Managing Fatigue

1. Managing Fatigue Kirsty McCulloch UniSA, Centre for Sleep Research

2. When I die, I want to go peacefully, Like my grandfather did In his sleep… Not screaming like the Passengers in his car!!

3. Background Module One

5. 500 10 400 Caffeine (mg/head/day) 9 300 Sleep (hrs) 8 200 100 7 1910 1930 1950 1970 1990 Sleep length versus caffeine consumption 1910-90

6. Fatigue Definition • Fatigue is the consequence of inadequate restorative sleep • Fatigue is an experience that results physiological performance decrements and psychological functioning

7. Exercise • Name some of the conditions that make you feel particularly tired or fatigued at work

8. Causes of Fatigue FATIGUE Work-related Non work-related Hours of work Situation & lifestyle Workload & environment Medical disorders

9. Joint Responsibility FATIGUE Organisational Responsibilities Employee Responsibilities Work-related Non work-related Hours of work Situation & lifestyle Workload & environment Medical disorders

10. Consequences of Fatigue Module Two

12. Accident Risk • 10-40% of road accidents involve driver fatigue (Shafer, 1993) • 5-15% of all fatal road accidents (Hartley et al, 1997; Wang & Knipling, 1994) • Fatigue is 4 times more likely to cause workplace impairment than drugs or alcohol (Akerstedt, 2000) • Increase in fatalities beyond the 9th hour of work (Nachreiner etal, 2000)

13. Comparing Fatigue and Alcohol • 40 subjects • 2 experimental conditions • Sleep deprivation (28hours) • Alcohol (one standard drink every 30 minutes from 8:30am) • Performance measured half hourly via computer based test

14. Comparing Fatigueand Alcohol

15. Comparing Fatigueand Alcohol

16. Commuting • Australian road statistics show that night shift workers driving home have a 4 to 7 times higher chance of having an accident • What will help? Caffeine, a nap plus time to wake up, interesting conversation • Above all else, pull over if you are fighting sleep because you cannot know the point at which you will fall asleep

17. Shiftwork and families One of the greatest ‘costs’ of shiftwork and fatigue is paid by families This is evidenced by: - increased divorce rates - learning difficulties for shift workers’ children - increased domestic workload - difficulties with childcare; and - decreased involvement in daily family life

18. Shiftwork and social life • Shiftworkers frequently cite social disruption as a major stress • Many shiftworkers will choose to participate in social or community activities in preference to sleep • If it is appropriate, inform your friends of your work times in advance of their event planning

19. Shiftwork and health “Shiftwork is probably bad for the heart, almost certainly bad for the head and definitely bad for the gut”Monk & Folkard, 1992

20. Smoko Break

21. Managing the Risk Module Three

22. A New Way of Thinking • Fatigue-related accidents are no longer viewed as ‘diminished responsibility’, but as a result of ‘voluntary impairment’ • Liability for accidents is now extended beyond the individual, to the company and other stakeholders

23. The Magic Cure SLEEP!!!

24. 7 hrs sleep 6 hrs sleep 5 hrs sleep 4 hrs sleep 3 hrs sleep 2 hrs sleep 1 hr sleep 1200 1400 1600 1800 2000 2200 0000 0200 0400 0600 0800 1000 Sleep Obtained During Breaks 24 22 20 18 16 14 12 Length of Break 10 8 6 4 2 0 Time of Break Onset

25. Napping • Cannot be achieved by everyone • Can be a powerful supplement to sleep but cannot replace it • Naps 10 minutes or longer may provide benefits such as improved alertness, communication & mood • Allow for 15 to 20 minutes wake-up time for sleep inertia to pass

26. Alcohol & Sleep • A couple of drinks before bed has no negative consequences on sleep but it is not a recommended strategy • At higher levels, that is four or more drinks, alcohol acts as a sedative to promote being unconscious • In addition, at these levels the structure and function of sleep can be negatively effected

27. Caffeine • Has stimulant effects that can improve alertness and performance • Is most effective when used strategically; that is, not all day every day but when you really need help staying awake • Can be effective for up to 4 hours

28. Caffeine Levels in Common Drinks • Instant coffee: 1 teaspoon contains approx. 80 milligrams • Brewed, plunger or espresso coffee: 1 cup contains between 80 and 120mg • Herbal tea: 1 cup contains from 0 to 30mg • Normal tea: 1 cup contains approx. 60mg • Others: 200ml Red Bull 80mg, 500ml Jolt cola 100mg, 375ml cola 50mg

29. Foods that Alert Us • Some studies have shown that eating low-fat high-protein foods can increase alertness • These foods must be low in fat because high-fat foods will slow you down • The effect is subtle and may be noticed after approximately 30 minutes • It is recommended that at least 100 to 120 grams of an appropriate food is eaten

30. Foods that Alert us • Fish: cooked or tinned • Low-fat dairy: cottage cheese, yoghurt • Lean meat: steak, chicken breast, lamb • Others: hard boiled eggs, protein powder • NOT deep fried food, nuts, fatty meats or pies, full cream dairy products

31. Foods that Slow us Down • Research shows that processed carbohydrates can give a ‘sugar hit’ but ultimately slow us down • Processed carbohydrates convert to simple sugars (the ‘sugar hit’) but insulin quickly reduces blood sugar levels • Examples: cakes, lollies, sweet biscuits, soft drinks, white bread, chocolate etc

32. ‘Good’ Carbohydrates • Any fresh fruit or vegetable • Wholegrain breads, pasta, cereals and brown rice • Rice cakes, popcorn • These ‘good’ carbohydrates have not been found to have any negative effect on alertness

33. Hydration • Dehydration slows you down and increases feelings of lethargy • Working in heat, air conditioning or at night is likely to be dehydrating • Drinking coffee, tea, soft drinks, cordial and eating salty foods can also make it worse • Adults should drink at least 2 litres/day

34. Exercise • Is obviously good for health and fitness • May have significant benefits on the quality and quantity of your sleep • Doesn’t need to be extreme; any activity that keeps your heart rate constantly elevated for at least 20 minutes is good • Suggested activities include a brisk walk with the dog, swimming, jogging, riding

35. Relaxation • If you can’t get to sleep after 30 minutes in bed, get up and do something relaxing • This can be anything from reading the paper or a book to listening to music; try not to do anything too physical • Many people have also reported considerable benefits of learning relaxation techniques like meditation or yoga

36. Finally… • Managing fatigue will always have its challenges • There are no golden rules but practical information helps good decision making • Appropriate solutions will depend on your age, household structure, sleeping environment and any medical condition • Individual differences will determine your ability to recover from various work regimes and fatigue

37. Questions?? Contact Details: Centre for Sleep Research, UniSA L7 Playford Building, City East • p: (08) 8302 6624 • f: (08) 8302 6623 • kirsty.mcculloch@unisa.edu.au