A primer on sleep

An estimated 51% of the global workforce is prone to a wide range of occupational illnesses that are caused by sleep deprivation. Sleep deprivation causes reduced motor, cognitive, and decision-making capabilities among workers, and can lead to accidents and even fatalities in the workplace. It also impacts our energy levels, mood, appetite, motivation, concentration and efficiency. Our work and productivity is likely to be affected, as is our ability to respond effectively to distressed workers and negative emotions in the workplace in general. 

How much sleep each person needs and how they can get the quality of sleep they need is individual. These tips and strategies can help you explore what will help keep you well rested, energetic and healthy.

Effective sleep habits

Good sleep habits go a long way toward promoting restful sleep. Here are some tips to consider:

• Aim for seven to eight hours of sleep a night. This is considered a “healthy” duration for adults.
• Have a consistent, fixed wake-up time – even on days off. This is key to building a consistent sleep pattern. 
• Expose yourself to bright light immediately after waking up and for 15 mins 2-3 times during your workday to promote alertness. You can achieve this by opening curtains, going outside, or turning on a sun lamp. 
• If you’re having sleep problems, avoid napping and go to bed earlier instead. Naps can interfere with the restorative value of night-time sleep. If a nap is necessary, make sure it’s less than 30 minutes to avoid grogginess. 
• When possible, don’t consume caffeine after 12 p.m. 
• Don’t smoke, consume alcohol, or exercise 2 to 3 hours before bedtime. 
• Create a relaxing bedtime routine; drink decaffeinated tea or warm milk or take a warm bath and avoid taking part in activities that provide a sense of alertness. 
• Sleep quality and quantity can be significantly influenced by the sleep environment. To make your sleep environment comfortable and conducive to sleep:
  
  • Use comfortable pillows and bedding
  • Keep the room temperature moderate
  • Darken the room with blackout blinds or use a sleep mask
  • Drown out disruptive noises with ear plugs or a noise machine
  • Remove or cover bright lights that might come from an alarm clock, phone, or laptop
• Don’t engage in activities like eating, talking on the phone, arguing, or anything involving screens within your sleep environment. 
• If you can’t fall asleep within 15 to 20 minutes, get out of bed and don’t get back into bed until you’re sleepy – not just tired. During this time, try to focus on activities that promote relaxation like stretching, meditating, reading a calming book, or colouring. Avoid all screens. 

Sleep and shift work

Shift workers make up approximately 16% of the workforce and engage in a variety of shift types including day, evening, and night shifts. Shift workers can find themselves having to sleep during the daytime, which causes circadian disruption because of the misalignment between internal physiological rhythms and externally imposed work-rest schedules. This contributes to difficulties both falling asleep and staying asleep. 

If you’re a shift worker:

• If you require caffeine to stay alert during your shift, drink caffeinated beverages before and during your shift to help improve concentration and reasoning, but avoid caffeine for at least 3 hours before going to sleep.
• Try limiting the number of consecutive night shifts you work in a row, because it can increase sleep deprivation. Limiting night shifts can help speed up recovery from sleep deprivation. 
• After a night shift, put on sunglasses before leaving the building and during your journey back to your sleeping environment. This can help reduce the brightness of natural light making your body feel like it should naturally be waking up. 

Here are some additional facts about shift work and its impacts: 

• Shift workers often have increased rates of workplace accidents, higher rates of absenteeism, and poorer job satisfaction compared to those who work more ‘standard’ hours. 
• Extended work hours, higher workload, and emotional work demands are significant factors for sleep disturbance among night-shift workers. 
• Shift workers' sleep quality may also be impacted with increased awakenings and decreased sleep efficiency. This can be explained by night shift workers attempting to perform their jobs at a time when their body is biologically anticipating sleep and attempting to sleep after their shift (commonly in the morning or early afternoon) at a time when their body is prepared to be active and alert. 
• Given the close relationship between sleep, circadian rhythms, and affective functioning, there has been some concern regarding the harmful effects shift work may have on emotional health.
• Shift work is associated with increased risks of workplace accident and injury, including during the work commute because driving performance fluctuates with time of day. With driving performance becoming increasingly impaired during the early hours of the morning, this can impact night shift workers who are commuting home after their shift in the morning.
• Approximately 10–20% of shift workers meet criteria for shift work sleep disorder (SWSD), which is characterized by insomnia and/or excessive sleepiness during wakefulness, accompanied by a reduction of total sleep time. 

