“The phrase ‘caught napping’ reflects people’s belief that napping is the most blatant manifestation of sloth. Naps can make you smarter, faster and safer. They should be widely recognised as a powerful tool in battling fatigue.” William C. Dement, “The Promise of Sleep” (Pan Books, 2001)

Sleep deprivation is now so widespread that the (US) Centres for Disease Control said in August 2012 that it is becoming ‘a public health epidemic.’

Poor sleep, tiredness and fatigue is becoming endemic in our society. At any one time 20% of the population is suffering from a sleep problem (Warwick University). 43% of working Americans sleep for 6 or fewer hours a night (Gallup). As a result health, safety and performance will be negatively affected with a corresponding impact on your organisation’s profitability.

In this discussion blog we want to explain the measures most of the workforce currently use to maintain alertness and then discuss whether creating a napping culture is likely to be beneficial to organisations from a health, safety and productivity perspective.

What are the effects of poor sleep?

Poor sleep has been linked to significant increases in the rates of obesity, diabetes, high blood pressure, heart disease, strokes and cancer as well as minor ill-health.  These result in direct medical costs as well as significant indirect costs associated with absenteeism and presenteeism.

According to Dr Sara Mednick in her book “Take a Nap! Change your life” (Workman Publishing, 2006), “no single organ is more affected by lack of sleep than the brain.” Dr Mednick goes on to say that in sleep-deprived subjects blood flow to three parts of the brain is compromised – the thalamus, pre-frontal cortex and inferior parietal lobe. These areas of the brain play a critical role in decision making, attention span and the speed at which we adopt new information.

There is also a link between sleep deprivation and stress. According to Mednick, sleep deprivation and stress result in elevated levels of cortisol. Synthasised in the adrenal cortex, cortisol helps to regulate our blood pressure, heart rhythm and ability to break down carbohydrates and fats. The end product is greater glucose in the blood stream.

The nutritional and health impact of the measures we currently use to maintain alertness

Many of the coping mechanisms we describe below will be familiar to you. It’s what we tend to do when we need a “lift”. For those who work night shifts these may be a more common occurrence. When working a night shift we are working against our natural body clock. This commonly results in sleeping issues as well as a struggle with blood glucose levels.

According to Lisa Smith, a CNHC-registered nutritional therapist and founder of Nutriology as our digestion naturally slows at night we are less able to absorb nutrients into the body. This results in cravings for high sugar and high fat foods, which release serotonin – the feel good hormone.

Caffeine

Caffeine is the world’s most commonly used stimulant. We tend to see increased caffeine consumption, especially in those working long hours or the night shift.

According to the website Caffeineinformer caffeine stimulates the central nervous system giving the body a sense of alertness as well as dilating blood vessels. It raises heart rate and blood pressure and dehydrates the body. However, what many people don’t know is that caffeine has a half life of between 6 and 9 hours meaning that consuming caffeine in this period before bed is likely to impact on the ability to fall asleep, which will lead to shorter sleep duration.

Energy Drinks

Anecdotally, when we speak to Occupational Health and Safety professionals across a broad range of industries we hear of an increasing consumption of “energy drinks” at work. These drinks tend to be very cleverly marketed and whilst they do provide a level of stimulation there are a number of side effects which need to be considered.

According to Lisa Smith; in excess or over prolonged periods these drinks can cause over-excitement of neurotransmitters and can also damage cells. The stimulants in energy drinks trigger a physiological response through the sympathetic nervous system. This results in elevated levels of cortisol, which over time can damage the hippocampus – the region in the brain associated with memory. In order to trigger this response the pre-frontal cortex (the region in the brain associated with logic, reason and sound decision making) is disabled.

High sugar and high carbohydrate foods

As we said previously working nights means we are working against our biological clock. This means that we are not absorbing food into our system correctly. This results in cravings.

Another trigger for these cravings is the release of serotonin. This is why that piece of cake or donut when tired and working at night feels particularly good. However, for those working at night, with the digestive system in night mode blood sugar levels rise and if the sugar is not burnt off through physical activity then the sugar is transferred into adipose fat which sits around the middle of the body.

