On March 24, a Chicago Transit Authority train derailed at O’Hare International Airport injuring dozens of people. The train operator reportedly said she fell asleep at the controls. Photo courtesy of the National Transportation Safety Board.
Journalist Amanda Chan had just returned to New York after a trip to Asia and was struggling to stay awake. Like many workers who are short on sleep, Chan, a senior editor at The Huffington Post, stared at her computer unable to focus on the task before her. But unlike most workers, she was able to get some sleep in one of the company’s two nap rooms.
“Arianna is very big on practicing what she preaches,” Chan said of Huffington Post founder Arianna Huffington, who has been publicly touting the benefits of sleep after a fall caused by exhaustion resulted in a broken cheekbone. “I will use them when I’m not getting things done. It’s great to just give your mind a break. With sleep in particular, you’re not going to work as quickly and be as productive. It’s hard for people to get a full seven to eight hours each night, so this is in everyone’s best interests.”
‘How you sleep directly impacts how you perform at work and how you function at home and at leisure.’
—Nancy Rothstein, sleep consultant
Whether it’s Huffington’s call for more shut-eye or the U.S. Centers for Disease Control and Prevention declaring sleeplessness a “public health epidemic,” the issue of sleep has been getting a lot of attention lately. And employers should take note. A drowsy workforce is not only less productive but can drive up health care costs and accident rates, experts say. Last year the death of a banking intern in London who collapsed after working 72 straight hours was widely blamed on a lack of sleep, as was the derailment of a Chicago commuter train earlier this year. Lack of sleep has been linked to chronic diseases, such as diabetes, obesity, heart disease, depression and even “early death,” according to the CDC, which reports that about 30 percent of the workforce — 41 million U.S. workers — don’t get enough sleep.
A 2014 study by corporate wellness firm Virgin Pulse found that about 75 percent of employees felt tired many days of the week, 30 percent said they were unhappy with the quality and quantity of their sleep, and 15 percent dozed off at work at least once a week. And that has bottom-line implications for U.S. companies — to the tune of $63.2 billion a year in lost productivity because of sleep deprivation, according to a recent Harvard University study.
“We have a population that’s becoming more and more sleep deprived, and we’re learning more about the impact of sleep on health and performance,” said Dr. Lawrence Epstein, a sleep medicine specialist and instructor at Harvard Medical School. “People are familiar with not feeling well-rested, but what they don’t realize is how big an impact this has on how well they perform their jobs and on their health and well-being.”
In an effort to bring that message to employers and the public, the American Academy of Sleep Medicine, of which Epstein is past president, launched an organization of board-certified sleep physicians and sleep centers. The group, called the Welltrinsic Sleep Network, will negotiate contracts for sleep medicine services with insurers, health care systems, large employers and managed-care groups, but will also focus on educating employers about how to spot sleep problems and develop wellness programs to address them.
No Resting Places for the Weary
While nearly 90 percent of all U.S.-based large companies have a wellness program, few address sleep problems and only 6 percent have formal employee nap rooms, according to the 2012 Employee Benefits Survey of 600 U.S. employers of all sizes by the Society for Human Resource Management.
Asleep at the Wheel
When most people hear about someone falling asleep on the job, it usually involves a truck driver, a train operator or some other transportation employee, and it often results in tragic consequences.
One of the main causes of sleepiness for workers in those industries is a medical condition called sleep apnea.
Some trucking firms like Schneider National Inc. and Swift Transportation Co. have adopted sleep apnea programs to help drivers who suffer from the disorder, which causes people to wake up dozens and sometimes hundreds of times a night because their airway closes off. Sufferers stop breathing and wake up struggling to breathe. Obesity is the most common cause.
Schneider, Swift, Gordon Trucking Inc. and Medline Industries Inc. are a few of the transportation companies that have turned to Houston-based Precision Pulmonary Diagnostics, which develops sleep apnea screening and treatment programs for truckers. Typically, diagnosing and treating a sleep disorder requires several appointments with doctors and specialists, but PPD offers a portable testing device and health coaches to help administer the treatment, according to Wendy Sullivan, a registered nurse who is vice president of project implementation at PPD.
The most effective treatment is losing weight, experts say, but another solution is a device called a continuous positive airway pressure, which is a mask that blows air into the airway to keep it open, which is part of PPD’s program.
Sullivan, who used to be an occupational health nurse at Schneider, said that she first spotted the trend in 2003 while reviewing medical claims at the company. She said that she noticed a large number of drivers who suffered from obesity, high blood pressure, diabetes and respiratory conditions, which are all signs of sleep apnea. Three years later the company launched its program.
“Businesses are always looking at how to improve health care costs, retention and reducing accidents, and they’ve focused on developing wellness programs, but sleep hasn’t been on the radar until recently,” Epstein said. “This is partly because sleep medicine is a new field and also because employers don’t realize that sleep problems [are] a health issue.”
