1  

Study Guide

For the:

Fatigue Management Course

Construction and Specialized Workers’ Training Society

120-19092 26th Avenue

Surrey, B.C. V3Z 3V7

Phone: 604-538-5101

Toll Free: 1-800-661-3001

Email: training@liuna1611.ca

2  

The information contained in this reference material is distributed as a guide only. It is

current to the best of our knowledge as to the revision date, having been compiled from

sources believed to be reliable and to represent the best current opinion on the subject.

No warranty, guarantee, or representatives are made by the author, as to the absolute

correctness or sufficiency of any representatives contained in this reference material and

the author assumes no responsibility in connection therewith; nor can it be assured that

all acceptable safety measures are contained in this reference material, or that other or

additional measures may not be required in particular or exceptional conditions or

circumstances.

Anyone requiring authoritative information concerning legislation, relations or other legal

requirements relating to industrial health and safety should contact the WorkSafe BC and

other regulatory agencies.

In this course, you will learn about the following regarding Fatigue Management:

What is Fatigue? The Casual Factors of Fatigue Recognizing Fatigue and Fatigue Indicators How Does Fatigue Affect You Sleep Debt Circadian Rhythms The Types of Sleep, Stages of Sleep, and Sleep Cycles Alertness & Sleepiness Rhythms Sleep Disorders Self-Assessment Fatigue Statistics Workplace-related Causes of Stress and Fatigue Proper Rest & Recovery Practices Exercise and Food Habits Myths & Misconceptions Driving Fatigued Driving at Night Driving Strategies Journey Management

3  

What is Fatigue?

Fatigue can be explained in terms of acute or chronic symptoms. Acute fatigue results from a sudden onset of short-term sleep loss and feeling ‘tired’ due to getting less sleep than normal the night before. Chronic fatigue on the other hand is a long-term state that results from an extended pattern of being deprived of adequate rest, which can also be heightened from prolonged mental/physical activity or long periods of stress and anxiety. Our ability to interpret, as well as gain and retain new information becomes increasingly impaired the more fatigued we get. The slower we interpret information, the more delayed our responses become. This results in slower decision making and longer reaction times, which reduces our vigilance and increases our inherent risks. As such, fatigue management also works as a pro-active safety measure, especially in high pace or high hazard occupations where regular use of power tools (pneumatic, gasoline or electric) or operation of heavy equipment and motorized vehicles is involved.

At its base, however, fatigue can be understood as a state of feeling very tired, resulting in a progressive loss of mental and physical alertness which can end with sleep.

Causal Factors of Fatigue

The following is a list of (including but not limited to) causal factors which can contribute to acute and/or chronic fatigue:

A lack of adequate sleep. (Either single instance or prolonged/habitual) The number of hours you have been awake since you last rested plays a huge

impact on the fatigue you feel. Work: (Shift length, shift work/night shifts, number of working days in a row, tight

schedules, physical and mental output) Stress, anxiety, and depression can all contribute to fatigue.

4  

Sleep disorders. Societal pressures and stretching yourself “too thin”. Not allowing for appropriate “me” time to do the things that allow you to unwind

appropriately. Other underlying health issues. Financial pressures. Driving at night when your body wants to be asleep, or with insufficient rest stops.

The individual situations listed above are just a short list of possible causal factors. Specific details about fatigue and fatigue management strategies will be covered in greater detail throughout the course.

Recognizing Fatigue and Fatigue Indicators

In general, your body knows when you are fatigued, and you have specific fatigue indicators which tell you when you need to sleep. Though those indicators vary, you must recognize when you are fatigued, and steps should be taken to attempt to get rest as soon as possible.

Though we can identify fatigue indicating factors, we cannot anticipate when precisely we will fall asleep. You need to pay attention to the hints and take action.

The following are a few common examples of mental and physical fatigue indicators:

Mental/Psychological Indicators of Fatigue:

Inattention to minor yet important details. Reduced morale and motivation. Degraded mental abilities. (including memory, decision making, and perception) Missing an exit while driving. Increased distractibility and irritability. Increase in errors of judgement. Reluctance to initiate tasks. Reduced communication skills. Reduced sense of humour and mood swings.

5  

Reduced ability to handle stress. Tendency to exaggerate. Tendency to take unnecessary risks. Wandering and disconnected thoughts

Physical Indicators of Fatigue:

Eyes go in and out of focus or close for a moment. Slow, slurred speech. Inability to stay awake. Having trouble keeping your head up. Blurred vision. Degraded sense of balance. Slowed reaction time. Constant yawning. Heavy and/or burning eyes.

o Fatigue can even cause head and body aches

How Does Fatigue Affect You?

