Issue #79 – December 23

Welcome to Focus on Fatigue!

It’s December and the silly season is once again upon us. At this time of year many people attend a variety of Christmas parties, and other end of year celebrations. It can be easy to find ourselves getting behind the wheel of a car at the end of a long night when we’re feeling tired and eager to get home to bed. For shift workers, driving at odds times of the day or night, often while sleep deprived, can be an all too common occurrence at any time of the year.

This month, our Focus on Fatigue newsletter will examine the issue of Drowsy Driving, including how to recognise the symptoms and what you can do to increase your chances of arriving home safely.

InterDynamics would also like to take this opportunity to wish all our Focus on Fatigue readers a very happy and safe Christmas and New Year period.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

It’s more than keeping your eyes open

We all know how important it is to be sober when we get behind the wheel of a car. The consumption of alcohol impedes our driving performance, making us more likely to have an accident. So we are careful about how much we drink, how long since our last drink, or we abstain from drinking alcohol altogether if we know we’ll be driving. We get behind the wheel of our car at the end of a long day, or at the end of the party, and we’re tired but sober. Does this mean that we are safe to drive?

Fatigue impairs driving performance

Studies have shown that extended wakefulness can impair your ability to drive in a similar way to drinking too much alcohol. Often we underestimate the effect of drowsiness on our driving performance, or we believe that we can fight off sleepiness long enough to get home safely. Unfortunately, this is not always true. Estimates vary (due to data collection and location variations) but around 10-20% of fatal and serious crashes are attributed to driver fatigue, with some suggesting the real numbers may be higher. The National Road Safety Action Plan identifies that ‘fatigue is four times more likely to contribute to impairment than drugs or alcohol’.

But what is drowsy driving and how do we know if it’s happening to us? When we do experience drowsy driving, what can we do about it?

What are the warning signs of drowsy driving?

The Sleep Health Foundation lists the following as signs of drowsy driving:

• Yawning
• Struggling to keep eyes open or focused
• Difficulty concentrating
• Difficulty remembering the past few kilometres
• Lane deviations
• Variations in driving speed
• Doing things to keep yourself alert – such as winding down the window or turning up air conditioning or music
• Head nodding – this is end-stage drowsiness, indicating that you are already having micro-sleeps

The danger of microsleeps

The American Academy of Sleep Medicine defines a microsleep as ‘an episode lasting up to 30 seconds during which external stimuli are not perceived. The polysomnogram suddenly shifts from waking characteristics to sleep. Microsleeps are associated with excessive sleepiness and automatic behaviour.’

Microsleeps are most likely to happen to people who are sleep deprived and performing a monotonous task, such as driving a car. Imagine, just for a moment, the possible consequences of experiencing a microsleep when driving. It may last a fraction of a second, or up to 30 seconds. Your car is still moving, your eyes may even be open, but your brain is asleep. You don’t see the brake lights of the car in front of you come on, or the red light up ahead, or the curve in the road, or the fact that you’re drifting onto the wrong side of the road. When you wake up from the microsleep, assuming you haven’t already had an accident, the decision-making areas of your brain are not the first ones to come back online. Meaning that even more precious seconds may elapse before you can react to what is happening around you.

Perhaps the scariest thing about microsleeps is this: You may not even be aware that you had one. So you keep driving. And chances are, it happens again. You can’t choose not to have a microsleep. You are no longer in control.

What about general drowsiness, without microsleeps?

Studies have shown that falling asleep at the wheel is not the only way in which drowsy drivers are at risk. They are also more likely to report crossing lanes while driving, more likely to increase their average driving speed, more likely to be aggressive and may take more risks due to an impaired ability to assess situations.

Why are shift workers more likely to experience drowsy driving?

Shift workers have been found to be one of the groups most at risk of drowsy driving (along with young drivers, commercial truck drivers, those with untreated sleep disorders and those who use medicines that make them sleepy). Shift workers are more tired than non-shift workers during commuting. They get less sleep overall, resulting in increased levels of sleepiness. The sleep they do get tends to be of a lower quality because of the increase in day sleep. They often commute longer distances. Shift workers are also more likely to be driving at times when their circadian rhythm (internal biological clock) is telling them it’s time to sleep.

One study conducted by researchers from Brigham and Women’s Hospital found that shift workers were at a higher risk for drowsy driving crashes when driving during the day after a night shift. Even short commutes were shown to be potentially dangerous, with the risk increasing as the length of the drive increased. “Even veteran night shift workers were vulnerable to the risks associated with drowsy driving,” said one of the researchers involved in the study.

What should I do if I experience drowsiness while driving?

A variety of measures have been suggested over the years, some of which may work better than others.

Napping

If it’s not possible to pull over for an extended sleep, napping can be a useful short term remedy for drowsiness. A 5-min nap may improve a driver’s condition, but a 10-20 min nap is most beneficial. A 10-min nap in a reclined position, improves the ability of a driver for at least 1 hour. Napping for longer than 20 mins may not be advisable if you plan to drive straight away after, due to the onset of sleep inertia (that groggy feeling we can wake up with after napping).

Caffeine

Caffeine increases alertness in sleepy people. It has been suggested that a minimum of two cups of coffee is necessary for a positive effect on driving performance. The consumption of caffeine in drowsy drivers has been found to reduce lane deviations, potential crashes, and sleepiness for about an hour.

The coffee nap

Some researchers have explored the idea of combining napping and coffee. This involves drinking one-two cups of coffee quickly (so they can’t be too hot) and then immediately lying back for a short nap. By the time you are waking up from your nap, the caffeine will have entered your system. This combination was found to effectively increase alertness in drivers for an hour. In fact, the coffee nap was found to be more effective than either coffee or napping by themselves.

Other interventions

While other interventions are anecdotally popular, they have limited or no proven effectiveness. These include:

• Keeping the interior of the car cool
• Listening to talk or music on the radio
• Varying the route a bit
• Stopping to walk around for a while
• Having a driving buddy

The real cure for drowsiness

It is always important to remember that the only thing that will truly cure you of drowsiness is sleep. Always take this into account before getting behind the wheel of your car. And if you really need to get somewhere and you are not safe to drive, keep yourself and other road users safe, and call a cab! The cost may be more in the short term, but less in the long term!

