managers, we should be striving  Employers are legally required to consult with employees on health and safety issues to get the best from our people and that means avoiding fatigue. Sleep is  Work patterns should allow for a minimum of between seven and eight consecutive the only cure for fatigue and should hours of sleep in each 24-hour period be considered a weapon to be utilised  Foster a culture that encourages drivers to acknowledge when they are fatigued and against its degradation. should not drive “It makes good business sense to protect our people from fatigue and,  Provide training on the importance of sleep and recovery to employees who drive in return, we will be rewarded with at work for significant periods of time a sharper-thinking, healthier, more  Signpost all employees to information about sleep and recovery effective and more efficient workforce.” Wing Commander John Rollo  Understand driver fatigue risk factors (both at-work and non-work) RAF Centre of Aviation Medicine  Make sure there are enough drivers to cover work schedules while maintaining required safety standards

 Ensure vehicles are well maintained, which reduces risk of breakdowns and delays

 Maintenance should include the environment within the driver’s area and cabin

 Be aware of drivers who swap shifts among themselves and the impact this can have Information summarised from: on working hours 2/ Understanding sleep deprivation

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Understanding sleep deprivation Signs of sleep deprivation The challenge for line managers is to be able to recognise the symptoms of sleep deprivation or poor sleep, particularly when it might be a health and safety issue that puts colleagues or members Decreased Performance Poor concentration/ of the public at risk. Knowing what communication deterioration easy distraction to look for is important.

Poor cognitive Poor mood/ Greater risk-taking assimilation inappropriate behaviour and memory behaviour

Inability to make Increased intake Increased sickness/ necessary of caffeine/ sickness absence adjustments energy drinks 2/ Understanding sleep deprivation

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Causes of sleep deprivation Work-related causes There are many reasons why people do not sleep Shift patterns: Shift work can create response, regardless of time of day issues because it involves working or night. Encourage employees to enough or suffer from a against the body’s natural rhythm. We disconnect work emails, calls and broken night’s sleep, which look at this in more detail on page 15. texts between agreed hours and/or causes them to suffer at weekends. Sharing out-of-hours Time zone work: Globalisation calls across teams can also help. tiredness the following day. means more people work across international time zones, either Stress: Work-related stress can have There may be more than one reason, travelling in person or engaging with an adverse impact on sleep. The risk and these may not be related to work, customers and suppliers outside is greatest at times of change, or when although the impact will be felt in the normal working hours, by phone or there is uncertainty at work. Some workplace. Line managers should try email. Allowance must be made for stress can be positive, but stress that to understand what is causing sleep extended working hours and the time is persistent over longer periods is deprivation to be able to take steps it takes to recover from jet lag and detrimental. It can make it difficult to to address the problem, including international time differences. Air rest and sleep and cause fatigue. recognising when changes to work travel within the same (or similar) time See page 25 for further detail. can help remove some causes of sleep zone can also be disruptive to sleep. deprivation. When health and safety See page 16 for more info. Work relationships: Work is is a concern, such as handling heavy central to many people’s lives, and machinery, an employer may request Working day/week: The 24/7 relationships with colleagues have that an employee consult with their economy requires many of us to work a significant bearing on wellbeing. GP before resuming duties. longer hours than a generation ago. A difficult relationship with a line Even when our formal working hours manager or bullying by colleagues can An employee might not even be aware have not changed substantially, we cause stress, which carries over into that he or she is not sleeping enough and find it harder to disconnect from a person’s home life, disrupting sleep. may not be able to pinpoint the reasons. work because of our mobile devices This might be the first time an employee and expectations of an immediate has considered the significance of sleep. 2/ Understanding sleep deprivation

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Changes in health and wellbeing

Temporary/treatable illnesses Pregnancy A short-term illness or injury can affect the quality of sleep Sleep can be difficult at any stage of a pregnancy and or cause sleep deprivation. Small adjustments to working adjustments must be made in the workplace if an employee arrangements, including working from home and flexibility chooses to disclose their pregnancy. Pregnant workers can around working hours, may aid recovery. review NHS Choices for advice about sleep during pregnancy.

Onset of a lifelong condition/disability Employees diagnosed with serious illness or those who experience a life-changing disability are more likely to suffer Age-related from sleep deprivation in addition to other problems linked 60 It is a myth that older people need less sleep, but we are to their diagnosis. A side effect of medication or treatment less able to sleep in a single block as we age. When we are such as chemotherapy can be sleep disturbance. Cancer older we are more prone to being affected by a poor sleep Research UK provides support for chemotherapy and insomnia. environment or entrenched lifestyle factors. An older worker may need more time to recover from a late/night shift than in their younger years. Information for aiding sleep in later life can be found at Age UK and could be used sensitively and, Mental health where appropriate, to start a conversation with employees. There is a close relationship between sleep and mental health. Living with a mental health problem can affect how well you sleep and poor sleep can have a negative impact on mental health. Business in the Community and Public Health England’s Menopause Mental Health Toolkit for Employers provides straightforward The menopause transition can disrupt sleep for a prolonged advice and actions for employers. The mental health charity Mind period. Employers are encouraged to make adjustments has useful information on sleep, including tips from mental health at work, such as providing desk fans, cold water fountains, advocate, Jonny Benjamin. Likewise, the charity Mental Health access to natural light, quiet workplace rest areas and Foundation has a guide to sleep. Workers can also review the non-synthetic clothing or uniforms. Good Thinking website and One You content on sleep and stress. 2/ Understanding sleep deprivation

