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Dead Tired

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Dr John Kerr
Chair, DoL, Exposure Panel on Workplace Psychosocial Issues
jandakerr@gmail.com

(P19, Thursday 27, Civic Room 3, 11.00)

Published in: Health & Medicine, Business
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Dead Tired

  1. 1. ‘‘Dead Tired’Dead Tired’ Members of the DoL PsychosocialMembers of the DoL Psychosocial PanelPanel
  2. 2. Panel MembersPanel Members • Dr. John Kerr Occupational Physician, Hastings • Rachel Irwin Clinical Psychologist, Wellington • Dr. Mark Floyd Occupational Physician, Wanaka • Shona Kelly Occupational Health Nurse, DoL, Whangarei • Frank Darby Technical Leader, DOL, Wellington
  3. 3. • Scene Setting John Kerr • Physiology of Normal Sleep Rachel Irwin • Physiology of Sleep Deprivation Shona Kelly • Workplace Effects Frank Darby • Sleeping Well Frank Darby • Conclusion John Kerr
  4. 4. Scene SettingScene Setting
  5. 5. 1 Scene Setting - Relevance1 Scene Setting - Relevance • Sleep is the third pillar of health – food, nutrition and sleep • Fatigue kills • Sleep is critical to: – health, – workplace safety and – Productivity. • Increasingly we are living in a 24 hour society • Different age cohorts have different sleep requirements – Teenagers – Older people • It is the most common medical disorder
  6. 6. 2 Scene Setting - Historical Facts2 Scene Setting - Historical Facts • In US 90 minutes less sleep per night in 2010 compared 1900 • Recent US study 90% presenting to GP had sleep related symptoms • Sleep loss and poor sleep are significant factors in: – Depression/Diabetes/Obesity/Hypertension/Cancer – Memory & memory consolidation/Concentration/Learning/Work performance/Alertness – Many others no doubt
  7. 7. 3 Scene Setting - Outcomes3 Scene Setting - Outcomes • Sleep disorders rank in the top ten risk factors for health conditions, and exceed such factors as alcohol or unsafe sex! • Equals annual estimated cost of asthma! • Effective treatment measures are available
  8. 8. Physiology of Normal SleepPhysiology of Normal Sleep
  9. 9. 1 Physiology of Normal Sleep1 Physiology of Normal Sleep NREM (Non - Rapid Eye Movement). • Stage N1 – transition between wake and sleep – Drowsy state, high muscle tonus, and absence of rolling eye movements – Occurs upon falling asleep and during brief arousal periods within sleep – 2-5% of total sleep time • Stage N2 – Decreased muscle tonus – Occurs throughout the sleep period – 45-55% of total sleep time
  10. 10. 2 Physiology of Normal Sleep2 Physiology of Normal Sleep • Stage N3 – delta or slow wave sleep – Most restful phase – Occurs mostly in the first third of the night – 5 to 15% of total sleep time
  11. 11. 3 Physiology of Normal Sleep3 Physiology of Normal Sleep REM (The rapid eye movement phase) • Active brain activity, absent muscle activity, rapid eye movements and dreaming • Occurs in 4-5 episodes throughout the night • 20-25% of total sleep time • Increases in duration throughout the night from <10 min to >60 min • NREM-REM cycles vary from 70-100 min initially to 90-120 min
  12. 12. 4 Physiology of Normal Sleep4 Physiology of Normal Sleep • Circadian rhythms help coordinate body functions for optimal performance • Suprachiasmatic nucleus (SCN) sets the clock to approximately 24.2 hours • SCN receives information on light and dark from the eyes and regulates body functions • Activity becomes random if SCN destroyed
  13. 13. 5 Physiology of Normal Sleep5 Physiology of Normal Sleep • Body temperature • Strength • Alertness – reaction time and cognitive reasoning • Sleep/wakefulness • Concentration • Kidney function, hormone secretion, blood pressure and digestion
  14. 14. Effects of Sleep DeprivationEffects of Sleep Deprivation
  15. 15. 1 Sleep Deprivation – effects on people1 Sleep Deprivation – effects on people • Decreased resistance to disease caused by a decrease in immune system function as measured by: – white cell count and activity • Increased inflammatory markers including – C reactive protein, an indicator of acute or chronic health problems • Decreased circulation • With sleep apnoea an increased risk of myocardial infarct (heart attack) • An increased risk by 3- 4 times of stroke
  16. 16. 2 Sleep Deprivation - effects on people2 Sleep Deprivation - effects on people • Decreased insulin production and increased glucose blood levels • Increased risk of impaired glucose tolerance and type II diabetes with inhibition of secreted insulin from the pancreas • Glucose-PET studies in individuals deprived of sleep have shown that after 24 hours of sustained wakefulness, the metabolic activity of the brain decreases significantly (up to 6% for the whole brain and up to 11% for specific cortical and basal ganglionic areas).
  17. 17. 3 Sleep Deprivation - effects on people3 Sleep Deprivation - effects on people • Impaired appetite control in the hypothalamus leading to – increased hunger/appetite …caused by – decreased leptin production (the hormone that turns off hunger) • Sleep < 7 hours per night leads to an increased risk of obesity
  18. 18. 4 Sleep Deprivation - effects on people4 Sleep Deprivation - effects on people • A decrease in core body temperature • Increased heart rate variability • Mood changes associated with depression • A decrease in the release of growth hormone.
