Effects of Sleep Deprivation on Fire Fighters and EMS ... - NAEMT

<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders
Section 5: Measures to Effectively Manage Work Hours
5.1 Introduction
One in five U.S. workers or more than 15 million Americans work evenings, nights, rotating
shifts or other irregular schedules. It is estimated that fatigue costs U.S. employers $136.4
billion annually in health-related costs and lost worker productivity (Ricci et al., 2007). The
health consequences <strong>of</strong> long work hours, inadequate sleep and disruption in daily rhythms are
discussed in Section 1. For the majority <strong>of</strong> sleep deprived individuals, the problem develops
insidiously, and while they might acknowledge their fatigue, they tend to discount its personal
impact and consider it an issue for others, not themselves (Jones et al., 2006). The concept <strong>of</strong>
adapting to sleep deprivation or training oneself to require less sleep is a myth. Although a
person can learn to sleep less, no one can learn to need less sleep.
Better understanding <strong>of</strong> sleep and circadian physiology, plus the interest <strong>of</strong> researchers (Rosa et
al., 1990; Horowitz & Tanigawa, 2002; Goh, Tong & Lee, 2000), occupational specialists and
health promoting organizations have generated a range <strong>of</strong> options and suggestions to improve
the lives and productivity <strong>of</strong> shift workers. Examples <strong>of</strong> the products and services that they <strong>of</strong>fer
are presented on pages 69 and 70.
In general, methods to minimize and cope with long work hours are divided into categories <strong>of</strong>
employment-related issues and those adaptations that individuals personally can make in their
working and non-working lives. Although organized into those domains, in reality, all strategies
require collaboration among workers and employers. Topics presented in this Section are organized
as they relate to workers, including screening, worker habits outside <strong>of</strong> work (sleep hygiene and
other lifestyle behaviors), stimulant use, family issues and commuting. Job structural issues presented
include worker environment, physical activity, naps, work hour structure, behavior-based fatigue
management and regulations.
5.2 Identifying At-Risk Workers
5.2a <strong>Sleep</strong> Apnea (see also Section 1, page 10 and Section 2, page 32)
Commercial motor vehicle operators (CMVO), truckers, are a group who work long hours and
whose alertness can have life threatening consequences. As discussed previously, obstructive
sleep apnea (OSA) is a disorder associated with increased daytime sleepiness. OSA is more
common among CMVOs, and because the consequences <strong>of</strong> increased sleepiness are so great in
trucking, regulations are in place to screen all CMVOs for the disorder (Hartenbaum et al.,
2006). A simplified version <strong>of</strong> the recommendations used to identify individuals in need <strong>of</strong>
specialized sleep laboratory studies to assess for OSA is presented in Table 5.1. Although OSA
may be suggested by history and certain physical findings (higher body mass index, greater
neck circumference and hypertension), it can only be diagnosed by an overnight study in a
specialized sleep laboratory. Once diagnosed, appropriate management, such as using nighttime
continuous positive pressure breathing apparatus or other measures, can correct the day time
fatigue (Hartenbaum et al., 2006). Those identified CMVOs with OSA are required to provide
documentation <strong>of</strong> appropriate treatment and be closely followed to insure that their illness is
being managed or they will not be licensed to drive.
59