Shift Work

SLEEPING ON THE JOB

By Mark Sabourin

Shiftwork. Fatigue. Over-tired workers. Lack of sleep. They may well represent the single biggest cause of accidents attributed to "worker error". But the solution is too simple to be easily accepted.

It's still difficult to understand why Dr. Mark Rosekind's research findings haven't made splashy headlines. Maybe newspaper editors, just like the rest of us, would rather not know that the pilot flying the jetliner seven miles overhead may be fast asleep.

Rosekind's findings were part of a study begun in 1980 by the Fatigue Countermeasures Program at NASA's Ames Research Center in California. As far as airline pilots are concerned, though, this isn't rocket science. Long-haul pilots won't readily admit that they nod off at the wheel, but they willingly tell you that serious chronic fatigue is foremost among their health and safety concerns. What surprised pilots, though, was what Rosekind suggested be done about the problem. If your pilots are too tired to stay awake, said Rosekind, let them take a nap.

Sleepy, alert, fatigued, tired, rested, awake . . . they're words people scatter about like pepper on mashed potatoes, but they have specific, if not entirely well understood, meanings, says Dr. Colin Shapiro, director of the International Sleep Clinic in Toronto. Run a marathon, says Shapiro, and you'll be fatigued. Don't get enough sleep, and you'll be sleepy. If you're sleepy, you'll be less alert and more prone to error. If you're sleepy enough, you'll fall asleep whether you want to or not.

In Canada, the transportation industry has taken the lead in sleepiness management probably because it is ideally placed to do so. Late-night highway drivers take comfort at the sight of a tractor-trailer pulled off to the side of the road while its driver takes a needed nap. The operations of railroads and airlines provide many opportunities for naps that in no way affect operating efficiency.

But it's an issue that stretches across industry barriers. "Fatigue," says Jon Shearer, a Sarnia-based consultant and former Carleton University professor, "affects virtually every single aspect of the human condition."

Sleepiness on the job is an issue for shiftworkers, commuters, workers in sedentary occupations, parents of new-born infants, early-shift workers and countless others (See "Asleep At The Switch", December 1997, p. 20). But, among many employers, the notion of a fair wage for a fair day's work still holds, and within that day there is no room for something as wasteful as a nap. Among many workers, completing a long, tiring shift is a matter of personal pride, and any suggestion that they might need a moment's rest might also suggest they are ill-suited to the job.

Just being sleepy, or tired or drowsy impairs your judgement and slows down your reaction time. Then there’s the phenomenon of "microsleeping" in which a sleep-deprived person will suddenly fall into a deep sleep for half a second or a second at a time. But, like the man who fell from a third-story window reported, it’s not falling that hurts, it’s that sudden stop coming up at the end. Snapping into microsleep for half a second probably won’t get you; it’s waking up totally disoriented and wondering where you are that’s the problem. Sort of like your computer if the power goes off for half a second. Try it while you’re sitting behind the wheel of a 25-ton truck barreling down the road at 88 feet per second and it could get pretty exciting.

But the same sort of problems apply if you’re driving a lift truck. Or leaning over a lathe. Or drawing up blood samples in a lab.

A study of 80 truck drivers, conducted by Transport Canada, the Trucking Research Institute and the U.S. Department of Transportation, over 4,000 hours of driving, found that 64 per cent of the drivers regularly experienced drowsy episodes while driving. And, among them, the electronically monitored drivers spent a total of 19 minutes -- a second here, a few seconds there -- fast asleep at the wheel.

EFFECTIVE COUNTERMEASURE

There are ways of combatting sleepiness, says Shapiro. Toss a poisonous snake into the room and see what happens, he suggests. Bright lights, a stimulating environment, conversation, exercise, drinking a cup of coffee are all techniques, tricks really, that are commonly used to heighten alertness in a sleepy person. But they only mask the underlying condition. If you’re sleepy and you don’t sleep, you only get sleepier.

"Napping is sleep," says Shapiro, "and sleeping is a countermeasure to being sleepy." Most of us are sleep-deprived from the start, Rosekind says, long before we put in that first hour of overtime or pull that first term-paper all-nighter. He blames Thomas Edison. Before the advent of electric light, people reported getting much more sleep, he says. On average, we need 8-1/4 hours of sleep per day. Most of us fall short of that requirement by an hour and a half apiece.