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Personal and lifestyle factors Bereavement The loss of a loved one can precipitate an extended period Poor housing of sleep deprivation. Fatigue, anxiety and mood swings are Living conditions that are noisy, cramped, damp, or poorly common during bereavement. Knowing that their employer heated and ventilated can contribute to fatigue and sleep supports them can help to minimise the employee’s stress deprivation. While most employers have limited scope for levels and reduce or avoid periods of sick leave, as well as influencing where and how people live, it is important to aiding sleep and recovery. It can help employees to have understand the pressures that employees and their families access to counselling sessions, which may be provided must cope with in order to provide appropriate support in through HR or an employee assistance programme. ACAS has the workplace. developed an employers’ guide, Managing Bereavement in the Workplace, in partnership with the bereavement charity Cruse. Employers who have influence over living arrangements – for example, those employing seasonal or migrant workers and those who provide temporary or overnight accommodation for staff, shift workers, people on call for duty (including emergency workers), or staff working offshore – have opportunities to create the conditions for employees to sleep New parents and recover after extended and intense periods of work. One inevitable consequence for new parents is sleep deprivation. Families have the option of shared parental leave Financial but employers also should consider making other reasonable Money problems can cause anxiety, which leads to sleep adjustments, particularly in the first few months. NHS Choices deprivation. Employers can signpost financial advice, including provides advice and support for new parents. credit unions, which offer lower rates of interest on loans. Citizens Advice is a source of online information about debt management. GamCare and Gamblers Anonymous give advice about gambling addiction and financial problems caused Personal life by gambling. Click on the below links for more information: Significant changes at home can also affect sleep patterns for prolonged periods, with a detrimental impact at work. Divorce and separation should be considered as risk factors, as should disputes over child custody. The charity Relate provides support and information for families. 2/ Understanding sleep deprivation

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“The serious impact of those “It’s important to take employee welfare Sleep disorders health conditions which cause seriously and that includes supporting sleep sleep-disrupting pain must be and recovery. Sleep is often underrated, Sleep deprivation or poor sleep may recognised by employers. If yet we need it to feel healthy and happy. be the consequence of a clinical sleep someone has a painful condition disorder, or this may be a contributory that affects their sleep, it then has “Poor sleep and fatigue are common factor. Line managers should encourage a far greater impact on that person’s problems, affecting millions of people employees to seek advice from their GP health and their ability to perform world-wide. Chronic sleep debt can have for symptoms of a possible sleep disorder. in day to day life, including at work. a seriously damaging effect on our mental These include insomnia and breathing- and physical health and research shows related disorders such as obstructive sleep “Therefore if someone has sleep- that lack of sleep erodes concentration apnoea. They can have a significant impact disturbing pain they need to target and problem-solving ability. Each hour on health and wellbeing, but they can be it by using analgesics or other of sleep lost per night is associated with treated. NHS Choices has information approaches so their sleep is less a temporary loss of one IQ point. about these and other conditions. disturbed. This is why shoulder pain, neck pain and other MSK conditions “This toolkit provides an invaluable insight can have a greater impact than for employers to know what steps they individuals and employers might can take to support sleep and recovery by improving staff environment, looking Line managers should consider health expect, because they are conditions which wake people from sleep.” for sleep deprivation signs and providing and safety implications when an employee advice on how they can address the issue has been diagnosed with a clinical Professor Anthony D Woolf with their employees. sleep disorder. Does it put the safety of Bone and Joint Research Group, colleagues, or members of the public at Royal Cornwall Hospital “Early detection is key if someone is risk? Should an employee be temporarily suffering with lack of sleep. It is much reassigned to other duties? easier to help and solve the problem if it’s addressed quickly. Once a sleep Workplace adjustments may be required issue becomes a sleep disorder, such to support employees who have a clinically as insomnia, it becomes much harder to diagnosed sleep disorder, including change the learned behaviour and habits.” extended leave or working from home, Lisa Artis temporary help with work responsibilities, The Sleep Council or reassignment to another role. 2/ Understanding sleep deprivation

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Stress All employers have a legal responsibility The Health and Safety Executive has under the Health and Safety at Work designed the Management Standards Stress is one of the main causes Act 1974 and Management of Health Approach to help employers manage of sleep deprivation or poor sleep and Safety at Work Regulations 1999 the causes of work-related stress. quality. In many cases, the cause to ensure the health, safety and welfare It is based on the familiar ‘Five steps at work of their employees. This includes to risk assessment’ model, requiring of stress is outside the workplace, minimising the risk of stress-related management and staff to work together. but in around a third of cases, it is illness or injury to employees. related to work.

People sometimes get confused about Line managers the difference between pressure and stress. Everyone experiences pressure Line managers play a vital role in regularly – it can motivate people to identifying and managing stress perform at their best. It is when people within the organisation. They are experience too much pressure and feel likely to see the problems that cause unable to cope that stress can result. stress first hand and will often be the first point of contact when an Many organisations have reported individual is feeling stressed. It is improvements in productivity, retention essential that they have the skills and of staff and a reduction in sickness behaviours to be able to manage absence after tackling work-related these situations. stress. As an employer, you are also required by law to assess the risk of stress-related ill health arising from work activities and take action to control that risk. 2/ Understanding sleep deprivation

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Mental health and HSE Management Standards work life balance The Standards refer to six areas of work that can lead to stress if not properly managed: Good mental health and work life balance are important for sleep and recovery.

Workplace initiatives to encourage sleep and recovery can be part of Demands Control Support a holistic approach to health and wellbeing, with a focus on mental health Workload, work How much say a Includes the encouragement, as well as physical and social wellbeing. patterns and the person has in the way sponsorship and resources work environment they do their work provided by the organisation, The mental health toolkit for employers, line managers and colleagues created by Business in the Community and Public Health England, is an ideal starting point.