The way fatigue affects the body can be both gradual and subtle. You may not even be consciously aware of how tired you are. Especially if you are engaged in a high skill or high tempo activity. It isn’t just those high pace environments that can gradually wear down a worker to the point of fatigue. The monotony of completing similar tasks, over and over, with little to no degree of change can also lead to boredom, and boredom is a breeding ground for the most dangerous thing that can occur on any job site, and that thing is complacency.

If you are engaged in a job that has even moderate levels of associated hazards, or is a task that you are unfamiliar with, you should always take into consideration your current fatigue level.

6  

The following is a list of factors to consider when determining fatigue level:

The number of hours you have worked in the last week or month. (Perhaps longer if you are on a sustained project with little to no extended days off for recovery time or rest periods).

Pattern of the hours worked last week or rotation. Perhaps you work shift work, rotating schedules, or night shift (all of which must

be taken into consideration when determining fatigue level). Start and finish times of the work shift. The number of hours you have been awake since you last slept. The duration and quality of your last sleep. Have you consumed chemical stimulants or depressants (even over the counter

medication such as cough medicine must be taken into consideration)? Stress at home and at work can drastically affect fatigue level. The physical intensity of your work must be considered. Emotional and mental state (depression and anxiety can lead to chronic fatigue). Current “sleep debt”.

When attempting to establish your current fatigue level, its good practice to take into consideration the factors listed above.

Getting inadequate sleep can result in a pattern involving bad sleep habits, which, if not confronted and behavioural changes made, can begin to escalate faster than people anticipate.

Tiredness leads to exhaustion and fatigue; fatigue leads to chronic fatigue; chronic fatigue leads to burnout.

7  

Sleep Debt

“Sleep Debt” is cumulative and can build over a period of days, weeks or months and is due primarily to a disruption in your normal sleep schedule, and a reduction in the hours of sleep you are getting. You can track your sleep debt by paying attention to the number of hours of sleep you get in any given sleep period. For instance, say you need (and are accustomed to getting) 8 hours of sleep every night, anything under 8 hours, for every hour less, would be added to the “sleep debt”

I.E. If you need 8 hours sleep, but only got 7, you would be at a -1 hour of sleep debt. If you only got 6 hours, and are accustomed to 8, you would be at -2 hours. If you are accustomed to 7 hours of sleep, (and know that that’s all the amount of sleep you need) but were only able to get 6 hours of sleep, then it would be -1 hour of sleep debt accrued. (and so on).

o Calculate your sleep debt over a 1 to 2 week period to try and get an accurate gauge of how much sleep debt you are accumulating in total hours of sleep lost. You might be surprised to see how much sleep debt can accrue over that relatively short period of time. (Especially when working long hours)

8  

A couple of commonly asked questions:

How many hours of sleep do adults typically need?

The amount (in hours) of sleep you need changes with age. The National Sleep Foundation recommends that adults between 18-64 years of age get 7-9 hours of sleep each night, and seniors over 65 years of age require 7-8 hours per night. It must be understood that the amount of sleep each individual will need is a case by case situation, as there is no “definite” amount in hours of sleep required. Some individuals claim to feel more rested, alert, and active after 6 hours of sleep as opposed to 8, and that may be the case for them.

What would be understood as a normal level of fatigue for an adult?

Feeling tired is one of the most common complaints doctors hear about, but it’s important to understand that feeling fatigued is normal if you had less sleep the night previous and are feeling tired that day. When fatigue becomes a concern is when it shifts from acute to chronic levels and begins to affect your overall health and well-being.

9  

Circadian Rhythms

Your circadian rhythm in terms of sleep refers to disruptions in the timing of when you are asleep and when you are awake, and the consequences that result from the disruption. We all have an internal clock that regulates our physical, mental, and behavioural functions over a 24-hour period. That clock is referred to as your circadian rhythm, and your circadian rhythm determines your natural sleep patterns.

Light is the main que influencing our internal circadian rhythms. When the sun is up, we have evolved to be awake during those sunlight hours.

The bodies master clock controls the production of melatonin, a hormone that makes you want to fall asleep. When there is less light, like at night, the brain makes more melatonin, so you get drowsy.

This is partially why it feels (and is) so unnatural to be awake during night-time, and to sleep during daylight hours.

Your internal circadian rhythm can be disrupted through 3 general areas:

1. Lifestyle choices such as how you spend your non-work time, sleeping habits, what your diet consists of, and even your physical condition.

2. Work Factors: Long hours, insufficient recovery time, shift work and night shifts. 3. Medical Factors caused by sleep disorders, or other underlying health factors that

conflict with your ability to get proper rest.

Disruption of circadian rhythms directly effects your concentration, reaction time, motivation, mood, and memory.

10  

The 2 Types of Sleep, The 4 Stages of Sleep, and Sleep Cycles

There are 2 types of sleep:

1. Non Rapid-Eye-Movement Sleep (Non-REM sleep), and 2. Rapid Eye Movement Sleep (REM sleep).

As well, sleep comprises of 4 concurrent stages.