Sleep and jet lag

Sometimes our job role requires us to travel, and we can experience jet lag. Jet lag refers to disruptions in the body’s internal biological clock (circadian rhythms) due to crossing time zones. Some strategies for minimizing jet lag include:

•  Adjust to the new time zone 2 to 3 days before travel. This means shifting your bedtime, wake-time and mealtimes.
• Ensure you’re getting adequate sleep before travel. A pre-existing “sleep debt” makes jet lag worse. 
• Once you arrive at your destination, adjust your meals and bedtime to the new time zone as soon as possible. 
• Due to the gastrointestinal impact of jet lag, it can be helpful to drink plenty of water, eat small, frequent, healthy meals and minimize alcohol when travelling.

Organizational strategies to help with sleep

• Teach employees about ways they can develop good sleep habits to help reduce sleepiness.
• Prioritize work-life balance by limiting extra work hours and ensuring individuals who are working overtime have a sufficient amount of time to rest throughout their shift, and time to sleep and recover between shifts.
• When possible, allow employees to choose what shift works best for them. Some people prefer to work at night while others like to work during the day. Either way, make sure employees have adequate recovery time during the rotation. 
• Consider providing flexible working hours and locations. This allows employees to work around life responsibilities, helping to reduce the chance that they will cut into their sleep time. It also means if an employee experienced a disruptive sleep, they could sleep longer to help recover. 
• One possible intervention is providing opportunities for napping.
  
  • A short nap can help reduce the effects of sleepiness and keep employees working hard.
  • Fewer than 5% of organizations currently have onsite nap rooms.

Common sleep problems

There are at least three different categories of sleep disorders: people with problems falling asleep, people with disturbances during sleep from movement or breathing patterns, and people with excessive daytime sleepiness (8). 

These are the most common sleep problems. If you experience any of the following symptoms, speak to your family doctor to seek assistance.

• Fatigue is an overwhelming sense of tiredness, lacking energy and a feeling of exhaustion, associated with impaired physical and/or cognitive functioning (Jiao & Ye, 2016). Fatigue is impacted by the amount of physical and psychological energy spent on tasks and is also influenced by our emotional state and the state of our immune system (Jiao & Ye, 2016). Fatigue can be reversed by rest, while sleepiness can only be reversed by sleeping naturally (e.g., without the use of stimulants) (Jiao & Ye, 2016). Chronic fatigue and loss of sleep can cause longer-lasting changes, including mental health issues (Parry et al., 2018). 
• Insomnia, the most common sleep disorder, is defined by difficulty initiating sleep, maintaining sleep, or both, resulting in daytime consequences (Holder & Narula, 2022). Individuals with insomnia feel tired upon awakening and fatigued during the day. 
• Restless leg syndrome is a sensory disorder characterized by an irresistible urge to move one’s legs (and sometimes arms) due to uncomfortable, tingling or “creeping” sensations that worsen when at rest (Holder & Narula, 2022). 
• Rapid eye movement sleep behavior disorder is characterized by increased muscle tone during rapid eye movement sleep, resulting in patients acting out their dreams with potentially harmful effects (Holder & Narula, 2022). 
• Narcolepsy is a rare sleep disorder that comes with frequent periods of sleepiness (both gradual and sudden sleep attacks). It’s sometimes associated with cataplexy (muscle weakness), sleep paralysis, and sleep hallucinations (Holder & Narula, 2022). Narcolepsy and everyday sleepiness at work should not be confused. One is a medical condition and the other is likely a result of lack of sleep (Jiao & Ye, 2016). 
• Obstructive sleep apnea is a common but underdiagnosed, and possibly life-threatening, sleep disorder. The primary feature of obstructive sleep apnea is a partial blockage of airways causing breathing to stop at night, leading to sleep disruptions. This can lead to excessive daytime sleepiness, hypertension, dry mouth, and morning headaches (Holder & Narula, 2022). 
• Chronic sleep deprivation can cause effects such as waking several times a night, insomnia, irritability, and sleepiness during the daytime. In the short term this may be manageable, but chronic cases can lead to individuals needing to manage their sleep using substances.

