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Insomnia in the workplace

"Problems with falling asleep or daytime sleepiness affect approximately 35 to 40% of the U.S. adult population annually and are a significant cause of morbidity and mortality. However, the prevalence, burden, and management of sleep disorders are often ignored or overlooked by individuals and society in general."

Source: Hossain JL, Shapiro CM.
The prevalence, cost implications, and management of sleep disorders: an overview.
Sleep Breath. 2002 Jun;6(2):85-102. Review.
PMID: 12075483

"Compared to good sleepers, severe insomniacs reported more medical problems, had more physician-office visits, were hospitalized twice as often, and used more medication. Severe insomniacs had a higher rate of absenteeism, missing work twice as often as did good sleepers. They also had more problems at work (including decreased concentration, difficulty performing duties, and more work-related accidents)."

Source: Leger D, Guilleminault C, Bader G, Levy E, Paillard M.
Medical and socio-professional impact of insomnia.
Sleep. 2002 Sep 15;25(6):625-9.
PMID: 12224841

"Whether it be difficulty initiating or maintaining sleep, the disruption of nocturnal sleep will invariably impact on daytime activities and often results in daytime fatigue, performance deficits (including memory and other cognitive deficits), an increase in the number of sick days taken by an individual and accidents (some catastrophic)."

Source: Chilcott LA, Shapiro CM.
The socioeconomic impact of insomnia. An overview.
Pharmacoeconomics. 1996;10 Suppl 1:1-14. Review.
PMID: 10163422

"The daytime functioning of insomniacs is a key point to understand the impact of insomnia on workers. Absenteeism is one major target in the evaluation of severe insomnia at the workplace. Most of the studies find a higher rate of work accidents in insomniacs. The economic impact is severe in term of direct and indirect costs. Insomnia is a common problem at the workplace. The negative impact is not only on individual but also at the societal levels."

Source: Metlaine A, Leger D, Choudat D.
Socioeconomic impact of insomnia in working populations.
Ind Health. 2005 Jan;43(1):11-9. Review.
PMID: 15732298

“…Drowsy driving is an underestimated risk factor in official statistics, and as many as 15-30 percent of today's traffic accidents are related to drowsiness; thus it is an even greater risk factor than alcohol. Drowsy drivers suffer from inattention, impaired concentration and may even fall asleep at the wheel. Accidents during dozing result in three times as many fatalities as other accidents.

Source: Haraldsson PO, Akerstedt T.
Drowsiness--greater traffic hazard than alcohol. Causes, risks and treatment
Lakartidningen. 2001 Jun 20;98(25):3018-23. Review. Swedish.
PMID: 11462875

"According to the National Institutes of Health, insomnia affects more than 70 million Americans. Direct costs of insomnia, which include dollars spent on insomnia treatment, healthcare services, hospital and nursing home care, are estimated at nearly $14 billion annually. Indirect costs such as work loss, property damage from accidents and transportation to and from healthcare providers, are estimated to be $28 billion."

Source: National Sleep Foundation
2005 Sleep in America Poll: Summary of Findings.
29 March 2005

"Effective insomnia management holds promise as a cost-effective health care intervention," conclude the authors of a study funded by the Pfizer Corporation.

Source: Martin SA, Aikens JE, Chervin RD.
Toward cost-effectiveness analysis in the diagnosis and treatment of insomnia.
Sleep Med Rev. 2004 Feb;8(1):63-72. Review.
PMID: 15062211

"While transient insomnia produces sleepiness and impairment in psychomotor performance, chronic insomnia is associated with absenteeism, frequent accidents, memory impairment, and greater health care utilization. The most consistent impact of insomnia is a high risk of depression."

Source: Roth T, Roehrs T.
Insomnia: epidemiology, characteristics, and consequences.
Clin Cornerstone. 2003;5(3):5-15. Review.
PMID: 14626537

Insomnia and industrial accidents

This study of the association between sleep and fatal occupational accidents concluded that “self-reported disturbed sleep is a predictor of accidental death at work.” Accidental death was nearly twice as likely in subjects who reported difficulty sleeping in the previous two weeks.

Akerstedt T, Fredlund P, Gillberg M, Jansson B.
A prospective study of fatal occupational accidents -- relationship to sleeping difficulties and occupational factors.
J Sleep Res. 2002 Mar;11(1):69-71.
PMID: 11869429

Sleepiness surpasses alcohol and drugs as the greatest identifiable and preventable cause of accidents in all modes of transport. Industrial accidents associated with night work are common, perhaps the most famous being Chernobyl, Three Mile Island, and Bhopal.”

Rajaratnam SM, Arendt J.
Health in a 24-h society.
Lancet. 2001 Sep 22;358(9286):999-1005. Review.
PMID: 11583769

This study of the legal ramifications of sleep-related accidents warns that ”Accidents related to sleepiness may result in criminal prosecution. Employers may be deemed liable for injuries of third parties caused by wrongful acts of employees committed in the course of their employment. In the future, it is likely that employers will need to take greater precautions to reduce sleepiness and fatigue in the workplace, especially where the risk to public and environmental safety, health and productivity are significant.”

Rajaratnam SM.
Legal issues in accidents caused by sleepiness.
J Hum Ergol (Tokyo). 2001 Dec;30(1-2):107-11.
PMID: 14564867 [PubMed - indexed for MEDLINE]

“…Drowsy driving is an underestimated risk factor in official statistics, and as many as 15-30 percent of today's traffic accidents are related to drowsiness; thus it is an even greater risk factor than alcohol. Drowsy drivers suffer from inattention, impaired concentration and may even fall asleep at the wheel. Accidents during dozing result in three times as many fatalities as other accidents.

Haraldsson PO, Akerstedt T.
Drowsiness--greater traffic hazard than alcohol. Causes, risks and treatment
Lakartidningen. 2001 Jun 20;98(25):3018-23. Review. Swedish.
PMID: 11462875

”The prevalence for falling asleep unintentionally at least once a month was 7.0% during work hours and 23.1% during leisure time. The risk of unintentional sleep at work was related to disturbed sleep, having shift work, and higher socioeconomic group. Conclusion: The risk of involuntary sleep at work is increased in connection with disturbed sleep….”

Akerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund G.
Work organisation and unintentional sleep: results from the WOLF study.
Occup Environ Med. 2002 Sep;59(9):595-600.
PMID: 12205231

A cross-sectional study evaluated the contribution of daily sleep habits to occupational injuries. Workers with sleep features of [difficulty initiating sleep], sleeping poorly at night, insufficient sleep, and insomnia had a significantly higher prevalence for injury after adjusting for multiple confounders. The findings suggest that poor nocturnal sleep habits are associated with self-reported occupational injury.

Nakata A, Ikeda T, Takahashi M, Haratani T, Fujioka Y, Fukui S, Swanson NG, Hojou M, Araki S.
Sleep-related risk of occupational injuries in Japanese small and medium-scale enterprises.
Ind Health. 2005 Jan;43(1):89-97.
PMID: 15732310