Non-REM sleep consists of the first 3 stages, while the 4th stage of sleep is understood as REM sleep.

Stages 1 & 2 are considered “light” sleep, while stages 3 & 4 are “deep” sleep

When you fall asleep, you usually fall asleep in stage 1.

If someone wakes you up during stage 1 sleep you will often deny being asleep. For very brief periods of stage 1 sleep, you may still feel as though you are awake,

but have in fact dozed off for periods of 1-2, or up to 20-30 seconds. These are known as “micro-sleeps”, which are often not remembered, as such, you could be asleep without really knowing it.

After 5-10 minutes of stage 1, you will naturally begin to reach stage 2 sleep.

This is considered the first real period of sleep. By the end of your entire sleep period (8-hour night) you will have spent more than half of it in stage 2. As the sleep period continues, you will enter stage 3 sleep.

Stage 3: It is more difficult to wake up from stages 3 and 4 as these are considered “deep sleeps”. If you are awakened during these stages, it is possible you will feel groggy or disorientated and your performance will be impaired. A condition known as “sleep inertia” can set in, which can last for 15 minutes or more.

Stages 3 and 4 are also the stages of sleep where we are more likely to reach the “dream state” where experiencing dreaming while asleep is possible.

11  

Stage 4: This is the stage where REM (Rapid Eye Movement) sleep occurs. In this stage the brain is much more active, and the body becomes somewhat relaxed and immobilized.

Sleep Cycles

We all rest through a defined repetitive “sleep cycle” – You go through 1 complete “sleep cycle” every time you progress through the specific sequence of “sleep stages” (stages 1-4, as discussed above)

Often, we go through 4 or 5 of these “sleep cycles” per sleep period. (8-hour night) Each sleep cycle (going through the final 3 stages of sleep) takes approximately

90-120 minutes to complete. o Stage 1 does not occur in each cycle unless you have wakened during your

sleep.

12  

Alertness and Sleepiness Rhythm

Your current level of alertness and sleepiness determine how well you are able think clearly, and so, your ability to safely and efficiently perform a task.

As mentioned with our circadian rhythms, our bodies follow a 24-hour pattern, and although individual rhythms vary slightly, (morning or evening person), everyone has two distinct dips in sleepiness and two distinct peaks in alertness.

Higher levels of sleepiness tend to begin around your usual bedtime, but the first distinct dip of sleepiness (your sleepiest point) occurs between the hours of 3-5 a.m.

Your second dip of sleepiness occurs approximately 12 hours later between the hours of 2-4 p.m. (Alertness can tend to wane to its lowest point around 3 p.m.)

Although taking naps is more common in countries with warm climate’s, mid day heat is not necessarily the cause of afternoon sleepiness. Studies have shown that the same 2 peak periods of sleepiness remain the same; from people who live in countries near the equator, or all the way up here in Canada.

Afternoon sleepiness is often called the “post lunch dip”, but it is a myth that lunch is the cause, as studies have shown that people feel sleepy in the afternoon whether they ate, or if they had no lunch at all. Sleepiness is primarily due to our own biological rhythms and not specific to the heat or what you have eaten, as is widely believed (though those factors do play into the overall equation regarding fatigue).

13  

In addition to those two dips in sleepiness, there are also two distinct peaks of alertness in a 24-hour pattern.

The first peak period of alertness occurs in the morning, usually a couple hours after your usual wake up time.

The second peak period of alertness occurs again roughly 12 hours later, between 8-10 p.m., a couple hours before your typical bedtime.

Peak periods of alertness occur at roughly 9a.m. and again around 9 p.m. in every 24-hour pattern.

Facts:

Sunlight in the morning tells your body clock to wake up and be alert Darkness tells your body clock to decrease alertness and get ready for sleep. Emergencies can temporarily increase your level of alertness and keep you awake

when fatigued, but this is primarily due to a burst of adrenaline, which will inevitably wane, and is often accompanied by a ‘crash’.

Sleep Disorders

Insomnia

A symptom categorized by persistent difficulty falling asleep and/or staying asleep. Insomnia is usually followed by physical and mental impairment the next day, with compounding effects the longer the duration of days between which quality (restorative) sleeps occur. Studies have shown that insomnia is 41% more common in women than men. Some of the associated difficulties regarding insomnia include complexities initiating sleep, or getting only “non-restorative sleep”, and is associated with impairments of daytime functioning or marked distress for a period of more than one month.

Non-Restorative Sleep

During sleep, the body goes through a restorative state wherein the immune system, cardiovascular system, and even the organ systems are revitalized – however, not all sleep results in vital function restoration. Insomnia patients, for instance, either find it hard to get a good night’s sleep or wake up to various sleep disturbances. That, in turn, gives insomnia patients low sleep quality and potential for onset chronic fatigue to set in.