Good Thinking is an online service that helps people to manage and maintain their wellbeing. One You also provides information about good sleep and recovery. Role Change Relationships Whether people understand How organisational change Promoting positive working their role in the organisation (large or small) is managed relationships to avoid and whether the organisation and communicated in conflict and dealing with ensures they do not have the organisation unacceptable behaviour conflicting roles 2/ Understanding sleep deprivation

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Sleep hygiene: the right conditions for a good night’s sleep Sleep hygiene is simply a description of the ideal conditions for a good night’s sleep. Each person has individual preferences but ‘good’ sleep hygiene includes:

Fixed times for going to Regular physical activity Maintaining a comfortable bed and waking up can positively impact sleeping environment Avoiding caffeine, nicotine sleep. Also keep to a that’s not too hot, cold, and alcohol late at night relaxing bedtime routine noisy or bright

Avoiding the use of a smartphone as an alarm Avoiding watching television, Turning off all devices at clock and charging the phone Avoiding eating a heavy making phone calls, eating least one hour before bedtime away from the bedroom at a meal late at night or working while in bed and keeping technology central charging point for out of the bedroom everyone in the household 2/ Understanding sleep deprivation

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Impact of blue light on sleep Computer screens, tablets, “It is not only the physiological smartphones, flat-screen televisions impact of the blue light on our Although any type of light can and LED lighting all emit large amounts ability to produce melatonin. If you stop people feeling sleepy, of blue light. Encourage employees check your work email, Facebook research has shown that light to limit their exposure to blue light in or BBC News before you turn in the few hours before they go to bed. for the night and read something towards the ‘blue’ end of the Some organisations choose to close that causes a negative emotion, spectrum is particularly likely to down email servers after a certain for example, this could impact keep people awake because it point in the evening, to encourage your ability to fall asleep or disturb staff to switch off from work. If using your sleep throughout the night. suppresses the production of the a smartphone, tablet or computer sleep-inducing hormone melatonin. is necessary late in the evening, it’s “By the same account, if you keep important to turn down the brightness your phone in your bedroom and and keep the device at least 12 inches wake up in the middle of the night to from the eyes. There are a number see it flashing with notifications then of apps available to dim lighting on the temptation to check it is there. We phones and tablets. recommend that people get an alarm clock, turn off their phones and other technology and charge them in the kitchen or living room away from the sanctuary of their bedroom. “Also, by leaving your phone off while you get up, dressed and eat breakfast makes for a better start to the day. You are setting your own agenda as opposed to allowing whatever you read to set it for you.” Laura Willis Shine Offline 3/ T aking action to support good sleep

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3/ Taking action to support good sleep 3/ T aking action to support good sleep

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Actions for employers We suggest you include 1. Prevention: creating the right culture and providing support sleep matters in your organisation’s approach  Embed sleep and recovery into your  Create quiet spaces for rest and relaxation, organisation’s health and wellbeing strategy where employees can switch off completely to health and wellbeing. from work for a period  Consult employees about the support These simple steps will also support they need and put it into practice with  Work with employees to create shift and reinforce actions you are already their collaboration patterns which allow for recovery, making taking to support other issues, adjustments for those who work out of the including mental health, physical   Conduct a sleep audit in the workplace, office, particularly those who spend time activity and musculoskeletal health. or encourage employees to self-assess on the road and will sometimes be long They will help you recruit and retain distances from home when their regular  Support line managers, particularly through working day ends valued employees and help them training, helping them to recognise symptoms to stay well at work for longer. of sleep deprivation  Incorporate flexitime for employees who work or travel across international time zones Starting the conversation about sleep  Use the HSE stress management standards with employees can be challenging; to reduce work-related causes of stress  Don’t count travel time as down time, even sleep is very personal and can be if employees have not been connected to difficult to discuss. As a first step,  Make sure staff have access to natural the office encourage employees to use the light and consider the use of daylight NHS Choices self-assessment tool simulator lamps, which emit a bright  Make allowance for additional time employees to review the quality of their sleep. flicker-free light close to natural sunlight, have spent away from their families particularly during the winter  Let staff unplug; encourage employees to  Temperature, ventilation and humidity switch off by reducing/halting out-of-work all contribute to comfort at work. They emails and protecting disconnected time help employees work efficiently during during non-work hours the day and rest/sleep at night, so ensure air conditioning is well maintained and  Bear in mind that some employees will find provide additional ventilation such as it stressful to be ‘out of the loop’ and work fans when necessary with them to decide what’s best for them 3/ T aking action to support good sleep

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2. Early intervention: recognising and addressing sleep deprivation

 Empower line managers to intervene  Lighten their load: Consider the possibility when necessary and to approach the that some employees are working long subject in a caring and concerned way hours because they are not coping well with their workload  O pen a dialogue with employees to talk and recognise if sleep deprivation  Explore ways to ease their burden: is a problem sometimes job redesign may be necessary  Remember that many will not consider that sleep and recovery is an issue that  Where appropriate, refer to Occupational can and should be addressed at work Health or an Employee Assistance Programme (EAP); Most EAPs have a  S ignpost to information that will help confidential helpline or advice service employees make lifestyle changes that for employees will address some of the problems they experience with sleep and recovery  When symptoms persist, encourage employees to seek professional help  S elf-care is an important first step, so promote good sleep routines  A pharmacist may be appropriate in the first instance and NHS Choices  Encourage use of self-care tools provides a lot of advice like sleep diaries or apps to help get a better understanding of triggers and issues 3/ T aking action to support good sleep

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“There are a number of determinants of insufficient sleep which will affect many 3. Recovery: helping employees to recuperate employees, including heavy commutes, not getting enough physical activity,  Help employees to understand the  Break-out spaces, sofa areas and smoking and alcohol. Employers can impact of excessive screen time relaxation pods are used by some provide practical support relating to on their mental wellbeing, work/life employers to promote rest and recovery all of these situations, which needn’t balance and sleep be complex or intrusive. Support can  Ensure staff take their full holiday range from allowing flexitime and home-  Encourage them to have screen breaks, entitlement. Time off work is not ‘nice working to help with long commutes, including a break from social media to have’ but an essential element of to incentivising employees to be more and news channels throughout the day work/life balance active (such as offering additional holiday time to employees who cycle to  Hydration aids recovery, so make work or meetings). This toolkit provides drinking water available throughout a good, comprehensive resource for the workplace employers to consult when considering employee support around sleep.”  Encourage exposure to natural light, as sunshine helps the body recover Marco Hafner natural rhythms disrupted by poor Senior Economist, RAND Europe sleep or lack of sleep

 Walking meetings, outside lunches and breaks from work that involve stepping out of the workplace can all be promoted

  Ensure staff have a quiet space away from their desks to eat lunch and consider providing spaces for staff to relax during the working day or night Appendices

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Appendices Appendices

Appendices 34

Glossary of terms

Good sleep This will vary from person to person, but evidence suggests the healthy daily sleep range is between seven and nine hours every 24 hours.

