Our second speaker was Dr. Madhukar Kaloji, a local board certified pulmonologist and sleep medicine specialist and owner of Pulmonary & Sleep Medicine Consultants, PC. Dr. Kaloji spoke on health -related consequences of Insomnia & sleep deprivation tying specifically into employee health. Insomnia is the inability to sleep, there is acute or short term insomnia as well as chronic or long term insomnia. Employees who have shift changes, or night shifts are more prone to the insomnia. Below we have included a few of his slides from presentation for you to review. Dr. Kaloji encouraged employers to take sleep deprivation seriously because there is a direct correlation between fatigue and accidents. Educate your employees on the right amount of sleep to thrive during their workday. If you have employees who show signs of fatigue you as an employer can recommend or require a sleep studies. If you have further questions about sleep studies and or proper sleep for your employees please contact Pulmonary & Sleep Medicine Consultants, PC at 757-460-6081.

1. Madhukar Kaloji,MD,FCCP.
Pulmonary & Sleep Medicine Consultants,
Clinical Asst.Prof., Eastern Virginia Medical School,
Norfolk-Virginia, USA.

2. ● Definition
● Epidemiology
● Significant public health problem
● Female gender, older age, medical and family history
● Psychological vulnerability: anxiety, depressive,
perfectionism, introversion etc.,

3. ● CDC estimates: 41 million working adults in the US
report sleeping 6 hours or less
● Acute or Short-term Insomnia( < 3mo )
● Chronic or Long-term Insomnia( >3 mo)
● Insufficient Sleep Syndrome( Volitional Sleep
Restriction)
● Short Sleeper
● Economic burden ( higher annual medical costs, less
productivity)

4. ● 40% of patients in primary care settings report at least
one sleep-related symptom
● Difficulty maintaining sleep-most common
● Non-restorative sleep, difficulty initiating sleep, early
morning awakenings
● Overall: Mixed symptomatology is more common

5. ● Fatigue, Malaise & Daytime Sleepiness
● Impairments in Memory, Attention, Concentration
● Impaired Academic/Social performance
● Dysphoria
● Behavioral problems( particularly in children)
● Errors in judgement / Accident proneness
● Dissatisfaction with sleep in general

6. ● Physical and/or Mental Fatigue play a major role in
operator-related accidents
● The Exxon-Valdez oil spill: a historic environmental
disaster ( fatigued crew & lack of supervision)
● The Libby Zion case( sleep-deprived interns and
residents)
● Numerous airline tragedies across the globe
( Pilot fatigue, swing shifts etc.,)
● The Three-Mile Island Nuclear accident

7. ● Road Traffic Accidents (due to sleepiness): major public health and
occupational hazard across the world.
● Increasing trends in Asia: increased no. of automobiles and worsening
congestion
● Sleep-related crashes and unintentional injuries: A very large cohort
of 54,399 men and women over a 14-year period (Bjorngaard et al.,
Sleep 2014; 37(11):1777.
● A dose-dependent relationship between number of symptoms and
risk of injuries/fatalities noted in the study
● Several studies have shown objective correlation w PVT ( a reaction
time > 500 milliseconds)

8. Peak incidence: midnight until 6 AM

9. ● “Allostasis”: the active process of maintaining stability (
homeostasis) through change
● A non-linear, sometimes reciprocating network
● All of the systems that are modulators show rhythms of
activity over the sleep-wake cycle
● Affected by circadian/sleep disruption
● Circadian disrupted mice: 5 week study showed weight
gain, increased leptin, pre diabetic state
● Numerous animal studies showed sleep-deprived mice
died of sepsis and septic shock

10. ● Insomnia and sleep fragmentation very common in
patients with Bronchial Asthma, COPD, OSA, Nocturnal
GERD etc.,
● Could indicate poor control of the underlying
pulmonary problem
● Nocturnal hypoxemia in COPD, CSA, CSR causes sleep-
maintenance insomnia-hypnotic dependence
● Sleep disruption in ICU patients: prolonged Ventilator
LOS, arrhythmias etc.,

11. ● Insomnia and Sleep Deprivation: very common,
disabling health problem
● Sleep disruption and non-restorative sleep linked to a
variety of medical as well as neuro-psychiatric
conditions
● Attention to co-morbid conditions crucial in
determining insomnia prognosis
● Increased awareness among non-sleep specialists very
important given wide-ranging clinical implications.