2014 WWCMA Presentations

1. HOW BETTER SLEEP TRANSLATES TO HEALTHIER,
MORE PRODUCTIVE EMPLOYEES
STUART F. QUAN, MD

2. Presentation Outline
• Sleep defined
• Implications of a sleep deficient workforce
• Results of Harvard survey of employee sleep
• Best practices for building an organizational culture that
supports healthy sleep
• Action steps
• Q & A
2

3. Photo: Sxc.hu by datarec
3

4. • A reversible behavioral state of perceptual
disengagement from, and unresponsiveness
to, the environment.
• A very complex amalgam of physiological
and behavioral processes.
• Unlike coma: physiologic, recurrent and
reversible.
Courtesy of NIH Sleep Academic Awards
Sleep Defined
4

5. “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.”
Allan Rechtschaffen, PhD (a retired pioneering sleep researcher)
5

6. Theories of Why We Sleep
• Inactivity Theory
• Energy Conservation Theory
• Restorative Theories
• Brain Plasticity Theory
6

10. Sleep Regulation
Two Systems
Homeostatic
• Level of sleep drive
Circadian
• ~24 hour biologic
clock
• Regulates timing of
sleep and wake

11. The Impact of Sleep
• Occupies 1/3 of our lives (3,000
hours a year)
• Necessary for physical and
mental health
Annually in lost productivity
due to employee sleep deficiency
11

12. Three Pillars of Health
Work toward goals in all three
Sleep Exercise Diet
12

13. Quick Poll
What is the average number of hours of sleep you actually get
on a work night?
a) Less than 6 hours
b) 6 - 7 hours
c) 7 - 8 hours
d) 8 - 9 hours
e) 9 or more hours

14. Year
Sleep Duration / Day
(hours)
1960 1980 2000
10
9
8
7
6
McAllister, E.J., Dhurandar, N.V., Keith, S.W., Aronne, L.J., Barger, Jamie, Baskin, M., Benca,
R.M. et al. (2009) Ten Putative Contributors to the Obesity Epidemic 49(10) 868 – 913
Self-Reported Sleep Duration in the U.S.
14

15. Sleep Duration in Adults
8%
21%
63%
8%
Men
< 6 hours
6 hours
7-8 hours
9 or more
hours
8%
20%
63%
9%
Women
< 6 hours
6 hours
7-8 hours
9 or more
hours
Center for Disease Control. Schoenborn, C. (2006) Sleep Duration as a Correlate
of Smoking, Alcohol Use, Leisure-Time, Physical Activity, and Obesity Among
Adults: United States, 2004 – 2006
Nearly 1/3 of adults get no more than 6 hours
of sleep each night
15

16. Health Impacts of Too Little Sleep
Obesity
Coronary
Heart
Disease
Diabetes
Mortality
Stroke
IMMUNE
FUNCTION
IMPAIRED
• Vaccines not as
effective
• Susceptibility to
illness
< 6 HOURS
SLEEP PER
NIGHT MORE
THAN 30%
INCREASED
RISK FOR:
16

17. Stress Hormones
Growth Hormones
Insulin and glucose
Appetite Regulating Hormones
Health Impacts of Too Little Sleep
• Stress hormones
• Growth hormones
• Insulin and glucose
• Appetite regulating
hormones
Widespread Hormonal
Changes
Stress Hormones
Growth Hormones
Insulin and glucose
Appetite Regulating Hormones
Appetite Regulation
• Leptin (appetite suppressant)
20% lower
• Ghrelin (appetite stimulant)
15-30% higher
• Morning carbohydrate
cravings and increased
appetite
• Altered brain reward center
responses
17

18. Mental Performance Impacts of Too Little Sleep
• Memory and learning is harder.
• Paying attention and completing work is harder.
• Concentrating, solving problems, and making decisions are
harder.
18

19. Physical Performance Impacts of Too Little Sleep
Overall Impact
• Decreased Reaction Time
• Diminished Motor Skills
• Decreased Short-term
Maximal Muscle Strength
• Reduction in Sprint
Performance
• Decreased Endurance
Example: Impact of 2-2.5 H Sleep
Deficiency on Tennis Serving Accuracy
Reyner, L.A. & Horne, J.A. (2013) Sleep restriction and
serving accuracy performance in tennis players, and
the effects of caffeine Journal of Physiological Behavior
120 93- 96

20. Quality of Life Impacts of Too Little Sleep
• Feel more sad
• Feel more irritable
• More difficult to get along
with friends and family
20

21. Safety Impacts of Too Little Sleep
•Make more mistakes
- Chernobyl Nuclear plant, Three Mile Island nuclear plant,
Exxon Valdez accidents
- Needle-sticks and diagnostic errors in medical personnel
- Increased car accidents after “spring ahead” clock change -
only 1 hour less sleep!
Drowsy driving is a RED ALERT!
21

22. SLEEP MEDICINE
March 24, 1989
•~258,000 barrels of oil spilled in Prince William Sound Alaska
•Economic cost: Billions
•Environmental cost: Incalculable

23. SLEEP MEDICINE
National Transportation Safety Board (1990) Safety Recommendation Sept 18, 1990 Retrieved from http://www.ntsb.gov/doclib/recletters/1990/M90_53_58.pdf
EXXON VALDEZ
•Greatest ecological disaster in the history of mankind
•Urban Legend: The ship’s captain was intoxicated.
•Fact*: At the time of the grounding, the ship was under the navigational control of the 3rd mate. “…he could have had as little as 5 or 6 hours of sleep in the previous 24 hours.”