To make things simpler “non-restorative sleep” is a poor quality of sleep

14  

Sleep Apnea

Is a sleep disorder characterized by having one or more breaks/pauses in breathing, or shallow breaths during sleep. Each pause in breathing, called an APNEA, may occur 5 to 30 times (or more) an hour.

Each low breathing event is called Hypopnea. There are 3 forms of sleep APNEA:

1. Central (CSA) - represents 0.4% of all cases of sleep apnea. a. Characterized as a lack of respiratory effort.

2. Obstructive (OSA) - represents 84% of all cases of sleep apnea. a. Characterized as a block in air flow such as some forms of snoring

3. Complex Sleep Apnea (A sort of combination of “central” and “obstructive” apnea - represents 15% percent of all cases of sleep apnea.

An individual with sleep Apnea is rarely aware of it and may suffer from chronic fatigue as a result. Symptoms may be present for years (even decades) without proper identification.

Narcolepsy

A chronic disorder characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme fatigue and falls asleep at inappropriate times.

Narcolepsy is a neurological disorder, not caused by mental illness or psychological problems, but more likely by genetics combined with an environmental trigger during the brain’s development.

Restless Leg Syndrome and Periodic Limb Movement

A neurological (nervous system) disorder characterized by an urge to move the legs in order to relieve unconscious abdominal sensations.

The urge to move the legs occurs during periods of rest, generally tends to be worse in the evenings and at night.

Advanced Sleep Syndrome

A chronic disorder of the natural timing of peak periods of sleepiness, and peak periods of alertness, relative to societal requirements and norms. (i.e. these people naturally want to fall asleep at different times than normal than most people would.)

15  

Delayed Sleep Phase Syndrome (DSPS)

Generally, people with DSPS tend to fall asleep sometime after midnight, making it hard to wake up at a “regular” time in the morning.

Often people with this disorder report they CANNOT sleep until early morning but fall asleep the same time every “night”.

As such, individuals who suffer from DSPS report that they find it difficult to wake up in time for a typical workday. If, however, they can follow their own schedules, e.g. sleeping from 5:00 AM to noon, they sleep soundly, awaken spontaneously, and do not experience excessive daytime sleepiness.

While the examples listed above are the main sleep disorders, there are other medically diagnosed disorders involving sleep as well. If you are having sleep issues, and feel it is affecting your quality of life, be sure to contact your family physician.

Fatigue Self-Assessment, Are You Fatigued?

Question 1: Do you sleep more often (in number of hours) on your days off than the days you work? YES or NO.

If you answered YES, this could be an indication that you might be behind on your required rest sleep debt.

If you answered NO, and you are sleeping the same amount on days off as you are on workdays, this is an indication that you are getting enough required sleep.

Question 2: How long does it generally take you to fall asleep? More or less than 10 minutes?

If you generally tend to fall asleep in less than 10 minutes, it may be an indication that you are somewhat sleep deprived.

On average, for a well-rested adult, it is normal to fall asleep gradually in a process that takes longer than just 10 minutes.

Question 3: Are you able to nap anywhere anytime? YES or NO.

If YES, that is good indication you are sleep deprived to some extent. o People with normal sleep patterns generally do not have the ability to nap

anywhere at any time.

16  

Question 4: When you are under the impression that you are indeed getting enough sleep each night, when you wake up in the morning, do you feel energized and alert, or do you still feel tired?

If you wake up feeling refreshed and ready to go, its likely you are getting enough rest. If you continually still feel tired even after getting what you deem as an appropriate amount of sleep, you may in fact not be getting enough sleep, or proper rest.

Complete the Epworth Sleepiness Scale (EPS) and add up your totals from the questions posed to help gauge your current level of fatigue.

Total Score Interpretation*:

0-7: It can be deemed unlikely that you are abnormally sleepy. 8-9: You experience an average amount of daytime sleepiness. 10-15: There is a possibility that you could be excessively sleepy depending on

the situation. You should consider seeking medical attention. 16-24: You are considered to experience excessive sleepiness and should seek

medical attention. *Reference: Johns MW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991; 14(6):540-5.

17  

Fatigue Statistics

A survey conducted by the better sleep council found that:

Fatigue is associated with 40% of incidents that occur on the jobsite. 31% of employees interviewed admitted lack of sleep occasionally affected their

work. 29% of those interviewed said they did not feel rested when they awoke before

going to work that day. o This study found that 38% of employees interviewed admitted having

napped at least once while at work in the past year. o And that employees of all ages and experience levels have reported feeling

fatigued to the point of “burn out”.