Research

• Aidman, E., Balin, M., Johnson, K., Jackson, S., Paech, G. M., Pajcin, M., Yates, C., Mitchelson, E., Kamimori, G. H., Fidock, J., Vedova, C. D., & Banks, S. (2021). Caffeine may disrupt the impact of real-time drowsiness on cognitive performance: a double-blind, placebo-controlled small-sample study. Scientific reports, 11(1), 4027.
• American Academy of Sleep Medicine (2001) The International Classification of Sleep Disorders, Revised. American Academy of Sleep Medicine. Westchester, IL.
• Brooks, A., & Lack, L. (2006). A brief afternoon nap following nocturnal sleep restriction: which nap duration is most recuperative?. Sleep, 29(6), 831–840.
• Caba, J. (2015) Night shift workers are at an increased risk for car crashes, even during daytime commute. Medical Daily, accessed 20 November 2023.
• Di Milia, L., Rogers, N. L., & Åkerstedt, T. (2012). Sleepiness, long distance commuting and night work as predictors of driving performance. PloS one, 7(9), e45856.
• Hilditch, C. J., Centofanti, S. A., Dorrian, J., & Banks, S. (2016). A 30-Minute, but Not a 10-Minute Nighttime Nap is Associated with Sleep Inertia. Sleep, 39(3), 675–685.
• Horne, J. A., & Reyner, L. A. (1996). Counteracting driver sleepiness: effects of napping, caffeine, and placebo. Psychophysiology, 33(3), 306–309.
• Lee, M. L., Howard, M. E., Horrey, W. J., Liang, Y., Anderson, C., Shreeve, M. S., O’Brien, C. S., & Czeisler, C. A. (2016). High risk of near-crash driving events following night-shift work. Proceedings of the National Academy of Sciences of the United States of America, 113(1), 176–181.
• National Road Safety Strategy, National Road Safety Action Plan 2018-2020 – Fatigue. Accessed 20 November 2023.
• NCSDR/NHTSA Expert Panel on Driver Fatigue and Sleepiness (1998) Drowsy driving and automobile crashes: Report and recommendations. National Highway Traffic Safety Administration.
• Reyner, L. A., & Horne, J. A. (1997). Suppression of sleepiness in drivers: combination of caffeine with a short nap. Psychophysiology, 34(6), 721–725.
• Rogers, A., Holmes, S., & Spencer, M. (2001). The effect of shiftwork on driving to and from work. Journal of human ergology, 30(1-2), 131–136.
• Sleep Health Foundation (2023) Drowsy Driving, Accessed 20 November 2023,
• Tefft, B.C. (2010). The Prevalence and Impact of Drowsy Driving (Technical Report). Washington, D.C.: AAA Foundation for Traffic Safety.
• Thomas, M., Gupta, C., Sprajcer, M., Demasi, D., Sach, E., Roach, G., Sargent, C., Dawson, D. & Ferguson, S. (2021). Fatigue and Driving: An International Review. Appleton Institute – Central Queensland University, Adelaide, Australia.
• Thompson, J., & Wundersitz, L. (2023) The contribution of driver fatigue to casualty and fatal crashes in South Australia, Centre for Automotive Safety Research – The University of Adelaide, South Australia, Australia.
• Tietzel, A. J., & Lack, L. C. (2001). The short-term benefits of brief and long naps following nocturnal sleep restriction. Sleep, 24(3), 293–300.

Blood Test for Sleepy Drivers Could Pave Way for Prosecutions

Linda Geddes, The Guardian, May 2023
A blood test to measure whether a driver who has caused an accident was impaired by lack of sleep could be available within two years.

Driver Fatigue – ‘A Dangerous Form of Impairment’ – Continues to Take Lives 

Tanya Mohn, Forbes, March 2023
Research found that many drivers may be unaware of how drowsy they are, and as a result, fail to take breaks because they may not realize the risks until it’s too late.

Sleep Deprived Medical Staff Pose Same Dangers on Roads as Drunk Drivers

Robin McKie, The Guardian, June 2022
Survey published in the journal Anaesthesia found 57% of respondents said they had experienced an accident or near miss when travelling home from a night shift.

Issue #78 – August 23

Welcome to Focus on Fatigue!

In our recent conversations with clients, the significance of fatigue’s impact on service delivery has repeatedly emerged. So, in this edition of Focus on Fatigue, we wanted to consider the broad reaching influence of fatigue – going beyond the realm of safety outcomes – to delve into its profound effects on service quality. Read on to see how quality sleep promotes quality service!

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

The impact of fatigue on service delivery

When we talk about workplace fatigue, the emphasis is often on safety outcomes. While safety is rightfully an important concern, the repercussions of fatigue on service quality and customer interactions are also significant.  While we know that fatigue can lead to reduced reaction speed, reduced accuracy and microsleeps, even before we reach this point, fatigue impacts mood and communication, diminishes emotional intelligence and impairs decision making. These impairments affect service delivery and service outcomes.

Emotional Intelligence and Service Excellence

Emotional intelligence forms the bedrock of exceptional customer service. The ability to understand, manage, and connect with emotions, both one’s own and others’, is crucial for fostering positive interactions. However, a study published in the journal Sleep Medicine highlights how sleep deprivation diminishes emotional intelligence. For service-oriented industries, such as healthcare and law enforcement, where customer interactions are frequent and diverse, emotional intelligence is pivotal. Fatigued employees may struggle to read cues, respond empathetically, or manage challenging situations effectively.

Impaired Cognitive Skills and Customer Relations

Constructive thinking and effective decision-making are cornerstones of quality service delivery. Research has shown that sleep deprivation impairs cognitive skills necessary for problem-solving and innovation.  In roles that demand quick thinking and constant interaction with the public, these impairments can lead to suboptimal solutions and inadequate responses.

Customer Complaints

The impact of fatigue on service quality can clearly be seen in a study featured in the journal Sleep looking at the relationship between predicted fatigue levels (utilising FAID Quantum) and public complaints. The study found that greater predicted fatigue and reduced sleep opportunity were strongly associated with an increase in public complaints.

Implications

Along with emotional intelligence and cognitive skills, fatigue also takes a toll on mood, motivation and productivity; reducing an individuals willingness to ‘go the extra mile’. Fatigue impairments can lead to misunderstandings, miscommunication, escalated encounters, longer resolution times and service errors, resulting in dissatisfied customers, adverse outcomes and complaints. Furthermore, fatigue can ripple through organisations, leading to absenteeism and higher staff turnover, further diminishing quality of service delivery.

Mitigating Fatigue for Enhanced Service Delivery

Organisations in service-oriented sectors can enhance service quality by prioritising fatigue management strategies. Investing in employee well-being by promoting healthy sleep practices, managing workloads, and providing opportunities for rejuvenation can have a profound impact. Encouraging short breaks, facilitating better work-life balance, and fostering a supportive work culture can significantly reduce the prevalence of fatigue.

References

Gordon, A. M., & Chen, S. (2014). The Role of Sleep in Interpersonal Conflict: Do Sleepless Nights Mean Worse Fights? Social Psychological and Personality Science, 5(2), 168–175. https://doi.org/10.1177/1948550613488952

Killgore, W., Kahn-Greene, E., Lipizzi, E., Newman, R., Kamimori, G. & Balkin, T. (2008). Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep medicine. 9. 517-26. https://doi.org/10.1016/j.sleep.2007.07.003

Paterson, J.L.,  Dorrian, J.,  Ferguson,S.A., Jay, S.M., Lamond, N., Murphy, P.J., Campbell, S.S., & Dawson, D.
(2011) Changes in structural aspects of mood during 39–66h of sleep loss using matched controls,
Applied Ergonomics, 42(2), 196-201, https://doi.org/10.1016/j.apergo.2010.06.014.

