Sleep deprivation can affect employee wellbeing and productivity, as well as contribute to serious illness. Dr Nick Summerton looks at the causes and offers tips on how employers can help staff get a good night’s sleep.
How did we get to the stage where cutting down on sleep became a good idea – and more than that, a badge of honour, or even one of success?
The rise of enterprise culture since the 1980s has had its effect, encouraging admiration for long-hours working and only accelerated by cool digital industries associated with non-stop energy and drive. It has also happened as a result of modern life, more access to technology and entertainment, a non-stop work and leisure ride where any space in the diary is an embarrassing void. If you’re having plenty of sleep then, the perception is, you are literally dozing while your life and career drifts.
Cutting back on sleep doesn’t make anyone perform better. The disasters at Three Mile Island, Chernobyl, Fukushima and numerous major transport accidents have all been linked to sleep deprivation.
Most adults (90% according to research) need between seven and eight hours of sleep each night. But the differences in our genes means there are some people who can get by with only three or four hours a night, and others who need up to 12 hours.
As we get older we seem to need the same amount of sleep, but will often have one period of deep sleep – usually in the first three or four hours – after which we wake more easily. The occasional night without sleep will make you feel tired the next day but it won’t affect your health. But after several sleepless nights you might find it difficult to concentrate and make decisions. You may also start to worry about not being able to get to sleep and this can affect your mood.
The Rand report “Why sleep matters – the economic consequences of insufficient sleep” (2016), studied the most common causes of sleep deprivation among 62,000 employees. Personal factors are associated with having problems sleeping, such as being overweight, smoking, having poor mental health and not taking enough physical activity.
Issues at home can also impact on sleep, such as financial concerns, caring for others, having children and divorce/separation.
But there are also workplace factors involved, such as lack of choice at work, unrealistic time pressures, irregular hours (for example, shift work) and long periods spent commuting.
The impact on health is serious and wide-ranging. Generally speaking, human beings can live longer without food (about 11 days) than they can without sleep. Insufficient sleep over time has been found to raise mortality risk by 13%. As an example, shift workers are more likely to develop cardiovascular disease, type 2 diabetes, obesity and cancer – as well as be involved in accidents at work, too.
It is believed that a lack of sleep leads to reduced levels of leptin – the chemical that makes you feel full up, encouraging overeating. Less deep sleep can affect the way our bodies process glucose and increase the risk of type 2 diabetes. There is also an impact on the workings of the immune system, making people more susceptible to illnesses in general.
In terms of the consequences for employers and HR, Rand found that insufficient sleep reduced workplace productivity: for example, a worker sleeping less than six hours per day loses about six working days due to absenteeism or presenteeism per year more than a worker sleeping seven to nine hours. There is also evidence (published in the British Medical Journal in 2010) that sleep-deprived people appear less attractive and less healthy, an issue for any employers with customer-facing staff.
HR and OH can help people by both raising awareness of the importance of getting enough good-quality sleep, and helping them to do it in practice.
How employers can help prevent sleep deprivation
Self-awareness – and not just accepting bad habits or sleep problems – is an important first step. Employees can complete a straightforward sleep self-assessment (the NHS provides this tool) or just monitor their sleep with a diary or an electronic device.
Discouraging the excessive use of electronic devices outside of working hours would help. The issue here is clarity, and employers would be doing more for their people by signalling limits on employees’ expected availability after working hours, introducing policies limiting after-hours and out-of-office communications.
The tradition of the siesta is unlikely to ever work with organisational demands and routines, and can also have a negative effect on people’s ability to get to sleep at night. But the opportunity for a short nap can still be useful as a means of restoring energy levels. Companies such as Google, Zappos and The Huffington Post provide “nap rooms” for staff to catch up on lost sleep.
Sleep problems are often rooted in underlying physical and psychological causes – such as restless legs or sleep apnoea – or problems such as depression. Sleep apnoea, for example, causes interrupted sleep due to loud snoring and stopping breathing that wakes you suddenly. It is particularly linked to being overweight, smoking and heavy drinking. Sometimes medicines can affect sleep. It’s therefore useful for HR to encourage health screenings, which will help with early identification of any issues affecting sleep, some of which may not be obvious. Given the level of risk, there’s a particular need for screening among shift workers.
According to a review in the British Medical Journal in the autumn of 2016, the best way to improve sleep in shift workers is to arrange a forward-rotating shift system (day-evening-night) and avoid short recovery periods (less than 11 hours).
For all staff it will help to educate and encourage managers to allow for more flexible scheduling, and avoid setting unrealistic time pressures for employees.
Allow some employees to work from home – especially those with long commutes or those with family/financial pressures (for example, carers).
In recognition of the fundamental importance of the issue, some firms have introduced “sleep training” as part of their work on building staff resilience. Accountancy firm PwC extended a programme involving a specialist sleep expert to all its UK employees in response to demand.
Most simply, HR should be encouraging greater recognition of the importance of sleep to health and wellbeing, providing advice and signposting to resources.
Five simple ways to improve sleep
As a GP, there are five simple things I suggest to my patients worried about their sleeping. They are the following:
Keep regular hours – It is really important to develop a sleeping routine. Going to bed and getting up at roughly the same time will programme your body to sleep better. It is also key to avoid sleeping in the day as this makes it difficult to switch off at night. Some people find it helpful to relax before going to bed – a warm bath, listening to quiet music or a relaxation CD might all help.
Organise the bedroom – People need to think about their bedroom and their bed. Focus particularly on ensuring that a bedroom is dark, quiet and neither too hot nor too cold. Ban televisions and electronic gadgets from the bedroom. Make sure that your bed is comfortable – is it too small? Too hard? Too soft? Or simply too old?
Avoid food and alcohol at night – Too much food, especially late at night, can interrupt sleep patterns. Alcohol may help someone to fall asleep initially, but will disrupt sleep later in the night. Also think about replacing any tea or coffee you drink in the evening with a warm milky or herbal drink.
Moderate exercise can also help with sleep – People should think about going for a swim or a brisk walk in the early evening. Also, deal with your worries. If you can’t sleep, don’t lie there getting stressed about it. Get up and do something you find relaxing, such as reading or listening to some quiet music, until you feel sleepy again, and then return to bed. It’s important people try to avoid lying in bed agonising about issues such as work. One tactic to suggest is that employees clear the mental decks by setting aside some time in the evening to review the day and make a list of things to be tackled the next day.
Try cognitive behavioural therapy – For some employees, sleep deprivation can turn from an occasional problem to a threat to health. Employers should consider funding some private sessions of cognitive behavioural therapy for insomnia (known as “CBT-I”) for those who are really troubled by poor sleeping. This is a very effective treatment for chronic insomnia according to a review published in the British Medical Journal in November 2016 – and is preferable to a reliance on sleeping tablets
Dr Nick Summerton is a GP and medical director of Bluecrest Wellness.