  19. 19. 5 Sleep Deprivation - effects on people5 Sleep Deprivation - effects on people • “Delayed phase insomnia” is caused by growth hormone production in puberty where teenagers don’t feel sleepy till much later than normal due to a delay in their circadian rhythm. • Chronic insomniacs tend to think that they are awake a lot of the time that they are actually asleep and this often contributes to their anxiety and hence sleep deprivation. • Micro-sleeps.
  20. 20. Workplace Effects of Sleep DeprivationWorkplace Effects of Sleep Deprivation Prevalence Effects - Sleep disorders - Inadequate Sleep Costs Workplace prevention
  21. 21. 1 Workplace Effects - Prevalence1 Workplace Effects - Prevalence • Gander et.al. June 2001. – 27% of NZers reported a current sleeping problem. • Te Ropu Rangahau Hauora a Eru Pomare and the Sleep Wake Research Centre. April 1999. – 37% rarely/never got enough sleep – 46% rarely/never woke feeling refreshed. – Maori reported more sleep problems and greater daytime sleepiness
  22. 22. 2 Workplace Effects – Sleep disorders2 Workplace Effects – Sleep disorders • Over 70 Sleep disorders: – Insomnia – Obstructive sleep apnea syndrome (OSAS) – Restless legs syndrome – All compromise daytime alertness. • Inadequate Sleep - leads to or affects - – Tiredness and lethargy – Performance deficits • Memory and concentration • Attention span • Vigilance • Complex thinking – Mood changes }These 3 most common
  23. 23. 3 Workplace Effects – Costs - 13 Workplace Effects – Costs - 1 • Conclusions of Hillman et. al. 2006 – “The direct and indirect costs of sleep disorders are high. The total financial cost (excluding suffering) of $4.5 billion represents 0.8% of the Australian GDP. The cost of suffering of $3.0 billion is 1.4% of the total burden of disease in Australia. Total = $7.5 Billion (2006) – Sleep disorders rank in the top 10, above alcohol and unsafe sex. – Sleep disorders contribute: - 9.1% of workplace injuries; - 8.3% of depression; - 7.6% of motor vehicle accidents; - 2.9% diabetes; - 2.1% hypertension – Direct health costs are 2% of $7.5 billion  not enough being done. – Spending on health disorders similar to that on asthma. The Economic Costs of Sleep Disorders. Hillman et. al. Sleep. Vol. 29. No. 3. 2006
  24. 24. 4 Workplace Effects – Costs - 24 Workplace Effects – Costs - 2 Hillman et. al. • Motor vehicle crashes - $0.8B • Workplace incidents - $2B • Productivity Costs - $1.2B Boston Consulting • Studies examining – the effects of OSAS on MVA – the effects of treating OSAS on MVA • At least 112 lives saveable in Australia each year Gander et. al. 2010. • Annual costs of OSAS for NZers (aged 30 – 60) are estimated at $40 million or $419 per case – with accidents a major contributor. • The estimated incremental net cost of treating OSAS was $389 per case treated, giving an estimated incremental net direct medical cost per quality of life year (QALY) of $94. • This is well below the average QALY cost of $6865 for drugs selected by PHARMAC for government subsidy.
  25. 25. 5 Workplace Effects – Prevention5 Workplace Effects – Prevention • Awareness • Information and training • Policies – Sleep disorders and sleep quality – Shiftwork management – Rest breaks and Napping • Health monitoring for staff – For sleep disorders – For sleep quality Suggestions only Safety Critical Industries Drivers
  26. 26. 6 Sleep Hygiene6 Sleep Hygiene 1 Physical 2 Food 3 Exercise 4 Technique 5 Routine See: www.sleep.org.au
  27. 27. 1 Sleep Hygiene – Physical1 Sleep Hygiene – Physical • Sleep in a dark (alkathene), cool room, in a warm, comfortable bed. • Control noises. – Which is more likely to wake you up – traffic (once you get used to it) or a helicopter flying over? Why? What is the significance of the answer? – When does noise compromise sleep the most? • Help wake up with sunlight – go outside. • Use sunglasses on the way home if you work shifts.
  28. 28. 2 Sleep Hygiene - Food2 Sleep Hygiene - Food • Avoid before bed: – Heavy food – Spicy food – Lots of food in the stomach – Smoking, Caffeine and Alcohol before bed • If it dissolves in water – good for night shifts.
  29. 29. 33 Sleep Hygiene - ExerciseSleep Hygiene - Exercise • Get regular exercise each day. – Before dinner or in the morning. • How can exercise help you sleep better? • When is exercise best for sleep? A fact not well known: People sleep better than they think. When people who have spent a night in a sleep laboratory are shown evidence of their sleep/wake distribution they usually express surprise. Conclusion: we sleep better than we think we do!
  30. 30. 4 Sleep Hygiene - Technique4 Sleep Hygiene - Technique • We can’t make ourselves fall asleep – so this section is about helping the conscious brain to cease its activity – Learn to relax if you need to (there are many methods). – Deal with problems - as you can - before going to bed. – Reserve the bedroom for sleeping. • No TV, telephoning, hobbies, studying. (!) Why? – Nap before 2pm, for not more than 20 minutes. – Avoid sleeping pills and alcohol. – Seek professional help if you need to. – If you can’t sleep, get up.
  31. 31. 5 Sleep Hygiene - Routine5 Sleep Hygiene - Routine • Regularity – aim for 8 hours. – Go to bed and get up at the same time each day. • Adopt a pre-sleep routine. – Avoid stimulating activities before bed. – Go to bed only when sleepy • Don’t nap in the evening. • Aim to sleep (nearly) all the time you are in bed. – Bedrooms need to become associated with the pleasant experience of sleeping, (as opposed to worrying).
  32. 32. 4 Scene Setting - Conclusion4 Scene Setting - Conclusion Sleep is critical to: – Health – Workplace safety and – Productivity. “Early to bed, early to rise keeps a man healthy wealthy and wise”

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