Riedy, S. M., Dawson, D. & Vila, B. (2019). U.S. police rosters: Fatigue and public complaints, Sleep, 42(3), zsy231, https://doi.org/10.1093/sleep/zsy231

Riedy, S., Dawson, D., Fekedulegn, D., Andrew, M., Vila, B., and Violanti, J. (2020), Fatigue and Short-term Unplanned Absences Among Police Officers, Policing: an International Journal, http://doi.org/10.1108/PIJPSM-10-2019-0165

Whitney, P., Hinson, J., Jackson, M. & Van Dongen, H. (2015) Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback, Sleep, 38(5), 745–754. https://doi.org/10.5665/sleep.4668

FAID Quantum Training

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We tailor our training to the client and organisation, to assist in addressing your unique circumstances and ensuring you get the most out of the process.

If you think your organisation might benefit from training and you would like to know more, please get in touch.

Issue #77 – May 23

Welcome to Focus on Fatigue!

We are often asked for advice on how to assess whether fatigue contributed to an incident and if it can be determined simply by looking at the FAID Score at the time of the incident? The short answer is no. A systematic and situation-specific assessment is required to determine whether fatigue was a contributing factor to an accident or incident.

In this issue of Focus on Fatigue, we will provide some insight into this process.

We trust you find it useful and informative.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Fatigue is a serious and complex issue and many organisations struggle with how to assess and determine whether fatigue contributed to an incident or accident. So, let’s have a look at this process. We will provide an overview of the information needed for a thorough investigation and identify personal and corporate/systemic fatigue-related contributors. We will also introduce the GRAID Investigation Tool, which can assist organisations in this assessment process.

Specific Details of the Occurrence

To assess whether fatigue was a contributing factor to an incident, you need to collect specific details of the occurrence. This includes timing, personnel involved, context, and incident details. This information will help you understand the circumstances surrounding the incident and determine whether fatigue may have played a role.

Preliminary Details

Once you have collected the specific details of the occurrence, you need to consider preliminary details related to the individuals involved and the circumstances surrounding the incident. This involves assessing factors such as:

• FAID Quantum hours of work assessment
• workload impacts
• work environment impacts
• non-compliance to work/rest rules
• self assessed Karolinska Sleepiness Scale
• self observed symptoms/behaviours
• personal health/medication
• third-party observations of symptoms/behaviours.

Assessing these questions will give you an initial determination as to the likelihood that fatigue was a significant contributing factor. If the likelihood is low, then no further investigation may be necessary. However, if the likelihood is not determined to be low, further investigation is warranted.

Personal and Corporate/Systemic Fatigue-Related Contributors

The next stage of the investigation involves assessing both personal and corporate/systemic fatigue-related contributors. Factors to consider include:

• the use of rest days
• secondary employment
• jetlag/significant recent time zone changes
• prior sleep in the previous 48 hours
• fatigue-related training
• sleep disturbance due to alcohol
• commute time prior to the occurrence
• sleep inertia
• fatigue detection technology
• quality of employer-provided sleeping environment
• predictability of working hours
• medical screening and monitoring
• record of absenteeism/sick days
• expectations and incentives that may increase personal fatigue
• whether rostering practices take into account fatigue
• alerting strategies and control measures

GRAID Investigation Tool

The GRAID Investigation Tool by InterDynamics was developed, together with Integrated Safety Support, to assist organisations in this assessment process. The tool applies a risk grading system developed by Zurich Risk Engineering and offers a consistent and practical approach to reviewing incidents, accidents, occurrences, and fatigue reports.

GRAID IT systematically steps the user through a review of 28 weighted fatigue-related elements. Once the investigation is complete, GRAID IT provides a grading of the likelihood that fatigue contributed to the occurrence, and the related scorecard can be reviewed. By taking a systematic approach to assessing fatigue, organisations can identify contributing factors and take steps to prevent future incidents.

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

Reducing fatigue and errors among nurses working night shifts

Issue #76 – March 23

Welcome to Focus on Fatigue!

Sleep is not always the easiest thing to come by, especially for those working long or night shifts. When we are deprived of adequate sleep, many of us are faced with a number of important questions. How tired am I? Can I continue working? Is my work performance suffering? Am I putting myself or others at increased risk? We all like to think we can accurately identify our level of fatigue and how we’re being affected by it, but is this actually the case? Do we know how tired we really are? Is fatigue self-monitoring an effective fatigue risk management strategy? This is the question we’ll be investigating in this month’s Focus on Fatigue.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Do we know how tired we really are?

Many shift workers rely on self-monitoring to assess their fatigue levels. But the question arises, how good are individuals at assessing their own level of fatigue and whether fatigue is impacting their performance?

Self-monitoring of fatigue levels: moderately good but not perfect

Studies have found that people are fairly good at recognizing when sleep deprivation is affecting their performance on simple tasks. However, one study of Australian fire fighters found that this ability to self-monitor performance begins to deteriorate after prolonged periods of wakefulness. Moreover, people tend to either over or under-estimate the degree that fatigue is hampering their performance. The ability to self-monitor fatigue can also be reduced during a person’s biological night (when our circadian rhythm is telling us we should be asleep).

Post-work evaluations are more accurate than predictions

Generally, people are better at evaluating their performance after completing a task, than predicting their performance before starting it. However, when it comes to risk management, pre-performance assessments are more valuable in reducing the risk of accidents or injuries. Feedback during the completion of a task can also lead to more accurate evaluation of performance.

Global predictions are more accurate

People tend to be better at making global predictions about our performance than they are at predicting how well they’ll do on particular tasks. For example, one study found that after a week of simulated night-shifts, participants were better able to predict their performance overall, than they were able to predict their performance for specific shifts.

This means that we aren’t necessarily great at identifying which tasks will be affected by our levels of fatigue. Considering that sleep deprivation does not affect all types of activities equally, such global predictions mean that we may not be good at adjusting our prediction of how well we will perform based on the type of activity we will be performing.

Acknowledging fatigue won’t help improve our performance – much

There can be a tendency to think that if we acknowledge how fatigued we are, then we can improve our performance by ‘trying harder.’ To a certain degree this is true. Studies have found that motivation to do well can make a difference to performance in people who are sleep-deprived (this depends heavily on the severity of the deprivation). However, it is important to remember that the best way to deal with fatigue, especially when we are able to recognize that fatigue is affecting our work performance, is to stop working and take a break or, preferably, have a sleep.

Work culture is also important

Fatigue will most commonly be apparent to a worker long before they cease to be ‘capable’ of working. Therefore, a person who acknowledges they are experiencing a high level of fatigue is not necessarily saying ‘I can’t continue working’ but may actually be saying ‘I believe it may be unsafe for me to continue working.’ It is imperative that workplace culture supports individuals who recognize that fatigue is impeding their work performance and wish to take steps to rectify the situation.

One useful tool

Overall, research tells us that self-monitoring can be one useful tool to assist in determining fatigue risk in the event of sleep deprivation. However, because our own assessment of fatigue has its limitations and is not necessarily as accurate as we would like to think it is, we should also be using the other tools at our disposal to assess risks that might be present as a result of fatigue.