Sleep quality The key determinants of sleep quality are the time spent sleeping in bed, the time taken to fall asleep and the amount of times sleep is disrupted.

Sleep deprivation Where good sleep (between seven and nine hours every 24 hours) is denied over a prolonged period of time. Chronic sleep deprivation involves sleeping less than six hours a night over a prolonged period of time.

Fatigue Generally considered to be a decline in mental and/or physical performance that results from prolonged exertion, sleep loss and/or disruption of the internal clock. It also refers to the issues that arise from excessive working time or poorly designed shift patterns.

Mental health A person’s condition with regard to their psychological and emotional well-being.

Sleeplessness Inability to sleep, or to achieve good sleep.

Sleep disorders A group of conditions which affect the ability to sleep well on a regular basis.

Recovery The process that enables a person to return to a normal state of health, mind or strength after a prolonged period of sleep deprivation. Appendices

Appendices 35

A guide to sleep Non-REM sleep REM sleep We all have a ‘sleep-wake cycle’, known as a Circadian rhythm, Stage 1: Light Sleep The first REM period usually begins During the first stage of sleep, we’re about 70 to 90 minutes after we fall the daily pattern of alternating half awake and half asleep. Our muscle asleep. We have around three to five wakefulness and sleep. This activity slows down and slight twitching REM episodes a night. Although we may occur. This is a period of light sleep, are not conscious, the brain is very rhythm is a biological programme meaning we can be awakened easily at active – often more so than when we tied to time, like an internal clock. this stage. are awake. This is the period when This clock tells us when it is time most dreams occur. Our eyes dart Stage 2: True Sleep around and our breathing rate and to go to bed and when it is time Within ten minutes of light sleep, we enter blood pressure rise. However, our to wake up. Our sleep-wake cycle stage two, which lasts around 20 minutes. bodies are effectively paralysed, occurs about once every 24 hours. The breathing pattern and heart rate start said to be nature’s way of preventing to slow down. This period accounts for us from acting out our dreams. the largest part of human sleep. Our Circadian rhythm is also influenced by cues After REM sleep, the whole cycle Stages 3 and 4: Deep Sleep begins again. from the external world. Most of us go to bed not During stage three, the brain begins to only when we are tired, but also when the outside produce delta waves, a type of wave that world says it is time. Similarly, we tend to wake up is large (high amplitude) and slow (low when the room becomes bright with morning light, frequency). Breathing and heart rate are or when the alarm clock goes off. These cues from at their lowest levels. the outside world are important in determining both the quality of sleep and how long we sleep. Stage four is characterised by rhythmic breathing and limited muscle activity. Sleep occurs in a recurring cycle of 90 to 110 If we are awakened during deep sleep, minutes and is divided into two categories: we do not adjust immediately and often non-rapid eye movement (non-REM), which feel groggy and disoriented for several is further split into four stages and rapid eye minutes after waking up. movement (REM) sleep. Appendices

Appendices 36

Clinical sleep conditions

Obstructive sleep apnoea (OSA) • Using a continuous positive airway Occasional episodes of insomnia may come pressure (CPAP) device, which prevents and go without causing any serious problems, OSA is a condition where the walls of airways closing during sleep by delivering but for some people it can last for months or the throat relax and narrow during sleep, a continuous supply of compressed air even years at a time. Persistent insomnia can interrupting normal breathing. This may through a mask have a significant impact on quality of life. It lead to regularly interrupted sleep, which can limit what can be achieved during the day, can have a big impact on quality of life and • Wearing a mandibular advancement device affect mood and lead to relationship problems. can increase the risk of developing certain (MAD), which are gumshield-like devices conditions. OSA is a treatable condition, fitting around the teeth, holding the jaw and It is not always clear what triggers insomnia, and there are a variety of treatment options tongue forward to increase the space at the but it is often associated with: that can reduce the symptoms. back of the throat during sleep • Stress and feeling anxious • Surgery may also be an option if sleep Sleep apnoea can have adverse effects on apnoea is thought to be the result of a • Poor sleeping environment, such as an workplace safety, but is frequently undiagnosed. physical problem that can be corrected uncomfortable bed, or a bedroom that is Employers may wish to consider screening for surgically, such as an unusual inner too light, noisy, hot or cold sleep apnoea in the workplace, or encouraging neck structure employees to undertake a self-assessment, • Lifestyle factors, such as jet lag, shift work using a tool like The Epworth Sleepiness Scale. or drinking alcohol or caffeine before going to bed • Mental health conditions, including depression and schizophrenia Insomnia • Physical health conditions, including heart Although sleep apnoea can present risks problems and chronic pain to workplace safety, there are a number People with insomnia find it difficult to sleep or of treatment options available, including: to stay asleep for long enough to feel refreshed. • Certain medicines, including antidepressants It affects about one in three people and is and steroids • Lifestyle changes, such as losing weight, common in older people. cutting down on alcohol and sleeping on the side of the body continued overleaf Appendices

