Dr. L. Casey Chosewood:
Hello to all of you and welcome to the CDC Workplace Health Resource Center’s webinar series. Make Wellness Your Business:
Sleep Strategies for the
Workforce is today’s topic. My name is Dr. L Casey
Chosewood and I will serve
as today’s moderator. The purpose of today’s call is
to discuss how sleep affects you and your workers’ personal
and professional wellbeing. We will discuss the benefits of
sleep, the current challenges
around getting enough sleep, and we’ll share some existing sleep
strategies and show you how the
CDC Workplace Health Resource Center, which we’ll also refer
to today as the WHRC, is
contributing to this critical topic, especially when it comes
to the safety, health, and wellbeing of you
and your workers. And now I’d like to
introduce today’s speakers. As I mentioned before
I’m Dr. Casey Chosewood and I
will serve as your moderator. I am the Director of the
Office for Total Worker Health
at the National Institute for Occupational Safety and Health
and we’re part of the Centers for Disease Control
and Prevention. Our office leads the Total
Worker Health Program at NIOSH
and Total Worker Health is defined as the program’s
practices and policies that
improve the safety and the quality of work for workers
while advancing their overall
safety, health, and wellbeing. We’re very concerned about safe
work, about healthier work
design, certainly things like sleep and stress and aging
and work and chronic diseases related to work are critical
focus areas for us. Before this role, I served as
the Director of the Health and
Safety for CDC’s own workforce, and I was the Medical
Center for CDC’s three
Occupational Health clinics. Our presenters today are two of
the nation’s topic experts when
it comes to the subject of sleep and its impact on our
work and our wellbeing. First, I’d like to introduce
Dr. Claire Caruso, a colleague
of mine at the National Institute for Occupational
Safety and Health. She’s the subject matter expert
on shift work, long work hours, and related workplace
sleep and fatigue issues. Her Ph.D. from the University of Michigan focused on the health and safety risks
associated with shift work and long work hours and the
underlying sleep and circadian rhythm research that provides
evidence for this topic. Claire is also a registered
nurse, which gives her additional personal
insights into this issue. Today regulatory agencies,
labor, and industries cite
her publications in their recommendations and in
their position statements
on working hours. She and her team have developed
a number of online training
programs for managers and workers and these programs
offer the latest evidence-base
recommendations to both prevent and better manage the demands of
long work hours and shift work. Our next presenter will
be Dr. Michael Twery. Michael is the Director of
the National Center on Sleep Disorders Research at the
National Institutes of Health. He has led sleep and respiratory
neurobiology research programs
at the NIH’s National Heart, Lung, and Blood
Institute since 1966. And he became the Director of
the Sleep Center there in 2006. Dr. Twery serves as a point of
contact for the coordination
of federally-funded sleep activities and a wide array
of scientific research. He also administers the Sleep
Disorders Research Advisory
Board, which is an important federal advisory committee
representing both sleep
disorders patients, their healthcare providers, and
biomedical researchers on needs and opportunities
around sleep research. Improving our understanding
of how sleep disorders and
insufficient sleep pose a national burden to our physical
and mental health, this has
certainly been a prime direction of particular
interest to Dr. Twery. He chairs the Sleep Health
Working Group and a focus area
within the nation’s Health People 2020 initiative that
established national objectives for specifically
improving sleep health. Well, our agenda
today is as follows. We’ll first cover sleep and
the workplace in our agenda. And within this portion,
our presenters will discuss
the benefits of sleep, the challenges around inadequate
sleep, and then provide some
great resources and strategies that employers can put in place
to address these challenges. We’ll then hear more about CDC’s
Workplace Health Resource Center
and I’m appreciative to them for inviting me here today
to lead the webinar. After that, we’ll learn some
next steps you can take to learn more and to intervene
in this important topic. And then we’ll move on to
your questions and answers. Now, here’s a warning. Get your pen and paper ready or
your keyboard and take some
great notes today because you’re going to hear lots of pearls,
ideas, strategies that are not
necessarily on the slides, so be ready to write down the great
information and recommendations
you’re going to hear. Now, I’d like to turn the
presentation over to Dr. Twery who will cover an overview
on the benefits of sleep. Dr. Twery, welcome
to the webinar. Dr. Michael Twery:
Thank you, Casey. Most every metric of workplace
performance, no matter how we
look at it and ultimately business success
is vulnerable to various
effects of sleep deficiency. Our productivity based on
time on task is limited by
our ability to stay awake. Creativity, intelligence,
motivation, effort, efficiency,
our effectiveness when working in groups, our emotional
stability and sociability are all diminished by
insufficient sleep duration. Irregular sleep schedules
or poor quality sleep. Optimal sleep health
requires seven to eight
hours in bed for adults. It requires a regular
sleep schedule. Timing is important. And good quality sleep. But health surveillance data
worldwide is now indicating that
a large proportion of adults and adolescents frequently do not
get enough sleep or rest. In the image that you see on
the screen right now is a U.S. map of insufficient sleep and it