References

• Armstrong, T. A., Cvirn, M., Ferguson, S. A., Christoforou, T. and Smith, B. (2013) Can Australian bush fire fighters accurately self-monitor their cognitive performance during a 3-day simulated fire-ground campaign? Sleep, performance and well-being in adults and adolescents, 18-23. 10th Annual Meeting, Australiasian Chronobiology Society: Adelaide.
• Baranksi, J. V., Pigeau, R. A., and Angus, R. G. (1994) On the ability to self-monitor cognitive performance during sleep deprivation: A calibration study. Journal of Sleep Research, 3(1), 36-44.
• Dorrian, J., Lamond, N., Holmes, A. L., Burgess, H. J., Roach, G. D., Fletcher, A., and Dawson, D. (2003) The ability to self-monitor performance during a week of simulated night shifts. Sleep, 26(7), 871-877.
• Muldoon, N., Sargent, C., Zhou, X., Kosmadopoulos, A., Darwent, D. and Roach, G. D. (2013) The efficacy of subjective ratings is limited during the biological night. Sleep, performance and well-being in adults and adolescents, 7-12. 10th Annual Meeting, Australiasian Chronobiology Society: Adelaide.
• Dorrian, J., Lamond, N. and Dawson, D. (2000) The ability to self-monitor performance when fatigued. Journal of Sleep Research, 9, 137-144.

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

Drowsy drivers just won’t stop soon enough, AAA study finds

Issue #75 – August 2022 – Why We Sleep

Welcome to Focus on Fatigue!

Sleep! It’s the activity we spend up to a third of our life doing (or attempting to!). So, it’s no wonder there is continually new research seeking to better understand how and why we sleep and what happens when we don’t.

In this issue of Focus on Fatigue, we bring you some recent studies on sleep and feature a review of Matthew Walker’s book ‘Why We Sleep?’.

We hope you find it interesting and informative.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Book Review – Why We Sleep by Matthew Walker

As founder-director of the Center for Human Sleep Science at the University of California, Berkeley, Matthew Walker has brought together into one book many recent studies in sleep research. He has analysed everything from sleep’s role in Alzheimer’s disease and depression, to its influence on learning and productivity.

An example of a fascinating study is the comparison between two similar businesses in towns on the east and west of the same time zone. The differences in productivity for individuals across this time zone were remarkable. In fact, those in the east, who get up when it is lighter and finish work when the sun goes down, not only slept better and were more productive but they even received more frequent increases in salary.

Walker’s 12 tips for healthy sleep are:

1. Stick to a sleep schedule. Go to bed and wake up at the same time each day. You can’t make up for lost sleep. This is the most important sleep habit.
2. Exercise at least 30 minutes on most days, but not later than three hours before bedtime.
3. Avoid caffeine and nicotine in the late afternoon. These take time to wear off.
4. Avoid alcoholic drinks before bed. Alcohol robs you of REM sleep, keeping you in the lighter stages of sleep.
5. Avoid large meals and beverages late at night.
6. Avoid medicines that disrupt sleep. Talk to your GP about whether medication contributes to insomnia, and ask about the best time to take medication so as not to affect sleep.
7. Don’t take naps after 3pm.
8. Relax before bed.
9. Take a hot bath or shower before bed.
10. Dark bedroom, cool bedroom, gadget free bedroom.
11. Have the right sunlight exposure. Daylight is key to sleep.
12. Don’t lie in bed awake. Get up and do something relaxing if you are lying awake worrying about not sleeping. Go back to bed when you start to feel sleepy.

The book is available in print, ebook or audiobook format, and explains the science behind the various studies in everyday language.

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

How Living on the Wrong Side of a Time Zone Can Be Hazardous to Your Health

Issue #74 – May 2022

Welcome to Focus on Fatigue!

A recent article, featured in Accident Analysis & Prevention, reviewed the effectiveness of Fatigue Risk Management Systems (FRMS). In this month’s Focus on Fatigue we feature this review, as well as considering the pros and cons of an FRMS in comparison to prescriptive hours of service rules.

We hope you find this issue helpful and informative.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Hours of Service Rules v Fatigue Risk Management Systems

Prescriptive hours of service (HOS) rules involve setting rules, such as maximum shift duration, minimum break duration and total work hours in a period, in order to manage fatigue.

Fatigue risk management systems (FRMS), on the other hand, are “a data-driven set of management practices for identifying and managing fatigue-related safety risks”¹. They are a tailored risk management- based approach involving multiple layers of defence (predictive, proactive and reactive). Let’s take a look at the pros and cons of both approaches.

Why not just set prescriptive hours of service rules?

While prescriptive hours of service rules may seem a simpler approach, there are a number of challenges with hours of service rules:

• While HOS rules may be appropriate for managing physical fatigue “prescriptive rule sets are not well suited to managing the risks associated with mental fatigue”².
• Not all hours are created equal! Prescriptive hours of service rules do not take into consideration circadian influence. “The relationship between shift duration and fatigue is critically dependent on time of day”², as is the effectiveness of recovery sleep.
• Often with a focus on regulatory compliance, over reliance on prescriptive rules can occur with no real grasp on whether a system is actually safe.

Advantages of FRMS

An effective Fatigue Risk Management System can…

• Allow flexibility to meet operational demand, while considering the risk context and remaining scientifically defensible.³
• Be tailored to the particular job or industry and better consider the particulars of night time operations and other nonstandard work schedules².
• Incorporate multiple layers of defence in the form of management practices that are predictive, proactive and reactive.
• Involve continual improvement; assessing the effectiveness of the system and continuing to refine and improve the safety environment.

Challenges to FRMS

However, there can be challenges to implementing an effective FRMS.

• FRMS implementation may be challenging in industries and organisations with limited resources.
• A just safety culture is required for an FRMS to be effective.

A hybrid approach

Hours of service rules can work in conjunction with an FRMS. Some regulatory bodies are now opting for a hybrid approach; combining prescriptive rule sets with risk management-based approaches. Or providing organisations the option of aligning with strict hours of work controls, or alternatively implementing an approved risk-based approach to fatigue management.

Resources

1. Sprajcer, M., Thomas, M., Sargen, C., et al. (2021) How effective are Fatigue Risk Management Systems (FRMS)? A review, Accident Analysis & Prevention, https://doi.org/10.1016/j.aap.2021.106398
2. Honn, K. A., VAN Dongen, H., & Dawson, D. (2019). Working Time Society consensus statements: Prescriptive rule sets and risk management-based approaches for the management of fatigue-related risk in working time arrangements. Industrial Health, 57(2), 264–280. https://doi.org/10.2486/indhealth.SW-8
3. Dawson, D. & McCulloch, K. (2005) Managing fatigue: It’s about sleep, Sleep Medicine Reviews, 9, http://doi:10.1016/j.smrv.2005.03.002
4. Gurubhagavatula, I., Barger, L., Barnes, C., et al. (2021) Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society, Sleep, 44(11), zsab161, https://doi.org/10.1093/sleep/zsab161

How Effective are Fatigue Risk Management Systems (FRMS)?