Workplace-Related Causes of Stress and Fatigue

Job stress can be a major contributing factor and primary source of individual fatigue. Job stress is defined as:

The harmful physical and emotional responses that can occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. It can lead to illness, injury, chronic fatigue, and eventual burnout.

Special emphasis in terms of fatigue management in the workplace must be exercised when working long rotations and/or shift work (especially night shifts)

Common workplace issues that studies have shown can cause fatigue (including but not limited to):

Shift Work and Night Shifts

A shift worker can confuse their internal circadian rhythm by working strange hours (such as at night) when their body is programmed to be asleep.

Workplace Stress

Can be caused by a wide range of factors including job dissatisfaction, heavy workload, conflicts with bosses or colleagues, bullying, constant change, or threats to job security.

Poor workplace Practices

18  

May include long work hours, hard physical labour, infrequent breaks, extreme temperatures, boredom, working alone with little or no interaction with others, or working on a repetitive task that feels like it has little inherent meaning.

Long Hours Combined with Many Consecutive Days Worked

Long hours with little to no recovery time in the interval will almost always lead to at least marginal levels of fatigue.

Poor Management Style and Social Environment

Lack of participation by workers in decision-making, poor communication in the organization, lack of family-friendly policies and lack of support or help from coworkers and supervisors can all contribute to workplace fatigue.

Unemployment

Financial pressures, and the emotional exhaustion of prolonged job hunting can lead to stress, anxiety, depression, and fatigue.

Burnout

Burnout is brought on from prolonged periods of stress and frustration, hence why it’s commonly discussed in the workplace. In fact, the World Health Organisation (WHO) changed its definition to be:

o “A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”.

Burnout (continued)

Understanding the difference between tiredness, exhaustion, fatigue, and burnout in the workplace is important as they can be hard to differentiate. Although it’s a fine line, a good indicator of what stage you are in is by gauging how quickly it takes for recovery.

A good night’s rest and a healthy meal usually alleviates tiredness. Perhaps a holiday or leave of absence from work focusing on unplugging, de-

stressing and recharging can relieve exhaustion. Fatigue requires a more constant effort to address the accompanying underlying

lifestyle factors which may take several months to overcome. Burnout is more difficult to address as it depends on the intensity and length of the

situation, quality of the individuals’ rest and recovery practices, and the overall situation of the person experiencing it. For some, a co-operative plan devised between them and their manager may be enough to start feeling on top of things

19  

again. Others may need to change company or career completely and start afresh. Some may need additional counselling or to develop new coping mechanisms like regular exercise, a relaxation routine, or even new hobbies.

Another way that burnout (professionally speaking) can be explained, is when you find yourself striving too hard in one area of life while neglecting everything else. “Workaholics” for example, put all their energies into their career, often shelving their family life and personal interests away, shifting their work/home life out of balance, and setting them up for a collision course with burnout.

Perhaps most importantly of all, take precedent to look out for yourself and those you care about. Do not prioritize work at all cost above your overall quality of life.

There’s a story about a worker who had quit 5 jobs, giving 2 weeks’ notice each time. In all 5 cases they were let go earlier. Which made him come to realize how replaceable we all are in the workforce. In a way, this is an empowering statement which can help workaholics detach from their job. Be sure to make time for the important things; go home and spend time with your family, use your vacation time, take a mental health day, make time for your hobbies and interests. Live your life, not just your work. Creating a work/life balance can undoubtedly be difficult, but there is no question that it is of paramount importance for sustained fatigue management.

Shift Work (continued)

Normally “Shift work” is used to denote a work schedule that divides the 24 hours into roughly similar sizes and uses 2 or more “teams” to provide full 24-hour coverage.

For many in the workforce, shift work is a way of life, but unless managed properly, shift work can create many fatigue problems.

Shift Work (especially night shift) can lead to the disruption of sleep patterns which can lead to:

Chronic fatigue. Persistent anxiety. Depression. Social withdrawal. Weight gain/loss. Substance Abuse. Decreased Alertness, and difficulty concentrating (a general feeling of “being out

of it”). Can trigger insomnia and/or other sleeping disorders.

The disconnection between our natural circadian rhythm and our required work schedule is often the primary cause of sleep disruption. Some sleep promoting measures (such as

20  

melatonin) can provide marginal help to improve sleep, but as of this date, there are no effective treatments which have been developed that can counteract all of the negative impacts that shift work schedules (especially night shift) have on human function and behavior.

Findings from several questionnaire studies have shown sleep durations average around 5–6 hours per sleep period when working night shifts. Far less than the typical 8-hour required rest period for adults in peak sleeping conditions (peak sleeping conditions consist of a dark quiet room, with 8 hours of consecutive non-interrupted sleep during normal rest periods [at night]).

