Poor Sleep and the Workplace: What You Need to Know
Over one third of U.S. adults have sleep issues, costing employers over 1.2 million working days and $411 billion annually. Here’s how you can help.
The Critical Role of Sleep in Wellness
No matter which “Pillars of Health” model you look at, sleep is recognized as a critical pillar in all of them. In fact, studies like this one have found that when rats are totally deprived of sleep they develop critical bodily malfunctions and die in just a matter of weeks. This isn’t surprising when you consider that many of the body’s major restorative mental and physical functions take place mostly, or in some cases only, during sleep.
How Poor Sleep Impacts Employee Health
We all recognize how a bad night’s sleep can impact an employee’s mood and ability to concentrate and perform tasks. However, what many don’t realize is that sleeping poorly on a regular basis can also have devastating long-term effects on health.
Here’s an impactful infographic from Johns Hopkins Medicine that you can use to create awareness about the health consequences of sleep deprivation.
The business impact of the health consequences is obvious, especially for employers with self-insured healthcare plans. While these conditions may take a relatively long time to develop, the negative impact of poor sleep habits on things like productivity and accident rates are far more immediate.
How Poor Sleep Impacts the Workplace
A large study recently published in the American Journal of Health Promotion says it all. The study looked at the association between the sleep and productivity of nearly 600,000 employees in multiple industries. When compared with employees who slept 8 hours per night:
- Employees who slept 10 or more hours per night missed an average of 1.6 more days of work and had 2.2 times more productivity loss
- Employees who slept 5 or less hours per night missed an average of 1.5 times more days of work and had 1.9 times more productivity loss
The study also found that on average, employees who reported “almost always” feeling tired during the day missed an average of 2.7 times more days of work and had 4.4 times more productivity loss than those who reported “almost never” feeling tired.
The employee sleep issue is far more prevalent than many employers realize. According to the Centers for Disease Control and Prevention (CDC), more than 35% of U.S. adults are getting less than the recommended minimum of 7 hours of sleep per night. The behavioral impacts are staggering.
The American Sleep Association tells us that insomnia is the most common specific sleep disorder, with short term issues reported by about 30% of adults and chronic insomnia by 10%. They also tell us that:
- 37.9% of adults reported unintentionally falling asleep during the day at least once in the preceding month
- 4.7% reported nodding off or falling asleep while driving at least once in the preceding month
Over 40% falling asleep on the job or behind the wheel? Wow! Productivity loss is one thing but imagine the legal and other risks – especially for a company that employs drivers, truckers, machinists and heavy equipment operators.
According to a study published in the Journal of Occupational and Environmental Medicine, moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Would management be okay if a combined 40% of its workforce either showed up to work drunk or drove drunk once a month? I think not.
The Economic Impact of Poor Sleep
According to a RAND Corporation study, the impact on the U.S. economy is devastating, including:
- Up to $411 billion a year in economic losses
- An equivalent of about 1.23 million lost working days every year
According to the National Safety Council:
- A fatigued worker’s reduced productivity costs employers $1,200 to $3,100 per employee annually
- A typical employer with 1,000 employees can expect to experience more than $1 million lost each year to fatigue ($272,000 due to absenteeism and $776,000 due to presenteeism)
- An additional $536,000 in healthcare costs could be avoided with optimization of sleep health
As we can see, the impact of poor sleep is extremely serious – for both employee and employer. If a robust sleep initiative is not yet part of your employee wellness program, the time to put it in place is now.
So how do you deal with poor sleep effectively? The first step is to understand what causes it in the first place.
How Insomnia Starts
One of the most obvious causes of poor sleep is lack of self-discipline. A good example is the person who got only 4 hours’ sleep because he/she couldn’t resist staying up till 2am playing video games.
But that’s not what we’re talking about here. Neither are we talking about employees who keep hitting the snooze button because they hate their job and want to delay the inevitable for as long as they can.
What we are talking about here is not a discipline problem – it’s an employee’s inability to get enough sleep even though they want to. In other words, insomnia.
Insomnia, which affects 30% of American adults, almost always originates from one of 3 starting points:
Medical or Health Issues
Anyone with chronic pain can tell you that it interferes with sleep. Many other medical conditions can also interfere with sleep – everything from gastrointestinal illnesses and diabetes to depression and post-traumatic stress disorder.
Then there are medical sleep disorders such as sleep apnea, which affects over 20 million Americans. Although often confused with snoring, people with sleep apnea stop breathing momentarily so it should be taken seriously. A “nasal continuous positive airway pressure” (CPAP) machine may be an effective treatment.
Another sleep disorder to be aware of is narcolepsy, which is a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. Employees with narcolepsy usually feel rested after waking, but then feel very sleepy throughout much of the day.
If an employee is having trouble sleeping due to pain, a suspected sleep disorder, or a medical condition, we suggest you recommend that they get professional help before chronic insomnia develops.
Ongoing Stressful Situations
Possibly the most common starting point of insomnia is an ongoing stressful situation. For instance, financial difficulties or relationship difficulties can create constant stress and anxiety.