A recent narrative review in Accident Analysis & Prevention sought to answer the question “How effective are Fatigue Risk Management Systems (FRMS)?” While there was limited data available assessing the effectiveness of FRMS as a whole, the review was able to include 231 records looking at different FRMS components. The review found that “FRMS components (e.g., bio-mathematical models, self-report measures, performance monitoring) have improved key safety and fatigue metrics. This suggests FRMS as a whole are likely to have positive safety outcomes.” The review noted that “FRMS implementation may be challenging in industries and organisations with limited resources” and that organisational and worker commitment, workplace culture, and training, are crucial to the successful implementation of FRMS. The full article can be accessed through the above link.

Sprajcer, M., Thomas, M., Sargen, C., et al., (2021) How effective are Fatigue Risk Management Systems (FRMS)? A review, Accident Analysis & Prevention, https://doi.org/10.1016/j.aap.2021.106398

Social Dialogue towards a Positive Safety and Health Culture

Dr Manal Azzi, International Labour Organisation, 2022 

Issue #73- March 2022

Welcome to Focus on Fatigue!

It’s been a busy few months here at InterDynamics and we are excited to share with you what we’ve been up to.

Our feature article also looks at two recent studies that offer hope for the long term health of shift workers.

We trust you find this issue interesting and informative.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

FAID Quantum Web Service

We are excited to let you know that we have been working hard behind the scenes creating FAID Quantum Web Service. This web based version of FAID Quantum will offer convenience and accessibility along with a modernized user interface. FAID Quantum Web Service will allow us to service an even broader market; expanding our range of options to suit your requirements. FAID Quantum Web Service is still in the early stages of release but is available for trial by visiting http://faidquantum.com and signing up for a free trial account. We welcome your feedback!

Covid Resilient Rostering

We have assisted a number of companies with bespoke Roster Design Solutions, taking into account fatigue and other context specific considerations. Most recently this has included “COVID resilience”; to minimise potential impact of COVID disruption. It is always satisfying looking at a challenging problem and developing workable solutions.

Nimbus Integration

We are pleased to announce that InterDynamics have recently partnered with nimbus to integrate FAID Quantum into nimbus’ time2work system. You can read more about the integration here.

Diet and exercise do make a difference!

We are constantly hearing about the health implications of shift work and poor sleep, and it is rarely good news. We know that shift workers are at increased risk of health problems, such as digestive upsets, obesity, cardiovascular disease, diabetes, depression and certain cancers, to name a few. However, two recent studies offer some hope.

Exercise
A study published by the British Journal of Sports Medicine found that exercising according to World Health guidelines could help counteract adverse health outcomes associated with poor sleep. The study particularly looked at cardiovascular disease and cancer mortality. Both poor sleep and physical inactivity have previously been associated with health risks. The study found that while poor sleep is still associated with these negative health outcomes, engaging in moderate to high levels of physical activity appeared to minimise the risk.

Meal Timing
Another study, supported by the National Institutes of Health, looked at the impact of meal timing in night shift work. Eating at nighttime was found to boost glucose levels, while restricting meals to the daytime prevented the high blood sugar linked to night shift work. The effects on glucose are believed to be due to circadian misalignment. Restricting meals to the daytime, may therefore reduce health risks linked to night shift work, particularly diabetes.

Future Interventions
Although there is no substitute for sleep, and more research is needed, studies such as these do offer hope for shift workers. They could lead to practical interventions and assist shift workers to proactively influence their health outcomes.

References

• Chellappa S, Qian J, Vujovic N, et al. (2021) Daytime eating prevents internal circadian misalignment and glucose intolerance in night work. Science Advances 7(49). https://doi.org/10.1126/sciadv.abg9910
• Huang B, Duncan MJ, Cistulli PA, et al. (2021) Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2021-104046
• Hulsegge, G., Proper, K.I., Loef, B. et al. (2021) The mediating role of lifestyle in the relationship between shift work, obesity and diabetes. Int Arch Occup Environ Health 94, 1287–1295. https://doi.org/10.1007/s00420-021-01662-6
• Monnaatsie M, Biddle S, Khan S & Kolbe-Alexander T. (2021) Physical activity and sedentary behaviour in shift and non-shift workers: A systematic review and meta-analysis. Preventive Medicine Reports, 24. https://doi.org/10.1016/j.pmedr.2021.101597

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

High physical activity levels may counter serious health harms of poor sleep

BMJ, Science Daily, June 2021
Physical activity levels at or above the weekly recommended amounts may counter the serious health harms associated with poor sleep quality, suggests a large long term study.

Moving more a shift in the right direction for shift workers

University of Southern Queensland, November 2021
A study by University of Southern Queensland researchers has highlighted the need to improve physical activity among shift workers.

Daytime meals may reduce health risks linked to night shift work

NIH, Science Daily, December 2021
A small clinical trial has found that eating during the nighttime — like many shift workers do — can increase glucose levels, while eating only during the daytime might prevent the higher glucose levels now linked with a nocturnal work life.

Blessed are the shift workers: but how well-rested are they?

Georgia Stynes, ABC, February 2022
In this audio discussion, Siobhan Banks, Director of the Behaviour-Brain-Body Research Centre at the University of South Australia, joined Georgia Stynes to talk about the relationship between sleep and shift workers. They also touch on the role of diet and exercise.

Issue #72- November 2021

Welcome to Focus on Fatigue!

It’s that time of year again! Some of us are springing forward, some of us are falling back and some are staying where they are!  And it’s all thanks to daylight saving!

Some people love it. Some people hate it. But we are all affected by it in some way, even if we don’t live in a place that observes daylight saving time.

In this month’s Focus on Fatigue, we will look at the ‘why?’ and the impact of all this strange time changing.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Why do we do it? And what’s the impact?

What’s the point?

The main purpose of daylight saving time, (did you know it is daylight saving not daylight savings?) is to make better use of daylight. We change our clocks during the summer months to move an hour of daylight from the morning to the evening. This allows people to take advantage of light and warmth and participate in evening activity. However, originally the motivation for daylight saving was to save on the use and cost of artificial light.

History of daylight saving

Some people credit Ben Franklin with the invention of daylight saving, which is a bit of a stretch. However, he did write a satirical piece for the Journal de Paris in 1784, suggesting Parisians change their sleep schedules to save money on candles and lamp oil.

Daylight saving was first proposed in earnest by George Hudson in New Zealand in 1895. However, residents of Port Arthur, Ontario (now Thunder Bay) were the first to adopt a period of daylight saving time in 1908, followed by some other locations in Canada. Germany was then the first country to implement daylight saving, in 1916 during World War I, to minimize the use of artificial light to save fuel for the war effort. UK, France and other countries followed suit shortly after, with Australia and Newfoundland adopting daylight saving in 1917 and the U.S. in 1918. Many reverted back to standard time after the war. Since then, it has been adopted on and off in various places for different periods.

