Dr Dingle's Blog / accidents
In today’s busy and hectic society many see sleep as a luxury rather than what it is – a necessity. More and more people are working overtime, and shift work trying to juggle a busy family life around their work. Along with this, it is not unusual for both parents to be working full time. The advent of our 24/7 society has pushed regular sleep to the side. Because of this, many men and women (and even children) wrongly consider sleep a waste of time.
Sleep is an essential element of the human body, without it we cannot survive. Getting enough sleep is associated with energy, joy, optimistic thinking and coping with negative emotions. Despite this almost 90 percent of Australians suffer from some type sleep disorder at some stage of their lives. Of these, 30 percent suffer from severe sleep disorders. Very few people regularly enjoy the amount or quality of sleep that they need. The estimated economic costs to the country from this are between $3 billion and $7 billion annually. There are also huge, unmeasured physical, psychological, emotional and social costs.
Sleep is complicated in the way that there are many different factors that influence the effectiveness of sleep. It’s not just duration that determines the effectiveness of said sleep, factors such as quality, frame of mind and deepness all contribute to the maximum desired outcome and even our perception of how we sleep. Many factors can play a part in the quality and quantity of our sleep and to maximise our sleep time an understanding of this is essential.
On average a healthy person will spend around one third of their life sleeping (Duman et al, 2009). Sleep is considered a natural periodic state of rest for the mind and body, in which the eyes will usually close and consciousness is completely or partially lost resulting in a decrease in bodily movements and responsiveness to external stimuli (Blanch et al, 2009). Inadequate hours of good quality sleep leads to a disruption to vital biological processes resulting in a decrease in cognitive function mental and physical health (Anderson et al, 2009) including impaired work performance due to a decrease in attention, judgement and responsible decision making (Volkow, 2009).
Why we sleep
Mammals are naturally diurnal animals and sleep for humans are broken into two distinct phases. These phases, Non Rapid Eye Movement (NREM) and Rapid Eye Movement (REM), represent the depth of sleep and electrical activity in the central nervous system (CNS) (Cirelli & Tononi, 2008). However, sleep is a heightened anabolic state where rejuvenation of many organ systems occurs, especially the immune and nervous systems. NREM is further broken into phases one to three during which have different waves of sleep and cognitive perceptions, phase one for example is associated with hyper‑CNS responses. During this phase the body may quickly jerk out of steep and this will be felt as a falling sensation (Walsh, 2009). Various genetic mutations have been associated with sleep including DEC2 mutations that lower the sleep requirement from eight hours to six and the 600072 prion gene that predisposes to Fatal Familial Insomnia (Kniff in, 2009; McKusick and Kniffin, 2009). The natural circadian rhythms of the body are a result of variations in levels of circulating melatonin hormone, from the pineal gland, and also adenosine levels which increase over the course of the day (Imeri & Opp, 2009).
Among the theories on why humans sleep, scientists have proposed the following:
Sleep may be a way of recharging the brain. The brain has a chance to shut down and repair neurons and to exercise important neuronal connections that might otherwise deteriorate due to lack of activity or over activity.
Sleep gives the brain an opportunity to reorganize data to help find a solution to problem, process newly learned information and organize and archive memories.
Sleep lowers a person’s metabolic rate and energy consumption.
The cardiovascular system also gets a break during sleep. People with normal or high blood pressure experience a 20 to 30% reduction in blood pressure and 10 to 20% reduction in heart rate.
During sleep, the body has a chance to replace chemicals and repair muscles, other tissues and aging or dead cells.
In children and young adults, growth hormones are released during deep sleep (World Federation of Sleep Research and Sleep Medicine Societies
Immune function is highest when we sleep
Detoxing. There appear to be “hidden caves” inside the brain, which open up during sleep, allowing cerebrospinal fluid (CSF) to flush out potential neurotoxins, like β-amyloid, which has been associated with Alzheimer’s disease. The research discovered “hidden caves” inside the brain, which open up during sleep, allowing cerebrospinal fluid (CSF) to flush out potential neurotoxins, like β-amyloid, which has been associated with Alzheimer’s disease. The interstitial spaces in the mouse’s brain took up only 14% of the brain’s volume while it was awake. Yet, while it slept, this increased by almost two-thirds to take up fully 23% of the brain’s total volume. The effect is that potential neurotoxins, like β-amyloid, are cleared twice as fast during sleep as during waking. While many neurological diseases, like strokes and dementia, are associated with problems sleeping. It could be that lack of sleep, and restriction of the brain’s cleaning system, may cause toxic metabolites to building up, leading to long-term damage.