Appendices 37

Clinical sleep conditions continued Cognitive Behavioural Therapy We can all benefit from improving the quality Treatment: insomnia will often improve There is a link between RLS and pregnancy of our sleep. For many of us, it may simply by making changes to bedtime habits, – about one in five pregnant women will be a case of making small lifestyle or attitude and using sleep hygiene methods. experience symptoms in the last trimester. adjustments in order to help us sleep better. If these don’t help, GPs may recommend For those with insomnia, it is usually necessary other treatments. If insomnia lasts for more to seek more specialist treatment. Sleep than four weeks, cognitive and behavioural medication is commonly used, but may have treatments or a short course of prescription negative side effects and is not recommended sleeping tablets as a temporary measure for the long-term. may be recommended. If it is possible to identify an underlying cause of sleeping Psychological approaches are useful for difficulties, treating this could be enough people with long-term insomnia, because they to return sleep to normal. Narcolepsy can encourage us to establish good sleep This is a rare long-term brain disorder that patterns and to develop a healthy, positive causes a person to suddenly fall asleep mental outlook about sleep, as well as dealing at inappropriate times. The brain is unable with worrying thoughts towards sleeping. to regulate sleeping and waking patterns normally. The condition is usually diagnosed One of the most widely used and successful Restless legs syndrome (RLS) between the ages of 20 and 40 years. There therapies is Cognitive Behavioural Therapy is no cure, but making changes to improve (CBT). This is useful even for people who RLS is a sleep-related movement disorder, sleeping habits and taking medication can have had insomnia for a long period of time. which gives an overwhelming and often help minimise its impact. The charity A full course of such a therapy with a sleep unpleasant urge to move the legs while at rest. Narcolepsy UK provides help and support specialist is potentially costly and is most RLS is believed to affect about 10 per cent to those with the condition. appropriate for people with severe sleep of adults, although the symptoms vary from problems. But some CBT principles can be mild to severe. The worst cases can severely appropriate and easily practiced for anyone disrupt sleep and cause insomnia. who is experiencing a sleepless night. Resources

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Resources for employers Resources

Resources for employers 39

Resources for employers

Further information about the business NHS Choices – Obstructive Sleep Apnoea Cancer Research UK – Support for impacts from lack of sleep: www.nhs.uk/conditions/obstructive-sleep- chemotherapy and insomnia apnoea www.cancerresearchuk.org/about-cancer/ RAND Europe – Why Sleep Matters cancer-in-general/treatment/chemotherapy/ www.rand.org/randeurope/research/projects/ NHS Choices – Sleep self-assessment side-effects/about/insomnia-chemotherapy the-value-of-the-sleep-economy.html tool for individuals www.nhs.uk/Tools/Pages/Sleep-self- HSE – Stress Management Standards assessment.aspx www.hse.gov.uk/stress/standards Further information and resources about sleep and sleep quality: NHS Choices – Why lack of sleep NHS Choices – Tiredness in pregnancy is bad for your health www.nhs.uk/conditions/pregnancy-and-baby/ HSE – Fatigue www.nhs.uk/Livewell/tiredness-and-fatigue/ pages/tiredness-sleep-pregnant.aspx www.hse.gov.uk/humanfactors/topics/fatigue. Pages/lack-of-sleep-health-risks.aspx htm TUC – Guidance on Supporting Working Women through the Menopause NHS Choices – Better sleep Information on managing specific www.tuc.org.uk/sites/default/files/TUC_ www.nhs.uk/LiveWell/sleep/Pages/sleep- circumstances relating to sleep: menopause_0.pdf home.aspx ACAS – Managing Bereavement NHS Choices – How to get to sleep in the Workplace www.nhs.uk/Livewell/insomnia/Pages/ www.acas.org.uk/media/pdf/7/a/Managing- bedtimeritual.aspx bereavement-in-the-workplace-a-good- practice-guide.pdf NHS Choices – Insomnia www.nhs.uk/conditions/insomnia Age UK – Aiding sleep in later life www.ageuk.org.uk/information-advice/health- NHS Choices – Narcolepsy wellbeing/mind-body/getting-a-good-nights- www.nhs.uk/conditions/narcolepsy sleep Resources

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Resources for employers continued

Sleep and sleep condition Mental Health Foundation – HSE – Research report on working organisations: How to sleep better guide long hours www.mentalhealth.org.uk/file/1485/ www.hse.gov.uk/research/hsl_pdf/2003/ British Snoring and Sleep download?token=BUCq_Am1 hsl03-02.pdf Apnoea Association www.britishsnoring.co.uk Mind – Information on sleep IOSH – Research on the effects of shift www.mind.org.uk/information-support/types- work on health Narcolepsy UK of-mental-health-problems/sleep-problems/#. www.iosh.co.uk/Books-and-resources/The- www.narcolepsy.org.uk Wha057SFhYJ effects-of-shift-work-on-health-(2015).aspx

Restless Legs Syndrome UK Safety Critical Offshore Workers – www.rls-uk.org Information about work patterns, Hours, shifts and schedules driving and long hours: www.offshoreworkers.org.uk/files/Publications/ The Sleep Apnoea Trust Association Offshore%20report%2028%204%2016.pdf www.sleep-apnoea-trust.org ACAS – Changing patterns of work www.acas.org.uk/media/pdf/5/b/B09_1.pdf ROSPA – Resources on driver fatigue The Sleep Council www.rospa.com/road-safety/advice/drivers/ https://sleepcouncil.org.uk/ Gov.uk – Health assessments for fatigue night working hours www.gov.uk/night-working-hours/health- Mental health resources: assessments

Business in the Community and HSE – Guide to managing shift work Public Health England – Mental www.hse.gov.uk/pubns/priced/hsg256.pdf Health Toolkit for Employers https://wellbeing.bitc.org.uk/sites/default/files/ mental_health_toolkit_for_employers_-_small. pdf Case studies

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Case studies Case studies

Case studies 42

Anglian Water Joe Perry, Head of Employee Relations, Anglian Water Services

At Anglian Water, the topic of sleep finds its way This is easier in an environment where there with a complete break from work. I try not into everyday conversations. We are the largest is a culture that fosters open and honest to email before 8am or after 6pm. I don’t water and water recycling company in England conversations about health and wellbeing. want my team checking their phone after and Wales by geographic area, so many staff The senior leadership of Anglian Water has work and on weekends. unavoidably spend a lot of time on the road. a strong commitment to health and wellbeing. The organisation has adopted Business in This holistic approach has many benefits Travel time can be significant and has to be the Community’s Workwell Model, which for wellbeing, including creating the right factored into a typical working day. That often puts employee wellbeing at centre stage conditions for healthy sleep. By doing so, means deciding whether to stay overnight in a in boardroom discussions. Our Healthier, we all benefit. hotel, or planning the day around a long drive. Happier, Safer programme has transformed Not surprisingly, many staff prefer to return the way that we think about wellbeing in home, even at the end of a long, challenging the workplace, with demonstrably positive day. A judgement has to be made about safety; outcomes. We work with employees to embed whether it would be better to drive up the day practices that support physical and mental before a meeting, or return home the day after. health across the organisation.

