Dr Alex Bartle. Director Sleep Well Clinic
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1 Dr Alex Bartle Director Sleep Well Clinic 1
2
3 Fatigue in the Workforce The structure of sleep Fatigue and sleep Consequences of fatigue Management of Shiftwork Conclusion
4 Sleep Architecture REM NREM Rapid Eye Movement Non-Rapid Eye Movement Stages 1 and 2 light sleep Stages 3 and 4 deep sleep 25% REM, 50% Stage 2 and 25% stages 3 and 4
5
6 FATIGUE Causes and Effects Fatigue is a complex state, characterised by lack of alertness and reduced mental and physical performance often accompanied by drowsiness. Fatigue is more than sleepiness and its effects go beyond falling asleep
7 FATIGUE Causes and Effects No physiological markers or blood tests Unlike alcohol However, there are a number of factors that can result in fatigue
8 Fatigue Effect of fatigue/sleep deprivation Increased irritability and lower stress tolerance Low motivation ( Can t be bothered ) Faulty judgment Lapses in attention and vigilance Impaired decision making and logical reasoning
9 Fatigue Effect of fatigue/sleep deprivation Poor concentration Learning and Memory difficulties Personality changes Adverse effect on Women s reproductive system Reduced Libido
10 Fatigue Effect of fatigue/sleep deprivation Slowed reaction time Susceptibility to illness Increased sensitivity to pain
11 Consequences of Sleep Deprivation Accidents At work (especially 3am 5am) To and from work
12 Sleep Statistics Fatigue and Excessive Daytime Sleepiness (EDS) Fatigue affects the lives of 20% - 50% of NZers 10% - 15% suffer from Chronic Insomnia 100,000+ car accidents in the US are the result of EDS 20% fall asleep while driving at some time
13 Sleep Statistics Fatigue was a major contributing factor for the following: The Three Mile Island disaster, 1979 (4.00am) Chernobyl, 1986 (1.30am) The grounding of the Exxon Valdez, 1989 (12.04am) Disastrous launch of the Challenger, 1986
14 SHIFTWORK How to Remain Alert at Night Avoid sleep debt Understand and respect the body clock Light Nutrition and stimulants
15 SHIFTWORK How to Remain Alert at Night (cont) Introduce interest Maintain muscular activity Temperature Noise
16 SHIFTWORK How to Improve Sleep after Nightshift Sleep as soon as possible after shift Avoid morning light Try to have one block of sleep only Use black-out curtaining / eye shades / ear plugs Disconnect phone / answer machine use call minder
17 SHIFTWORK How to Improve Sleep after Nightshift (cont) Avoid stimulants at work and sedatives at home Try to anticipate shift changes Inform neighbours and friends Discuss with family
18 SLEEP DEPRIVATION IN THE WORKFORCE Individual - Personal lifestyle choice - Personal responsibility - Economics/job availability - Genetics owl lark SWSD. (Shift Work Sleep Disorder) - Medical fitness - Age
19 SLEEP DEPRIVATION IN l Alertness Strategies - Naps - Caffeine - Good sleep habits - Managing the sleep environment - Exercise - Diet - Medication - Sleep scheduling
20 SLEEP DEPRIVATION IN Individual Investigate specific sleep disorders OSAS 4% Insomnia 10-15% RLS/PLM s 10-15% SWSD
21 SLEEP DEPRIVATION IN THE WORKFORCE Conclusion - The 24hr society is here to stay - Work outside normal biological circadian rhythms & attendant sleep loss leads to increasing health & safety risks. - Shiftwork affects societies, organisations & individuals - environmentally, economically and in health & well-being - Although solutions are complex, there are solutions through education.
22 FATIGUE vs SLEEPINESS SOCIAL PSYCHOLOGICAL SLEEP RHYTHM PHYSIOLOGICAL FATIGUE TREATMENTS
23 FATIGUE vs SLEEPINESS PSYCHOLOGICAL SLEEP RHYTHM PHYSIOLOGICAL MEDICATION SLEEPINESS
24 Two Most Common Sleep Disorders Are 1) Insomnia 10 15% of adults suffer from chronic and severe insomnia 2) Snoring and Obstructive Sleep Apnoea (OSA) Snoring up to 60% adults snore regularly OSAS 4% of males, 2% females over 40
25 Sleep Hygiene for those with insomnia Behavioural Sleep Hygiene involves improving factors required for the maintenance of a normal, regular sleep/wake cycle. eg. Avoid stimulants/alcohol, Exercise regularly, Bedroom environment comfortable, dark, quiet. Regular sleep schedule. Allow 1hr unwind time. Important, but by itself, rarely effective
26 Stimulus Control for those with insomnia Stimulus Control is based on classical conditioned response to certain stimuli. This involves strengthening the relationship between bed and sleep, and breaking the negative relationship between bed and anxiety and wakefulness Important and Effective
27 Stimulus Control Therapy Go to bed when sleepy Do not watch TV, read, eat or worry while in bed Do not nap during the day Set regular wake up/get up time including weekends Get out of bed if unable to fall asleep in minutes, or anxious. Remain up for minutes only. Repeat as often as necessary
28 Bed Restriction Therapy for those with insomnia Bed restriction therapy is designed to improve sleep consolidation and sleep efficiency. This is achieved by initially increasing the homeostatic drive to sleep. Sleep efficiency is improved. Time in bed can then be increased The most difficult, but the most effective
29 Bed Restriction Therapy Average the time asleep over 2 weeks Add ¼ - ½ Hour Restrict time in bed to that time (never less than 5hrs) Increase time in bed slowly when sleeping is consolidated to 85% - 90%. Restrict further if < 80%
30 Medical problems associated with Insomnia Gastrointestinal x 3.33 Chronic pain x 3.19 Hypertension x 3.18 Heart Disease x 2.27 Cancer x 2.17 Diabetes x 1.8
31 Thank You Dr Alex Bartle The SLEEP WELL Clinic Christchurch, Auckland, Wellington Nelson, Tauranga, Whangarei
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