Most likely we sleep for a combination of these reasons
Part 2 and more coming
Sleep, like most other processes in our body, is mediated by the interaction of cytokines and chemokines with neurotransmitters (Dilger & Johnson, 2008). During infection our sleep patterns change and interactions of cytokines, especially IL‑1 and IL‑1 2 and the neurotransmitter serotonin amplify (Dantzer et al. 2008; Lange et at. 2006). During sleep, it has been suggested that, the synapses not used during the day's activities are given an opportunity to prime and regenerate, cognitive function also rejuvenates, memories are consolidated and on a cellular level glycogen stores can re‑fuel. However, sleep deprivation has been associated with inflammatory based diseases including obesity, Cardiovascular Disease and Diabetes (lmeri & Opp, 2009).
Sleep deprivation has been shown to further enhance end stage renal disease, decrease vaccine efficacy as attested with both Influenza and Hepatits A vaccines, prolong wound healing, lengthen critical care stays and enhance depression or other psychiatric disorders (Lange et al. 2003; Miller et al. 2004; Koch et al. 2009).
Several recent studies report that reducing sleep to 6.5 or fewer hours for successive nights causes potentially harmful metabolic, hormonal and immune changes. All of the changes are similar to those detected in the normal aging process (Cobb, 2002) and so sleep deprivation could be the biggest indicator of how long you live (Sateia, et al., 2004). There is a strong link between sleep deprivation and low immune system function (Redwine, et al., 2003). A reduction of sleep makes people more prone to infection and potentially more prone to cancer; one study found that poor sleep was associated with a 60 percent increase in breast cancer.
In one study of 153 volunteers who spent less time in bed, or who spent their time in bed tossing and turning instead of snoozing, were much more likely to catch a cold when viruses were dripped into their noses, while those who slept longer and more soundly resisted infection better. The study showed that even relatively minor sleep disturbances can influence the body's reaction to cold viruses ( Cohen et al Archives of Internal Medicine). The men and women who reported fewer than seven hours of sleep on average were 2.94 times more likely to develop sneezing, sore throat and other cold symptoms than those who reported getting eight or more hours of sleep each night. Volunteers who spent less than 92 percent of their time in bed asleep were 5 1/2 times more likely to become ill than better sleepers, they found.
Sleep deprivation also contributes to the physiological state known as fatigue. A fatigued person is accident prone and judgment impaired. After approximately 20 hours of no sleep, reaction times are comparable to having a blood alcohol reading of .08. Staying awake for 24 hours leads to a reduced hand‑to‑eye coordination that is similar to having a blood alcohol content of 0.1. An example of a sleep deprivation accident occurred when a space shuttle mission was aborted 30 seconds before lift‑off because a technician who had worked several consecutive l2hr shifts accidentally released 18,000 pounds of liquid fuel just minutes before the scheduled flight. An investigation of the Challenger space shuttle disaster attributed ground crew fatigue as one of the factors contributing to the disaster. An incident such as this shows the seriousness of the situation and the potential loss of life through human related errors in technical fields. Even operating simple machinery such as forklifts can become extremely dangerous if the operators are not filly alert. Other examples of work related sleep deprivation include a flight which flew 100 miles out over the Pacific before controllers on the ground were able to wake the pilots up using chimes, piped into the cockpit audio. It is common practice for flight attendants to check in on pilots to ensure they do not fall asleep. The Exxon Valdez oil spill occurred on a ship with a crew that had had very little sleep, with the accident happening in the middle of the night.
45 to 80% of all nursing home residents suffer from chronic pain and this pain is strongly linked to insomnia (Dodla and Lyons, 2006). In Japan a survey conducted by Tanaka and Shirakawa (2004) found that one in five Japanese people suffer from insomnia, and within the elderly population one in three suffer, because of this the Japanese government increased the needs of insomnia patients at community health sites and names insomnia a refactory disease of the 21st centuary. A similar Honk Kong based study found 11.9% of Chinese people living in Honk Kong suffer from insomnia approximately three times a week and the females were 1.6 times more likely to show symptoms of insomnia than males (Li et a!. 2002).
Accidents, errors and Risk taking
Studies using card games have found that with little sleep, players get stuck in a strategic rut. Sleepy people keep taking risks, even though it’s obviously not working for them.
A study of musicians who practised a new song had improved in speed and accuracy compared with before a night’s sleep. a good night’s sleep can also improve motor performance.
In a study of 1891 male employees compared with those working 6-8 h day(-1) with good sleep characteristics, positive interactive effects for workplace injury were found between long work hours (>8-10 h day(-1) or >10 h day(-1) ) and short sleep duration (<6 h). This study suggests that long work hours coupled with poor sleep characteristics are synergistically associated with increased risk of workplace injury. Greater attention should be paid to manage/treat poor sleep and reduce excessive work hours to improve safety at the workplace (Nakata 2011).