If you feel you’re experiencing any of these sleep problems or disorders, speak to your general practitioner to help support your sleep. 

The sleep cycle

It’s useful to understand general information about sleep and the sleep cycle.

• The average adult needs about 6 to 9 hours of sleep, but there are exceptions to this. Consistently sleeping fewer than your needed hours can lead to a range of health consequences. Inadequate sleep can impact memory and reduces the ability to do previously learned tasks. On the other hand, consistently sleeping too much can create excessive lethargy and fatigue. 
• We have two main types of sleep:
  • REM (rapid eye movement) sleep is characterized by dreaming. It’s when our brain and body functions are restored. This includes energy conservation and memory consolidation. A lack of REM sleep is associated with disorders like depression (Parry et al., 2018). 
  • Non-REM sleep is characterized by four stages that progressively deepen from light to restful to deep sleep. We cycle through stages 1, 2, 3, 4 and REM throughout the night. Each complete cycle takes about 90 minutes. 
  • Throughout the night we increasingly spend longer periods in REM sleep. This leads to sleep feeling “restorative” or restful. 
• Sleep patterns can be impacted by a range of factors, including: 
  
  • Stress levels
  • Low mood and depression
  • Anxiety
  • Physical health conditions
  • Worry about sleep
• External factors that interfere with our regular sleep patterns can include work, loved ones, travel, noise, temperature, medications, etc.
• The good news is our bodies are resilient and can recover from chronic sleep debt within a few days to a week. 

Sleep quality

Quality of sleep is important to a person’s health, and poor-quality sleep is associated with an increase in sick leave and long-term health problems. Quality of sleep is measured by duration, the number of times an individual is woken during the night, and their ability to go back to sleep. Sleep is needed to maintain optimum health and performance, as it supports the mechanisms that facilitate physiological and cognitive function. 

Consequences of Sleepiness 

• Reduced information processing
• Difficulty regulating emotions
• Decrease in job performance
• Inability to read others’ emotions accurately
• Increased risk for accidents 

Mood, worry and sleep

• Depression and anxiety are the most common psychological health conditions, and both impact sleep significantly.

• Worry and anxiety are a normal part of life, and they have a strong impact on sleep. If worries are preventing you from sleeping, it can be helpful to keep a “worry log.” When you find yourself feeling worried, you should:

  • Get out of bed

  • Write down your worries

  • Ask yourself three key questions:

    • What’s the evidence for this worry?

    • What’s the problem to be solved?

    • What can I do about it right now?

Writing down worries can help reduce the activity they cause in our thoughts and allow the mind to relax and fall into sleep. 

• Relaxation strategies can help you fall asleep. You could try:
  
  • Four stage breathing
  • Visual imagery
  • Progressive muscle relaxation
  • Guided sleep meditation
  • For more ideas see Managing stress.

If you’re having trouble identifying contributors to your sleep problems, keep a sleep journal to help reveal patterns and factors impacting sleep. For one to two weeks in the journal, track your: 

• Diet
•  Activities (work and leisure)
• Level of stress that day
• Mood when you go to bed
• Time of day you go to bed 
• Time of day when you fell asleep (approximately)
• Time of day when you wake
• How you feel when you wake

After the two weeks, you may be able to recognize what’s impacting your sleep and take corrective action to support healthy sleep. If you’re not able to identify what’s disrupting your sleep, discuss your sleep journal with your general practitioner so you can find a resolution together. 