Proper Rest and Recovery Practices

Think about all the factors that have been covered which can interfere with a good night's sleep - from work stress and family responsibilities, to unexpected challenges, all of which can contribute to increased levels of fatigue.

While you might not be able to control all the factors that interfere with fatigue levels, you can adopt habits that encourage better sleep.

Aids to Better Sleep

Getting better rest starts with your own bedroom.

Keep the room dark Have good ventilation Keep the room a comfortable temperature A quality mattress helps a lot Ensure the room is quiet Make time to relax and unwind before going to bed Avoid sleep interruptions Restrict caffeine intake before bed Eat healthy snacks at night (if hungry) and avoid junk food before bed to prevent

indigestion and heartburn Avoid alcohol as a sleep aid Restrict nicotine before bed

21  

Good Sleep Practices

Establish a bedtime routine and sleep schedule. Try to go to sleep and get up at the same time every day. This helps set your body’s internal clock and optimize the quality of your sleep.

Try to avoid watching television in the bedroom. Be smart about napping. While napping is a good way to make up for lost sleep, if

you have trouble falling asleep or staying asleep at night, napping can make things worse. Limit naps to 15 to 20 minutes in the early afternoon.

Try to avoid eating before bed, as laying down horizontally can add to the effects and potential of heartburn and indigestion to set in.

Fight after-dinner drowsiness. If you get sleepy way before your bedtime, get off the couch and do something mildly stimulating, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may wake up later in the night and have trouble getting back to sleep.

Ease into sleep. Setting aside a little time before bed for relaxation can help you transition into sleep.

Inspect labels on cold medications to be sure they do not impact your sleep in a negative way

22  

Time and Stress Management

As mentioned, stress has a significant impact on our overall fatigue level, as such, stress management tactics also by proxy work to reduce fatigue.

Find a proper balance between work, family, social obligations, and downtime. Learn to say NO and make time for yourself. Try to avoid over-committing, as there

is a tendency to underestimate how long tasks will take. Delegate tasks to others around you when necessary and ask for help if you need

it. Break down bigger projects into smaller steps, focusing on one specific task at a

time. Try to leave the house 15 minutes early every day to give yourself plenty of time

to get to where you need to be. Running late can add to stress levels. Learn to distinguish between the “shoulds” and “musts” and which less important

tasks can be left for later if you are feeling overwhelmed. Make good lifestyle choices, both mentally and physically Know your limits.

How Exercise and Food Habits Affect Fatigue Levels

Though exercise is unquestionably good for our health, properly timing your exercise is of paramount importance to maximize the beneficial effects toward rest and recovery. A good workout can indeed make you more vigilant and energized for the day ahead; however, exercising right before bedtime can lead to a poor night’s sleep due to those increased levels of energy and alertness.

Our body temperature is also linked to sleep functionality. Since our body temperature rises during exercise and can take as long as 6 hours to drop to normal levels, it is important to give the body enough time to cool off before going to bed to maximize rest and gain restorative sleep.

Food is also related to sleep through appetite and metabolism. Research has shown that people who don’t get enough sleep are more likely to have bigger appetites. This link between appetite and sleep provides further evidence that sleep and obesity are at least somewhat correlated. As well, since our hormones are regulated when we are sleeping; when you are sleep deprived, your hunger hormones go out of whack. When this happens, it can increase the feelings of hunger felt, and decrease your ability to tell when you are “full”. Additionally, the feelings of fatigue and hunger in how we interpret them are

23  

comparable. When you are truly feeling sleepy, you might also feel like you instinctively need to snack instead of just going to bed.

Research indicates that changing up your sleep routine by making sure you are getting sufficient rest decreases levels of persistent fatigue. Due to the fact that fatigue can be misinterpreted as hunger, this leads to less of an inclination to constantly snack or eat because you feel tired. This too varies in a case-by-case manner.

Our individual physical conditioning practices and level of nutrition/food habits are important influences in our rest and recovery as well the overall effects of fatigue we feel on a day to day basis.

Proper eating habits throughout the day have a significant effect on:

Rest quality. Increased stamina (decreases the onset level of fatigue felt). Alertness and mental acuity, proper nutrition and regular exercise have been

shown to increase an individual’s capacity to read and retain information, solve problems with less frustration, and explain situations with greater detail.

Fatigue Combat Strategies that Work Moderately (still relevant, though not as important as some other long-term strategies to combat fatigue)

Eating Habits

Try not to overeat. Small meals are better than a few large feasts for keeping nourishment and energy levels up throughout the day. (Breakfast is especially important).

The body's circadian rhythm naturally produces drowsiness in the mid-afternoon. A protein and carbohydrate snack can bring up energy levels which help stave off this effect.

Exercise

Research indicates that a 15-minute exercise routine in the middle of the day is as effective of a short-term remedy to fatigue as a 1-hour nap can be.