A study looking at the effect of working “standard shifts” (that is, the traditionally accepted long, sleepless shifts) for hospital interns showed that the interns made 36 percent more serious medical errors during a standard work schedule compared to during an intervention schedule that eliminated extended work shifts. The errors included significantly more serious medication errors and 5.6 times as many serious diagnostic errors. As a consequence, the overall rates of serious medical errors were significantly higher during the standard schedule than during the intervention schedule (Landrigan, 2004). Fortunately, most serious medical errors were either intercepted by people who were awake and concentrating or did not result in clinically detectable harm to the patient. How does this affect you? It might be all right if you could always go into hospital at the beginning of the shift or be operated on only by doctors who had just started a shift.
One study found that interns who worked 24-hour shifts made 36 percent more medical errors than those working 16-hour shifts and five times the number of diagnostic errors, and were 61 percent more likely to accidentally cut themselves during procedures.
The study found that the rates of serious medical errors in two intensive care units “were lowered by eliminating extended work shifts and reducing the number of hours interns worked each week.” By asking interns to work less, the hospitals improved their performance.
A number of studies have highlighted the increased number of motor vehicle accidents associated with young adults driving fatigued. It’s conservatively estimated that at least 112 lives could be saved in Australia if fatigue and falling asleep at the wheel were eliminated.
Several studies have highlighted the increased number of motor vehicle accidents associated with young adults driving while fatigued. Fatigue is estimated to be responsible for 35 percent of road accidents. It’s conservatively estimated that at least 112 lives could be saved in Australia every year if fatigue and falling asleep at the wheel were eliminated. In the United States, the National Highway Traffic Safety Administration (NHTSA) reports that fatigue and sleep deprivation contribute to about 100,000 highway crashes each year, causing more than 1,500 deaths annually (Sullivan, 2003). At a grander level the 1989 Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster and the Chernobyl nuclear accident have each been attributed to human errors in which sleep deprivation played a role (Grunstein, 2000).
Research on 59 participants, those who were confirmed night owls (preferring late to bed and late to rise) had lower integrity of the white matter in various areas of the brain (Rosenberg et al 2014). Lower integrity in these areas has been linked to depression and cognitive instability.
Sleep and weight
Obesity in another disorder linked with insomnia. Research shows that diets that are higher in saturated fats are more susceptible to chronic diseases and disorders which includes insomnia (Novak et al. 1995). This is an alarming fact as 20% of the population of the United States of American are overweight or obese (Patterson et al. 2004).
Many studies, including one spanning twenty years, have tested the hypothesis that sleep and obesity are linked and the majority of results show positive correlations (Gangwisch et al. 2005). Further studies, with over 500,000 total participants via meta‑analysis have supported obesity and insomnia in adults and children (Cappuccio et al. 2008). The trends of increasing BMI and reduced sleep hours appear to go hand in hand, along with sleeping troubles related to Sleep Apnoea often seen in obese patients.
This link between Obesity and the symptoms of its associated diseases demonstrates a common trend towards diminishing an individual’s peak performance. Obesity and many of the health conditions which result from it increase the lower productivity levels associated with lower mental and cognitive functioning.
Obesity is also a serious factor in poor sleep habits. In a number of studies obesity was associated with "reduced sleeping hours " (Ko et al (2007). Obesity, particularly abdominal and upper body obesity, is the most significant risk factor for Obstructive Sleep Apnea (OSA). Patients with sleep apnea often experience daytime sleepiness and difficulty concentrating (Teran-Santos et al, 1999). Studies have also shown a strong association between sleep apnea and the risk of traffic accidents (Terán-Santos et al (1999). In fact, subjects suffering from sleep apnea were at a higher risk than those who had consumed alcohol to be involved in a traffic accident. This has major implications, particularly for overweight and obese workers using any form of equipment of driving vehicles.
This lack in sleep will then leave the employee going to the work already feeling tired, irritable and stressed, therefore making it difficult to concentrate, and highly increasing the chances of being injured or making a mistake which may put fellow workmates in danger (Lynch, 2005) It is situations like this, where the worker comes to work already feeling tired, that the employee is putting his safety and other's safety at risk.
Shift workers are known to be a high-risk group for obesity. In the current study population, rotating-shift workers showed a higher distribution of the highest body mass index compared with daytime workers
In a study of the brains of 24 participants after both a good and a bad night’s sleep. after disturbed sleep, there was increased activity in the depths of the brain, areas which are generally associated with rewards and automatic behaviour. It seems a lack of sleep robs people of their self-control and so their good intentions are quickly forgotten.
