HOW BETTER SLEEP TRANSLATES TO HEALTHIER,

MORE PRODUCTIVE EMPLOYEES

STUART F. QUAN, MD

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

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Photo: Sxc.hu by datarec

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• 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

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“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)

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Theories of Why We Sleep

• Inactivity Theory

• Energy Conservation Theory

• Restorative Theories

• Brain Plasticity Theory

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Sleep Regulation

Two Systems

Homeostatic

• Level of sleep drive

Circadian

• ~24 hour biologic

clock

• Regulates timing of

sleep and wake

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

Three Pillars of Health

Work toward goals in all three

Sleep Exercise Diet

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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

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.

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Sleep Duration in Adults

8%

21%

63%

8%

Men

< 6 hours

6 hours

7-8 hours

9 or morehours

8%

20%

63%

9%

Women

< 6 hours

6 hours

7-8 hours

9 or morehours

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

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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:

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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

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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

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

Quality of Life Impacts of Too Little Sleep

• Feel more sad

• Feel more irritable

• More difficult to get along

with friends and family

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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!

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SLEEP MEDICINE

March 24, 1989

• ~258,000 barrels of oil spilled in Prince William Sound Alaska

• Economic cost: Billions

• Environmental cost: Incalculable

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.”

SLEEP MEDICINE

Airliner Crashes in Little Rock June 1, 1999

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.”

SLEEP MEDICINE

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%

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

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Safety Impacts of Too Little Sleep

Drowsy driving is a RED ALERT!

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Being awake for 18 hours is similar to being legally drunk

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

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What is OSA?

• Cessation of airflow with ongoing respiratory effort

Overview of OSA

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

Sleep Apnea Risk Factors

•Obesity

•Male gender

•Family History

•Small/recessed jaw

•Age

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

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

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

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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!”

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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

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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

Ho

urs

pe

r N

igh

t

N=1083

Participants Hours of Sleep

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Harvard Study Results

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sleep withSmart Phone

Email/TextBedtime

Email/TextRisetime

Never

Rarely

Sometimes

Often

Always

N=1083

Technology Behaviors

40

Harvard Study Results

0

2

4

6

8

10

12

14

% < 6 Hours Sleep

N=1083

Not Digitally Connected Digitally Connected

41

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

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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

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SLEEP AND WORK: WHAT CAN BE DONE?

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

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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.

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Organizational Actions – Mitigate Risk

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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.

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

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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?

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.

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

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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?

What to Expect from a Sleep Evaluation

• Detailed sleep history

• Bedtimes

• Waketime

• Napping behavior

• Snoring history

• Nighttime movements

• Physical examination

• Medical history

• Sleep Study

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

Q & A