reveals that sleep deficiency is affecting 20 to 40 percent
of adults in every state. The legend of the map shows that
states with the lightest color,
the white shading, are in that 20 percent, the 30 percent
range, and then the progressive
darker colors of green show, are associated with higher rates
of insufficient sleep among
U.S. adults. However, this map of sleepiness
is only showing you the invisible threat, this
issue of being awake. What it is not showing is
the impact of chronic sleep
deficiency on our health. And this is where scientists and
researchers have made amazing breakthroughs in
just the last decade. Scientists have started to
identify the nuts and bolts of
how sleep and circadian biology are regulating gene expression
and cell function in almost
every single organ, whether it be the brain, the heart,
or the immune system. All of these systems are closely
coupled to our sleep health. Sleep deficiency undermines
these functions. They run inefficiently and
ultimately over time contribute
to the risk of many conditions, whether it be the risk of
catching the common cold, obesity, diabetes, heart
disease, and even cancer. Bottom line: sleepy
employees are often
unproductive employees. And because sleep deficiency
undermines their health, it undermines their health and
many work-related behaviors. So, the continuous lack
of sleep affects everyone. It affects health, safety, and
performance and in the
workplace, sleep deficiency is predicting a lower work
rate, slower completion
of even basic tasks. Insufficient sleep is both
physically and mentally harmful. So, one starting point to
improve sleep health might be to
take a look at your workplace and consider is sleep
deficiency, sleep deprivation a
characteristic that is commonly tolerated or perhaps even
rewarded or encouraged
in your workplace? Is this a systemic
problem or practice? A second idea is can materials
that you can obtain from CDC and other sources be used to educate
employees about sleep health? The average individual may not
understand what the effects are
and how to recognize when sleep deficiency is affecting them,
affecting their contribution
in workplace teams, and their interaction with customers,
all of which are important
to sleep in the workplace. Are individuals aware that their
performance is fluctuating
widely from day to day? In some cases, these ups and
downs might reflect changes in the amount of sleep this
individual is obtaining. Invite employees to keep sleep
diaries might help individuals
recognize these problems. And also, these sleep diaries
can be a useful starting
point if the individual seeks consultation or wants
to discuss their sleep
problems with a physician. The diary is very, very useful. Our human biology is
organized around sleep. And the bottom line from the
scientific end is there is no
immunity or vaccination to prevent the effects
of these deficiencies. So, one difference between
sleep and many other workplace
performance factors is that the impact of sleep deficiency is
occurring in the workplace but also every place between
the workplace and home. In fact, driving to and from
work, a very prevalent and common problem in many
settings is drowsy driving. Individuals who are at risk
of drowsy driving can take them
out of their workforce at least temporarily and can interfere
with their own success. But sleep occurs at home. It’s not occurring
in the workplace. Sleep disorders, whether it be
insomnia, sleep apnea, they’re all contributing to the
problem of sleep deficiency. But the effects, if left
untreated, can impact employee productivity and
performance in work. Encouraging employees to be
there and enabling employees to
recognize these problems and to seek the assistance of their
physician, discuss these
symptoms with their physician can help minimize the
effects of sleep disorders. There’s also another dimension,
which is a bit less tangible in some ways, and that’s
the societal outcomes. Because sleep affects every
dimension of our activities, our
interpersonal relationships, it affects how we can,
our relationships with family,
with spouses, children, how we behave, how the adults, the
parents behave can also impact the outcomes in the family
and also affect their risk. Balancing, this is another
example of where balancing
professional and personal responsibilities is
very, very important. It’s important in the workplace. It’s important in the family and
these two success in these two venues will only contribute
to the workplace environment. It’s important with respect
to interacting with peers. We all have a greater depth
of behavioral regulation and reserve when we’re
well rested and awake. And of course, it affects our
overall mood and happiness. Now, I’d like to turn the
presentation over to Claire,
who will discuss emerging technologies that employers
can consider implementing. Claire? Dr. Claire Caruso:
Thank you, Michael. I appreciate this opportunity to
just give you just a few of the
many strategies that managers and workers can use to promote
alertness on the job, sleep health, and all of
the health benefits. The first thing I’ll
talk about is naps. These are really an
important counter-measure
to help relieve sleepiness. Just falling asleep for a few
minutes has an alarming effect. Our brains benefit from this
brief period of sleep, not just
a quiet time to recover from sleepiness and to
restore alertness. One problem we have, though, is
the cultural barriers in the United States to
using naps at work. Some workplaces have policies
that reprimand people for sleeping on the job and
workers have been fired. However, as managers begin to
understand the strong science behind the usefulness of naps,
this will probably change. There is a lot of good science
about the usefulness of naps. It’s a healthy method to restore
alertness when somebody’s feeling very sleepy