24. SLEEP MEDICINE
Airliner Crashes in Little Rock June 1, 1999

25. SLEEP MEDICINE
American Airlines Flight 1420
National Transportation Safety Board (2001). National Safety Transportation Board Retrieved from: http://www.ntsb.gov/doclib/safetystudies/SS0101.pdf
•Overran the runway and crashed at Little Rock International Airport
•Commonly believed cause: related to slick landing conditions caused by a thunderstorm with wind shear
•Fact*: Crew had been awake 16 hours and was past usual bedtime. “The flight crew’s degraded performance was consistent with known effects of fatigue.”

26. SLEEP MEDICINE

27. Quick Poll Question
What percentage of Americans admit to driving a car while
feeling drowsy?
a) 30%
b) 40%
c) 50%
d) 60%
e) More than 60%

28. Drowsy Driving
• 100,000 police reported crashes each year are
caused by sleepy drivers
o Estimated 1,550 deaths
o 71,000 injuries
o $12.5 billion in monetary losses
o Tip of the iceberg since it is difficult to attribute crashes to
sleepiness
The Problem with Drowsy Driving. National Sleep
Foundation. Retrieved from
http://sleepfoundation.org/sleep-news/the-problem-drowsy-
driving
28

29. Safety Impacts of Too Little Sleep
Drowsy driving is a RED ALERT!
29
Being awake for 18 hours is similar to being legally drunk

30. Common Sleep Problems
POOR
SLEEP
Often hidden, these
issues are likely
impacting your
employees
RESTLESS LEGS
SYNDROME
Affects 2-15% of
Americans
CIRCADIAN
RHYTHM
DISORDERS
• Jet Lag
• Shift Work
Disorder
• Phase Problems
NARCOLEPSY
Affects 1 in 2,000
Americans
INSUFFICIENT
SLEEP
Affects most Americans!
SLEEP APNEA
• 12 - 18 million
Americans
• 90 million snore, 37
million habitually
INSOMNIA
Chronic or short-term,
insomnia
affects 50% of
Americans
30

31. What is OSA?
•
Cessation of airflow with ongoing respiratory effort
Overview of OSA

32. Symptoms
•
–Daytime sleepiness
–
Impaired work performance
–
Decreased quality of life
–
Increased rate of
automobile accidents
•
–High blood pressure
•
–Snoring
–
Witnessed apneic episodes
–
Choking or gasping episodes
•
Other symptoms
–
AM headaches
–
Bedwetting
–
Heartburn
–
Impotence
–
Respiratory failure
–
Psychiatric disorders
Overview of OSA

33. Sleep Apnea Risk Factors
•Obesity
•Male gender
•Family History
•Small/recessed jaw
•Age

34. How Common is Sleep Apnea (OSA)?
• Mild OSA ~ 1 in 5 US adults
• Moderate/Severe OSA ~ 1 in 15 US adults
• >85% with treatable disease undiagnosed
• 2-3:1 Male:Female Predominance

35. Consequences of Sleep Apnea
• Behavioral, Cognitive and Functional impairment
• Increased risk of accidents & injuries
• Increased risk of glucose intolerance/diabetes
• Increased risk of hypertension and cardiovascular
events
• Mortality

36. Insomnia: Most Common Cause of Sleepless Nights
• 1/3 of the adult population
occasionally and 10–15% on a
chronic basis
• Can be acute in response to a life
event
• Can become chronic
Affects
• Daytime irritability, poor
concentration
• Risk of depression and depression
relapse
• Increased risk of heart attacks and
diabetes
Health
Consequences
36

37. Sleep and Your Work Culture
01
02
03
WORSE HEALTH
INCREASED HEALTH
CARE COSTS
REDUCED PRODUCTIVITY
Corporate cultures today often celebrate
people who sacrifice sleep for work.
This flawed
reasoning
impacts the
“triple bottom
line!”
37

38. Harvard Survey of Employees
Purpose:
Discover what attitudes and beliefs leaders and
employees have about sleep health
Use:
• Engender discussions about and sleep and sleep health in
public forums.
• Make individual employees aware of their own sleep habits
and how these impact their lives
38

39. Harvard Study Results
6.2
6.4
6.6
6.8
7
7.2
7.4
7.6
7.8
8
Workdays Weekends Sleep Need
Hours per Night
N=1083
Participants Hours of Sleep
39

40. Harvard Study Results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sleep with
Smart Phone
Email/Text
Bedtime
Email/Text
Risetime
Never
Rarely
Sometimes
Often
Always
N=1083
Technology Behaviors
40

