Sleep and Occupational Health and Safety

Sleep disorders such as obstructive Sleep Apnoea, along with related medical conditions, can cause excessive daytime sleepiness, which in turn, leads to a greater incidence of car accidents, work accidents and injuries resulting in sick leave and lower productivity.

This section includes information on the relationship between Fatigue and Driver Performance, Fatigue and Shift Workers, and other industry-specific issues.

Just click on any of the headings below to go to that section:

Fatigue and Sleepiness
Fatigue in Shift Workers and Manual Labourers
Sleep Disorders and Driver Performance
Sleep Workshops and Workplace Seminars
Fact Sheets
What to do if you have Symptoms of Fatigue or Sleep Apnoea

• Fatigue is caused by lack of sleep or poor quality sleep.  A person suffering from fatigue may display these signs:
  • Slowed reflexes and responses;
  • Impaired decision making and judgement;
  • Impaired hand to eye coordination;
  • Short term memory problems;
  • Poor concentration;
  • Reduced ability to pay attention to the situation at hand; and
  • Reduced function in daily activity. [i]
• Excessive daytime sleepiness is reported by up to 31% of the adult population. [iii]
• Increased or Excessive sleepiness during the day, which manifests itself as a lack of concentration/inattention or a tendency to doze at inappropriate times when intending to stay awake, can be caused by:
  • medical sleep disorders such as obstructive sleep apnoea, periodic limb movement disorder, circadian rhythm disturbances (eg. advanced or delayed sleep phase syndrome), some forms of insomnia; and narcolepsy.
  • prior sleep deprivation (restricting the time for sleep) - Insufficient sleep (less than 5 hours) prior to driving is strongly related to accident risk [ii];
  • poor sleep hygiene habits,
  • irregular sleep/wake schedules, including shift work and irregular rostered work; or
  • the influence of sedative medications and/or alcohol.

• Occupations involving work outside normal hours have a profound effect on sleep quantity and quality: [iv]
• Approximately 9% of women, and 24% of working-age adult males suffer from sleep disordered breathing (defined as an apnoea-hypopnea score of 5 or higher). [v]
• Working more than an average of 48 hours per week represents the largest occupational health and safety risk faced by Australian workers today. [vi]
• Fatigue and alcohol cause similar affects to the human body - the impairment after 17 hours of sustained wakefulness is similar to a blood alcohol level of 0.05%, while after 24 hours of being awake the impairment is similar to 0.1% blood alcohol.

• Fatigue is the main cause of driver recognition failure
• 33% of road accidents in Australia were attributed to sleepiness
• Most sleep-related motor vehicle accidents occur in the early hours of the morning

• The majority of clinical evidence indicates that sleep deprivation causes a cumulative deterioration in mood, fatigue and performance - at least 2 nights of recovery sleep are required before these attributes are restored to baseline levels. [vii]
• The shortening of the sleep period caused by an early start at work has also been shown to be associated with an increase in errors and accidents in transport workers. [viii]

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• Approximately 9% of women, and 24% of working-age adult males suffer from sleep disordered breathing (defined as an apnea-hypopnea score of 5 or higher). [v]
• Working more than an average of 48 hours per week represents the largest occupational health and safety risk faced by Australian workers today. [vi]
• Night-shift workers sleep an average of 8 hours less each week than do day workers – this equals the loss of an entire night's sleep every week;
• Studies have found that in some instances, sleepiness is severe enough to result in night workers unintentionally falling asleep while on duty. [vii]
• Sleep taken after night work and to a lesser extent, before morning work, tends to be significantly shorter and of inferior recuperative value compared with sleep taken following afternoon work. [viii]
• Fatigue and alcohol cause similar affects to the human body - the impairment after 17 hours of sustained wakefulness is similar to a blood alcohol level of 0.05%, while after 24 hours of being awake the impairment is similar to 0.1% blood alcohol.

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The main physiological consequence of long shifts and night shift schedules is disruption of circadian rhythm which can have a harmful effect on performance, sleep patterns, accident rates, mental health, and cardiovascular mortality – including:

• Increased risk of accidents on the night shift and with long working hours, [ix] as well as dangerous manual handling practices, and over-use injuries;
• Stress and burnout, and constant fatigue, exhaustion;
• Mental Health - anxiety or panic about work, depression, poor memory and concentration;
• Aches - frequent headaches, backaches and pains;
• Mood - being irritable and short tempered;
• Heart palpitations and heart disease - shift workers have a 40% increase in risk of coronary heart disease, including angina pectoris, hypertension, and myocardial infarction. [x]
• Gastrointestinal disorders; and Reduced resistance to colds and flu or other infections. [xi]

• The majority of clinical evidence indicates that sleep deprivation causes a cumulative deterioration in mood, fatigue and performance - at least 2 nights of recovery sleep are required before these attributes are restored to baseline levels. [xii]
• The shortening of the sleep period caused by an early start at work has also been shown to be associated with an increase in errors and accidents in transport workers. [xiii]
• Shift work and particularly night work, may present special risks to women of child bearing age. [xiv]

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Sleepiness and Road accidents:

• In Australia, up to 33% of crashes are attributed to sleepiness (compared to an estimated 1-3% in the USA and 10% in France). [iv]
• 20-30% of accidents involving commercial drivers are sleep-related – as found by a recent House of Representatives inquiry into managing fatigue in transport. [v]
• The risk of accidents is directly related to increasing chronic sleepiness - sleepy drivers have a much higher risk of being involved in an accident than the rest of the population, and will often be involved in multiple accidents. [vi]
• Most sleep-related motor vehicle accidents occur in the small hours of the morning, with a further peak around 5 p.m. - more than 40% of these accidents are work related. [vii]