and it’s very useful. So, some enlightened
employers are making use
of naps during work breaks. How will, so there’s a
couple things I’ll cover. You might think, well how
long should this nap be? Well, you could use both short
naps, sort of 15 to 30 minutes, or longer naps and it
depends upon the situation. For instance, if you’re working
on a daytime schedule, a brief nap like less than 20
minutes could be useful. You can set the alarm for 15 to
30 minutes to wake up and this brief nap will increase
alertness for several hours. And the other benefit is you’ll
wake up with less grogginess
than if you slept for a longer period and the other benefit is
that it doesn’t disrupt your
sleep that night because you won’t go, your brain won’t go
into the deeper stages of sleep and reduce the build-up
of sleep pressure. Longer naps, an hour and a half
or more, can be useful during
emergencies when workers have to work long hours, for example
during snowstorms when the next
group of workers can’t come in, or there’s a whole range of
emergencies that can happen. And these happen in a wide range
of work settings, from police to
fire to healthcare, but also to a variety of service
operations such as heating and
air conditioning technicians. So, you might think, well when’s
a good time to take a nap? Well, if someone is feeling a
very strong sense of sleepiness
when they’re at the job or when they have to drive or
whatever, a nap at that
point could be useful. And there are times during the
day when we can predict that
people may feel sleepiness, and this is during the night, you
know, when we normally are
sleeping and for those people that are working night shift,
they may feel strong periods of sleepiness, particularly between 2:00 a.m. and 5:00 to 6:00 a.m. The other time that we tend to
feel sleepy is in the middle of
the afternoon from about 2:00 to 4:00, so during those
times a nap can be useful. The other tip I can give you is
people can combine the benefits of both caffeine
and a short nap. So, how that would work is you
would drink some caffeine and then you would lay down
and take a short nap. The caffeine takes about 30
minutes to take effect, and so
when you wake up from that nap in about 30 minutes, you’ll get
the alerting benefits from both. Then you might think, well, what
kind of environment is good for
this, for taking a nap? Well, you want a safe place. A safe room close to the
workplace that’s conducive,
that’s quiet, dark, comfortable, and cool and doesn’t expose
the workers to slamming
doors and other noises. And if you’re using the short
naps, less than 30 minutes, you
can have, provide a reclining upholstered chair with
the elevated leg rests. But for longer naps, it’s best
to have a horizontal surface, a
bed, because it allows the brain to go into the deeper stages
of sleep and reduce the sleep pressure and promote
better recuperation. A couple cautions. Beware on awakening people can
feel a period of grogginess
and they can have declines in performance and mood
during this time. So, you want that to pass before
you carry out critical tasks. It depends upon the situation
how long this will last. If someone is sleep deprived,
it may last a while. For a very short nap,
it’ll probably just last a
few minutes, ten minutes. It could last 30 to
60 minutes depending. It will, this period of
grogginess will pass more
quickly by taking some caffeine, being in a brightly lit
area let’s say outside,
or washing one’s face. The other thing I want to
point out is these naps are
a temporary aid for improving alertness and it’s not a
replacement for getting a regular long period
of sleep at night. Next, I will talk
about indoor lighting. There’s been a lot
of study on lighting. It has a big impact on our
sleep, our circadian rhythms, our alertness, and
our sleepiness. And in recent years, they have
found that the different colors
of light have differing impacts. Blue light, which
is part of white light,
shifts circadian rhythms. The warmer light, like red,
yellow, orange have much less
effect on the circadian rhythms. So, some workplaces can use this
kind of information to design
lighting to help people maintain alertness, let’s say if they’re
working night shift, and help their bodies get adjusted
to those work times. Some places for night shift have
got set up brightly-lit areas where the workers can
go in intermittently. Pretty much this is recommended
for the first half of the shift
and then for, towards the end of the shift, you move towards the
lesser lit areas, so that when they go home, they
can fall asleep. There are other strategies
being used by companies. We’ve heard through the news
outlets that one company that offered their employees
money for sleeping. So, for the people who were
sleeping seven or more hours a night for 20 days, they offered
a maximum of up to $500 a year. Now, that company really
understands the importance of sleep health for
their, their operation. Exercise improves sleep, so some
employers are, have exercise rooms with exercise equipment
and exercises classes. One of the major problems that
the workplace can help with is reducing this widespread lack
of information about sleep. People don’t get this
information in their schools,
their training programs, their healthcare visits
for the most part. And they really need this basic
information to move them to better practices at
home and at work. So, this Resource Center
provides a lot of links for some
great sources that managers and workers can
use to get this critical
information about sleep. The National Institute for
Occupational Safety and Health
has several online training programs that are tailored
specifically for several types
of workers and managers and we’re developing
more as time goes on. There are also resources
available from the National
Safety Council, Neuro Research, Transamerica Center for Health