Benefits of napping

Let me start by asking you two questions:

If there was a pill that…

• Made you 100% more alert
• 34% more productive
• Improved your memory by 36%
• Reduced you risk of dying of heart disease by up to 64% ­and
• Gave you up to 8 hours of enhanced energy

… all without any nasty side effects, would you:

1. Take that pill?
2. Recommend to your staff that they take that pill?

If the answer to either or both of those questions was yes then you need to seriously think about adopting a napping strategy.

In her book Dr Sara Mednick lists 20 benefits of “what napping can do for you”. Here we pick out a selection of the benefits she lists:

• Increase your alertness: Staying alert is the most important determinant of your efficiency. NASA studies have conclusively demonstrated that alertness can increase by as much as 100% after a brief nap.
• Improve accuracy: Making mistakes costs time, money, energy and at worse, lives. Napping can improve both speed and accuracy.
• Make better decisions: Every day we all make decisions, both trivial and significant. Pilots allowed to nap during flights committed fewer judgement errors on takeoff and landing than non nappers.
• Increase your bottom line: According to the 2004 Shiftwork Practices survey by Circadian Technologies, workmen’s comp costs are highest where employees report the most fatigue and claims at facilities that ban napping are 4 times higher than facilities that allow it.
• Reduce your risk of heart attack and stroke: Studies conclusively show that fatigue contributes to hypertension, heart attack, stroke, arrhythmia and other cardiovascular disorders. Take a nap to reduce your risk of these maladies.

Nap components and how altering the time and length of a naps can achieve different outcomes

The components of a nap mirror the stages of sleep that we go through when we sleep at night. Each stage of sleep is associated with different benefits.

So how long should a nap be?

Studies have shown the benefits of naps of even just 5 minutes. However, the answer to this depends on what you want to achieve. A “power nap” of 20 minutes (of sleep) or less will ensure you don’t pass beyond stage 2 sleep. Beyond this and you are likely to wake up in a period of deep sleep. This may result in sleep inertia and make waking up and returning to work fully alert more difficult.

William Dement in his book “The promise of sleep” (Pan Books, 2001) says that “a short nap can improve alertness without decreasing our sleep debt.” This is important when considering napping whilst at work, especially on a night shift, because it is important that a nap doesn’t prevent an individual from falling asleep when it comes to their main sleep episode.

However, a nap with slow wave sleep or REM sleep is going to be especially useful to those who suffer from poor sleep and who may not achieve enough restorative sleep during their main sleep episode or who need a creative solution to a problem.

The types of nap

Types of nap will depend on the benefits sought and the time of day of the nap.

An operational nap, limited to 20 minutes, can stave off the effects of fatigue for the duration of the work period and improve alertness for the rest of the shift and where commuting after a shift.

A recovery nap can be taken after the effects of fatigue have already manifested themselves. This situation shouldn’t come about but a recovery nap will significantly help with ongoing performance.

A preventative nap can be used prior to a known period of extended sleeplessness to improve alertness and performance during wakefulness and can be used by night workers to help with hormonal balance after periods of insufficient sleep – especially where sleep duration suffers by having to sleep during the day.

Varying the time of day and length of a nap can deliver different benefits. Being able to customise your nap is a powerful tool in addressing the most pressing needs.

Summary

It is a simple fact that sleep deprivation is widespread, whether this is due to time constraints, long hours, poor sleep habits, sleep disorders, young children or any number of other reasons. There isn’t an industry that is immune from the effects of sleep deprived employees.

As we have discussed the common strategies we use to increase alertness come with significant negative nutritional and health consequences.

Combine sleep deprivation with poor nutritional choices and the resulting effect on your employees will be: increased absenteeism and presenteeism, higher healthcare costs, lost working time, reduced alertness and vigilance, more errors, mistakes, accidents, poor memory and poor decision making.

Perhaps it’s the word napping that puts bosses off the idea. If that is the case then how about instead we introduce the concept of “controlled rest”? Now surely that’s an idea we can all get behind!

What next?

We hope that this blog post has provided sufficient food for thought to encourage an internal debate within your organisation.

This post is an extract form a comprehensive discussion paper entitled “Can the introduction of controlled rest periods benefit your organisation’s bottom line?” To download a free copy of the full paper please click here.

Tiredness and fatigue is costly, unproductive, unhealthy and unsafe. Third Pillar of Health (an IIRSM-accredited organisation) helps companies worldwide improve key business metrics through staff assessment, recommended solutions and education on tiredness and fatigue.