Fatigue: Sleeping Giant of the Workplace

How can undiagnosed sleep apnea affect the workplace?

• By Boyd Goodson
• Jan 24, 2023

Fatigue is a plague for a number of industries, including manufacturing, construction, energy and transportation. The effect of fatigue on the brain is reported to be as harmful as drunk driving, with shared symptoms such as loss of situational awareness, underestimation of risk, hindered visual perception and reduced reaction times. 

Many infamous workplace accidents are directly and indirectly caused by employee fatigue—one of the worst being the 1986 catastrophe at the Chernobyl nuclear plant, which was specifically attributed to human error. Operators were found to have worked a 13-hour shift attempting to function on too little sleep. In the 2001 Canadian National train disaster, two of the freight train crew members had been recently diagnosed with sleep apnea and suffered from chronic sleeplessness. The resulting fatigue caused the collision with another train, two fatalities and the spillage of 3,000 gallons of diesel.

Fatigue is more widespread than reported, with the strong majority of Americans completely unaware of the dangers of chronic fatigue due to lack of sleep. Significantly, a major driver of underreported fatigue is the oft-undiagnosed chronic condition that is sleep apnea.

To address fatigue and minimize the associated risks, a long-term partnership is required between workers and companies.

The Major Underlying Cause of Fatigue

Americans are living longer, but research shows that the time spent living in good health—or a person’s "health span"—is not increasing in parallel.

For employers, that means the workforce is living longer, but chronic medical conditions are incapacitating workplace function more than ever. In fact, lifestyle-related diseases are expected to increase from 58 percent of deaths in 2000 to 76 percent of deaths by 2030.

One of the reasons chronic diseases will continue to cause health decline at this pace is the aforementioned pervasive underlying cause of which most people are unaware: sleep apnea.

Sleep apnea happens throughout the sleep cycle and is caused by the collapsing of the upper airway, resulting in irregular breathing patterns and even cessation of breathing for long periods. What is often misunderstood is that sleep apnea affects surprising segments of the population, crossing gender, age and fitness demographics.

Sleep apnea affects an estimated 30 million people in the U.S. alone. Of the utmost concern for employers is that 80 percent of sleep apnea sufferers go undiagnosed, which means a significant percentage of workers are carrying out their jobs much-hindered by the condition and are a potential risk to themselves and others, a risk that can be mitigated directly by employers.

Pervasive and Undiagnosed

Besides immediate challenges—often in the form of accidents or concentration and memory issues—sleep apnea is causally related to many common chronic conditions, including heart disease, diabetes, Alzheimer’s and hypertension. For example, sleep apnea increases the risk of heart failure by 140 percent and heart disease by 30 percent. ADHD and mood disorders like depression can also be spinoffs of the condition.

To compound the problem, the current dominant medical models don’t reward quick, simple diagnosis treatment, and no one branch of medicine wholly owns the diagnosis and treatment of sleep disorders. As a result, it is often a long and tedious journey from initial awareness through diagnosis and treatment.

Research shows that employer inaction around direct screening and treatment of common, preventable medical conditions comes at a high cost—estimates for the financial impact of undiagnosed sleep apnea is to the tune of $150 billion per year for the nation.

Waking up to Worker Fatigue

Employers are on high alert to mitigate on-the-job risks and prioritize their employees' overall sleep wellness.

Undiagnosed sleep disorders impact every workplace in many ways: fatigue, concentration issues, reaction times, irritability, depression, anxiety and poor judgment, to name a few. The risk of on-site injury goes up too.

In 2016, a study by Hirsch Allen and Park showed that workers with sleep apnea are more than twice as likely to suffer an on-the-job accident, particularly related to vigilance problems.

Many companies are already addressing the sleep disorder problem head-on, and a study from Frost & Sullivan found that companies proactively reducing sleep apnea among workers experienced a 40 percent reduction in workplace absences and a 17.3 percent increase in productivity after initiating treatment for the condition.