Everyone knows that performance drops when you're sleepy. The medical literature is thick with studies on the implications of sleep deprivation. Rosekind's own research, using real live pilots flying jumbo jets on trans-Pacific routes, showed a consistent decline in performance, measuring factors like vigilance and reaction time. And on five separate occasions during the study, high over the Pacific, the pilots being studied simply fell asleep.

But Rosekind took another group of pilots, flying the same aircraft over the same routes. He allowed these pilots an opportunity for a 40-minute nap as the plane cruised high over water, while the rest of the flight-deck crew remained vigilant. The results were startling. Performance improved 34 per cent. Alertness doubled.

Surprisingly, Rosekind's research on pilots found its most attentive audience not in the U.S. airline industry, but among railroaders, particularly the Brotherhood of Locomotive Engineers and their Canadian employers at CN, CP and Via Rail. The federal government had threatened to impose hours-of-service restrictions on railroad employees unless the industry came up with something better. A study was commissioned, and the results confirmed what workers had been saying all along: Thanks to scheduling uncertainties and the demands of the industry, locomotive engineers were working in a constant state of jet lag induced by shiftwork and lack of sleep.

The railroad industry's response was a 10-point fatigue countermeasures program. It's mostly conventional stuff: education, lifestyle training, scheduling. Where they broke new ground was when they introduced napping as part of railroad operations.

George Hucker, international vice-president and national legislative representative for the Brotherhood of Locomotive Engineers, was one of the people responsible for selling the program to workers. Given the industry's history of not always amicable labour-management relations, it wasn't an easy sell. Many workers feared it was the thin edge of a wedge leading to longer hours. Others, says Hucker, were "from Missouri" and had to be shown that the program worked. Showing them the benefits of the program is easy, says Hucker. All they have to do is try it.

Circumstances in which train crews may take a nap are carefully defined, says Hucker. While a train is in motion, both the engineer and the conductor must be awake. It's a safety issue, says Hucker. "We as a union are not prepared to allow people to sleep in the cab of a locomotive when it is in motion."

The fatigue countermeasures program envisions three types of nap: an opportunity nap, a planned nap, and a demand nap. An opportunity nap occurs when a train is pulled off on a siding, says Hucker. The crew may radio the dispatcher and inform him or her that they will be taking a nap. Radios are then switched to a special frequency to allow for emergency communication while cutting out the usual radio chatter.

A planned nap is one negotiated between the crew and the dispatcher. The crew may radio in requesting a nap, and the dispatcher will schedule the crew to pull off at an appropriate siding. A demand nap occurs when a crew feels it must get some rest at the next available siding or safety will be at risk. In these circumstances, the crew will insist that it be pulled off at the next available siding.

The program is still in the process of being rolled out across the country, says Hucker, as the fatigue countermeasures must be tailored to each location. However, where it has been implemented, "it did not impact the operation of the railroad at all," Hucker assures. Gary Gibson, Vice President of Risk Management at CN Rail, concurs. In practice, it is a policy based on opportunity, he says. "People aren't allowed to bring everything to a screeching halt for a nap."

Hucker agrees that's how it ought to be, and recognizes that union members have a big stake in keeping the railway competitive. "I'm a senior union officer, but I've also got to be cognizant of the fact that I don't want to impact the company's operations to the point that all that good traffic that's coming out of Detroit is now back on the 401 [highway] again."

It's an argument that could just as easily be given by management, a more thoughtful spin on the often-heard knee-jerk reaction to proposals for planned rest at the workplace: I'm not paying people to sleep. Except it's not true. Employers, especially those running 24-hour operations or unusually long shifts, are paying their workers to sleep on the job. They just don't realize it. Anyone who is sleepy enough will fall asleep, no matter what the circumstances, say the experts. Even just a momentary lapse -- what we call "dozing off for a second" and what scientists call a "microevent" -- can have catastrophic consequences if it occurs at the wrong time. Mark Rosekind took a hard look at microevents and long-haul pilots. He found a significant decline in microevents if the pilots took a nap.

TOSS IN A FUTON

Cory Levenberg, owner of 42 Inc., a Berkeley California-based computer consulting firm, had always known his employees were sleeping on the job. It's pretty-well an accepted practice in the industry, he says, as jobs must be completed by deadline. Working around the clock, 60 or 70 hours a week, is not uncommon. Nor is it unusual to find employees asleep on the company couch or, late at night, on the floor by their desks.

Levenberg put up with it for a while, then decided this had to stop.