41. Harvard Study Results
0
2
4
6
8
10
12
14
% < 6 Hours Sleep
N=1083
Not Digitally Connected Digitally Connected
41

42. Harvard Study Results
0
2
4
6
8
10
12
Bedtime Email/Text No Bedtime Email/Text
% <6 hours Sleep
N=1083
Impact of Email / Texting at Bedtime
42

43. Other Factors Associated with Reduced Sleep on Workdays
Insufficient
family
support
Work
stress
Inadequate
work-life
balance
Too much
to do at
work
Less likely to
believe that
sleep is 3rd
pillar of
health
.
Family not
getting
enough
sleep.
REDUCED
SLEEP ON
WORKDAYS
43

44. SLEEP AND WORK: WHAT CAN BE DONE?

45. Organizational Actions – Shift Workers
SHIFT
WORKERS
Employees that don’t
work traditional 9 a.m.
to 5 p.m. hours
(Approx. 14% of
Americans)
hospitality, health care,
customer service, etc.
TEAMWORK
Working with others
helps keep shift
workers alert
TEDIOUS
TASK EARLY
Ensure schedules
don’t leaving the
tedious/paperwork
activities to the end
of the shift when
workers are most
sleepy
EXERCISE
During breaks
encourage exercise
or some type of
activity to keep the
blood moving
SHIFT
AHEAD
If changing shifts,
move the start time
forward (clockwise)
OFFER
NAPS
Provide opportunities
for brief naps during
the shift
45

46. Organizational Actions – Encourage Naps!
34%
EMPLOYERS
ALLOW
NAPPING
According to
respondents of
National Sleep
Foundation poll
6%
Of organizations
offer NAP
ROOMS
According to SHRM
survey
16%
DESIGNATED
NAPPING AREAS
At their employers,
according to the same
NSF poll
Napping is cheaper and more effective than coffee.
Just a 20 minute nap can make employees more alert.
46

47. Organizational Actions – Mitigate Risk
47
Technology and our “always on” corporate mindsets
can be a curse that places employee safety and
decision-making at risk.
EVALUATE TECHNOLOGY
USE POLICIES
• Are employees encouraged to
be “on call” when on vacation or
work travel in a different time
zone?
• Consider technology “freezes”
where work email can’t be
accessed during late evenings.
CONSIDER
ACCOMMODATIONS FOR
LONG HOURS
• After staying late and/or coming
in early for work, are employees
commuting in a drowsy state?
• Consider safe transportation
offerings and nap options.

48. Organizational Actions to Promote Healthy Sleep
SLEEP
HEALTH
CHANGE THE
CULTURE
Provide positive role
models. Consider offering
napping rooms.
EVALUATE POLICIES
Consider flexible
schedules, restrictions on
email use/time, and other
sleep friendly practices.
COMMUNICATE
Share positive messages
and information about
sleep health
OFFER PROGRAMS
Include screenings,
seminars and coaching
as part of your overall
wellness efforts
48

49. Self-Screening for Employees: BEARS
• B: Bedtime Problems
- Do you have trouble falling asleep at bedtime?
• E: Excessive Sleepiness
- Do you have difficulty staying awake during the day?
• A: Awakenings
- Do you wake up frequently at night?
• R: Regularity and Duration of Sleep
- Do you have consistent bed and wake times?
- Do you sleep for 7 1/2 - 8 hours per night?
• S: Snoring
- Do you snore loudly?

50. More Self-Screening for Tools Employees
CHECK CONSISTENCY
Keep a sleep diary
VERIFY AMOUNT NEEDED
Take the vacation test
CHECK FOR SNORING
Ask bed partner or tape record
If you are tired after 8 hours
in bed or your bed partner
complains of your
snoring/stopping breathing,
consult a sleep specialist.

51. Tips for Employee Self-Treatment
Avoid chemicals that interfere with
sleep
Turn bedroom into sleep-inducing
environment
Establish a soothing pre-sleep
routine
Go to sleep when you’re truly
tired
Keep a consistent sleep schedule
Use light to your advantage
Lighten up on evening meals
Exercise early
Caffeine, nicotine and alcohol
Quiet, dark, cool temp
Warm bath, avoid stressful activities
Don’t try to sleep if you’re not tired
Keep the same routine on weekends
Morning light brightens mood; synchronizes
internal clock
Big meals before bed cause heartburn and
disturb sleep
Exercise improves sleep, but done too close
to bedtime can make it difficult to fall asleep
51

52. What Should Your Doctor Ask You About Your Sleep
•Is your sleep restful or restorative?
•Do you snore or stop breathing at night?
•Do you move excessively at night?
•Are you sleepy during the day?

53. What to Expect from a Sleep Evaluation
• Detailed sleep history
• Bedtimes
• Waketime
• Napping behavior
• Snoring history
• Nighttime movements
• Physical examination
• Medical history
• Sleep Study

54. Sleep
• You need it (even busy, highly competent people)
• It is good for you
• Free
• NO doctors appointments or prescriptions
• NO side effects
• NO expensive devices or equipment
• Can do at home - NO weather or travel issues
• NO learning involved
• It feels good
• Consult a sleep specialist if these sleep tips do not help
Sleep Medicine

55. Q & A