What we have discovered is that high-level brain regions required for complex judgments and decisions become blunted by a lack of sleep, while more primal brain structures that control motivation and desire are amplified.”
In other words: lack of sleep robs people of their self-control and so their good intentions are quickly forgotten.
On top of this, the researchers found that after being deprived of sleep, participants displayed greater craving for high-calorie junk food. The more sleep-deprived they were, the greater the cravings. A stufy of 13,284 teenagers found that those who slept poorly also made poor decisions about food. Similarly, a Swedish study found that at a buffet, tired people were more likely to load up their plates.
The link has even been made from poor sleep through to food shopping. A Swedish study found that men who were sleep-deprived bought, on average, 9% more calories than those who’d had a good night’s sleep. These results were likely the result of the poor decision-making. It had been thought that the tendency to eat more after poor sleep was related to the so-called ‘hunger hormone’ ghrelin. But the latest studies suggest that it’s simple self-control that is most important in causing the sleep-deprived to over-indulge.
Obvious symptoms of sleep deprivation constant yawning and the tendency to doze off when not active for a while; for example, when watching television, Grogginess when waking in the morning Sleepy grogginess experienced all day long (sleep inertia) Poor concentration and mood changes (more irritable).
Some of the physical effects found from long term fatigue are heart disease, diabetes, high blood pressure, gastrointestinal disorders and depression (Workplace health and safety QLD, 2008). A study conducted by Andersen involving rats also showed sleep deprivation affects the expression of genes related to metabolic processes, response to stimulus and signalling pathways (Andersen et al, 2009).
Numerous studies have shown that even a little bit of sleep deprivation decreases efficiency and increases risk of disease, including cardiovascular disease, cancer and diabetes. Sleep deprivation has been shown to negatively affect endocrine (hormones) and metabolic functioning as well as nervous system balance (Nilsson, et al., 2004). Sleep deprivation is associated with an increased concentration of cortisol plus other indicators of increased stress such as elevations in pulse rate, body temperature and adrenaline secretion (Vgontzas, et al.,1999). Sleep deprivation also appears to increase blood concentrations of certain chemicals called cytokines and C-reactive proteins (Irwine, 2001 and Vgontzas, et al., 1998), indicating an inflammatory reaction. The effect of unremitting low-grade inflammation may be to damage the inner walls of the arteries, which sometimes leads to vessel narrowing, high blood pressure, stroke, and heart disease (Irwine, 2001). During truncated sleep, your heart might have to work harder, constricting blood vessels and increasing blood pressure even more, which could conceivably result in a heart attack or stroke (Martins, 2003).
Sleep is as important to the human body as food and water, but most of us don’t get enough sleep. Insufficient sleep or disruptions to the sleep contribute to adverse health effects. Numerous studies have also shown that even a little bit of sleep deprivation decreases efficiency and increases risk of disease, including cardiovascular disease.
Initial changes to cardiovascular system from insomnia include hypertension, which is a potent co‑morbidity for other cardiovascular diseases. Hypertension has been linked to reduced sleep duration, with the highest correlation shown under 6 hours sleep per night (Gottlieb et al. 2006). However, associations have also been made between sleep of over 9 hours per night and hypertension and obesity. Furthermore this has not been supported at all in some studies and PPI in one older North American population actually showed a reduced risk of hypertension (Phillips, BOková and Enrigh, 2009.).
A study of 71,617 female health professionals found that sleeping fewer than five hours per night was associated with a 39 percent increase in the risk of coronary heart disease; even six hours per night showed an increase of 18 percent compared to sleeping eight hours per night (Najib, et al., 2003). In an analysis of data on more than one million people, the levels of nearly all forms of death were two-and-a-half times higher for people who slept four hours or less compared to those who slept between seven and eight hours on average
A study of 71,617 female health professionals found that sleeping fewer than five hours per night was associated with a 39 percent increase in the risk of coronary heart disease; even six hours per night showed an increase of 18 percent compared to sleeping eight hours per night. In an analysis of data on more than one million people, the levels of nearly all forms of death were two-and-a-half times higher for people who slept four hours or less compared to those who slept between seven and eight hours on average
Experimentally, sleep deprivation has been shown to negatively affect glucose metabolism and to enhance factors associated with Type 2 diabetes (Nilsson, et al., 2004). Research has also shown that people who experience sleep disorders were as much as three times as likely to develop Type 2 diabetes (Kawakami, 2004). Subjects in one study demonstrated impaired glucose tolerance for ten days after four hours of sleep deprivation (Spiegel, et al.,1999). It is also found that sleep deprivation can play a role in obesity. Sleep deficits bring about physiologic changes in the hormonal signals that promote hunger and, perhaps thereby, obesity (Spiegel, et al., 2004). One study found that after two days of sleep curtailment the subjects had reduced levels of the fat-derived hormone leptin and increased levels of the stomach-derived hormone ghrelin. These hormones are responsible for regulating hunger and appetite (Spiegel, et al., 2004). These hormonal differences are likely to increase appetite, which could help explain the relative high BMI in short sleepers.