Current situation

Approximately 70 countries currently utilise daylight saving time (DST), or summer time, in at least part of the country. Countries near the equator are less likely to observe daylight saving. They have less need for it due to the warmer climate and more consistent daylight hours throughout the year. Even within countries that do observe daylight saving, it is often not adopted by all states and territories.

While the savings on energy may have originally been a valid justification, this advantage no longer stacks up. Our energy use has changed (more energy-efficient lighting, more electrical gadgets and energy sucking air conditioners), negating, or reversing, the energy saving benefit in some instances.

Divided opinions

Daylight saving remains an issue of contention in many places. It continues to be a topic of debate in Europe and America, with future changes likely. Some are pushing to abolish daylight saving time, while others are pushing to adopt daylight saving time all year round.

Challenges

Daylight saving is problematic for farmers, who have lobbied against it from the beginning. It disrupts their schedules, particularly dairy farmers, and leaves less morning sunlight to get crops to market.

When it comes to conducting global business, constantly changing time zones also present challenges, and not all countries start/end daylight saving at the same time. This means the time difference between two locations can change four times in a year and the situation becomes further complicated when scheduling across multiple locations.

A number of studies have shown negative impacts relating to daylight saving. Most of these relate to the period immediately after the time change, resulting from disruption to circadian rhythm and sleep. Research suggests that the shift to daylight saving raises the instance of heart attack and other cardiac events. A study out of the US found a jump in fatal car crashes in the days following the shift to DST. And another study identified an increase in workplace injuries immediately following the switch to DST.

So, what’s the upside?

Along with those who enjoy the longer summer evenings, there are other benefits too. The extended evening light may result in an increase in physical activity in children and a decrease in robberies. Studies also found that it may result in fewer wildlife killed by vehicles and less road incidents.

Tips to adjust

For those who do have to go through the transition to and from daylight saving time, keep in mind these tips:

• Start to slowly adjust your body clock in the few days leading up to the start of daylight saving by waking up a little earlier each day.
• Eat a healthy breakfast first thing in the morning.
• Spend time outdoors. Go for a walk in natural light.
• With children, adjust slowly by putting children to bed a little earlier each day in the few days before the change, and reverse the process at the end of daylight saving.

Research

• Barnes, C. & Wagner, D. (2009) Changing to daylight saving time cuts into sleep and increases workplace injuries. Journal of Applied Psychology, 94(5), 1305–1317. https://doi.org/10.1037/a0015320
• Buckle, A. (n.d.) History of Daylight Saving Time (DST). Time and Date. https://www.timeanddate.com/time/dst/history.html (Accessed 20/10/2021)
• Chudow, J. Dreyfus, I. et al (2020) Changes in atrial fibrillation admissions following daylight saving time transitions, Sleep Medicine, 69, 155-158. https://doi.org/10.1016/j.sleep.2020.01.018
• Doleac, J. & Sanders, N. (2015) Under the Cover of Darkness: How Ambient Light Influences Criminal Activity. The Review of Economics and Statistics 97(5), 1093–1103. https://doi.org/10.1162/REST_a_00547
• Ellis, A. et al. (2016) Daylight saving time can decrease the frequency of wildlife-vehicle collisions. Biology Letters, 12. http://doi.org/10.1098/rsbl.2016.0632
• Ferguson, S., Preusser, D., Lund, A., Zador, P. & Ulmer, R. Daylight saving time and motor vehicle crashes: the reduction in pedestrian and vehicle occupant fatalities
• Fritz, J., VoPham, T., Wright, K. & Vetter, C. (2020) A Chronobiological Evaluation of the Acute Effects of Daylight Saving Time on Traffic Accident Risk. Current Biology 30(4), 729-735. https://doi.org/10.1016/j.cub.2019.12.045
• Goodman, A., Page, A. & Cooper, A. (2014) Daylight saving time as a potential public health intervention: an observational study of evening daylight and objectively-measured physical activity among 23,000 children from 9 countries, International Journal of Behavioral Nutrition and Physical Activity, 11(1), 84. https://doi.org/10.1186/1479-5868-11-84
• Guven, C., Yuan, H., Zhang, Q., & Aksakalli, V. (2021) When does daylight saving time save electricity? Weather and air-conditioning. Energy Economics, 98. https://doi.org/10.1016/j.eneco.2021.105216
• Jiddou, M. R., Pica, M., Boura, J., Qu, L., & Franklin, B. A. (2013) Incidence of myocardial infarction with shifts to and from daylight savings time. The American journal of cardiology, 111(5), 631–635. https://doi.org/10.1016/j.amjcard.2012.11.010
• Kantermann, T., Juda, M., Merrow, M. & Roenneberg, T. (2007) The Human Circadian Clock’s Seasonal Adjustment is Disrupted by Daylight Saving Time. Current Biology, 17(22), 1996-2000. https://doi.org/10.1016/j.cub.2007.10.025
• Kotchen, M. & Grant, L. (2008) Does Daylight Saving Time Save Energy? Evidence from a Natural Experiment in Indiana. NBER. https://doi.org/10.3386/w14429
• Küfeoğlu, S., Üçler, S., Eskicioğlu, F., Öztürk, B. & Chen, H. (2021) Daylight Saving Time policy and energy consumption, Energy Reports, 7, 5013-5025. https://doi.org/10.1016/j.egyr.2021.08.025
• Pacheco, D. (2020) Daylight Saving Time. Sleep Foundation. https://www.sleepfoundation.org/circadian-rhythm/daylight-saving-time (Accessed 20/10/2021)

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

Related Articles

Daylight Saving Time Explained

CGP Grey, You Tube, October 2011
Every year some countries move their clocks forward in the spring, only to move them back in the autumn. To the vast majority of the world who doesn’t participate in this odd clock fiddling, it seems a baffling thing to do. So what’s the reason behind it?

Should we abolish daylight saving time – or apply it across Australia?

Nick Evershed, The Guardian, October 2021
These interactive graphics use sun position calculations to show how daylight saving affects daylight hours, and the effect of any changes

Study analyzes the potential consequences of canceling daylight saving time

Emily Henderson, News Medical, October 2021
A study by José María Martín-Olalla of the University of Seville has analyzed retrospectively and from a physiological perspective the potential consequences of canceling daylight saving time, the biannual change of clocks. In his conclusions, he argues that maintaining the same time during all twelve months could lead to an increase in human activity during the early morning in the winter months, with the potential repercussions on human health that this would entail.

Recent Studies Relating to Sleep and Fatigue

Meeting sleep recommendations could lead to smarter snacking

Ohio State University, Science Daily, September 2021
Missing out on the recommended seven or more hours of sleep per night could lead to more opportunities to make poorer snacking choices than those made by people who meet shut-eye guidelines, a new study suggests.