Caffeine

24  

Caffeine can be helpful in improving wakefulness in the short term, but people who drink caffeine regularly become increasingly less sensitive to its effects.

Caffeine tends to increase the excretion of water from our body, resulting in dehydration. Be sure to remain mindful of this and drink plenty of water (though it is always good practice to drink adequate amounts of water throughout the day regardless).

Avoid caffeine within 4 hours of falling asleep as it will make falling asleep more difficult.

o A pattern involving lack of sleep can often create a vicious cycle with dependence on caffeine. The more tired you are, the more caffeine you will consume to stay awake during the day. Yet, the more caffeine you consume, the harder it will be to fall asleep at night, leaving you feeling even more tired the following day. If this occurs, and you find yourself getting less sleep day after day, be mindful that the hours in your collective “sleep debt” can grow, and the only way to properly restore optimum levels of rest and recovery, and minimize your “sleep debt” is through sleeping. You cannot sustainably cheat the amount of sleep you get by supplementing for caffeine.

25  

Fatigue Combat Strategies that DO NOT Work

Nicotine. o Having a cigarette does not relieve fatigue.

Turning up the radio or opening the windows while driving. Chewing gum or eating sunflower seeds will also not relieve fatigue.

Though these strategies are ones that many others have tried before, do not be fooled into thinking these are effective in combating fatigue.

Relieving fatigue is best done through rest, whether it be power naps, anchor sleeps or simply a good night’s sleep. There is no substitute for sleep.

Myths and Misconceptions about Sleep and Fatigue

The following are a few common examples of misconceptions which are in fact inaccurate:

Misconception #1: “I know when I am going to fall asleep.”

Misconception #2: “Sleeping during the day is the same as sleeping at night.”

Misconception #3: “Our bodies get used to working night shifts, and after a while, it makes no difference.”

Misconception #4: “If I get a lot of sleep tonight, I won’t need to get as much sleep in the next few nights.”

Misconception #5: “I am very experienced with this task, and I can fight off any feelings of fatigue and just get it done.”

Misconception #6: “Over the years my body has gotten used to getting less sleep than I need, so I’m used to it, and it doesn’t affect me at all.”

It’s important to remember that in many cases workers get so caught up in the task they are engaged in, that they do not come to realize how fatigued they have become until sitting down and relaxing. This can be especially dangerous when you get lulled into a false sense of security thinking that your workday is over, and you can finally “relax on the drive home” not consciously aware of how fatigued you in fact are. In many ways, the trip to and from work can be the most dangerous part of the day.

26  

Driving Fatigued

The AAA foundation for Traffic Safety recently released a new study showing that the tragedy of “drowsy driving” (driver fatigue) is far more pervasive than indicated in previous estimates. Their study showed that:

Driving while fatigued was a contributing factor in about 1 in 6 deadly crashes (16%).

1 in 8 crashes resulting in occupant hospitalization involved driver fatigue (12.5%). Driver fatigue was a factor in 1 in 14 crashes in which a vehicle was towed (7%). During the week after daylight savings time fatal accidents increased on average

by 6.5%. 1 in 4 fatigued drivers that were involved in a crash, were also found to have been

speeding. Only 1 in 5 drivers will recognize fatigue/drowsiness and pull over to rest.

These percentages are significantly higher than most previous estimates, indicating that the impact of driver fatigue in motor vehicle crashes has not been fully understood.

If you fall asleep at the wheel, even for a slight moment, it can be fatal. For perspective, you can travel roughly the distance of a football field in less than 3 seconds.

Though we can self-identify fatigue indicating factors, we cannot anticipate when precisely we will fall asleep. You need to pay attention to indicative hints and act.

Driving Drowsy Symptoms and Signs:

Sleepiness:

Yawning. Feeling drowsy. Nodding off. Difficulty focusing.

Sore or Tired Eyes:

Heavy eyes. Sore or itchy eyes.

Lazy Steering:

Weaving within your lane. Rigid steering. Less frequent minor steering corrections.

27  

Slow Reactions:

Lazy posture. Late recognition of hazards. Late response to hazards.

Aches and Pains:

Stiffness in the back or neck. Cramps in the legs or feet. Headaches.

Poor Judgement:

Poor driving decisions in judging distances and changing lanes. Possible tailgating.

Loss of Concentration:

Trouble remembering the last few km driven. Missing traffic signs or exits. Feeling restless and irritable (road-rage). Hitting rumble strips.

At the first signs of drowsy driving (driver fatigue), you should take a break until you feel alert. – If more serious signs of fatigue are shown, stop and get sleep until you feel completely alert.

28  

Driving at Night/When it is Dark Out

Driving conditions are remarkably different and worse when it’s dark. Our vision is significantly reduced while driving at night, making it specifically difficult to spot pedestrians, cyclists, motorcyclists, and wildlife.