Part 5 and more coming
Many sleep problems but by far the biggest is sleep deprivation and poor sleep. However too much sleep can also be a problem. Over sleeping may also be a problem. In one study sleeping 10 hours or more also increased the mortality rates by one and a half times.
Sleep is as important to the human body as food and water, but most of us don't get enough sleep. Dysoninia (poor sleep) related sleep disorders alone are broken into Intrinsic, Extrinsic and Circadian‑Rhythm sleep disorders including disorders such as but not limited to: "Psychophysiologic Insomnia, Sleep State Misperception Idiopathic Insomnia, Narcolepsy, Recurrent Hypersomnia, Idiopathic Hypersomnia...Restless Legs Syndrome & Intrinsic Sleep Disorder NOS" (MSM, 2001, pp. 27).
Risk factors for sleep related illness are diet, lifestyle, occupation, stress and grief, amongst many others (Helmanis, 2006 pp. 24‑25).
Almost 90 per cent of Australians suffer from some type sleep disorder at some stage of their lives. Of these, 30 per cent suffer from severe sleep disorders. Very few people regularly enjoy the amount, or quality of sleep that they need. The estimated economic costs to the country from this are between 3 and 7 billion dollars annually. There are also huge, unmeasured physical, psychological, emotional and social costs.
Causative factors for insomnia may be multifaceted but generally include some psycho physiologic hyperarousal or emotional distress. Other precursors may be pain, movement disorders, psychiatric disorders, circadium rhythm dysfunction, medication and substance abuse (Billiard and Bentley, 2004). In some cases, the risk of insomnia is subject to a genetic bias. However, specific physiologic indicators for the familial influence have not been fully identified (Parkes and Lock, 2009).
Insomnia is the difficulty initiating or maintaining sleep or both resulting in inadequate quality or quantity of sleep (Tomoda et al, 2009). Insomnia can manifest itself by many symptoms from not being able to sleep at normal hours and low quality and quantity of sleep to sleeping but not finding it refreshing. Other symptoms may include daytime sleepiness, frequent waking, early morning waking and difficulty retuning to sleep (Cureresearch.com, 2005).
Most adults have experienced insomnia or sleeplessness at one time or another in their lives (Straker, 2008). It is estimated that insomnia effects around 30-50% of the general population with 10% experiencing chronic insomnia (Straker, 2008). It has been estimated that in the US that 70 million people suffer sleep problems, and of these, 30 million suffer chronic insomnia (Stahura and Martin, 2006). Recently a survey showed that 1046 of the 2000 adults surveyed experience at least one night of lost sleep due to insomnia symptoms; the survey also concluded that insomnia is a growing issue of concern (Goolsby, 2006).
Insomnia generally affects women more than men and the incidence rate tends to increase with age (Straker, 2008).
There is a clear correlation of age to insomnia (Curless et a!. 1993). A number of surveys have reported between 28% and 64% of post menopausal women suffer from insomnia (Hachul de Campos et al. 2006).
Insomnia can be classified into three categories transient, short-term and chronic insomnia (Tomoda et al, 2009). Transient insomnia are symptoms lasting less than one week, short term insomnia are symptoms lasting between one-three weeks and chronic insomnia are those symptoms lasting longer than three weeks (Tomoda, 2009).
Narcolepsy is a sleep disorder that causes overwhelming and severe day time sleepiness (Retsas et al, 2000). Pathologic sleepiness is characterised by the fact that it occurs at inappropriate times and places (Retsas et al, 2000). These daytime sleep attacks may occur with or without warning and can occur repeatedly in a single day (Edgar et al, 2006). People who suffer from Narcolepsy often have fragmented night time sleep with frequent brief awakenings (Edgar et al, 2006).
Narcolepsy is typically characterised by the following four symptoms:
Excessive daytime sleepiness (90%)
Cataplexy: A sudden and temporary loss of muscle tone often triggered by emotions such as laughter. (75%)
Hallucinations: Vivid dreamlike experiences that occur while falling asleep or upon wakening. (30%)
Sleep paralysis: Paralysis that occurs most often upon falling asleep or waking up. The person is unable to move for a few minutes. (25%) (Retsas et al, 2000)
Interestingly, regular night time sleep schedule and scheduled naps during the day is required for favourable outcomes (Edgar et al, 2006).