So he built his staff a napping room. Since word got out, his phone hasn't stopped ringing, and Levenberg still wonders what all the fuss is about. Levenberg's actions were born of necessity, and how he chose to go about it might offend the experts. People like Colin Shapiro and Mark Rosekind have built successful careers telling others that 20-40 minutes is probably the ideal length for a nap, and that sleep inertia -- that feeling of stunned uselessness that often follows waking -- quickly passes.

Levenberg went for none of that. People generally seemed to know that a 20 minute nap would freshen them, he says. Today "the loft", as it is known, is used every day, day and night. Levenberg has found no need to write rules or institute policies. Some people never use it. Others may use it every day. No one abuses it,he says.

Thanks in large part to Canada's leadership, napping, or planned rest, is gaining a foothold in the North American rail industry. According to Ed Coburn, publisher of Working Nights, a U.S.-based newsletter, the practice is gaining some small measure of acceptance elsewhere, but it's still far from the mainstream.

Partly, this is due to our lack of understanding of what, precisely, happens when we nap. There is no doubt among scientists that performance seriously declines as we become sleepy. There is little doubt among scientists that performance increases meaningfully after a 20-minute nap. What no one seems to understand is why.

Mark Rosekind, who left NASA's fatigue countermeasures program and is now president and chief scientist of the California-based Alertness Solutions, feels the answer may lie in the simple fact that, among all sleepiness countermeasures available, only napping addresses the core issue: a lack of sleep.

SLEEP INERTIA

Confusion about sleep inertia is also used by many as an argument against napping. There are many stages to sleep, explains Rosekind, and the body cycles through each in turn. An effective nap does not go beyond the second stage of sleep, he says, and that means no more than 45 minutes for pretty well all of us. Someone awakened from the deeper stages of sleep will feel the effects of sleep inertia, and may perform worse than before falling asleep. But even that passes, he says. People who feel "groggy and out of it" after a nap should spend 10 to 15 minutes slowly building up their level of activity. Rosekind promises performance will improve.

It works, says George Hucker. Locomotive engineers are given guidance on the appropriate length of a nap, and warned of the symptoms of sleep inertia. They are instructed not to return to operations unless they feel it is safe to do so. "We're not asking people to snap out of a nap, pull out the throttle and start moving a train," he says.

But perhaps the biggest hurdle napping has to overcome is a cultural one. Infants nap. Adults -- at least North American adults -- don't. In our culture, says Mark Rosekind, people who nap are considered stupid, lazy or non-productive.

"We've got to turn that around," he says, and goes a bold step further. It is physiologically unnatural, he says, to stay awake all day.

The circadian clock that governs our sleep-wake pattern is programmed for two sleep periods every 24 hours, says Rosekind. We all know it is natural to fall asleep at night, he says. But it is just as natural to fall asleep in the afternoon. What most of us refer to as the "post-lunch dip" has little to do with lunch and a lot to do with the time of day.

"We all get sleepy around siesta time," says Rosekind.

It's a controversial issue. The scientific evidence is clear that the performance of long-haul pilots would be improved if regulations allowed for what Transport Canada calls "planned rest on the flight deck." But there are other issues, too. Public perception, for instance. Would the traveling public be comforted with the knowledge that the Captain may be taking a nap? And then there is the fear among pilots -- seldom expressed outright, but clearly present -- that if planned rest on the flight deck is approved, airlines will begin backing away from their practice of augmenting the size of crews on long-haul flights.

As far as Dr. Claude Thibeault is concerned, neither argument holds water. Thibeault is senior director of occupational health for Air Canada, and he says "there is a certain amount of controversy over this, and it is political controversy. There is no scientific controversy."

Thibeault is a member of a number of international air-medical committees. He knows what his colleagues are talking about. And, he says, just about every major airline in the world is now looking at napping on the flight deck.

Pilots on augmented flights are still falling asleep, he says. "It's a lot better to have one person napping when everybody knows he's napping than everybody napping when nobody knows they're napping. There's no question that this is the issue."

Gary Butler is a doctor, a pilot, and air-medical chairman for the Airline Pilots Association of Canada. He agrees that augmenting flight crews does not necessarily address the issue of pilot fatigue, if only because the first pilot to rest often is not tired and gets no sleep. He also concedes that none of the fatigue countermeasures currently used by airlines in Canada is truly effective. But he won't embrace napping. As far as he is concerned, it is a strategy of last resort, to be used only if all other countermeasures fail, if fatigue is an issue, and if napping is permitted within the airline's policy.

