WELLNESS AND FATIGUE MANAGEMENT
More than 50% of all mobile users have downloaded a health app. Patient Generated Health Data is increasingly seen as an important complement for clinician diagnosis and DISC aims to leverage the new technological innovations fostered by this movement to increase operator and mobile worker-safety across the UK.
Fatigue and sleepiness during driving are the main risk factors for traffic accidents and deaths worldwide. In a study commissioned in 2019 by Transport for London from Loughborough University, 21% of the bus drivers surveyed indicated that they have to fight sleepiness at least 2-3 times a week, and 36% of respondents had a ‘close call’ due to fatigue in the past 12 months. The contributing factors to fatigue are wide and at times complex, including shift patterns, sleeping patterns (infant at home, etc.), diet and opportunity to exercise.
The Council and Edinburgh Trams are committed to supporting the implementation of an open culture in which drivers/mobile operators and their managers feel comfortable talking about fatigue related issues.
How long should I sleep?
The National Sleep Foundation recommends between 7 and 9 hours of sleep per night. Dr Thomas Roth, Detroit Henry Ford Hospital, said: “The number of people who can survive on 5 hours of sleep or less without any impairment, expressed as a percent of the population, is zero”. However, sleep quality is as important as sleep quantity. The older an individual is, the more fragmented their sleep is, with frequent episodes where they wake up during the night. Any individual, no matter what age, will exhibit an increase in cardiovascular risks, diabetes, reduced alertness, impaired memory and even higher risk of depression if their sleep is chronically disrupted.
What are the consequences of lack of sleep?
Sleep deprivation and Attention
Concentration is the first mental function affected by lack of sleep. First and foremost, sleep deprivation impairs attention and working memory, but it also affects other functions, such as long-term memory and decision-making. Presented with a problem (a pedestrian crossing the road, or a dangerous curve), the brain will not only take longer to identify and evaluate the danger, but also longer to react to it. Operating at fewer than 5 hours of sleep, the risk of a car-crash is multiplied by 3. At fewer than 4 hours of sleep it is multiplied by 11.5.
Humans need more than seven hours of sleep each night to think clearly. After ten days of just seven hours of sleep, the brain is as dysfunctional as it would be after going without sleep for twenty-four hours. After being awake for 19 hours, an individual’s concentration abilities are the same as someone who is over the legal alcohol limit
This is valid for both accumulated periods of sleep deprivation, and single periods without sleep (for example, waking up at 7am then going out driving at 2am without at least 2 hours of sleep in between).
Not only this, but individuals who are sleep-deprived underestimate the degree to which their performance is reduced.
This is especially problematic as consistent sleep deprivation leads to micro-sleeps. A micro-sleep is an episode where an individual falls asleep and becomes unconscious for between 1 second – multiple minutes. People experiencing micro-sleeps often remain unaware of them, and micro-sleeps are thus a leading cause of road and rail accidents.
Sleep Deprivation and Health
More than twenty large-scale epidemiological studies have clearly shown that the shorter someone sleeps, the shorter their life. Lack of sleep has been shown to be one of the causes of diseases such as heart disease, obesity, dementia, diabetes, Alzheimer, and cancer. At fewer than eight hours of sleep a night, and especially less than six hours a night, an individual:
- Will become physically more tired a lot faster.
- Will eat more. Short sleep increases the sensation of hunger and compromises the impulse control part of the brain, leading directly to the consumption of high calorie foods and a higher risk of obesity, another key trigger of heart attacks.
- Will see a change in his/her capacity to breathe. Their bloodstream will thus contain less oxygen.
To learn more about the health risks: https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/
Can I compensate for a bad night’s sleep?
Three full nights of recovery sleep (i.e. more nights than a weekend) are insufficient to restore performance back to normal levels after a week of short sleeping. Finally, the human mind cannot accurately sense how sleep-deprived it is when sleep-deprived. While naps or caffeine can temporarily help with concentration, neither can restore more complex functions of the brain such as learning, memory, emotional stability, complex reasoning or decision-making.
How can I improve my sleep?
Stick to a sleep schedule
Aim to go to bed and wake up at the same time each day. Even going to bed 1 hour after your usual bedtime is a risk factor for heart attacks.
Exercise, but don’t exercise too late in the day
Frequent exercise is associated with a decrease in cardiovascular mortality as well as the risk of developing cardiovascular disease. Thirty minutes of active exercise is recommended every day (it can be broken down in 10-min sessions). However, avoid exercising 2-3 hours before bed as it raises your core body temperature, which prevents you from sleeping. Humans sleep better at a temperature around 18 degrees Celsius because in order to initiate sleep, the body temperature must drop by 2 to 3 degrees.
Avoid caffeine & nicotine in the late afternoon
Colas, coffee, teas (that aren’t herbal) and chocolate all contain caffeine, which is a stimulant. Even consuming these in the afternoon can have an effect on your sleep: 7 hours after drinking a coffee, 50% of the caffeine ingested will still be within your body. Nicotine is also a mild stimulant, and smokers will often wake up earlier than they would otherwise, due to nicotine withdrawal. While someone can still fall asleep, their sleep quality will be significantly lowered.
Avoid alcoholic drinks before bed
A nightcap has the opposite effect to what is intended. Alcohol keeps you in the lighter stages of sleep, and fosters night awakenings. Alcohol-infused sleep is therefore not continuous and restorative.
Unfortunately, most of these night-time awakenings go unnoticed by the sleeper
since they don’t remember them. Alcohol also increases the risk of sleep apnoea, a condition where the breathing stops and starts when sleeping.
Avoid large meals late at night
While lights snack before bed satisfy hunger, heavy meals can cause digestive issues, which interfere with sleep.
Don’t nap after 3pm
Every human being is more fatigued after lunch (post-prandial alertness dip). However, taking naps too late in the day can make it hard to fall asleep at night.
Avoid digital lights before bed
Blue light suppresses the secretion of melatonin by up to 50%. Melatonin is a hormone that regulates sleep/wake cycles – it increases in the evening to induce sleep.
To reduce blue light at night, you can:
- Use blue light filters on our phones & tablets. iOS 9.3 or later (iPhone 5S & iPad 2 onwards) has this built-in – called Night Shift. On Android there are apps for this, a popular one being Twilight.
- Use blue light filters on computers. For MacOS & Windows f.lux is an option. Windows 10 also has a built-in “Night Light” function that offers similar functionality.
You can also use blue light filters on your home lighting system.
Get the right sunlight exposure
Sun exposure during the day helps us to regulate sleeping patterns. Try to get outside in the natural sunlight for at least 30 minutes per day.
Don’t stay in bed if you (really) can’t sleep
After 20 minutes in bed without managing to get to sleep, it is recommended to do another activity such as reading and wait until your fatigue levels rise, in order to avoid sleep anxiety.
Discuss with your GP the risks and use of sleeping pills
Some sleeping pills impair next-day alertness and motor skills, thus putting drivers at risk.
A study implanted by the Scripps Clinic Viterbi Family Sleep Centre and the Jackson Hole Centre for Preventive Medicine, USA, showed that individuals taking just eighteen sleeping pills per year were 3.6 times more likely to die over a 2.5 years period.
While this study cannot directly demonstrate that the drugs themselves are the direct cause of death, it is recommended you discuss with your GP the need and frequency of sleeping pill usage.