feeling tired?

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feeling tired?
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Shiftwork and Fatigue
Fatigue is a loss of alertness which eventually
ends in sleep
Once, a pilot crashed after 16 hours on duty
because he read an altimeter incorrectly. He had
been flying safely for 15 hours, and suddenly he
couldn't read an altimeter? This is hard to
believe. That's fatigue.
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Fatigue is a serious issue

• Fatigued operators can cause accidents, (eg Three
  Mile Island, Bhopal, Space Shuttle Challenger,
  Exxon Valdez and Chernobyl)
• USA cost of sleep-related accidents estimated
  to be between 43 - 56 billion
• UK annual cost of work accidents caused by
  sleepiness estimated to be 115 240 million
• 25 of fatal truck crashes are due to fatigue
• 7 of motor vehicle accidents may be attributed
  to fatigue, a figure that rises to 15 for
  motorway accidents
• pilot fatigue is implicated in upwards of 20 of
  near-accidents in aviation

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The Sleep Quiz
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Im safe at work so it doesnt matter if Im
sleepy?

• Falsebeing sleepy can cause
• slower reaction time
• impaired judgements and decision making
• decline in attention
• decreased alertness
• increased moodiness and aggressive behaviour
• difficulty in remembering things

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I can tell when Im going to fall asleep

• False.
• People do not know how sleepy they are
• The more tired you become, the less able you are
  to make a good judgement about your ability to
  remain awake
• Being awake for 18 hours is as great a risk as
  driving drunk

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Signs of tiredness

• The signs include
• not feeling refreshed after sleep
• difficulty keeping your eyes open and focussed
• greater tendency to fall asleep while at work
• more frequent naps during leisure hours
• lots of yawning
• extended sleep during days off
• increased errors and loss of concentration at
  work
• feeling irritable, restless and impatient

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Lack of sleep is the only cause of fatigue...

• False but it is the only cure
• Causes of fatigue include
• Workload
• Social factors
• Individual factors e.g., age, diet, fitness etc
• Shift work

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The older you get, the fewer hours of sleep you
need

• False
• Sleep needs remain unchanged throughout adulthood
• Older people wake more frequently through the
  night
• Shift work becomes harder with age (4050 yrs)
• Ability to cope with early starts may improve

10
Most people need 8 hours of sleep to function at
their best

• True
• 7 8 hours is recognised as an average and
  normal need
• Less than this and you build up a sleep debt
• Sleep comprises several stages which must follow
  a certain pattern if you are to feel fully rested
  and alert
• Stage 1 and 2 transitional phase between waking
  and sleeping
• Stage 3 and 4 deep sleep
• Rapid Eye Movement (REM) sleep

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If I sleep a lot now, I wont need to sleep much
later

• False
• Sleep is not like money you cant save it up
  and you cant borrow it
• While napping is an effective means of managing
  alertness it is not a substitute for regular
  sleep

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Everyone has a biological clock

• True
• We have evolved own internal body clock /
  circadian rhythm
• It controls a number of internal rhythms, eg,
  sleep/wake cycle, body temperature
• It is this body clock that makes us feel sleepier
  and less alert when we try and work at times
  normally reserved for sleep

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The human body can adjust to nightshift work

• False
• Our body clock programmes us to feel most sleepy
  when it is dark
• Eating meals at times normally reserved for sleep
  means they are less well digested
• On night shifts you tend to get less sleep and it
  is of a poorer quality (e.g., after one week of
  night shifts, workers had lost the equivalent of
  one nights sleep)
• Successive night shifts, eg, 4, result in an
  increase in accident risk

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Features of shiftwork that lead to fatigue

• Timing of shifts (earlies, lates and nights)
• Duration of shifts
• Rotation of shifts
• Rest and recovery periods

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Early Starts

• Associated with a reduction in duration of sleep
• Sleep periods prior to early start are on average
  3 hours shorter
• Difficult to compensate with earlier bedtime
• Social pressures
• Forbidden zone
• Fear of not waking up early
• Successive early starts cumulative sleep
  deficit

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Snoring is not harmful as long as it does not
disturb sleep

• False
• Chronic snoring may indicate sleep apnoea, a
  sleep disorder
• Other common sleep disorders are
• Insomnia
• Restless leg syndrome

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Drinking coffee cures drowsiness

• False
• Caffeine has a short term effect
• Caffeine should be used carefully as it will
  disrupt sleep
• Other measures such as opening windows and
  putting on the radio are not effective
• The only cure for drowsiness is to get some sleep

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Conclusions

• Being tired impact on our performance and
  increases the risks of an accident
• The amount and quality of sleep are important
  factors in ensuring you wake up feeling fully
  rested
• Shift work makes us more prone to fatigue because
  it makes us work against out natural circadian
  rhythms

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Coping with Shiftwork
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Sleep Strategies

• Managing your work time
• Use naps to improve alertness
• Create a good sleep environment
• Establish a regular pre-sleep routine
• Establish a regular bedtime and wake-up schedule
• Manage your caffeine intake
• Other advice
• Avoid alcohol
• Take regular exercise
• Manage your diet

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Managing Your Work Time

• There are different tips for managing fatigue
  depending on your shift pattern and the type of
  shift you have just finished.
• Example managing night shifts
• Go to bed as soon as you get home
• Have an afternoon nap
• Avoid exposure to daylight
• Eat 3 regular meal with lunch during your night
  shift

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Creating a good sleep environment

• Quiet
• Dark
• Warm/cool
• Comfortable bed that you associate with sleep
• Fresh air
• Free from interruptions

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Pre-sleep routine

• You can learn that it is time to relax and go to
  sleep
• Establish a pre-sleep routine to provide specific
  cues
• Reading
• Listening to music
• Getting dressed for bed
• Only get into bed when your tired

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Napping Not to be used whilst at work

• Limit naps to about 30 45 minutes including the
  time it takes to fall asleep
• Naps of 15 20 mins are most restorative
• Give yourself time to get over sleep inertia
• There is no minimum time period for effective
  napping
• Improved alertness may last for several hours

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Caffeine

• It is a stimulant so it can keep you awake but it
  can also disrupt sleep
• Use caffeine in moderation and when it is most
  needed
• Avoid it for several hours before sleep
• Dont quit cold turkey, cut back gradually
• How much caffeine is okay?