But that could be changing, according to Dr. Jennifer Turgiss, vice president of health solutions for Virgin Pulse, which is based in Framingham, Massachusetts. At a recent benefits conference, Turgiss said that she was surprised to discover that when clients asked their employees which of seven lifestyle management programs they were most interested in — stress, sleep, nutrition, physical activity, weight management, depression and smoking cessation — sleep management was the No. 1 program chosen. The programs are offered through vielife, a corporate wellness firm that Virgin Pulse uses. The results surprised the employers as well.
“The clients were quite sure that stress and weight management would be the most popular programs,” Turgiss said. “We were all surprised that sleep was the preferred program. Our first population was a school district, and then we approached an energy company in California and a manufacturing firm in the Midwest and the results were the same.”
To find out why the sleep program was in such high demand, the two companies conducted a study that was released earlier this year titled “Asleep on the Job” that surveyed employees at the three companies, which Turgiss declined to identify. The study showed that four key factors are keeping workers up at night: stress, thinking too much, physical discomfort and “environmental disruptors,” like a bedroom that is too hot or too cold.
“The main thing that was consistent is that they didn’t feel that sleep disruption was about their jobs only,” she said. “They also had very full lives with families, small children or older parents or volunteer work. When they left their work life, they had a full evening at home. They had very, very long days.”
To help employees cope, Virgin Pulse offers a six-week online sleep program developed by vielife called Wake Well that offers articles, sleep challenges and quizzes, an online sleep diary and other tracking tools.
While there is plenty of research showing the connections between sleep, health and job performance, sleep consultant Nancy Rothstein said that companies are just waking up to the problem, so to speak. Employers may be investing more in wellness programs, but most overlook sleep, according to Rothstein, whose Chicago-based firm is called The Sleep Ambassador. She argues that sleep is not a wellness issue but a risk-management issue.
“How you sleep directly impacts how you perform at work and how you function at home and at leisure,” said Rothstein, who has consulted with Procter & Gamble Co. among other employers. “Corporations don’t think about how their employees sleep, but if a company is looking at total worker well-being, they need to.”
The ‘Fourth Leg’
Christopher Barnes, an assistant professor of management at the University of Washington in Seattle, calls sleep “the fourth leg of the wellness stool” along with mental attitude, nutrition and exercise. He said that a lack of sleep affects not only long-term health but also workplace accidents and behaviors, which are his areas of expertise. Even one hour can make a big difference. In a 2009 study of mining accidents over a 23-year period, he and a colleague found a nearly 6 percent spike in injuries because of daylight saving time, specifically on the Monday following the time change. One lost hour of sleep resulted in an increase in the number of injuries and in their severity.
“Even losing relatively small amounts of sleep have a profound effect on performance,” he said. Part of the problem is the macho attitude that many have toward sleep — something that Barnes, a former U.S. Air Force officer, knows something about.
“There’s a culture that we live in that devalues sleep,” he said. “I come from a military background where there is this macho attitude that we can tough it through. We see it often in other organizations as well, like among high-tech organizations that have all-night coding parties. We think that because we’re special these sleep-deprivation issues don’t affect us.”
Workplace accidents and health problems are some obvious indicators of sleep deprivation, but less visible are behavioral issues. Barnes said that sleepy heads are not only more prone toward accidents but also toward unethical behavior.
“Temptations require self-control to resist them,” he said. “When people are short on sleep, self-control is at a lower level. You might start thinking that if you cook the books a bit you’ll get a bigger bonus. Without enough sleep, you’re less able to control that decision.”
It also makes for grumpier workers and that can lead to issues with anger and depression and lower levels of job satisfaction. “And that carries over to lots of other outcomes, like doing just the minimum required duties of your job,” he said, which in turn hurts a company’s bottom line.
Technology and changing work cultures that allow employees to work around the clock have a tremendous impact on sleep habits, and the pace can’t be sustained for very long, according to Barnes.
“Managers focus on short-term performance so they drive their people hard to squeeze more performance out of them, but doing that makes people weary, runs them down and makes them leave the organization.”
But there are things employers can do, like asking employees if they would be interested in participating in a sleep wellness program, Rothstein said.
“Realize that not everyone wants to say, ‘I’m not sleeping and it’s affecting my job,” she said. “Who’s going to admit that? Then you ask, ‘What’s the best way for our company to offer this?”
She said that employers aren’t ignoring the problem. They just don’t realize it exists; even if they do, solutions are not easy to find.
“There aren’t 15 million products that they can use to do something about it, but there are steps they can take like not making people work 60 to 80 hours a week or coming into the office after a big trip. It’s about a shift in corporate culture and acknowledging that sleep is important, that it’s essential to your work.”