Additional resources

Managing stress. Learn how to manage your reactions to stress and protect your well-being.

Coping with change. Explore how you can navigate change in ways that help you accept and adapt to changes that are outside your control.

Four stage breathing. One of the most effective, immediate strategies for regulating your mood in the moment is to work actively on slowing down your breathing. Four stage breathing is one method for doing so.

Progressive muscle relaxation. Learn the simple exercise of Progressive muscle relaxation (PMR) to help reduce and prevent muscle tension, often caused by mental stress and anxiety. PMR involves purposefully and systematically tightening, then relaxing, groups of muscles and can allow you to become more in-tune with your body so you can help yourself relax.

References

1. Becker , P. M. (2022). Overview of sleep management during COVID-19. Sleep Medicine, 91, 211-218. https://doi.org/10.1016/j.sleep.2021.04.024.
2. Cheng, P., & Drake, C.L. (2018). Psychological Impact of Shift Work. Curr Sleep Medicine Rep, (4), 104–109. https://doi-org.uproxy.library.dc-uoit.ca/10.1007/s40675-018-0114-7
3. Godos, J., et. al. (2021). Association between diet and sleep quality: A systematic review. Sleep Medicine Reviews, 57, 101430. https://doi.org/10.1016/j.smrv.2021.101430
4. Henderson, A. A., & Horan, K. A. (2020). A meta-analysis of sleep and work performance: An examination of moderators and mediators. J Organ Behav, 42, 1– 19. https://doi-org.uproxy.library.dc-uoit.ca/10.1002/job.2486
5. Holder, S., & Narula, N. S. (2022). Common sleep disorders in adults: Diagnosis and management. American Family Physician, 105(4), 397+. https://link.gale.com/apps/doc/A719328899/AONE?u=ko_acd_uoo&sid=bookmark-AONE&xid=4b0561a9
6. Irfan, M., et al. (2022). Prioritizing causal factors of sleep deprivation among construction workers: An interpretive structural modeling approach. International Journal of Industrial Ergonomics, 92, 103377. https://doi.org/10.1016/j.ergon.2022.103377.
7. Jeon, B. M., & Kim, S. H. (2022). Associations of extended work, higher workloads and emotional work demands with sleep disturbance among night-shift workers. BMC Public Health, 22(1). https://link.gale.com/apps/doc/A727546759/AONE?u=ko_acd_uoo&sid=bookmark-AONE&xid=c2fac1fd
8. Jiao, X., & Ye, M. (2016). A review of research on sleepiness at workplace. Journal of Human Resource and Sustainability Studies, (4), 155-161. doi: 10.4236/jhrss.2016.43017
9. Joshi, K. G., & Joshi, H. G. (2019). Working the night shift? Strategies for improving sleep and performance. Current Psychiatry, 18(1), 48+. https://link.gale.com/apps/doc/A572716213/AONE?u=ko_acd_uoo&sid=bookmark-AONE&xid=a5453cfe
10. Mulhall, M. D., et. al. (2019). Sleepiness and driving events in shift workers: The impact of circadian and homeostatic factors. Sleep, 42(6). https://doi.org/10.1093/sleep/zsz074
11. Parry, D.A., Oeppen, R.S., Amin, M.S.A. & Brennan, P.A.. (2018). Sleep: its importance and the effects of deprivation on surgeons and other healthcare professionals. British Journal of Oral and Maxillofacial Surgery, 56(8), 663-666. https://doi.org/10.1016/j.bjoms.2018.08.001.
12. Shriane, A. E., Ferguson, S. A., Jay, S. M., & Vincent. G. E. (2020). Sleep hygiene in shift workers: A systematic literature review. Sleep Medicine Reviews, 53, 101336. https://doi.org/10.1016/j.smrv.2020.101336.