Studies, and the Massachusetts
Department of Public Health. So, besides educating and
promoting that, managers can
do a lot of other things. You can promote a workplace
culture that respects the need
for people to be off work, to get good quality sleep,
and recover from work. It’s critical that managers
send these messages to their
workers because there are some conflicting messages out in our
society about being productive
and advancing in one’s career and so forth that are actually
counter to good sleep health. For instance, one of my bosses
several layers up a few years ago posted a blog and she was a
great promoter of sleep health. And in it she said, when it
comes to our health, sleep
habits can be just as important as diet and exercise,
but a third of us aren’t
getting enough sleep. And this is enormously expensive
to our healthcare system and our
nation’s productivity. Managers can relay how they
improve their sleep practice and
how much better they feel and how they’ve seen their ability
to cope with the challenges at
work that these have improved. There’s lots of other
opportunities across the
year to give these messages. During the flu shot season,
managers can tell, remind the
workers to make sure they get sleep after their
shot for several days. There’s evidence that when
people slept better after they got the shot, their levels
of antibody were higher. The other times are
during the spring. You know, we had that time
change a couple weeks ago and in the fall we have
another time change. Well, that one hour change in
the time we have to get to work
and get up and go to sleep impacts some people
for up to a week. And so, this is another time
when we can remind people about
how to better adjust to these time changes, as well as if
that, if I’m doing fine, I have
to remember that the other people around me may
be having trouble. Another issue is on-call work. It’s very difficult to be
on-call 24 hours a day and
obtain good sleep health. And so, the workplace has to
recognize this and it’s useful
to set up the expectation that when people leave the job, they
do not need to be responding to emails, phone
calls, and so forth. Managers can tell their
employees this during the
meetings and they can model the behavior they want seen, like
they themselves will not respond to emails and so forth
after their shift ends. Now, we understand this is a
real challenge for global
operations when your customers and co-workers across the globe
are on a different time zone. But I think that as managers
understand the difficulties that
this will cause for workers to try to respond 24 hours
a day, seven days a week or
whatever, people are smart. I think that they will create
better ways of handling that. Job stress leads to insomnia and
other sleep problems, so that’s
another issue that managers can work towards reducing and that
would be by creating a good
psychological work environment. For instance, people are treated
with dignity and respect. They’re given resources
to do their job. They’re recognized for a
job well done and so forth. You can look at your policies
and some of these may be very
relevant to sleep health. For instance, your
shift lengths. You can consider setting limits
on the length of the shift and
overtime and hours per week. You can look at, see if any
policies encourage excess of overtime and if there are
some, you can modify them. You can explore flexible
scheduling options. Shorter shifts and telework. Telework can be very helpful. It saves time that they don’t
have to commute and grooming themselves to get
ready for work. Next thing that could be looked
at is the work schedules themselves, the design
of the work schedules. It helps to give workers input
into their schedule because
they’ll likely consider their own personal responsibilities
and capabilities
as they provide their input. Be cautious about using
long hours per day. You have to remember that these
extended hours prolong exposure to the workplace hazards such
as noise, heat, and so forth. And by that extended hours, that
may be exceeding the established
permissible exposure limits. Also think about the
work that’s being done. Is it feasible to do
that during a long shift? I mean if work has very heavy
physical demands, emotional
demands, cognitive demands, and the pace of the work is fast,
that could be pretty difficult. Next, I’ll talk a little bit
about 24-hour operations. Just have a couple tips. A lot more information is
available on our Resource,
at the Resource Center. Think about, if you have a
24-hour operation, is that night
shift task that you’re trying to accomplish, is it really
necessary to be done at night? Keep in mind that night shift
is associated with increased
risk for errors, injuries, and development of
chronic illnesses. Now, we understand that there
are certain types of work that we just cannot do
without during the night. Some manufacturing processes,
for instance, healthcare,
police, fire, and so forth. But if, if some of the tasks
are optional, consider moving
those to the daytime hours. For your permanent, for your
night shift operations, use the permanent night
shift with caution. Some people really adjust to
it well and they like it, but
most people have difficulty. Be sure to give people
adequate time off each day. At least 10 hours
between shifts. If not, 11 or more
is much better. Next, I’ll move on to some
good sleep practices for
both employers and managers. These are, have been, there’s a
lot of support that these help
improve sleep and it’s important to try, for people to use
these to help themselves. So number one, create a very
good sleep environment. You want to have a comfortable
mattress and pillows. If you haven’t replaced these
in a number of years, consider
doing that because they do get lumpy, wear out, and you’ll
wake up with aches and pains. The other thing is
have it comfortably cool,