Reports have indicated that while only 25% of our driving is done at night, 50% of all traffic deaths occur during those hours. It doesn't matter whether the road is familiar or not, driving at night is always more dangerous.

One reason driving at night and in the early morning hours can be especially dangerous is that our bodies are designed to be asleep during those times. Try to avoid driving between the hours of midnight and 6 a.m. (many companies have that as a standard policy)

The mixture of our natural circadian rhythms, a possible long day already completed, headlight glare and limited sight can all cause compounding problems when combating fatigue which necessitate increased levels of vigilance when driving at night. If you are simply too fatigued when getting behind the wheel to remain vigilant, you should NOT be driving.

Tips to Help Combat Darkness When Driving

Aim your headlights correctly and make sure they're clean

Reduce speed

Look away from oncoming lights

If you wear glasses, make sure they're anti-reflective

Minimize distractions, like talking with passengers or listening to the radio

Clean the windshield to eliminate streaks

Slow down to compensate for limited visibility and reduced stopping time

Even with high-beam headlights on, visibility is limited to about 500 feet (250 feet

for normal headlights) creating less time to react to something on the road,

especially when driving at higher speeds.

29  

Initiating Proactive Drowsy Driving Strategies

Getting a good sleep prior to a drive the night before in a good sleep environment is of vital importance.

Take a break from driving every 2 hours or so. Stop and stretch or go for a little walk if need be.

Tracking and reacting to sleep debt is important. Studies show that if your sleep debt gets to ~ 15 hours or more you can display some of the same characteristics as a drunken driver while behind the wheel.

Try to avoid driving if you have been awake for 17 hours or more since your last sleep period.

Drink water while driving – it helps with the absorption of nutrients which regulate body temperature and prevents dehydration.

Without an adequate amount of water your body will struggle and will therefore become fatigued.

Water prevents de-hydration (de-hydration drastically limits physical and mental functioning and can accelerate fatigue, and dramatically magnify its effects. Symptoms of de-hydration include: Headaches, nausea, dry mouth/lips, muscle weakness and decreased concentration.

What we want to do is try to stay out ahead of dehydration by drinking lots of water and fluids that replenish your electrolytes, which in turn helps alleviate fatigue.

Journey Management

In addition to adopting and initiating good fatigue combat strategies for driving, you should know how to make the distinction between a “journey” and a “trip”.

Journeys comprise of a single leg of travel over long distances - whereas - trips are often considered short travel periods.

Though journeys can be assumed to be more potentially dangerous, it’s important to not become complacent when behind the wheel for what can be understood as “quick trips”. Though fatigue may not play as much of a contributing role in ‘trips’, it’s important to stay vigilant and don’t assume that just because you “know the roads”, or that “it’ll only take a few minutes to get there” are excuse enough to let your guard down. If you don’t feel as though you are rested, don’t get behind the wheel, even if it’s “just for a few minutes”.

30  

A good way to avoid fatigue on a long journey is appropriate pre-planning.

Design the most effective, efficient, and safe route between two points that provides enough time for rest and fuel stops.

In planning a journey, several factors should be considered:

Driver

The driver must understand their abilities and limitations. Drivers must ensure they get proper rest. Time must be allotted for rest, fuel, and food stops. Try to avoid driving if you have been awake for 17 hours or more. In terms of rhythms, bodies are the most tired at two points in the day, between 12

am and 6 am, and in the mid-afternoon. People often neglect or are unaware of how fatigued they may be in the afternoon.

Vehicle

Drivers must make sure their vehicle is in good shape and mechanically ready for the trip.

Is it your personal vehicle, or a vehicle that you are familiar with? If not, be sure to familiarize yourself before commencing with the drive.

Road Conditions

Weather and traffic conditions must be considered. Remember, traveling in mountainous areas or in the winter it may require extra time.

If you are unfamiliar with the drive, its good practice to give yourself extra time to get there in case of unanticipated encounters which may slow you down.

31  

Conclusion

Our co-ordination and strength, computing power and speed, as well our ability to gain and retain new information becomes progressively diminished the more fatigued we become. Though the exact mechanisms of how sleep works to rejuvenate the body and mind are still somewhat unknown, one thing sleep specialists and scientists do know is that getting adequate restorative sleep is directly linked to optimum levels in our mood, learning, memory and problem solving capabilities and also increased levels in output regarding our physical capacities relating to healthy movement and functioning. It is imperative that we understand and be conscious of our own individual limitations regarding fatigue. In terms of rest and recovery, we must use these tools in a pro-active manner in our attitude toward fatigue management. Which is a far better strategy than pushing the envelope by getting less and less sleep, taking a wait and see approach, thus, being re-active in your response, leaving you with little other recourse other than to deal with the consequences there-after.