This opens up a natural opportunity to talk In such an environment an employee is less about sleep and sleeping habits. How do likely to feel uncomfortable if his or her line you get a good night’s sleep in an unfamiliar manager asks them how they are sleeping. room and bed? More importantly, how does They are also more likely to come forward this compare to how you sleep at home? if they have a concern that is affecting his or The discussion is now about sleep hygiene, her sleep, knowing that it will be addressed although we may not think of it as such. We sympathetically. Across the organisation, are sharing information and advice about we adopt practices that are conducive to sleep that will help employees, whether they good health and wellbeing which are, by are working or at home. Any workplace extension, good for sleep and good for conversation that encourages discussion recovery. We are encouraged not to work about sleep or, more broadly, health and at the weekends and to take all our holidays wellbeing, is a good thing. Case studies

Case studies 43

Dystonia and long-term conditions Anonymous

Long-term conditions can have a profound Typically, that task was completed by 1am. I love strong, black coffee and I am inclined impact on sleep. I have a neurological condition By then, I would be too wound up to sleep to drink too much of it. Sensibly, I should only called dystonia, which affects people in and my dystonia was wide awake. have coffee in the morning, or after lunch. different ways. In my case, dystonia affects the Anything later than that seems to encourage upper left side of my body, causing involuntary These days, I have a better work life balance spasms that disrupt my evening. spasms in my arm, shoulder and neck. but dystonia is a constant and it still intrudes Fortunately, I am right-handed so it does not on my sleep. I combine work with fostering, One issue with my dystonia is that it is invisible affect my handwriting, for example. But I have so I often work in the evening once the children to most people (although my wife knows to make adjustments to do basic tasks, such are asleep. I have to be firm about my routine. when it is causing me problems). It has a as tying shoelaces and hammering in a nail. I try to switch off my laptop at least one hour limited impact on my life, particularly when I cannot carry a mug of tea with my left hand. before I intend to go to sleep, although 90 compared to many other long-term conditions. minutes is better. It is easy to cheat by simply It is also fiendishly difficult to explain. So, However, dystonia is most affecting when using my mobile phone instead and it takes discussing it with colleagues or line managers I am trying to relax or go to sleep. Even though a lot of willpower not to check emails one last has been awkward and is generally best my body is ready to sleep, my left arm and time. But the benefit of switching off in terms avoided. I know many people with long-term shoulder have other ideas. Eventually, it settles of quality of sleep and how much better I feel conditions will feel the same way. Yet talking down. But on a bad night it might cost me, the next day is immense. about it is important and the first step towards say, 30 minutes of sleep, which is a lot over putting in place support which might make the course of a week. Exercise is critical for me. It is an important a significant difference. antidote to my desk-bound work, but it also Stress has a big impact on my dystonia, as seems to reduce the impact of my dystonia. does the cold. Coffee also seems to aggravate On days when I have been able to get out the symptoms. Yet I am my own worst enemy on the bike or go for a run, the spasms abate when it comes to managing my condition. As and are easier to manage. The opposite is a journalist and editor, I worked unusual hours also true. If I go several days without exercise, and often against deadlines. For some years, I the spasms can be really intrusive. My sleep could not sleep until I had seen and responded suffers and I am definitely less productive to, the first editions of the national newspapers. the following day. Case studies

Case studies 44

Guy’s and St Thomas’ NHS Foundation Trust Dr Ali Hashtroudi, Clinical Director and Honorary Senior Lecturer

We consider sleep and recovery issues The second strand of our sleep and recovery Historically, sleeping on shifts used to be in relation to our staff in two capacities at work is proactive. We run a number of discouraged. We are working to promote Guy’s and St Thomas’. Many of our staff work initiatives as part of our ‘5 ways to a healthier taking a short nap at long breaks during night in shifts and we know first-hand the potential YOU’ programme which encompasses all our duties as it helps improve sleep patterns. To impact this has on health and wellbeing. health and wellbeing offerings for staff, such establish this, some ground work is needed to The risks of shift work causing different types as smoking cessation, gym memberships, shift the culture to accept that taking breaks of ill health is documented in literature too. exercise groups, healthy eating support etc. and sleeping during breaks is important, but We run monthly campaigns themed around also to support this to happen. For instance, We have two strands of work around sleep different topics. One recent campaign was you need a place for people to sleep, planning and recovery at Guy’s and St Thomas’. We under the slogan HALT (hungry, angry, late, for breaks in advance and proper handovers have around 15,300 staff (and an extra 3,000 tired) when we reiterated the importance of to ensure the continuity of care. Bank staff), many of whom work in shifts, maintaining a healthy work-life balance and so we know the importance of the issues. taking breaks. As part of this campaign, we The Working Time Directive (WTD) often The first strand is ‘reactive’, involving those also focused on the importance of sleep and comes up and it is essential that it’s embraced who come to the Occupational Health team how to maintain a sleep pattern – especially by all. This doesn’t just mean paying attention because they are struggling with shift work. for those who do shift work. to working hours, it means providing health We deal with these issues on an individual checks for staff who undertake shift work. basis, understanding what the problems We’ve worked with a leading specialist The bottom line is to ensure everyone, staff are and how best we can address them. (Dr Michael Farquhar) to develop workshops and managers, recognise the importance For example, people on insulin may struggle and seminars, including training on sleep of sleep in the context of productivity, health with shift patterns, so we provide them with and recovery, for our paediatric junior doctors. and wellbeing. expert training to manage their medication We’re currently working to roll out the ideas to and their work pattern. Sometimes referrals staff in other directorates. onto other services like sleep disorder specialists are necessary. Whatever the action, the end product of these interventions is to advise staff and managers on how best to handle these issues. Case studies

Case studies 45

Menopause and sleep deprivation Anonymous

The menopause is a significant cause Inevitably, I suffered from severe fatigue during and easy access to water. But what really of sleep deprivation or poor sleep. It is the day, which made me short-tempered and will make a difference is creating a culture a normal and natural part of ageing and affected my ability to concentrate and to make where employees are able to discuss issues affects all women. Yet its impact, which can good decisions. There were many times when like the menopause with their line manager, last several years, is not easily discussed I felt too unwell to go to work. But knowing that knowing that they will be treated sensitively in a workplace environment. This makes this was something that was likely to persist and without prejudice. it difficult for organisations to make the for a long time, several years even, meant that necessary adjustment to support women I knew I had to find a way to manage the way at this stage of their lives. I felt.