very, very dark and quiet. It helps to go to sleep and get
up about the same times every
day, including your days off. These consistent sleep times
help the brain understand when to be awake and
when to be asleep. Get some exercise every day. People who report the best sleep
tend to exercise vigorously, but even walking for 15 minutes
or so can be helpful. Look at your caffeine intake. Stop that well before bedtime,
at least five hours beforehand, and think about your
own sensitivity. You may have to stop
it well before that. Set a time to relax before
bedtime, about an hour or more, and use this time to do
only relaxing things. So, don’t use that time to plan
your next exciting vacation or, you know, look at an
action-packed film or whatever. Use this time for
relaxing things. Lower the light levels. Stop using the devices with
the backlit screens like our computers and our
tablets and our phones. Those acts of brushing one’s
teeth, getting dressed for bed,
it signals to the brain that we’re winding down now and we’re
getting ready to fall asleep. Also, take care of the
variety of things that
can disturb sleep. If you’ve got a chronic illness
like, that involves pain or
respiratory symptoms like from asthma or nose irritation, deal
with that, so you don’t have
those symptoms during the sleep. Unfortunately, the way our
body works is the pain and the respiratory symptoms are
more bothersome at night. Also in dealing with noise from
traffic, barking dogs, and so
forth, you may have to use some soft earplugs and these are
available in the pharmacies. All these measures
do improve sleep. If someone has consistent
problems with sleeping or
feeling sleepy during work, they should see their
healthcare provider or
sleep disorder specialist. There’s a lot of good options
available to improve peoples’
sleep and quality of life. As I said, this short
presentation can only give you a
few of the many strategies that are available for
workers and managers on
this sleep health topic. Be sure to check the resources
to get more information. Now, I’ll turn the session
back over to Casey. Casey? Dr. L. Casey Chosewood: Thank
you so much, Claire. And Michael as well. I found your comments today very
rich and practical and very,
very actionable, so I certainly learn something new
from you guys every
time I hear you speak. Now, to talk a little bit
about the CDC Workplace
Health Resource Center. As you may know, the CDC’s been
involved in raising awareness
of a number of critical public health issues, including that
around sleep health and its
connection to work and worker safety, health, and wellbeing,
and really with the goal of improving the overall quality
of the health of Americans. We want you to take a look, if
you haven’t had a chance yet,
at the website for the CDC Workplace Health Resource Center
and for many, it can be your
first stop online to help you launch or expand a work
health place program in
your own environment. Certainly, the site is filled
with evidence-based and credible
resources and it can really help employers tailor workplace
health promotion goals to meet
their organization’s needs. A number of tools exist on the
website and here you can see that there a variety
of things available. Currently the website has more
than 300 resources and that list
is growing every single day. I’ll just reiterate that the
website is completely free and it includes a number of
interesting case studies. What I might consider is very
important real life examples
from organizations much like your own, including
organizations of different sizes
with an emphasis on solutions that work in small and
medium-sized businesses. There’s a section on emerging
issues, such as the focus of
today’s webinar, improving sleep quality, to address the
health and safety of workers. And there are a number of
workplace health strategies that
available there that can play really a significant role
in keeping healthcare more affordable for your organization
and for your workers. The WHRC includes resources
to help small businesses as
I mentioned, design workplace health programs that are
actually accessible for employers with as few
as 12 or 25 workers. There are also on the site
evidence-based summaries
and issue briefs. For example, there’s a new issue
brief just out now on total
worker health and I would invite you to take a look at the
integrated approach to health and safety that the Total
Worker Health Program espouses. You will also find on the site a
suite of webinars and videos to
help organizations like your own who are really looking to
start or improve the workplace
health promotion program. On this next slide, you will
see a snapshot of the website
where visitors can search for these credible resources just by
entering a few key words in the search box on the upper
right-hand corner. In this example, you
see the search results after
entering the key word sleep. Now, if you find a resource that
you think will be useful for
you, simply select the resource and you’ll be directed
to its source. The website is continually
being updated, so I invite
you to check back regularly. It’s also interesting that you
can help us rate the quality of
these resources and we give you a five-star rating system to
do that, to give feedback. That not only helps others, but
it will give us some feedback,
too, about the quality and how people are perceiving the
quality of the products that are offered through the
Resource Center. Here you see a new sleep brief
that helps employees and
employers address this often very thorny issue that we’ve
been hearing about today. Now, to summarize what we’ve
been talking about today, I just
want to leave you with a few things in the
sleep summary here. Clearly, sleep plays a critical
role in our safety, our health,
and our overall wellbeing. While sleep is highly
individualized, it is very closely tied to so many
