Circadian Rhythm Issues: Do they affect you?

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By: Samantha Carroll, RN, BSN, BA, WCCM, CRP, CCM

Clinical Supervisor, the Kingstree Group

It’s a scenario no manager wants to encounter: Jan, a 35 year old office worker in San Diego had worked
4 nights in a row putting the finishing touches on a huge project as a major deadline loomed on the
horizon. After work, she agreed to stay a couple hours longer to help out a coworker. When Jan finally
left the office three hours later, she was so deliriously tired that she missed a step getting into her
vehicle, fell forward onto her face causing serious injury. She was bruised and swollen and was later
diagnosed with a severe nasal fracture. She was out of work for 2 weeks secondary to the rhinoplasty
procedure necessary to repair the fracture.

Lack of Sleep Stats:

The body operates on a circadian rhythm sleep/wake cycle. It is naturally programmed for sleeping
during night hours. Demanding work schedules may disrupt the body’s natural cycle, leading to
increased fatigue, stress and lack of concentration. According to a sleep index study conducted by the
National Sleep Foundation, 68% of adults are not getting the amount of sleep required. (7-9 hours) We
are a society driven to produce, and often sleep may seem to get in the way of that. But excess
productivity can be accompanied by excess risk, particularly with shift workers or those that work on
projects into the night on a regular basis. In fact, those who work night and rotating shifts are almost
twice as likely to be injured on the job than those working day shifts.

Type 2 Diabetes:

Irregular sleep cycles can disrupt the quality of sleep as well as the quantity. This can
often lead to weakened insulin resistance and increase the risk of type 2 diabetes.

The Costs:

Sleep disorders are a major driver of costs in the workplace. When sleep disorders result in lost or poor
sleep for an employee, the National Safety Council reports an impact on:

  • Absenteeism
  • Presenteeism, (being present at work but not fully functioning)
  • Healthcare costs
  • Injuries
  • Costly Accidents

The National Safety Council goes on to report a typical employer with 1,000 employees can expect to
experience more than $1 million lost each year to fatigue: $272,000 due to absenteeism and $776,000
due to presenteeism. An additional $536,000 in healthcare costs could be avoided with optimization of
sleep health.


Investigators in the Sleep Matters Initiative, led by directors from Brigham Health and Harvard Medical
School say, “Promotion of healthy sleep is a win-win for both employers and employees, enhancing
quality of life and longevity for workers while improving productivity and reducing health care costs for
employers. Additionally, occupational fatigue-management programs can increase knowledge of sleep
disorders, educate participants on the impact of reduced alertness due to sleep deficiency and teach
fatigue countermeasures, as well as screen for untreated sleep disorders.”

Organizational changes that can help workers with safety and productivity according to the National
Sleep Foundation:

  • Work environment – A work environment that is cool and bright helps shift workers stay alert on
    the job. Exposure to bright light or sunlight (if sun is still up) can help improve alertness. Giving
    workers the ability to stand up, stretch or walk periodically is also important. If there is food on site,
    offer healthy options like vegetables and fruits to keep workers’ energy up and promote good
    health as well as blood sugar regulation.
  • Arranging workloads: If possible, shift workers should plan to do the work that requires the most
    concentration and skill (carries highest safety risks) at the time in their shift when they are most
    alert. Even employees who work traditional hours should plan to do their most vital tasks early
    in their day.

There are many physiological and psychological factors that could be impaired due to working extended
or irregular hours. The Federal Aviation Administration uses an I’M SAFE checklist for employees to
assess themselves throughout their workday. This is a valuable tool for any industry to use, giving
employees an opportunity to address any issues they may have that would render them unsafe in their
particular workplace setting.

I’M SAFE Checklist

Illness: Do I have any symptoms?

Medication: Have I been taking prescription or over the counter drugs?

Stress: Am I under psychological pressure from the job, financial matters, family?

Alcohol: Have I consumed alcohol within 8 hours?

Fatigue: Am I tired and not adequately rested?

Emotion: Am I emotionally upset?

No matter the work environment, awareness of the dangers of long work hours and extended, irregular
work hours for employees is a serious matter. This also is true for employees who travel frequently and
are subject to time changes.Using education and workplace organization, employers can help improve
their health care costs, productivity and even save lives.

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