SLEEP DEPRIVATION AT WORK

A Hidden Problem in Need of Creative Solutions

Chris Knoepke, PhD, MSW, LCSW, CEAP In Honor Of

Julian Haskell Wexler (1922-2015) My source of deprivation Advocate for safe & rested workers Coffee Talk

What kinds of sleepiness or other sleep/rest-related issues or complaints/concerns do you encounter in your work , in your own life, or among people you know? General Info About Sleep

• “Sleep Debt” gathers quickly • Sleeping only 6 hours a night for two weeks causes the • “sameNevertheless, cognitive impairments most of us –asfor not asleeping variety at of all reasons for 2 – nights’ over the same two donweekst get the sleep we need Already Interfacing with EAPs How Sleep Works

• Stage 1: Dozing • Stage 2: Snoozing • Stage 3-4: Deep Sleep • REM: Dreaming, Active Brain

*AgriLife.org: Texas A&M Extension Approximate Sleep Needs Through Life

Ages Hours/Day of Needed Sleep <1 16-17 1-5 11-13 (including naps) 5-12 10-12 12-18 ~9 (delayed phase) Early/Middle Adulthood ~7.5-8 (highest incidence of disturbance) Late Adulthood (age >65) ~8 (6 at night +, early rising, poor architecture)

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

• 18 hours of sustained wakefulness = .05 BAC – At 24 hours = .10 BAC • Mild Sufferers have worse cognitive performance than those @ .06 BAC – Severe, untreated OSA sufferers are 17 times more likely to be in a car accident than those without OSA (or whose OSA is being treated). Basic Causes of Lost Sleep/Rest

• Lifestyle, Social/Familial Demands • De facto sleep disorders • Occupational Sleep Deprivation Disordered Sleep

• We tend to have a “black and white” view of sleep • Common disorders of sleep include: • • Sleep Phase Problems • Sleep Apnea • • Restless Leg Syndrome/PLM • Odd or Dangerous Behavior Occurring While Sleeping Identifying Sleep Problems: BEARS

• problems? • Excessive sleepiness during the day? • Awakenings at night? • Regularity of sleep (number of hours)? • /apneas Handout – Insomnia • Occasional trouble sleeping is not insomnia, but it is a good way to tell that something isn’t quite right. • Different types and phenotypes: • Onset • Maintenance • Terminal Circadian Rhythm Problems

• Circadian Rhythms regulate our Sleep/Wake Cycle • • • Delayed • Advanced

Borrowed from Yue, n.d. Snoring and (OSA)

• Snoring that isn’t OSA is usually only a big deal to the people in the room with you • Sleep apnea, though, is characterized by intermittent partial or complete collapse of some portion of the upper airway • Sleep Apnea increases risk of • Accidents (17x greater risk of MVA*) • Heart disease (unmanageable HTN = red flag) • Mood disturbances (unmanageable depression = red flag) • Metabolic dysfunction (unmanageable diabetes = red flag) • Excessive daytime sleepiness (frequently tired despite adequate time spent sleeping = red flag) *Morin, 2000 Occupational Sleep Deprivation Where Do Employers Fit Into the Sleep Equation? What About Napping?

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

• Increases positive emotions including energy (Taub, Tanguay, & Clarkson, 1976), motivation (Hayashi, Watanabe, & Hori, 1999), and joy (Luo & Inoué, 2000).

• Toddlers who were not permitted to showed more negative responses to an unsolvable task than did toddlers who napped (Berger et al., 2012) Question (from Goldschmied et. Al, 2015)

If a lack of sleep results in increased impulsivity and an increase in negative emotional responding, Will a nap counteract this behavior? Participants

No Nap Nap

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

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

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

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

Goldschmied et. Al., 2015 Study Protocol

Pre-Study Period Pre-Nap Nap Opportunity Post-Nap 3 days

Consistent 60 minute Nap/ Sleep Schedule: EEG Hookup EEG Unhook 6-9 hours Movie Viewing

Verified by Task Battery: State Sleep Diary & Frustration Questionnaires: Voicemail Tolerance Impulsivity

State Task Battery: Questionnaires: Frustration Impulsivity Tolerance

Goldschmied et. Al., 2015 Frustration Tolerance Task Feather, 1961

Goldschmied et. Al., 2015 State Impulsivity Measure (STIMP) Wingrove & Bond, 1997

14 visual analogue items designed to assess impulsive mood.

(1) Impulsivity and Control of Behavior (five items) • “Tend not to think about consequences of actions” (2) Control of Thoughts (five items) • “Easily distracted” (3) Feelings of Impatience (four items) • “Want to get things done quickly

Goldschmied et. Al., 2015 Goldschmied et. Al., 2015 STIMP Results 36

35 No Nap 34 Nap

33

32

31

30 STIMP Total Score Total STIMP 29

28

27 Pre Post Goldschmied et. Al., 2015 Frustration Results 110000 100000 90000 Nap 80000 No Nap 70000 60000 50000 40000 30000

Time on Unsolveable Task (ms) Task onUnsolveable Time 20000 10000 0 Pre Post Goldschmied et. Al., 2015 Study 3: Conclusions

• Wakefulness across the day decreases our ability to tolerate frustration and impulsive feelings

• In contrast, a brief nap enhances the ability to tolerate frustration and decreases feelings of impulsivity

May help us develop interventions Group: Where Would it be Important/Effective to Incorporate Sleep?

• Workplace Wellness Programs • Scheduling • Napping at Work • Other Areas of Company Policy/Procedures?? Integrating into Wellness Programs

1. Where does the company fit? 2. What component of the wellness programs? • Screening? How? • Health promotion? How? • Disease management? How? Education for All Employees: “” • Some tips or tricks to getting good or better sleep • Might be a good idea if you start to notice that you aren’t getting as much sleep – or as much rest – as you want • Check the environment (noise, heat, light are frequent culprits of bad sleep) • Look at your schedule (sleeping at vastly different hours from night to night because of work or social life – remember your Circadian Rhythm!) • Avoid Nicotine/Alcohol/other sedative use in the evening • Avoid exercising in the evening • Take advantage of your body’s internal sleep signals (metabolism, body temperature, heart rate, etc.) Integrating Naptime

Lets pretend you decide that you are going to accommodate 45 minute naps for employees at your company.

• How would you sell this to decision-makers? • What logistical problems would you need to overcome? • What cultural issues would you need to overcome? Questions?