A prime example is the transportation sector, which is populated by businesses leading initiatives above and beyond regulations to improve safety and address a root cause of worker fatigue, saving lives and reputations.

Furthermore, many industries are rapidly adopting and turning to a direct primary care model, taking employee wellness into their own hands.

The Direct Primary Care Model

Healthcare is the second highest operating cost after payroll, and the rapid rise in healthcare costs remains an alarming topic. Employer-sponsored health insurance plans experienced the highest annual increase of per-employee expenses since 2010 at 6.3 percent last year, and similar increases are anticipated this open enrollment season.

To combat mounting costs, employers are taking control of employee health and investing in direct primary care (DPC), bringing physicians to employees and skipping the insurance hurdles. The DPC model provides better value, aligns with organizational values and goals and, ultimately, reduces healthcare spending.

As direct primary care sites proliferate among organizations, sleep wellness is one specialty that has gained attention.

The Solution

To address sleep wellness and combat fatigue in a timely manner, organizations and direct primary care physicians are turning to companies that use new technology that allows for at-home testing and monitoring, tele-health and predictive analytics to disrupt the traditional diagnosis-to-treatment journey. This approach also factors in ongoing monitoring and coaching to ensure therapy continuity—a critical success factor so often overlooked in the traditional model of care.

This integrated approach is simple, efficient and particularly effective at reducing employee absenteeism. For employees wondering if they might have sleep apnea, the direct-care model makes the discovery-to-treatment journey as short as seven days. This model runs without requiring overnight sleep labs, additional approvals or diagnostic steps.

Direct Healthcare Management is Valuable

There is a strong correlation between patient health and the financial model used by care providers. Regular healthcare providers focused on early screening and prevention are rare. This fact is strongly linked to the prevention model proving to not be as much of a money maker as the managing of conditions that result from retroactive care, like the prescribing of medications associated with illness, and the ongoing treatments that become necessary.

It is well-researched and fair to assert that the current insurance-based healthcare system typically underinvests in screening and treatment. This leads directly to a nation of workers suffering from underdiagnosed, easily treatable conditions.

The good news is that there are effective, readily available screenings, diagnostic tools and ongoing treatments that are cost-effective for sleep apnea that employers can tap into as long as they are prepared to step outside the traditional insurance payer/provider model and take on an active role in worker health. And the payoff is significant—financially and in the form of worker well-being.

Company Health and Lifespan will Improve

To belabor the point, living with fatigue in the workplace when solutions abound is the culprit underlying so many safety, health and well-being risks that innovative companies are choosing to play an ever-increasing role in streamlining preventative care.

Open discussions are encouraged, as are screenings to remove the stigma and silence around sleep apnea. Normalize and educate via company communications; share statistics about the surprising pervasiveness of sleep disorders that are found across gender, fitness or measures of body mass.

Bottom line: Therapies for sleep apnea are very effective. CPAP machines work, but they don’t work if workers don’t realize they have a problem.

The benefit of addressing the epidemic of workplace fatigue lies not only in helping employees live longer and in better health but also fuels the life and health span of the company.

Sources

https://consumer.healthday.com/senior-citizen-information-31/age-health-news-7/americans-living-longer-than-ever-cdc-683595.html

Frost and Sullivan. Hidden Health Crisis Costing America Billions. American Academy of Sleep Medicine, 2016, https://aasm.org/advocacy/initiatives/economic-impact-obstructive-sleep-apnea/

Hirsch Allen AJ, Park JE, Daniele PR, et al. Obstructive sleep apnoea and frequency of occupational injury, Thorax 2016;71:664-666, https://thorax.bmj.com/content/71/7/664.full

https://scitechdaily.com/johns-hopkins-researchers-have-identified-a-potential-new-treatment-target-for-sleep-apnea/

https://www.uspharmacist.com/article/obstructive-sleep-apnea-a-review

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm

https://www.sleepfoundation.org/sleep-apnea/sleep-apnea-linked-heart-disease

Disparities and Genetic Risk Factors in Obstructive Sleep Apnea - PMC (nih.gov)