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SLEEP DEPRIVATION AT
WORKA Hidden Problem in Need of Creative
Solutions
Chris Knoepke, PhD, MSW, LCSW, CEAP
In Honor Of
Julian
My source of sleep deprivation
Haskell Wexler (1922-2015)
Advocate for safe & rested workers
Coffee Talk
What kinds of sleepiness or other sleep/rest-related issues or
complaints/concerns do you encounter in your work , in your own
life, or among people you know?
General Info About Sleep
• “Sleep Debt” gathers
quickly
• Sleeping only 6 hours a night
for two weeks causes the
same cognitive impairments
as not sleeping at all for 2
nights over the same two
weeks
• “Nevertheless, most of us
– for a variety of reasons –
don’t get the sleep we
need
How Sleep Works
• Stage 1: Dozing
• Stage 2: Snoozing
• Stage 3-4: Deep Sleep
• REM: Dreaming, Active Brain
*AgriLife.org: Texas A&M Extension
Approximate Sleep Needs Through Life
Ages Hours/Day of Needed Sleep
<1 16-17
1-5 11-13 (including naps)
5-12 10-12
12-18 ~9 (delayed phase)
Early/Middle Adulthood ~7.5-8 (highest incidence of
disturbance)
Late Adulthood (age >65) ~8 (6 at night +naps, early rising, poor
architecture)
Sleep Deprivation is as Impairing as Alcohol (in terms of cognitive performance)
• 18 hours of sustained
wakefulness = .05 BAC
– At 24 hours = .10 BAC
• Mild Sleep Apnea Sufferers have worse
cognitive performance than those @ .06 BAC
– Severe, untreated OSA sufferers are 17 times more
likely to be in a car accident than those without
OSA (or whose OSA is being treated).
Basic Causes of Lost Sleep/Rest
• Lifestyle, Social/Familial Demands
• De facto sleep disorders
• Occupational Sleep Deprivation
Disordered Sleep
•We tend to have a “black and white” view of sleep
•Common disorders of sleep include:
• Insomnia
• Sleep Phase Problems
• Sleep Apnea
• Narcolepsy
• Restless Leg Syndrome/PLM
• Odd or Dangerous Behavior Occurring While Sleeping
Identifying Sleep Problems: BEARS
• Bedtime problems?
• Excessive sleepiness during the day?
• Awakenings at night?
• Regularity of sleep (number of hours)?
• Snoring/apneas
Handout – Epworth Sleepiness Scale
Insomnia•Occasional trouble sleeping is not insomnia,
but it is a good way to tell that something isn’t
quite right.
•Different types and phenotypes:
•Onset
•Maintenance
• Terminal
Circadian Rhythm Problems
• Circadian Rhythms regulate our Sleep/Wake Cycle
• Jet Lag
• Shift Work
• Delayed
• Advanced
Borrowed from Yue, n.d.
Snoring and Obstructive Sleep Apnea (OSA)
• Snoring that isn’t OSA is usually only a big deal to
the people in the room with you
• Sleep apnea, though, is characterized by intermittent
partial or complete collapse of some portion of the
upper airway
• Sleep Apnea increases risk of
• Accidents (17x greater risk of MVA*)
• Heart disease (unmanageable HTN = red flag)
• Mood disturbances (unmanageable depression = red flag)
• Metabolic dysfunction (unmanageable diabetes = red flag)
• Excessive daytime sleepiness (frequently tired despite
adequate time spent sleeping = red flag)*Morin, 2000
What About Napping?
• Identified as one of the most effective countermeasures to sleepiness and fatigue (Horne & Reyner, 1996).
• Increases positive emotions including energy (Taub,
Tanguay, & Clarkson, 1976), motivation (Hayashi, Watanabe, & Hori,
1999), and joy (Luo & Inoué, 2000).
• Toddlers who were not permitted to nap showed more negative responses to an unsolvable task than did toddlers who napped (Berger et al., 2012)
Question (from Goldschmied et. Al, 2015)
If a lack of sleep results in increased impulsivity and an increase
in negative emotional responding,
Will a nap counteract this behavior?
Participants
No Nap Nap
N (No. female) 18 (9) 22 (11)
Age (SD) 21.31 (1.78) 20.05 (1.79)
Self-reported Total Sleep Time (SD) 8:01 (0.03) 7:42 (0.03)
Present Sleepiness – Stanford Sleepiness Scale Score 2.94 (1.21) 2.73 (1.08)
Goldschmied et. Al., 2015
Study Protocol
Pre-Study Period
3 days
Consistent Sleep Schedule:
6-9 hours
Verified by
Sleep Diary & Voicemail
Pre-Nap
EEG Hookup
Task Battery:
Frustration Tolerance
State Questionnaires:
Impulsivity
Nap Opportunity
60 minute Nap/
Movie Viewing
Post-Nap
EEG Unhook
State Questionnaires:
Impulsivity
Task Battery: Frustration Tolerance
Goldschmied et. Al., 2015
14 visual analogue items designed to assess impulsive mood.
(1) Impulsivity and Control of Behavior (five items)• “Tend not to think about consequences of actions”
(2) Control of Thoughts (five items)• “Easily distracted”
(3) Feelings of Impatience (four items)• “Want to get things done quickly
State Impulsivity Measure (STIMP)Wingrove & Bond, 1997
Goldschmied et. Al., 2015
STIMP Results
27
28
29
30
31
32
33
34
35
36
Pre Post
ST
IMP
To
tal
Sco
re
No Nap
Nap
Goldschmied et. Al., 2015
Frustration Results
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
110000
Pre Post
Tim
e o
n U
nso
lvea
ble
Ta
sk (
ms) Nap
No Nap
Goldschmied et. Al., 2015
Study 3: Conclusions
• Wakefulness across the day decreases our ability to tolerate
frustration and impulsive feelings
• In contrast, a brief nap enhances the ability to tolerate
frustration and decreases feelings of impulsivity
May help us develop interventions
Group: Where Would it be Important/Effective
to Incorporate Sleep?
• Workplace Wellness Programs
• Scheduling
• Napping at Work
• Other Areas of Company Policy/Procedures??
Integrating into Wellness Programs
1. Where does the company fit?
2. What component of the wellness programs?
• Screening? How?
• Health promotion? How?
• Disease management? How?
Education for All Employees: “Sleep
Hygiene”• Some tips or tricks to getting good or better sleep
• Might be a good idea if you start to notice that you aren’t getting
as much sleep – or as much rest – as you want
• Check the environment (noise, heat, light are frequent culprits of bad sleep)
• Look at your schedule (sleeping at vastly different hours from night to night
because of work or social life – remember your Circadian Rhythm!)
• Avoid Nicotine/Alcohol/other sedative use in the evening
• Avoid exercising in the evening
• Take advantage of your body’s internal sleep signals (metabolism, body
temperature, heart rate, etc.)
Integrating Naptime
Lets pretend you decide that you are going to
accommodate 45 minute naps for employees at your
company.
• How would you sell this to decision-makers?
• What logistical problems would you need to overcome?
• What cultural issues would you need to overcome?