I have a senior position in a large organisation, The average age for the onset of menopause with significant responsibilities and a busy is 50. But the transition phase can take place schedule every day. I have worked through over several years, so it is not unusual for the menopause, but it has sometimes been a women in their early to mid-40s to feel the challenge to maintain the same pace because effects. Treatment for other conditions, such as of a lack of sleep, which may have built up ovarian cancer, can bring on the menopause over several nights. much earlier.

Knowing that I’d wake up in the early hours Employers need to become more aware of the of the morning sweating profusely several impact of the menopause, particularly if they times a week meant I could never go off to are serious about equality of opportunity for sleep peacefully. I rarely enjoyed deep sleep. women and about the recruitment and retention At times, the sweating was so bad that I of older workers. There are simple, practical needed to take a shower and change the steps that will help, such as giving more people bed sheets. The disruption prevented me the opportunity to work from home, flexible from going back to sleep. hours, better air conditioning in the workplace Case studies

Case studies 46

NATS Julie Elder, HR & Corporate Services Director

NATS looks after the vast majority of aircraft Even with these controls in place, people vary flying in the airspace above the UK. Our in how they cope with shift work depending An excerpt from a recent article on shift air traffic controllers are responsible for on their health, fitness, age, lifestyle and work and sleep on the NATS in-house the safe passage of aircraft 24 hours a day, domestic responsibilities. Some adapt well, intranet site: 7 days a week. They work a shift system to others do not. Recognising this, NATS Human Working shifts that differ from the routines accommodate this. With increasingly busy Factors specialists run a programme to inform of friends and family can leave you feeling air traffic, our controllers can be just as controllers about the importance of proper rest isolated and it is important to make the busy at 5 o’clock in the morning as they and sleep to promote high performance in the effort not to lose contact with them. are at 5 o’clock in the afternoon. work place. For example, all staff in NATS with a role that has safety implications (and this • Talk to friends and family about shift The safe and efficient movement of aircraft extends beyond air traffic controllers to include work. If they understand the problems depends heavily on the skill and performance engineers, managers, etc.) have to complete you are facing, it will be easier for them of our controllers. Controllers have to process a detailed e-learning course on fatigue to be supportive and considerate large amounts of information, make timely management. This helps them to recognise • Make your family and friends aware of decisions and be vigilant continually for the signs of tiredness and fatigue and to know your shift schedule so they can include potential problems. Our regulator, the Civil how to prevent these things affecting the jobs you when planning social activities Aviation Authority, recognised nearly 30 years they do. This training material is augmented ago that to maintain consistently high levels by regular ‘campaigns’ that promote various • Plan your domestic duties around your of safe performance, the amount of time topics, such as techniques to maintain alertness shift schedule and try to ensure that controllers can ‘talk to pilots’ needs to be and maintaining good sleep habits. you do not complete them at the cost of tightly regulated. Our controllers’ working rest/sleep. You may need to change the hours and rest breaks are therefore carefully times/days when some jobs are done controlled – probably to a greater extent than any other profession in the UK.

continued overleaf Case studies

Case studies 47

NATS continued

To help controllers tackle tiredness as their Finally, NATS has a fatigue risk management working day progresses, NATS air traffic policy and strategy which underpins all our controllers are encouraged: efforts in this area. The overarching principle of this is that fatigue management must • To use their mandated rest breaks in such be a shared responsibility between both a way that their recovery from a spell in management and staff. Simply speaking, this front of a radar display or in the control tower means that everyone in the Company needs is maximised. For example, getting some to take seriously the risks that fatigue can fresh air is promoted but sitting down at a bring to the air traffic control operation and computer to check emails is discouraged. take steps both when at work and when at • To take short (20-30 minute) naps where leisure to rest, sleep and recover from the their duties allow, as these have been demands of the job. shown to boost productivity and alertness later in the day. NATS provides suitable facilities for this. • To set up their working environment in such a way that it is conducive to aid concentration and minimise physical fatigue. Case studies

Case studies 48

Royal Mail Group Dr Shaun Davis, Global Director of Safety, Health, Wellbeing & Sustainability

At Royal Mail, we recognise that there are potential resulting behaviours – if people been instrumental – it’s easier for staff to links between sleep and a range of physical aren’t sleeping well, their anxiety levels engage with wellbeing issues under the and mental health issues and for the benefit might rise and they may get trapped in banner of a branded campaign with its own of our staff, we wanted to consider ways to a negative cycle of poor diet and lifestyle. identity and to talk openly about sleep and approach the issues of sleep and recovery. recovery in the workplace without it feeling Alongside this, we have an employee like a taboo topic. One of the ways we have done so is through assistance programme, including a 24/7, 365 our ‘Feeling First Class’ programme. It’s a helpline that families and staff can access. We comprehensive health and wellbeing initiative signpost to legal and therapeutic services and which promotes good work, exercise and Occupational Health can refer to counselling. sleep and is available to all our 141,000 permanent staff and 20,000 Christmas casuals. Poor sleep and fatigue go hand in hand and The programme promotes balance – for good fatigue is extremely dangerous – it’s often the health and wellbeing, you have to do everything cause of accidents at work and on the roads. together and everything in moderation. Diet, We recognise that we have a responsibility to exercise, alcohol consumption and sleep all our shift workers to promote safety and so we affect how you are at work. have moved to full compliance with Working Time Regulations. This is key not just because Through the programme, we ran a mini it’s a legal requirement, but because it means campaign on sleep, promoting information we’re giving people time to recover. on good habits. We’ve also empowered and coached line managers to have conversations Sleep is a difficult subject – it is intensely with staff about health and wellbeing on personal, but it is also essential to people’s a range of difficult to approach topics – ability to perform at work. For us, creating a relationship or financial issues, stress and, positive culture around wellbeing has been crucially, sleep. Managers have been trained key to opening up conversations on difficult to spot signs of sleep deprivation and the subjects like sleep. ‘Feeling First Class’ has Case studies