aspects of worker wellbeing. Our energy level, our attitudes,
our working relationships, our
personal relationships with friends and family and
coworkers, our creativity,
our spark if you will, our happiness, even our immune
system that we heard from Dr. Twery is strongly associated
with a healthy sleep hygiene. And in my view, it’s much too
important to isolate this issue
that’s something, that’s only managed in the personal domain
or only viewed as a personal
responsibility because the workers all report to a
workplace with an employer who
can have a tremendous role in improving sleep opportunity for,
for their workers, and I would
say have a responsibility when they have such a strong voice
in the schedules that people
maintain for their work. So, for employers we encourage
you to integrate sleep into your
health and wellbeing strategy, into your safety programs, into
your training and orientation programs, and also introduce
it into your risk assessments. When you’re talking about risks
and exposures that workers face,
factor in schedules and shifts as an important influence on
many, many health, safety,
and wellbeing outcomes. Tailor sleep strategies by using
the resources that are available
from some of the high quality places you’ve been
hearing about today. You know, we also believe that
employers can assist and educate workers around the
topic of sleep. Make sure you pay close
attention to work demands,
schedules, and deadlines. Make sure they’re realistic
and there’s adequate staffing. For employees, we want each and
every one of you to create a manageable sleep routine and do
all you can to stick with it. Overall, we’d like to leave
you with this message. What happens at work can
strongly influence our
opportunities for high quality sleep, so developing
sleep-centric and worker-centric
programs around managing and improving the quality of sleep
are of critical importance if
we want to improve the safety, health, and wellbeing
of all our workers. Alright. So, let’s move on to a few next
steps on how you can stay
connected and continue to learn more about this topic and
others within the Workplace
Health Resource Center. We invite you to stay connected
with us on social media. You can see LinkedIn, Facebook,
and Twitter options here. Certainly check back to the
website of the WHRC to learn
about new product updates, upcoming events, including a
discussion on mental health best practices that will
be offered very soon. Upcoming soon also is a
train-the-trainer webinar
designed to help navigate the Center’s many resources
and the website. You can follow us, as I
mentioned on social media. Finally, if you would like to
partner with us on an upcoming
event or you have follow-up questions about this webinar,
other upcoming activities, or
the Center, please email [email protected] Again, that’s
[email protected] and someone from the Center
will follow up with you. Here on this next slide, you
can see a number of promotional
opportunities that are out there using materials that have been
developed and can be shared via
your own social media channels. If you would like to access
promotional materials, you can
visit the website or again email the Center at
[email protected] Now, it’s time for us to move
on to our question and answer
portion of the meeting and I’ll invite Michael and Claire to
join me back on the line. Again, to thank both of you for
your wonderful presentation. I would remind folks that you
can enter your own questions at this point still if you
would like to do so. And I will start off by really
just asking Claire a question
that we, that we know has come up, and that is that you know,
managers oftentimes ask what are
some of the ways that people will behave or will appear
when they’re not getting
enough good quality sleep. So, do you have some guidance
for supervisors or managers on
really ways they could help out if they notice people
are struggling? Dr. Claire Caruso:
Well, this is Claire. They can be looking for symptoms
and some of the obvious ones
would be that the person is yawning a bit, has droopy
eyelids, maybe they’re even
involuntarily falling asleep and you can see them
doing that at work. They may have a
slow reaction time. They could have slurred speech. In fact, there has been studies
that have compared people
in the lab when they were sleep-deprived and they compared
them when they had alcohol and
they did find some similarities. People can have a blank stare
that’s caused by short episodes of sleep just a
few seconds long. They could have mental
signs, such as difficulty concentrating,
difficulty remembering. Emotional signs. They could be more quiet
or withdrawn than usual. Lack of energy, motivation. Don’t care attitude. They could have inappropriate
emotions, like they might giggle
and laugh in serious situations. They can have a problem with
their thinking, you know. They may fixate on a solution,
even though to you it’s
obviously some other better alternatives are
easily available. They may have more
risk-taking behavior. They, and their risk
assessment may be poor. And they may misinterpret
oral communication. So, you can see there’s a whole
range of behaviors that somebody
may show when they haven’t gotten, haven’t been
getting enough sleep. Dr. L. Casey Chosewood: Great. Thank you for that, Claire. We’ve got a question that’s
come in and it’s addressed to
Michael, but I will start with Michael, then see if Claire
wants to add anything as well. But the question, Michael,
is, is there any rule about
snacking before going to bed? Does that seem to have any
impact on sleeping pattern? So in general, consumption
of food close to or
near the bedtime period? Dr. Michael Twery:
So, I think there’s several
dimensions to that question. One of the reasons we snack in
general is, is part of how we achieve some, restore our
emotional regulatory balance. We eat.