Worrying about the bills or emotional discord makes healthy, deep sleep very hard to achieve. And as we will soon find out, the very things uninformed employees do to try and sleep in these circumstances are a recipe for the curse of chronic insomnia to set in.
Lack of a Good Sleep Routine
The third starting point for insomnia is the lack of a good sleep routine. When employees go to sleep and wake up at inconsistent times during the week, their body clock – the mechanism that regulates their body’s daily sleep and wake cycles – gets thrown off and cannot prepare them for sleep.
Shiftwork is particularly problematic, because constantly changing shifts disrupts the consistent sleep routine that your body clock needs to maintain its natural rhythm. Frequent travelers are also at risk, because they are regularly in different time zones and often have no set sleep routine.
Understanding the Awful Curse of Chronic Insomnia
Virtually everyone has experienced insomnia at one time or another, and there’s no doubt about it – it’s a beast. Your mind starts churning and you spend what seems like hours tossing and turning, only to wake up feeling like you haven’t slept a wink. Your mind is fuzzy, you have a slight headache, and you’re dreading the day ahead. Your mood isn’t the best either – as your poor co-workers will soon find out!
Fortunately, most insomnia is short-term in nature, and passes before its effects become too damaging. For instance, an employee lies awake all weekend worrying about Monday’s performance review, but they sleep fine again come Monday night – assuming the review went well, of course!
However, chronic insomnia is a very different story. Not only can it can turn the employee’s entire life upside down, unless they know the right way to deal with it, it’s virtually impossible to get rid of.
Chronic insomnia usually takes one of 3 forms:
- Difficulty falling asleep
- Waking up during the night and not being able to get back to sleep
- Waking up too early
Most people assume it’s caused by the event that created the sleep difficulties in the first place – job worries, relationship difficulties, etc. But that’s not it.
The door to chronic insomnia opens when an employee realizes they’ve been sleeping badly for a while. If they begin to worry about not sleeping well when they go to bed, their thoughts may become a self-fulfilling prophesy, creating anxiety and causing them to sleep poorly again.
As the cycle perpetuates itself night after night, the employee’s beliefs and thoughts about not being able to sleep eventually become embedded in the subconscious parts of the brain, where the employee has little control over them. At this point they have successfully formed a new habit – the health-robbing, productivity-sapping habit of chronic insomnia.
But the problem doesn’t end there.
Unfortunately, employees with insomnia usually try to solve it in ways that may seem logical but have just the opposite effect. Rather than fixing the problem, they add to their psychological woes by throwing their body clock off. This makes the problem even worse.
Here are a few examples of common mistakes that can cause or perpetuate insomnia, and why:
- Staying in bed more than 15-20 minutes when you can’t sleep – trains your brain to stay awake in bed
- Going to bed earlier or sleeping in to try and catch up on sleep – varying your sleep routine disrupts your body clock
- Reading or watching TV in bed – trains your brain that your bed is a place for staying awake
- Napping – disrupts your body clock
- Drinking alcohol close to bedtime – disrupts sleep and interferes with functions related to long-term memory
So, what can you do to solve your employees’ chronic insomnia issues?
The Best Way to Reverse Chronic Insomnia
As we know, the first thing many employees tend to do when confronted with a health issue is to try medication. It’s no different with insomnia. So how effective is sleep medication? As noted in this comprehensive literature review, sleep medications may be a helpful short-term treatment for insomnia. However, long-term use is not recommended due to side-effects and issues with dependence and tolerance. Besides, think how chronic insomnia develops in the first place.
In order to reverse it, two things need to happen:
- The brain needs to be trained to revert to its pre-insomnia beliefs and thoughts
- The body clock needs to be reset to its pre-insomnia state
In other words, the treatment should be both cognitive and behavioral in nature. This explains why research like this Harvard Medical School study have found cognitive behavioral therapy (CBT) to be significantly more effective than a medication in treating chronic insomnia.
According to Mayo Clinic, “CBT-I is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.”
CBT-I can be delivered one-on-one or in group settings by a therapist, or via scalable and cost-effective online solutions that fit neatly into corporate wellness programs.
However, the irony is that no matter how effective CBT-I is on paper, it won’t work for an employee that doesn’t follow the prescribed behavior change protocol. Unfortunately, that’s often exactly what happens.
Getting Employees to Follow the Behavior Change Protocol
The reason adherence rates aren’t higher in CBT-I is that it tells the employee which behavioral changes to make, but not how to make them. To explain how this affects CBT-I participants, I first need to give you some context.
My organization’s expertise is helping people to eliminate tough-to-break behaviors, and 30-plus years of research and experience have taught us that habits with an emotional component are the hardest to change. The reason is that when people try to change an emotionally-driven habit, the brain perceives it as a threat and sends out alarm signals in the form of anxiety, frustration, deprivation – sometimes even physical urges. The feelings are uncomfortable and when ignored, they usually grow more intense – until they finally “force” the person to go back to their old behavior to get rid of them.
