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By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations
The CDC reports that 30 percent of civilian employed U.S. adults, which equates to 40.6 million workers, lack sufficient sleep. These adult workers are sleeping less than 6 hours a day, when the recommended amount of sleep is 7 to 8 hours a day. The CDC survey showed a 34.1 percent rate of short sleep duration among workers in manufacturing compared with all workers combined. About 44 percent of workers who worked the night shift experienced short sleep duration compared to 28.8 percent of day shift workers. Workers with high rates of short sleep duration included 69.7 percent of night shift workers in transportation and warehousing and 52.3% of health-care and social assistance workers.
The lack of sleep may lead to the development of chronic diseases and conditions such as diabetes, cardiovascular disease, obesity, and depression. In addition to soaring health care costs to treat these chronic diseases and conditions among workers, businesses must also contend with safety issues and lost productivity.
A new study published in the Journal of Occupational and Environmental Medicine points out that chronic sleep deficits can cost up to $3,156 per employee. The problem is how to reach workers who could benefit from healthy sleep guidelines and healthcare. The study examined a novel approach to how businesses can deliver an effective healthy sleep program through a workplace wellness facility.
According to the study, there have been numerous studies on the effectiveness of cognitive-behavioral therapy for insomnia (CBT-1) to help people sleep better both short- and long-term. CBT-1 even carries an evidence-based medicine “stamp of approval” for treatment of chronic primary insomnia and comorbid insomnia symptoms. CBT-1 covers “sleep hygiene, stimulus control, guided imagery, self-talk (cognitive restructuring of dysfunctional thoughts about sleep), meditation, and relaxation techniques”, among other things.
As the study indicates, the question then becomes how to deliver CBT-1 effectively to employees?
How the study was set up
A voluntary 8-week worksite-based healthy sleep program was set up at the Mayo Clinic Dan Abraham Healthy Living Center to help employees gain knowledge of factors that influence sleep as well as gain skills and behavioral techniques to improve their sleep. The participants completed questionnaires about their sleep behavior, energy level, sleep problems, bed partners, use of sleep medication, daytime performance, stress level, caffeine habits, napping, etc., both before and after the completion of the sleep program.
Eight, one-hour live participatory sessions covering CBT-1 were held, with seven of those sessions delivered by wellness coaches. Participants were given skill-building exercises such as guided imagery, muscle relaxation, sleep hygiene, meditation, and yoga, and their assignments included, among other things, keeping a sleep log, attending classes in meditation and yoga, and identifying self-talk related to sleep.
The study analyzed the outcomes for 53 individuals covering the period 2010 through 2012.
Key facts about the participants
· 64.2% of the participants were female· Median age was 56.4 years· 67.9% were married· 62.2% worked day shifts· Average body mass index of 26.6 kg/m· 56.6% of the participants were employees· 17% of the participants were spouses or domestic partners· 26.4% of the participants were students, retirees, or volunteers at the medical center
Key findings pre- and post-healthy sleep program
· Poor quality sleep: Decrease in poor quality of sleep from 5 nights on average per week to 3.5 nights on average per week· Impact on job performance: Slight decrease in sleepiness impacting job performance from 2.5 days on average per week to 2 days on average per week· Feeling rested: Increase in average rating of 3.9 (10 = always) for feeling rested after a night’s sleep to 5 (out of 10)· Knowledge about sleep: Increase of average rating of 4.9 (10 = extremely knowledgeable) for knowledge about sleep to 6.9 (out of 10)· Trouble getting asleep: Decrease of average rating of 5.5 (10 = always) for trouble getting asleep to 3.8 (out of 10)· Trouble staying asleep: Decrease in average rating of 7.0 (10 = always) for trouble staying asleep to 5.8 (out of 10)· Ability to deal with sleep problems: Increase in average rating of 4.4 (10 = extremely confident) in ability to deal with sleep problems to 6.3 (out of 10)
The study examined a small group of people who voluntarily participated in the healthy sleep program. The authors believe that a larger study with more diverse samples is needed.
OCCUPATIONAL MEDICINE PERSPECTIVE: Leslie J. Hutchison, MD, MPH, FACOEM, of HLM Consultants notes that although the article does not indicate the cost of the program, he believes the savings cited can carry over multiple years without repeated training. “The significant positive effects of the intervention suggest that other interventions are likely to increase the impacts on job performance, further decreasing sleepiness impacting job performance,” explains Hutchison. “Follow-up study of this group might define residual problems that could be addressed in further training or other interventions.”
The study results show the benefits of a healthy sleep program where workplace wellness coaches are used and sleep experts help design and deliver the program in a group setting. The participants reported an improved quality of life, more energy at work and at home, and a significant decrease in stress. The study also underscored the importance of participants having more confidence in their ability to deal with their sleep problems after completing the program, as this could lead to behavior change.
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