So far, he has nothing to worry about, though that may soon change. Planned rest on the flight deck is permissible under the Canadian Aviation Regulations, but only following application by the airline and approval by Transport Canada. According to Transport Canada, only charter carrier Air Transat is currently approved for planned rest on the flight deck. But Captain Ron Clark, senior director of flight operations, standards and training for Air Canada, says an application for planned rest has been made, and is currently before government regulators. If approved, it will become part of airline policy to be used in conjunction with current practices, which include limitations on hours of service and flight crew augmentation. And, according to Transport Canada, other applications are expected.

On the issue of workplace sleepiness, it would seem that science has done its bit. Sleepy workers are sloppy workers and sloppy work gives rise to accidents. No respectable scientist, no competent manager and no dedicated union representative would argue otherwise. It's the next step that's proving difficult to take.

While an afternoon nap may be a tough sell, the same is not true for the overnight shift. The early morning hours have long been known as a critical time for human-error accidents, and many employers are searching for ways to make them safer. In an ideal world, says Shapiro, workplaces would simply shut down for half an hour sometime between 3 and 5 a.m. Workers would either be paid for the time or have their shifts lengthened to make up the difference.

Rosekind sets his sights a little lower. Identify your most vulnerable periods, he tells employers. Likely, these will be somewhere in the 3 o'clock to 5 o'clock window. Next, identify your most vulnerable people. These may be individuals with unusual circumstances: a medical condition, a sick relative or a new-born infant at home, a long commute. Third, identify your most safety critical people. Fourth, put together a rotation that allows planned rest for vulnerable and safety critical people.

Employers need not invest in an expensive facility, he says. "People can nap in a chair if they need to." They may not need a nap every day. "You have to be practical," he says. "Identify the people who need it and give then an opportunity for a planned half-hour nap."

To be most effective, napping must be one element of a larger fatigue countermeasures program, experts agree. This can include lifestyle training for workers and their families and an examination of work scheduling practices.

What you don't want, says Rosekind, is spontaneous, uncontrolled napping. That's what is happening now. He looks at the data and calls the decision a "no-brainer." The argument in favour of workplace napping will be won on the basis of its economic benefits, he says.

"Which person do you want on the job, the one with 34 per cent better performance and 100 per cent more alert, or the other guy?"

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HOW TO NAP

Mark Rosekind doesn't buy the "I can't nap" argument. He agrees that there is variability among individuals, but says anyone who is sufficiently sleep deprived will nap if the conditions are right, and the clock strikes three.

Shapiro also says that there is a fair bit of variability among individuals in their ability to nap. The older you get, the easier napping seems to become. But no matter how old, or young, you are, it is behaviour that can be learned.

• Time of day, or night, is important. The hours of three-to-five, a.m. or p.m., are prime napping times, say the experts.
• Early evening is a bad time for a nap. It also helps if you're sleepy, but that's pretty much a given according to Mark Rosekind, as most of us are sleep deprived anyway.
• William Anthony, author of The Art of Napping, suggests you follow a routine prior to your nap. If possible, try to repeat the same habits or "winding down" you follow prior to your normal sleep period.
• The environment should be consistent for the duration of the nap, says Anthony. A change in the background noise level or ambient air temperature -- either an increase or a decrease -- can interrupt your nap.
• How long to nap is something you should determine for yourself. We each have our own ideal napping range. Expect somewhere around 45 minutes to be your maximum and test various nap lengths. If you wake up feeling groggy and disoriented, you probably entered a deeper stage of sleep. Shorten your next nap until you find the time that leaves you feeling alert and refreshed.
• Use an alarm clock to wake up, or arrange for a colleague to wake you. Allow sufficient time after waking to shake off the lingering effects of sleep inertia. Just as when you were preparing for your nap, if you follow a routine after waking from your regular sleep period, try to mimic it after your nap.
• There are two circumstances where napping would be inappropriate, says Rosekind. First, people with insomnia should probably avoid napping, as it may interfere with their sleep schedules. Second, naps should not be taken close to one's normal sleep period.
• Not everyone will benefit to the same extent from a nap. The Mayo Clinic in the U.S. suggests the following "naptitude" test: Nap for one week, don't nap for the next. During the two-week period, record when you go to bed at night, how long it takes you to fall asleep, how many times you wake up, how many total hours you sleep, and how you feel in the morning. During the week that you take naps, also record how you feel after your mid-day snooze. At the end of the two weeks, try to judge whether naps are good for you based on how they affect your sleep habits.
• And if you find you simply can't nap, don't worry about it. Shut your eyes. Relax. Rest. Lie down and focus your mind on something else.

Just in case, set the alarm.

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