We sleep. These are all mechanisms of
restoring that mental function. Now, in terms of rules, we
have science and the science
says that consuming the heavy carbohydrate loads and fats at a
circadian-inappropriate time of
day is a problem because our, if we’re, if our bodies are
preparing for sleep, the
chemistry, the metabolism of our body is not prepared to
properly, sufficiently metabolize those
incoming calories. So, eating pizza, eating pizza
at night or chocolate cake or
even, it may be healthier snacks, fruits have
many carbohydrates. And so, the bottom line is,
research is showing that this
appears, this late night snacking or eating at the wrong
time of day does contribute to
the risk of weight gain. And there are studies underway
right now to look at, to develop
dietary recommendations about, you know, eating the correct,
when to eat during the day. Dr. L. Casey Chosewood: Great. Thanks, Michael. Claire, anything
you’d want to share? Dr. Claire Caruso: Um, I guess
the other point is that if
somebody is hungry, that may make it difficult for them
to fall asleep or stay asleep,
so a very, very light snack is sometimes recommended, like a
combination of a little protein
and a little carbohydrate. Now, this wouldn’t
be a big snack. It would be a small one. And also, if people are feeling
hungry close to bedtime, maybe they should consider
when they are eating. Maybe they need to adjust the
times when they are eating
their dinner and so forth. Dr. L. Casey Chosewood: Great. Thank you both for that. We actually had a couple of
questions that came in around
this issue of eating and sleep, so I think you did a great job
of addressing the other
questions on this topic as well. We oftentimes hear, too, in the
medical profession about people
who eat too late or too much near their bedtime will get GI
symptoms or gastroesophageal
reflux oftentimes it can certainly impair the duration
and quality of sleep. We’ve had a question
come in about the
Resource Center itself. First of all, is the
Resource Center free? It absolutely is. There are no costs associated
with use of the Resource Center,
so really regardless of the size of your budget, the Center is
suited for your business or your
organization’s opportunities to build or expand a healthy
workplace culture. And also, folks ask about some
of the criteria for information
to be included in the site. Well, there are a few standards
obviously that CDC follows before posting this to assure
its quality and credibility. First of all, the information
that’s featured has to be published within the last ten
years, so that it’s up to date. It has to be available and
accessible to the public free
of cost without a registration required to reach those
resources that we link to. The resource has to be
U.S.-based currently and it also
has to be relevant to workplace health and factually accurate
with appropriate citations
and an evidence base. And all of the sites are vetted
before becoming part of the Resource Center by a peer
panel of experts in the field. So, that gives you some
information about how items
are chosen for inclusion as a resource in the
Workplace Center. Well, let’s get back to a
question about sleep and this
one specifically, Claire, is about policy
language around naps. And there may be some
examples out there. Is there a source
you’re aware of where policy
language around naps exists? If not, it might be something
that we could follow up with more information on
the website later. Dr. Claire Caruso: Yeah, the
NIOSH Training for Nurses on
shift work and long work hours, it’s an online training
program that we developed and
released a couple years ago. It has a whole module on naps
and it doesn’t give you specific
language, but it does tell you what things to consider when
you’re developing, you want
to use naps in the workplace. So, you might want to, for
instance, consider how you’re
going to time the naps, how you’re going to schedule
people for the naps. Are you going to have enough
staffing to cover the workload
when people are napping? Are you going to have someone
wake them up or have them use an
alarm and if they don’t return to the work site in an
appropriate time, have
somebody check on them? So, I’d like to refer you to
that NIOSH Training for Nurses,
that module seven on naps, an important countermeasure
to fatigue. Dr. L. Casey Chosewood: Great. Thank you for that. There is another question here
that I will pose to you first,
Michael, and then we’ll see if Claire has anything to
add, and that really is about
this connection between blood circulation and sleep patterns
and getting good quality sleep. Certainly we know that a number
of chronic conditions can impact
sleep and the lack of high quality and good sleep can
predispose to certain chronic
conditions, so if I could just ask for a few thoughts about
this connection between sleep and chronic disease, and we’ll
start with you, Michael. Dr. Michael Twery: Okay. So, when we don’t have a regular
sleep schedule, either sleep,
insufficient sleep duration, irregular timing of sleep, or
poor quality sleep, all of these
conditions are associated with abnormalities in our
autonomic nervous system. This is the part of our nervous
system that is, that is coupled to mediating how we,
how we deal with stress. Stress hormones
are secreted, hormones are
secreted at the wrong time. And this type of response is
sustained if this is a chronic
condition, a chronic exposure, it appears to contribute to
cardiovascular disease risk. Dr. L. Casey Chosewood: Great. Thank you for that. Yes, stress is oftentimes a sort
of central mediator for so many
of the poor health outcomes associated with
challenging work schedules
and heavy work demands. Claire, anything you want to add
to this connection between sleep
and work and chronic disease? Dr. Claire Caruso: Yeah. There is a lot that
could be said about it. I guess one thing I’d like to
do is again refer people to the
NIOSH Training for Nurses on shift work and long work
hours (module three). Module three covers the risks
when people work these
schedules, but also those risks also relate to people who don’t
have adequate sleep because
we’ve, the theory is that these work schedules, people who work
long work hours, impact health
and safety by disturbing sleep, circadian rhythms and
family and social life. So, it’s a, the common
thread would be disruption to
