Lack of sleep hurts job performance

It afflicts, by some accounts, nearly 90 percent of U.S. workers.

Fields from health care to transportation have tightened regulations to minimize its impact. But it continues to plague the workforce - and the results can be devastating.

It is fatigue - or sleepiness - on the job.

Four people were killed Tuesday when a Sky Express bus overturned on Interstate 95 near Richmond. The driver was charged with reckless driving, and police cited fatigue. The U.S. government halted rides by the company, which also operated out of Virginia Beach. Records show Sky Express had high levels of safety violations, including driver fatigue.

"We are a nation of walking zombies," said Cornell University sleep researcher James Maas, who is a consultant for Paramount Sleep, a mattress manufacturer in Norfolk. Three-quarters of Americans, he said, have trouble sleeping at least three nights a week.

"If we operated machinery like we try to operate our bodies," Maas said, "we'd be accused of reckless endangerment."

Scientists have linked lack of sleep to a long list of medical problems, including obesity, high blood pressure and diabetes.

The consequences also can be traced at work - including a decline in alertness, fuzzed decision-making and less ethical behavior. A 2007 study by CVS Caremark estimated lost productivity related to fatigue at $136 billion a year.

The dangers are aggravated for overnight, or shift, workers, such as bus and truck drivers, who are going against the grain of natural circadian rhythms.

"Human beings are generally set up for being awake during the day and asleep at night," said Dr. Anne Redding, medical director of Bon Secours' Sleep Disorders Center. "What happens when people work nights is that they don't have the light to stimulate them when they're working and they don't have the dark when they're sleeping, so their bodies get confused."

The U.S. Bureau of Labor Statistics does not track fatigue-related injuries. But Dr. Soham Sheth, a neurologist with the Sleep Center at Chesapeake Regional Medical Center, cited studies that showed a 50 percent increase in car crashes among shift workers.

Transportation officials have reported at least six instances so far this year of air traffic controllers falling asleep on the job. In response, the Federal Aviation Administration revised some rules in April.

The minimum time off between shifts was increased to nine hours from eight. Fewer controllers may work alone during a midnight shift.

But the agency refused to permit sleeping during breaks. "We're not going to pay controllers to nap," U.S. Transportation Secretary Ray LaHood said on CBS' "The Early Show."

That, however, might be one of the best antidotes, sleep scientists say.

"By falling asleep on the job," said Dr. Gregory Belenky, director of Washington State University's Sleep and Performance Research Center in Spokane, "they point to the problem and the solution. Sleep - sanctioned, scheduled and controlled."

The medical profession also has wrestled with the issue, particularly as it applies to residents. After the 1984 death of college student Libby Zion in a New York hospital, her father, a lawyer and former New York Times reporter, relentlessly criticized her treatment. Among his targets: the long hours worked by residents.

Since then, their schedules have become more regulated, and the Accreditation Council for Graduate Medical Education is increasing restrictions in July. First-year residents will be allowed to work no more than 16 consecutive hours. Now, they may work 24 straight hours with patients and an additional six for duties such as paperwork that don't involve patients.

"We have not had any incidents reported where the care of patients was compromised because residents were too fatigued," said Linda Archer, associate dean for graduate medical education at Eastern Virginia Medical School. But the new rules, she said, "will better reassure the public."

Archer said EVMS trains professors, who supervise the residents, to spot signs of fatigue and encourages residents to nap on their down time. Sentara Norfolk General Hospital has a wing of "call rooms" where they rest, she said, and EVMS is asking other hospitals to set aside nap rooms.

In the transportation industry, truckers may drive up to 11 consecutive hours after a 10-hour break. "We tell them to take frequent breaks," said Bill Jackson, chairman and safety director of RJR Elite Trucking Inc. in Norfolk. "Don't try to drive 10 straight hours."

Jackson said he preferred previous rules that made it easier for truckers to break up their sleep time. "Very few people can sleep for 10 hours in any kind of environment, certainly not in a throbbing truck," he said. "It's kind of unrealistic."

Cabdrivers may work a maximum of 13 consecutive hours. Black and White Cabs of Norfolk and Virginia Beach limit drivers to 12 hours, said Frank Azzalina, director of business development.

Harold Jaggan, manager of Yellow Cab and Blue and White Taxi companies in Chesapeake, Portsmouth and Virginia Beach, encourages overnight drivers to get "plenty of sleep and stay alert throughout the night." Between calls, "some of them fall asleep in their cars, wherever they're parked," he said. "That can be dangerous. I don't like it, but some of them end up doing it anyway."

Firefighters work 24-hour shifts, said Norfolk Battalion Chief Harry Worley. They may sleep in bunk rooms during quiet periods at night, but not during the day. They work no more than 12 hours during each shift on a medic unit, or ambulance.

"We try to avoid a fatigue factor with that, particularly when they're caring for patients in the back," Worley said.

The CVS Caremark study, which surveyed nearly 29,000 people, found that 38 percent reported "low levels of energy, poor sleep or a feeling of fatigue" within the past two weeks.

That might understate the problem. In a survey of 1,000 workers in November by Philips Consumer Lifestyle, 85 percent acknowledged they would be more productive if they slept more.

Workers, scientists said, can help themselves by maintaining regular sleep schedules and avoiding bright lights and stimulants such as exercise and caffeine before bedtime.

But what can employers do?

Sheth, from the Chesapeake sleep center, suggested employers switch their workers' shifts as infrequently as possible. When they do, it's better to move clockwise - for instance, going from a midnight shift to a morning, not an evening, shift.

Bon Secours' Redding said bosses should keep workers busy. "If you're in the middle of something that is very complicated and intense, you're going to be awake."

Working in teams and chewing gum also keep people alert, said J. Catesby Ware, chief of EVMS's Sleep Disorders Center at Sentara Norfolk General. So do bright lights. "You do not want a dimly lit workplace."

All agreed: Bosses should be supportive of napping during breaks, whether during the day or overnight.

"It should be libelous to deny a person the rest he needs to maintain alertness," said Cornell's Maas. "When someone says, 'I'll fire you if I catch you napping during a shift,' it's absolute nonsense. What you want to do is to control napping."

When asked whether employers should outfit workplaces with cots for napping, Ware said: "That's not a bad idea.... It should not be taboo; it's the wise thing to do."

Sleep researchers worry that the issue still isn't taken seriously enough. "We sweep it under the rug," even in his own field, Ware said. "It's money for hospitals. If they keep more residents working around the clock, they don't need as many physicians."

Maas said, "We treat sleep as a luxury, and not a necessity. People say, 'Suck it up; there aren't enough hours in the day.' "

But he warned: "This machismo feeling of 'work until you drop' is not productive. It's detrimental."

Philip Walzer, (757) 222-3864, phil.walzer@pilotonline.com