Sleep apnoea affects over 12 million Americans with it being more prevalent in men than women (Sjosten et al, 2009). Sleep apnoea not only deprives sleep from the individual but their partners too (Yip, 2001). Sleep apnoea is defined as frequent and loud snoring and breathing cessation for at least 10 second for five or more episodes per hour followed by awakening abruptly with a loud snort as the blood oxygen level drops (Sjorsten et al, 2009). People with sleep apnoea can experience anywhere between 5 apnoeic episodes per hour to several hundred per night (Sjorsten et al, 2009).
Symptoms of sleep apnoea are:
Excessive daytime sleepiness
Obesity is the major cause of sleep apnoea often losing weight is all that is need to treat this disorder (Yip, 2001).
Part 3 and more coming
The benefits of sleep include:
Being physically and mentally alert;
Having more energy;
Making fewer mistakes (including causing accidents);
Feeling psychologically and emotionally recovered;
and to experience:
Improved cognitive function;
Higher stress tolerance and resilience;
Normal body balance;
Reduced risk of CVD, diabetes and cancer;
Living longer; and
during sleep the mind is cataloguing our memories and deciding what to keep and what to throw away it is making memories stronger. It also seems to be reorganizing and restructuring memories.
It’s not possible to learn something new when you sleep, like a foreign language, but you can reinforce something you already know.One study found that students learned to play a series of musical notes better after listening to them during a 90-minute nap. The research shows that memory is strengthened for something you’ve already learned. Rather than learning something new in your sleep.
A review of studies on sleep found that we tend to hold on to the most emotional parts of our memories.
Getting enough sleep is associated with energy, joy, optimistic thinking and coping with negative emotions.
Stages of Sleep
4 to 8
Transition between sleep and wakefulness
Eyes begin to roll and close
Consists of mostly theta waves with some brief periods of alpha waves (similar to waves of wakefulness)
Stage lasts 5-10 mins
8 to 15
Brain wave peaks become higher
Spontaneous periods of muscle tone mixed with periods of muscle relaxation
Heart rate and temperature decrease
Stage last 5-10 mins
2 to 4
Deep Sleep or Delta sleep
Very slow brain waves
0.5 to 2
The last of deep sleep before REM begins.
Consist mostly of Delta waves
Beta waves have a high frequency and occur when the brain is active when asleep and awake.
Frequent bursts of rapid eye movement (REM) and muscle twitches.
Increase in heart and breathing rate
Vivid dreaming occurs here.
When a person falls asleep and wakes up is largely determined by their circadian rhythm, a day-night cycle of about 24 hours. Circadian rhythms greatly influence the timing, amount and quality of sleep (Lockley et al. 1997).
Literally hundreds of circadian rhythms have been identified in mammals (Campbell 1993). Among the numerous systems and functions mediated by the circadian timing system are, hormonal output, core body temperature and metabolism. The circadian clock is believed to sit in the suprachiasmatic nucleus (SCN) located in the hypothalamus of the brain. It was thought that processes now linked with circadian timing e.g. sleep wake cycles, were due solely to environmental cues, for example solar activity, it is now recognised however that these biological rhythms are regulated by factors inherent to the organism (Campbell 1993). A circadian rhythm displays a 24 hour cycle of wakefulness and sleep synchronised with the world’s night/day clock (Mansuy et al, 2003). Everyone’s cycle will vary depending on behavioural and psychological factors (Mansuy et al, 2003). The most typical pattern will be low alertness in the mornings as we wake, to highly alert mid afternoon (Swain et al, 2007).
The natural circadian rhythm in the body, which maintains a regular sleep-wake cycle, makes important contributions to physiological processes and psychological health. The normal rhythm is reset daily by the influence of bright light in the morning. Shift-workers, who may work at night and sleep in the daytime, and blind people may have difficulty maintaining a normal sleep-wake cycle because the natural environmental cues are miss-timed (Morris 1999). Studies show that shift work is one the greatest influencing factor causing an alteration in an individual’s cycle along with sleeping disorders (Baulk, 2008). Altering the circadian cycle can lead to periods of decreased alertness leaving people extremely vulnerable to accidents and injuries (Andersen et al, 2009).
Our sleep patterns appear to be polyphasic. In one experiment, subjects were exposed to 14 hours of darkness; then they remained in a state of quiet rest for about two hours before falling asleep. They then slept for four hours, awakened from a dream, spent another two-hour period in quiet rest, and then fell asleep again for four hours more. The subjects awoke at 6 a.m. each morning from their dream sleep and then spent two hours in quiet rest before arising at 8 a.m. These subjects followed their own natural rhythms, sleeping for eight hours with blocks of time at quiet rest (Wehr, S.E, 1996). This polyphasic sleep appears to be a pattern in many mammals. We experience hypnagogic imagery – a state described as dreaming, drowsy, floating, wandering – every night just before we fall asleep. Every night before we go to sleep we spend a few minutes in a state of relaxed wakefulness characterised by drifting thoughts and alpha brainwaves.