Case studies 49

Unilever PLC Marcus Hunt, Health & Wellbeing Manager UK, IRE & Europe

We have made sleep a priority at Unilever. into a competition to win a sunrise alarm items and resources such as our Employee Throughout 2015, we launched a range of clock. All of this helped ensure employee Assistance Programme (including financial sleep initiatives, among them our national involvement and engagement with the topic. advice support), our support of daily physical ‘Sleep Well’ campaign, which we connected activity and the promotion of mindfulness. very closely to our annual celebration of A sleep psychologist helped to inform our We also encouraged the promotion of our World Mental Health Day. approach and, with their input, we co-wrote materials and resources to colleagues’ family a sleep handbook for employees. This members to help support their ongoing needs Sleep is fundamental to good health and provides key information on sleep hygiene, at home – which may be directly or indirectly wellbeing and we decided to approach lifestyle factors, sleep enablers, sleep and related to sleep. the issue in a range of ways. The ‘Sleep shift work and sleep and mental health. Well’ campaign included a number of We received great employee feedback options, with each site given a selection We also developed a practical workshop following the ‘Sleep Well’ campaign, with of resources to help meet the needs of the for employees, focusing on sleep, lifestyle almost 60% of national employees engaging diverse working environments across the and stress factors. The one hour sessions with our resources, but things didn’t end there UK. Our colleagues broadly work across were delivered either face to face or online, – we have an ongoing commitment to this manufacturing, distribution, research and to ensure another way to reach employees issue and, for example, we are now running a development and office work spaces. directly. We also produced evidence based global programme on sleep with a supportive webinars, podcasts and literature with top webinar to colleagues globally. One of the particularly engaging and tips on sleeping well. interactive options was a pop-up roadshow set, showing a typical bedroom and the This campaign and the materials continue key factors in it that can affect sleep. The to be part of our ‘Unilever Global Health & pop-up set had moveable discs showing Wellbeing Strategy’ – which has the four pillars sleep ‘preventers’ (like mobile phones of physical, mental, emotional health and and bright lights) and ‘enablers’ of sleep. purpose. As we discuss and promote good Employees were encouraged to move the wellness behaviours, our ongoing dialogue discs around to select correct enablers about sleep continues to be especially and preventers, which then entered them connected with emotional and mental health Case studies

Case studies 50

Yorkshire Building Society Sarah Moore, Wellbeing Lead

You wouldn’t expect employees of Yorkshire We followed up with campaigns around sleep, An important consideration is that it became Building Society to be at risk of sleep framed as an integral part of our approach clear to us that for many employees a barrier deprivation. We don’t have shift workers as to health and wellbeing and co-created to a good night’s sleep is their children not such and many of our staff work in branches, by employees. Our aim was to provide the sleeping well. So, we signposted to advice to which keep regular office hours. But when information people need to understand why help their children at bedtime, knowing that this we started talking about sleep as part of our sleep is good for you and to help people get is a positive step towards also helping parents. approach to health and wellbeing at work, more sleep. We posted articles about sleep, we quickly realised how important sleep is with practical advice about how to get a good Sleep is a deeply personal experience and as an issue. night’s sleep, which have proven very popular not everybody will want to talk about it. But, across the organisation. as we found, it is an issue that concerns many In the first instance, the subject of sleep was employees. Having an open conversation in raised by an employee during one of our Working with the Mental Health Foundation, the workplace encourages people to think regular discussions. A follow-up post on our who support our wellbeing programme, we about their own sleep patterns and whether intranet was widely read and attracted more provided additional advice about how to heal there are things they can do to help themselves than 40 responses from our colleagues, who after a period of poor sleep. This encompassed sleep better. shared tips and advice for getting a good health, environment, attitude and lifestyle. We night’s sleep. We used one of our weekly made available an eight-week sleep course staff intranet polls to find out more about and encouraged employees to access sleeping habits and 30 per cent answered: ‘Unmind’, our own health and wellbeing portal, “Sleep? What’s that?” So, we knew that our which includes sleep support. colleagues would welcome more support. Acknowledgements 51

Thank you to the following organisations for contributing to the development of this toolkit:

•AS AC • Health and Safety Executive • Sleep Apnoea Trust Association • Amacus • Heineken • Society of Occupational Medicine • Anglian Water Group • HM Revenue & Customs • Sunderland University • Bone and Joint Research Group, • IOSH • Teesside University Royal Cornwall Hospital • Linklaters • The Sleep Council • Bupa • Mental Health Foundation • TUC • CIPD • Muckle LLP • Unilever • Circadian • NATS • Yorkshire Building Society • Connect Health • Newcastle United Foundation • Council for Work and Health • RAF • Crisis • RAND Europe • Crossrail • Royal Mail Group • Faculty of Occupational Medicine • Sainsbury’s • Guy’s and St Thomas’ • Shine Offline Foundation Trust 52

Business in the Community 137 Shepherdess Walk Resources for employers London N1 7RQ Business in the Community and Public Health England have developed T +44 (0)20 7566 8650 a range of toolkits to support employers with employee health and wellbeing: E [email protected] www.bitc.org.uk

January 2018

Sleep and recovery: a toolkit for employers

This report was written, designed and produced by Forster Communications.

© 2018 Business in the Community. Business in the Community is registered in England and Wales. Charity No 297716. Company No 1619253.