It’s interesting to note that this is the chief reason smokers have such a hard time staying quit and dieters put the weight back on. But let’s look at how it affects a chronic insomniac. Here’s an example:
An important behavioral protocol for a chronic insomniac is to get out of bed if they’ve been lying awake for 15-20 minutes without falling asleep. If they don’t get up, they will continue to perpetuate their brain’s dysfunctional subconscious belief that the bed is a place for lying awake.
Yet the thought of getting out of the nice comfy bed and wandering around in the middle of the night is an uncomfortable one so the odds are that this protocol will not be followed for long. The result: the subconscious brain will continue to think the bed is a place for staying awake, and the chronic insomnia will continue.
In other words, when you implement a sleep program, make sure it not only provides a form of CBT-I but is also designed to provide participants with the necessary knowledge, skills and tools to overcome the emotional roadblocks they will face.
Everyday Tips for Sound Sleep
In addition to implementing a sleep program, here’s a list you can use to educate your employees about the basics of getting a good night’s sleep. The list was developed by SelfHelpWorks in conjunction with Dr. Michael Grandner, one of the country’s foremost sleep experts and co-creator of our LivingWellRested® online program.
- Keep your sleep schedule as regular as possible
- Do not go to bed early, even if you are tired
- Write down the problems you will have to deal with tomorrow, then forget about them
- Keep electronics out of bed
- Eat well and exercise regularly
- Stop drinking alcohol at least two hours before bedtime
- Love your room and your pillow
- Stay hydrated – drink about a cup of water an hour
- If you can’t sleep within 15-20 minutes of putting the light out, get out of bed
- Before you go to bed, visualize yourself falling asleep quickly and sleeping throughout the night
- Shoot for seven to eight hours of sleep every day
- Greet each day with enthusiasm – throw open your shades, get the tea or coffee brewing, and get your blood pumping
If you always feel tired and don’t sleep well, or sleep too much, get professional help from your doctor or a mental health counselor.
Workplace Fatigue: Organizational Causes
The following list is based on results from the 2017 National Employee Survey on Workplace Fatigue, which is packed with valuable information and is well worth downloading:
- Shift work – 17% of the workforce works a non-day shift. Night shifts, early morning shifts, rotating and irregular shifts can contribute to fatigue.
- High-risk hours – 41% must occasionally work at high-risk times. Employees who even occasionally work at night or in the early morning are at risk.
- Demanding jobs – 81% have jobs with a high risk of fatigue. Jobs that require sustained attention, are physically or cognitively demanding can increase risk.
- Long shifts – 21% work long shifts. Working 10 or more hours can be physically and mentally exhausting.
- Long weeks – 22% work long weeks. Working 50 or more hours a week is tiring.
- No rest breaks – 10% do not get a rest break. Rest breaks mitigate fatigue risk by giving a worker time to recuperate from job demands.
- Quick shift returns – 14% get less than sufficient time off between shifts. Employees need at least 12 hours between shifts to recover.
- Long commutes – 31% have long commutes. Long commutes decrease the time available to recover.
As you can see, these issues can generally be addressed by simply changing and/or enforcing corporate policies. Especially in the case of a less-informed organization, working with management to create awareness and implement appropriate policies to reduce workplace fatigue could literally save a fortune – both in dollars and in human lives.
Bringing Healthy Sleep to the Workplace
Here’s a brief list of items to consider in putting together an effective sleep initiative:
- Familiarize yourself with the research behind poor sleep and fatigue.
- Make the entire C-Suite aware of the prevalence and impacts of poor sleep and workplace fatigue. Get their buy-in.
- Compare the organization’s policies with the list above and work with the relevant departments to revise as applicable.
- Publicize the updated policies and follow up with applicable departments to ensure they are being followed to manage fatigue.
- Select and implement a good sleep solution that includes both CBT-I and training that enables participants to overcome emotional roadblocks to adherence.
- Put up posters and infographics in your workplace to maintain awareness and promote your sleep program.
- Provide regular sleep education workshops to the entire workforce.
- Include fatigue as a prominent topic in your safety sessions.
- Make educational materials available to the workforce (tip: check out the books and brochures available from WELCOA).
- Share fatigue risk factors in your newsletters and other communications.
- Incorporate activities like sleep disorder screenings and a sleep management course into your wellness program. Consider incentivizing them when appropriate.
About the Contributor // Bryan Noar is the VP of Strategic Partnerships at SelfHelpWorks, and an avid member of WELCOA who is always glad to discuss all things wellness.
About SelfHelpWorks // Since 1999, SelfHelpWorks has provided online video-based lifestyle and disease management programs for health plans, employers, and providers to reduce health risk within organizations. SelfHelpWorks targets the psychological drivers of unhealthy behaviors so individuals can make and maintain healthy lifestyle changes. The company offers programs on obesity and unhealthy eating, tobacco addiction, diabetic lifestyle adaptation, chronic stress, insomnia, alcohol overuse and physical inactivity. For more information and to download our free 2019 Wellness Program Considerations report, please visit us at www.selfhelpworks.com.