Another interesting method for lessening the impact of sleep deprivation was through a study that found there were certain hours better to sleep through the night. A new Stanford University study on the science of sleep deprivation suggests that early morning sleep is more restful than a middle‑of‑the‑night nap. In a study of two groups of men they found that early‑morning sleepers scored higher on wakefulness tests and on measures of sleep efficiency. (Stratton, 2003) Although this study shows that there may some advantages to when you get your sleep it is more an avoidance of the problem rather than a solution.
We are also influenced not just by sleep but also our perceptions of its quality. If we think we’ve had a wonderful sleep last night, we feel and perform better, even if our sleep was actually the same as usual. In this study researchers randomly told some people they’d had better sleep than others after they were hooked up to some placebo brain sensors). When they were given a cognitive test the next day, those who’d been told they slept the best also did the best in the test.
Part 3 and more coming
When health is absent, Wisdom cannot reveal itself, Art cannot manifest, Strength cannot be exerted, Wealth becomes useless, And reason is powerless." — Herophilus 300 B.C.
Our work places are either a great place to promote health or to contribute to the health problem. Our work environments are experiencing an emerging health crisis from longer workdays, deskbound occupations, access to poor quality foods and poor physical activity. In many cases they are contributing to a deterioration in employee health as our work and the workplace has the potential to have a significant affect on the mental, physical, economic and social well-being of workers. Major concerns in the work environment are work-related stress, obesity, diabetes, cardio vascular disease, fatigue , poor sleep and the many other conditions that come from these. Many of our workplaces for example have increased the risk of putting on weight due to sedentary practices, stress and long and awkward work hours. This of course has the potential to lead to many other chronic health conditions which cost the individual, community and employers. From an employers perspective poor health has the potential to reduce the quality of work and productivity within many workplaces and is likely costing the economy billions of dollars in workplace productivity alone. While the costs of workplace productivity are significant it is also likely that some obesogenic (increasing the risk of putting on weight) environments are likely to be the focus of legal action as the rates of illness and obesity increase. This is particularly the case for inflexible workplace, long hours and shiftwork.
An employee’s health and productivity at work is not only affected by their work environment but also by factors that are not work related. These factors vary between individuals and depend on the individuals chosen lifestyle outside of work. However, through empowering staff members on healthy lifestyles the overall health management of individuals will benefit not only the company but also the broader community. Wellness in the workplace is influenced by many different factors including the communication between co-workers and employers, physical demands especially in sedentary occupations and the eating habits, lifestyles of employees and much more.
When it comes to common health issues of most employees, wellness programs can provide an easy and cost effective solution. Fatigue, stress, depression and obesity are commonly interrelated and increasingly common in most workplaces. The workplace has been viewed as an attractive place for wellness programs as it has established communication channels and it provides a convenient, familiar physical and social setting. In addition, it serves to benefit the employers from the improved health of employees.
Many factors contribute towards the creation of a healthy employee who is able to work consistently at a high level of efficiency and productivity; however health is one of the most important determinants. The costs of unhealthy workers are usually measured by employers in terms of easily quantifiable direct health costs such as medical claims, disability funds and compensation payouts. In the US where figures are more easily accessed because the employer has been traditionally responsible for health care cost, compared with employees who are struggling, thriving employees have 41% lower health-related costs to the employer, a difference of $2,993 per person. For every 10,000 employees, this represents a difference of nearly $30 million to the employer. However, when looking at the health/productivity costs borne by employers, only a small portion of these expenditures are direct medical costs. Indirect costs are more difficult to distinguish and measure, they include those costs incurred from employee mortality, absenteeism and the reduced productivity and presenteeism including poor concentration and focus, low output, and disruption of other workers evident in an employee while still working.
An employee health behaviors are strong predictors of job performance and absenteeism. Many studies have demonstrated the link between poor health factors and absence from work including positive associations between absenteeism and obesity, stress, physical inactivity, and hypertension. While the frequency and severity of poor health are directly related to days absent from work. Healthier workers work more and are away less.