Sleep Disorders and Their Effect on Commercial Drivers

• Australian truck-drivers have a 16% prevalence of chronic sleepiness (as attested by an Epworth sleepiness scale score of more than 10).  33% of these truck drivers have symptoms of excessive fatigue on medical examination.
• Sleep Disorders are very common among commercial drivers:
  • 60% had sleep disordered breathing;
  • 16% had Obstructive Sleep Apnoea; and
  • 24% had excessive day time sleepiness. [viii]
• There is a strong association between acute sleepiness in drivers and the risk of a crash in which an occupant was injured or killed (that was independent of the effects of acute alcohol consumption and other major confounding factors). [ix] 
  • The risk of an accident is increased eightfold when a driver is sleepy.
  • There is a threefold risk for drivers who drive with five hours or less of sleep.
  • There is also an increased risk of an accident/injury associated with driving in the early hours of the morning. [x]
• In Australia, legal liability for sleep-related accidents extends to a driver who has a sleep disorder and suffers daytime sleepiness (in the context of widespread public knowledge regarding sleep disorders driving risk).  It also extends to the employer of a driver with a sleep disorder who does not have a program for employee screening and education.  Further, employers, supervisors and drivers are all liable in the event of accidents caused by sleepiness due to extended shifts, or inadequate breaks between shifts [xi] *

How Treatment Can Help

• Patients with suspected sleep apnoea and/or chronic excessive sleepiness or another sleep disorder should be referred to Sleep Services Australia for further assessment, and investigation with an overnight sleep study (polysomnography)) and management.  We can implement treatment, which is managed by our Respiratory and Sleep Physicians.
• There is clear evidence that treatment of obstructive sleep apnoea with nasal continuous positive airway pressure (CPAP) dramatically reduces the risk of accident, and the costs of hospitalisation for motor vehicle accidents in sleep apnoea patients. [xii]
• Sleep Services Australia specializes in providing home-based diagnostic sleep studies, which can be customized for a particular workplace and industry.  Please contact us for more information via telephone on 1300 867 533 or e-mail ohs@sleepservicesaustralia.com.au.

References

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Sleep Workshops & Workplace Presentations

Sleep Workshops and Talks

Through our interactive presentations, Sleep Services Australia can offer your company or practice the opportunity to hear about our services at a time that suits you.  As an example, our service can involve a presentation to:

• Medical Practitioners or Allied Health Professionals,
• a group of employees (either pre-employment screening, or as part of your overall occupational health strategy),
• Occupational Health and Safety risk assessors or managers,
• Corporate Health service providers; or
• Practice staff.

Our senior staff can attend at your offices or workplace, and provide a comprehensive overview of our services, including:

• sleep disorders and their treatment - including risks of going without diagnosis and treatment, or
• a specific area that are relevant to your company - such as the relationship between driver performance and sleep disorders, or shift work and its effect on sleep; and
• how to arrange your employees to be screened with a Sleep Study.

Potential Sleep Study or CPAP Treatment Outlets

We also offer an excellent practice training course for medical staff in your practice or company, so you may consider having an in-house medical practice dedicated to diagnosis and treatment of sleep disorders.

How to arrange Sleep Presentation or Workshop

Please contact us to arrange an in-house presentation or a Sleep Workshop for your company or practice:

• E-mail your query toevents@sleepservicesaustralia.com.au , or
• Complete our Online Query Form (Click Here);
• Telephone us on 1300TOSLEEP (1300 867 533) for the cost of a local call; or
• Fax your request, with a brief overview of your company or practice, to our Head Office on (03) 9832 2295, marked Attn: Marketing Coordinator.

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You can download our handy Fact Sheets on topics relevant to you:

• What is Normal Sleep?
• What is Snoring?
• What is Obstructive Sleep Apnoea
• Treating Obstructive Sleep Apnoea
• What is Fatigue and Sleepiness?
• Fatigue and Driver Performance
• Tips for Getting a good night's Sleep
• Sleep Hygiene Tips for Shift Workers
• Sleep Tips for Jet Lag

The Australian National Transport Commission has implemented the Driving and Your Health campaign - Click here for more information. Other fact sheets on sleep apnoea in general, and the effect of fatigue and driving can also be downloaded from the NTC website www.ntc.gov.au.

Brochures supplied by the National Transport Commission:

• Supplement 2a - Obstructive Sleep Apnoea
• Fact Sheet 2 -  Sleep Disorders and Driving
• Fact Sheet 3 - Fatigue and Driving

The Assessing Fitness to Drive document can be downloaded from the Austroads website www.austroads.com.au

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• Make an appointment with your doctor if you believe that you have a sleep disorder such as Sleep Apnoea, or suffer from Excessive Daytime Sleepiness.
• Your Doctor may refer you to Sleep Services Australia's Sleep Physicians for assessment and management.
• For general questions about our services, complete our Online Query Form (Click Here) or e-mail your contact details to query@sleepservicesaustralia.com.au
• Telephone us on 1300 867 533 (for the cost of a local call) if you are unsure of what to do.
• For medical enquiries about your sleep behaviour, or to discuss you Sleep Study results, please contact your referring Doctor.

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