NASA Lab Studies Sleepiness and Use of Automated Systems

Abby Tabor, NASA’s Ames Research Center, September 2021
Drowsy driving accounts for a large proportion of car crashes, according to the National Highway Traffic Safety Administration. So, you might think self-driving cars would fix that. After all, computers just don’t get sleepy. But today’s vehicles are only partially automated, requiring the human driver to stay alert, monitor the road, and take over at a moment’s notice. A new study conducted by the Fatigue Countermeasures Lab at NASA’s Ames Research Center in California’s Silicon Valley suggests this passive role can leave drivers more susceptible to sleepiness – especially when they’re sleep deprived.

Issue #71 – September 2021

Welcome to Focus on Fatigue!

The benefit of fatigue education and training has come up in conversation with clients a couple of times recently. So, in this month’s Focus on Fatigue, we thought we would delve into the research to determine whether fatigue education is an effective fatigue management strategy.

Our ‘In the News’ section also features a recently released paper on “Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety and health” by the Academy of Sleep Medicine and the Sleep Research Society. This paper is a comprehensive review of fatigue risk management and a valuable resource, which we highly recommend reading.

The FRMS Team

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Is fatigue education and training effective in improving sleep, fatigue and safety outcomes?

An effective fatigue management system

An effective fatigue management system involves multiple layers of protection. One of these layers of protection is promoting and fostering a safety culture that recognises fatigue as a safety concern. Organisations and individuals that recognise fatigue as a safety concern are more likely to respond appropriately as fatigue-related risks escalate. A culture of concern can be stimulated by adequate fatigue education and training that focuses on managing fatigue-related risks for the organisation as well as the individual.

Studies on fatigue education & training

A number of studies have looked at the effectiveness of fatigue education and training in the workplace. These studies have been conducted in various industries including emergency medical services, health care, policing, trucking and aviation. The interventions varied in delivery method, length and content but included fatigue training and/or sleep health education.

Benefits of fatigue education and training

Some of the benefits observed following fatigue education and training programs were:

• Improvements to patient safety and personal safety
• Improvement in sleep quality
• Reduction in ratings of acute fatigue, stress and burnout
• Individuals more likely to identify and seek treatment for sleep disorders
• Improvement in fatigue management knowledge, self-efficacy, attitude & behavioural intention

Factors influencing effectiveness of training

Certain factors were found to improve the effectiveness of training in some of the studies:

• Training was found to be more effective when it included content specific to the work setting and tasks
• Training delivered via lecture style or expert led training was more effective than other methods
• Adoption of trained behaviour was more likely when supported by a company safety culture
• Revisiting training every two years assisted retention of benefits

Fatigue education programs equip the individual with the tools and knowledge to proactively manage the effects of atypical work schedules. This assists in putting fatigue risk on the radar and reducing fatigue related incidence.

Research

• Arora, V. M., Georgitis, E., Woodruff, J. N., Humphrey, H. J., & Meltzer, D. (2007). Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help?. Archives of internal medicine, 167(16), 1738–1744. https://doi.org/10.1001/archinte.167.16.1738
• Barger, L. K., Runyon, M. S., Renn, M. L., Moore, C. G., Weiss, P. M., Condle, J. P., Flickinger, K. L., Divecha, A. A., Coopler, P. J., Sequeira, D. J., Lang, E. S., Higgins, J. S. & Patterson, P. D. (2018) Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis, Prehospital Emergency Care, 22:sup1, 58-68. https://doi.org/10.1080/10903127.2017.1362087
• Barger, L. K., O’Brien, C. S., Rajaratnam, S. M., Qadri, S., Sullivan, J. P., Wang, W., Czeisler, C. A., & Lockley, S. W. (2016) Implementing a Sleep Health Education and Sleep Disorders Screening Program in Fire Departments: A Comparison of Methodology. Journal of occupational and environmental medicine, 58(6), 601–609. https://doi.org/10.1097/JOM.0000000000000709
• Fournier, PS., Montreuil, S. and Brun, JP. (2007) Fatigue Management by Truck Drivers in Real Life Situations: Some Suggestions to Improve Training. Work  29(3), 213 – 224.
• Gander, P, Marshall, N, Bolger W & Girling I (2007) An evaluation of driver training as a fatigue countermeasure, Transportation Research Part F: Traffic Psychology & Behaviour, 8(1), 47-58. https://doi.org/10.1016/j.trf.2005.01.001
• Garbarino, S., Tripepi, G. & Magnavita, N. (2020) Sleep Health Promotion in the Workplace. International Journal of Environmental Research and Public Health, 17(21), 7952. https://doi.org/10.3390/ijerph17217952
• Hu, C. J., Lee, F. P., & Hong, R. M. (2020) Fatigue Management Health Education Intervention Effects on Flight Attendants. Aerospace medicine and human performance, 91(12), 911–917. https://doi.org/10.3357/AMHP.5643.2020
• James, L., Samuels, C. H., & Vincent, F. (2018) Evaluating the Effectiveness of Fatigue Management Training to Improve Police Sleep Health and Wellness: A Pilot Study. Journal of occupational and environmental medicine, 60(1), 77–82. https://doi.org/10.1097/JOM.0000000000001174
• Machin, M. (2017) A Evaluating a Fatigue Management Training Programme for Coach Drivers in L. Dorn (Ed), Driver Behaviour and Training, (pp. 75-83). Aldershot, UK: Ashgate
• Smidt, M, Mitchell, D & Logan, K (2021) The Potential for Effective Training of Logging Truck Drivers, Journal of Agricultural and Biological Engineers, 27(1), 29-41. https://doi.org/10.13031/jash.1408

InterDynamics recently conducted another successful fatigue training workshop with Columbia River Bar Pilots. Columbia River Bar Pilots have shown a strong commitment to fatigue management over many years and enlist InterDynamics to periodically conduct managing fatigue training workshops as part of this commitment.

Derek from Columbia River Bar Pilots offered the following reflection:
“The Columbia River Bar Pilots employ a robust fatigue management system that benefits from periodic in-person training on fatigue and sleep science.  Healthy sleep promotes safety by improving alertness and decision-making to prevent accident and injuries to our pilots.”

InterDynamics’ Managing Fatigue Training Workshops have been successfully utilised across aviation, construction, energy, rail and marine industries; equipping participants with general awareness information on managing fatigue, as well as managing the social and lifestyle impacts of working shift work. The workshops provide personally relevant and practical techniques for managing individual fatigue.

Effect of Fatigue Training on Safety, Fatigue and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis

Barger, L. K., Runyon, M. S., Renn, M. L., Moore, C. G., Weiss, P. M., Condle, J. P., Flickinger, K. L., Divecha, A. A., Coopler, P. J., Sequeira, D. J., Lang, E. S., Higgins, J. S. & Patterson, P. D. (2018)

Abstract

Background: Fatigue training may be an effective way to mitigate fatigue-related risk. We aimed to critically review and synthesize existing literature on the impact of fatigue training on fatigue-related outcomes for Emergency Medical Services (EMS) personnel and similar shift worker groups.