The loss of a qualified professional due to moving to a new job, illness or even death can often be difficult and costly for the organization to replace. The cost of rehiring and retraining a suitable replacement could result in large organizational outlays of time and money, well in excess of $100,000. Not only will a new candidate be difficult and costly to find, but an immense amount of expertise, experience and organizational knowledge will be lost. Karoshi is a term coined in Japan, literally translating into ‘death from overwork’ in English. Karoshi is described as ‘unexplained death’ thought to arise due to a combination of elevated working hours, high stress and poor health, with the major medical causes of death being heat attack and stroke. In Japan working weeks that exceed 60 hours are not an exception. The first case of karoshi was reported in 1969 where a 29 year old married man died from a stroke and his death could not be attributable to anything other than occupational stress and chronic overwork. In 1994 the Japanese Government’s Economic Planning Agency in the Institute of Economics estimated the number of karoshi deaths at around 1,000 or 5% of all deaths as a result of cerebrovascular and cardiovascular disease each year within the 25-59 age group.
In the US the cost of turnover per person employed who is healthier is 35% lower than that of those who are struggling. For every 10,000 employees, this represents $19.5 million. Although turnover is more common among younger employees, higher wellbeing was predictive of lower turnover and lower turnover costs in the next year for younger and older employees alike. Those who were struggling or suffering in overall wellbeing were more than twice as likely as those who were thriving to say they would look for another job if the job market improves. This means that the actions that employers take today to improve health — in addition to improving job performance — are likely to have important implications on the moves employees make in the future.
Presenteeism represents a cost that is difficult to quantity but a large contributor to lost productivity. Many people are under the flawed assumption that when people are at work that they are productive, however if employees are sick, injured, stressed or burned-out in the workplace, they are not working to full capacity. Presenteeism is the worker coming in who shouldn’t and in the process is not just less productive but may also be reducing the productivity of other employees. This doesn’t just occur over health but when a person is sick they may be slowing everyone else down. Presenteeisms result in a negative impact not only on the quantity of work completed, but also on the quality of products, services, decisions, and co-worker and customer interactions. Although presenteeism cannot be directly quantified in a straightforward manner many studies now suggest it may be one of the biggest costs to employees. So you might be better off staying away from work when you are sick.
Unhealthy workers are also more likely to have workplace accidents and healthy and focused employees is less likely to endanger themselves and other co-workers through negligent behavior caused by poor physical and psychological health. A number of studies have now found that investing in wellness programs and the health of employees can reduce accidents. This also includes accidents on the way home from work if an employee is fatigued or distracted with their health. Accidents are expensive for all companies because of downtime, the resources that need to be dedicated to investigation, lost productivity from injured workers and workers’ compensation. In Australia, workers’ compensation costs are unacceptably high, reflecting relatively high frequency rates of occupational injuries which may be prevented through a wellness program.
The direct cost of stress is more than $20 billion to the Australian economy, and around two thirds of that to Australian employers because of stress-related presenteeism and absenteeism. 95% of all claims for mental disorders in the past ten years are for mental stress. These claims are the most expensive type of workers’ compensation claim due to their typically lengthy periods of work absence. Professionals make more mental stress claims than any other occupation, mostly for work pressure. This is despite the fact that the Australian Bureau of Statistics (ABS) Work-related Injuries Survey 2009–10 which showed that 70% of workers who reported they experienced work-related mental stress did not apply for workers’ compensation.
Productivity is affected heavily by seasonal illnesses and their available treatments. Allergies are a highly prevalent condition in the general population affecting people in varying ways. Symptoms of allergies include itching and irritation of the nose; watery nasal discharge, nasal congestion, sneezing and are often accompanied by fatigue, weakness, malaise, irritability and decreased appetite. Studies now show that individuals with allergy disorders generally score lower on tests on social functioning, role limitation, mental health and energy / fatigue and pain compared to controls. In the US allergy disorders result more than 4 million workdays lost per/year in the United States.
However, it is not just the disorder the can have an effect on productivity; the drugs used to treat the illness may also affect productivity levels. Medications are also often a hidden cost in presenteeism, accidents and lost work productivity. The use of sedating antihistamines for allergies had a 50% higher risk of on-the-job injury than control subjects. Another study found that driving impairments exhibited due to the use of a sedating antihistamine were worse than that connected with a blood-alcohol concentration of 0.1%. In a study of nearly 6000 employees those who used sedating antihistamines experienced on average an 8% reduction in daily work out-put compared to those who used non-sedating antihistamines. Many other medications including pain killers and cholesterol lowering drugs can result in lost productivity. The fatigue and muscle soreness created by cholesterol lowering drugs may impact productivity especially those with more physical work. While their effect on memory may be even more problematic. A colleague of mine recalled the effect these drugs were having on the memory of police officers who were called to be witnesses. Awkward eh.
The message is that it is in everyone’s best interests to promote health, both the individual and the company they work for. The good thing in all of this is that companies are increasingly adopting workplace wellness programs which if adopted well can make a big difference to the health of their employees.