Dr Dingle's Blog / economy
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
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.