Methods: We performed a systematic literature review for studies that tested the impact of fatigue training of EMS personnel or similar shift workers. Outcomes of interest included personnel safety, patient safety, personnel performance, acute fatigue, indicators of sleep duration and quality, indicators of long-term health (e.g., cardiovascular disease), and burnout/stress. A meta-analysis was performed to determine the impact of fatigue training on sleep quality.

Results: Of the 3,817 records initially identified for review, 18 studies were relevant and examined fatigue training in shift workers using an experimental or quasi-experimental design. Fatigue training improved patient safety, personal safety, and ratings of acute fatigue and reduced stress and burnout. A meta-analysis of five studies showed improvement in sleep quality (Fixed Effects SMD −0.87; 95% CI −1.05 to −0.69; p < 0.00001; Random Effects SMD −0.80; 95% CI −1.72, 0.12; p < 0.00001).

Conclusions: Reviewed literature indicated that fatigue training improved safety and health outcomes in shift workers. Further research is required to identify the optimal components of fatigue training programs to maximize the beneficial outcomes.

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

AASM, Sleep Research Society Issue Guidance on Work Shift Duration for Employers

Matthew Gavidia, AJMC, July 2021
The Academy of Sleep Medicine and the Sleep Research Society issued guiding principles for employers on designing optimal work shift durations in the workplace, which address risk factors, countermeasures, and shared decision-making implications. The complete paper can be accessed here.

Owls and larks do not exist: COVID-19 quarantine sleep habits

AMHSI Research Team, Science Direct, January 2021
The coronavirus pandemic presented a unique opportunity to study the daily temporal patterns and sleep habits of humans. The question to be explored was: Are there discernible differences in sleep between the normal operational environment and the stay-at-home condition?

Issue #70 – July 2021

Welcome to Focus on Fatigue!

Do you rely on coffee, or another form of caffeine, to get you up and going in the morning, to counteract the mid afternoon slump or to get you through the night shift? If so, you are not alone! Caffeine is consumed by over 80% of U.S. adults.

Caffeine is a stimulant, widely known to help you stay awake and stave off tiredness. However, in this month’s Focus on Fatigue, we will look at how effective caffeine is in counteracting the affects of sleep deprivation and whether it has it’s limits.

The FRMS Team

InterDynamics Pty Ltd
320 Adelaide Street Brisbane Qld 4000
Tel +61 7 3229 8300
www.interdynamics.com

Views expressed in articles and links provided are those of the individual authors, and do not necessarily represent the views of InterDynamics (except where directly attributed).

Caffeine can only do so much….

A recent study from MSU’s Sleep and Learning Lab has assessed how effective caffeine is in counteracting the negative effects of sleep deprivation on cognition. The study found that while caffeine counteracted impairment caused by sleep deprivation on a simple attention task (PVT), it did not significantly affect performance in a more challenging placekeeping task (UNRAVEL).

Placekeeping ability is a cognitive control process that plays a role in procedural performance, problem solving and other higher order tasks. It is the ability to perform the steps of a complex task in a prescribed order without skipping or repeating steps.

The study concluded that this finding “has implications for intervention research and suggests that caffeine has limited potential to reduce procedural error rates in occupational settings”.

While there are short term benefits to consuming caffeine during periods of sleep loss, it is worth being aware of caffeine’s limitations. Let’s break down what we know.

Caffeine can:

• Increase alertness and reduce fatigue
• Improve mood
• Help maintain cognitive performance – Caffeine can help counteract degraded cognitive task performance due to sleep deprivation on vigilance tasks and simple tasks that require sustained focus and response.
• Help maintain physical performance

However, caffeine can also…

• Make you overconfident – Caffeinated people are more likely to feel confident about their work performance, even when that performance has suffered. This may have serious consequences in real-life situations where accurate self-perception is crucial for avoiding risks.

Caffeine does not:

• Help with complex decisions – Caffeine does not help you make complex decisions in the face of changing information. While the effects of caffeine consumption on complex decision making have not been well researched, one study did find that a moderate dose of caffeine did nothing to reverse the effects of sleep deprivation in this sort of context. In other words, drinking coffee may make you feel alert, but it may not help you think more clearly in complex situations.
• Improve performance in complex tasks – Caffeine does not appear to significantly counteract performance impairment, caused by sleep deprivation, in procedural performance, problem solving and other higher order tasks.
• Replace sleep – Sleep gives your brain time to conduct a whole host of basic maintenance jobs that it simply cannot do when you’re awake.

While caffeine can be a useful tool, it does have it’s limitations and there is no real substitute for sleep!

Research

• Kamimori, G.H., McLellan, T.M., Tate, C.M. et al. (2015) Caffeine improves reaction time, vigilance and logical reasoning during extended periods with restricted opportunities for sleep. Psychopharmacology 232, 2031–2042. https://doi.org/10.1007/s00213-014-3834-5
• Ker, K., Edwards, P. J., Felix, L. M., Blackhall, K., and Roberts, I. (2010). Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database of Systematic Reviews, 5, CD008508. https://doi.org/10.1002/14651858.CD008508
• Killgore, W. D. S., Lipizzi, E. L., Kamimori, G. H. and Balkin, T. J. (2007) Caffeine effects on risky decision making after 75 hours of sleep deprivation. Aviation, Space and Environmental Medicine, 78, 957-962. http://doi.org/10.3357/ASEM.2106.2007
• McLellan, T., Caldwell, J. & Lieberman, H. (2016), A review of caffeine’s effects on cognitive, physical and occupational performance. Neurosicence & Biobehavioral Reviews, 71, 294-312. https://doi.org/10.1016/j.neubiorev.2016.09.001
• Smith, A. (2002) Effects of caffeine on human behaviour. Food and Chemical Toxicology, 40(9), 1243-1255. http://doi.org10.1016/s0278-6915(02)00096-0
• Smith, P. F., Smith, A., Miners, J., McNeil, J. and Proudfoot, A. (2000) The safety aspects of dietary caffeine. Expert Working Group on Caffeine. Australia New Zealand Food Authority. Canberra, Australia.
• Stepan, M. E., Altmann, E. M., & Fenn, K. M. (2021). Caffeine selectively mitigates cognitive deficits caused by sleep deprivation. Journal of Experimental Psychology: Learning, Memory, and Cognition. Advance online publication. https://doi.org/10.1037/xlm0001023

In the News

Provided below are a selection of articles from around the web on the issues associated with fatigue. We hope you find them useful and interesting.

Don’t count on caffeine to fight sleep deprivation

Michigan State University, Science Daily, May 2021
Sleep scientists assessed how effective caffeine was in counteracting the negative effects of sleep deprivation on cognition.

How overwork is literally killing us

Christine Ro, BBC, May 2021
Alarming new research shows that people working more than 54 hours a week are at major risk of dying from overwork. It’s killing three-quarters of a million people each year.

How caffeine and alcohol affect your sleep

Matt Walker, Sleeping with Science, July 2020
Caffeine wakes you up, and alcohol makes you nod off, right? It’s not that simple. Sleep scientist Matt Walker takes us into the eye-opening ways that these drinks affect the quantity and quality of our sleep