sleep and circadian rhythms. But you could also, another
thing I guess a brief thing that
I could add is that when we are laying sleeping, it
gives our heart a rest. To some extent our blood
pressure goes down, our heart
rate goes down, and all of that you can think would
be beneficial. But then again I would like to
refer people to module three of
the Nurse Training because it gives, it can go into more depth
on the various chronic health problems that can result from
not getting adequate sleep. Dr. L. Casey Chosewood: Great. Thank you for that, Claire. You know, having seen that
training module, it’s just
really very, very rich with a lot of actionable
recommendations. And the other thing, even though
it’s developed for nurses, it
really is applicable to a wide number of workplace settings,
so I echo that encouragement
for folks to check out. We have a question come in
around this issue of sleep
and belly fat or obesity and certainly there is a strong
evidence base for the lack of
good quality sleep and obesity for shift work that’s so common
in so many industries and occupations today and its
association with obesity. I’ll ask you, Michael, any
thoughts about this sort of
connection between poor quality sleep or poor duration
of sleep and obesity? Dr. Michael Twery: Right. So, connected to abnormalities
in our appetite control,
abnormalities in our metabolic hormones, there is a, there is
a, science has now established
a mechanistic, a causal pathway between sleep deficiency,
irregular sleep schedules, or poor quality sleep,
and weight gain. But I want to be careful about
the label of belly fat because
there are genetic and other factors that can influence
where fat is deposited. In some places it may be
associated with particular
health risks compared to other sites, so the fat that is
exterior to the belly fat that
we often see hanging over, hanging outside the body, versus
fat that is clinging to organs. And then there is fat that may
be intercalated into the muscle structure that can weaken
muscle neuro transmission. These are all have different
medical significance. And so, someone who’s concerned
about this, they have, you know,
they have a regular pattern of, they feel they’re chronically,
the sleep deprivation or
insufficient sleep is a daily burden, I’d encourage
them to, you know, seek
the medical advice. How does this information, how
do these symptoms, how they are important for them
as an individual. Dr. L. Casey Chosewood: Great. Thank you for that, Dr. Twery. Certainly we know that shift
work, long associated with a
high risk for certain chronic diseases including obesity,
diabetes, even severity of
stroke in shift workers has been shown, so there clearly seems
to be some connection between a
number of chronic disease risk factors and their association
with sleep disruption and poor
duration and quality of sleep. We have a question really
asking about how a company,
specifically their wellness program leader can go about
getting advice on implementing a high-quality sleep health
program in their setting. And thank you for that. It’s an opportunity for us to
refer you back to some resources
that are available both at NIH and the National Institute for
Occupational Safety and Health, NIOSH, that our speakers both
represent those organizations. I’ll also refer you to the
Workplace Health Resource Center is a very credible place for
additional information as well. I mentioned some of the
resources that are industry and
organization-specific on the NIOSH website really
apply broadly to all
workers more generally. We have just perhaps time for
a couple of more questions and
Michael, one that has come in before really is fairly general
and it’s talking about how
employers can sort of approach this issue of sleep hygiene or
helping employees manage sleep habits when they are off
the clock or not at work. And this really gets to the
last question what advice would
you have for employers who are wanting to help their
employees manage sleep habits? Dr. Michael Twery: Casey, I
think that there’s an immense
opportunity to fill the, you know, basically knowledge
vacuum out there. There’s a lot of things that
people can see, you know, one-off observations and
reports in the media. But the reality is that the
average person is not yet aware or familiar with how sleep
deficiency is affecting them. So, there’s a lot of
materials on the CDC website. There’s material on the
NIH website to help close
this information gap. This is a, this is
a very low level just
providing information. Connecting that information with
perhaps with the discussion of
the barriers and challenges to, you know, that the company
observes in the workplace,
problems in terms of whether it be in terms of performance and
production or whether it be customer service or the
teamwork, you know. Is sleep, you know, and just
bringing the question up is a form of education and providing
leadership in these areas. It’s one place to get started. It’s very low-hanging
fruit and we would
certainly encourage that. Anyone who feels that
insufficient sleep is a regular
daily problem for them, please, can they be, you know, have the
option, the encouragement to, you know, obtain that
medical consultation. If they have a sleep
disorder, it can be treated. Dr. L. Casey Chosewood:
Great. Thanks. And in many ways, that was a
wonderful summary for us to
end our day together today. Claire, I’ll give you one more
opportunity if there’s any final
remarks you’d like to make to our panel and our
attendees today. Dr. Claire Caruso: Yeah, I
think one thing about the sleep
topic is if people haven’t been getting enough sleep, once they
do, I don’t believe they’ll want to go back to their
previous life. It makes such a big difference
in the quality of your life, how
you feel, how your health is. It’s really a journey that is
well worth it and there’s a lot of great resources to help
people start that journey. Thank you. Dr. L. Casey Chosewood: Great. Again, my thanks to all of you
and the people at the Workplace
Health Resource Center for inviting me to be
your moderator today. This is all the
time we have for. Thanks again to Dr. Michael
Twery and Dr. Claire Caruso and
on behalf of the CDC Workplace Health Resource Center
and the NIOSH Office
for Total Worker Health. I’m Dr. Casey Chosewood.
Stay safe and well. And hey, guys, get some sleep. Good day.