If the thought of discussing sleep hygiene at work sounds foreign, listen in to this episode to hear why more employers are discussing sleep disorders to ensure team safety and productivity. Gage Koeller, senior research analyst at MDGuidelines, and Matt Thiese, PhD, assistant professor at the University of Utah, share startling statistics on costs as well as ideas for what you can do to improve employee health. Find additional insights and research from our guests in their column Why Should Employers Care About Rising Sleep Disorder Rates? The column was published in DMEC's @Work magazine, and we've unlocked it for listeners. Find the link below.

Resources:

1. Why Should Employers Care About Rising Sleep Disorder Rates?
2. FMLA/ADA Training for Supervisors & Managers
3. Join the DMEC membership community

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Heather Grimshaw: Hi, thank you for joining us. I'm Heather Grimshaw with cmec, and today we're talking about why employers should care about rising sleep disorder rates. Our guests are Gage Kohler, Senior research analyst with MD guidelines, and Dr. Matt Theise, assistant professor at the University of Utah, who wrote a column on this topic in At Work magazine. We'll open this content for listeners and include a link in the Notes section of this episode.

Our guests have agreed to share some additional context and guidance on the topic of sleep disorders with us today. To level set Insomnia and related sleep disorders are a significant burden for the US Workforce due to health and safety issues. Costs associated with These disorders exceed $100 billion annually due to lower productivity, increased accidents, and elevated healthcare use.

So the real question is how can employers mitigate these issues, especially with the dramatic increases seen and cited in the column. So our first question for you today is how employers identify these types of issues and mitigate them. Gage, would you tackle this question for us first?

Gage Kohler: Absolutely. Thank you Heather. It's a good question. It is difficult for an employer to actually identify insomnia or sleep disorders directly. It's a bit of an invisible condition in that its symptoms can can present similarly to other conditions, but also it could even be temporary fatigue, stress or other conditions like that. So in general it's pretty complicated and difficult to diagnose.

But the DSM 5 defines insomnia as having a predominant dissatisfaction with sleep despite an adequate opportunity for at least three nights per week for at least three months. So it's kind of a longer term sleep disorder. But I think before I get into more about that, I wanted to kind of mention how we focus a lot in this article on insomnia and other sleep disorders. But it's also important to recognize that Getting bad sleep is a problem in itself, even if you or your employees don't fit into this DSM 5 insomnia definition. So I've seen statistics saying that as much as 75% of Americans are not getting highly restorative sleep. And then as we've kind of mentioned in the article, and in general, poor sleep has been estimated to increase costs for employers by as much as almost $2,000 a month per employee annually. So in general, employees can be aware of the downstream effects that show up in the workplace. I think that's kind of a good place to start. These often include increased absenteeism, intermittent lead usage, presenteeism are coming to work, but with fatigue and reduced concentration could result in higher error rates or safety incidents, or as we mentioned, the noticeable decline in productivity. And then in some cases, employers also see elevated healthcare utilization tied to conditions that co occur with sleep disorders such as anxiety, depression or chronic pain. So all that is to say, it's important to look more downstream rather than try to diagnose insomnia upfront. As an employer, it's difficult. There could be other things that they're looking into that these symptoms could be. So I think for employers to mitigate, it's important for managers to kind of recognize these changes in performance and safety risk, but again, not self diagnosed based on that alone.

But they should make sure that if something is occurring with the employee, that the employee should understand the organization's available resources, which could be an employee assistance program.

Maybe they offer mental health leave days for them to go home, get some sleep, things like that.

Dr. Thiese: The sort of the downstream components at an individual level. Right. That's almost passive, like looking to see, okay, error rates, have error rates gone up or absenteeism or presenteeism. And it's a passive way for employers to look at things. But I also want to point out employers could also do an active, a little more active, a little more proactive component of having,

you know, anonymous pulse surveys or that type of thing where they send out and say, hey, you know, know, how's everyone doing? Please take a moment and fill out the survey, have some specific questions about sleep, sleep quality or sleep duration in there and then be able to look at that in aggregate and see are there other things going on. Because it doesn't always, it's not always the sleep that shows up and causes errors or absenteeism or presenteeism. Right. That can be morale issues or other issues as well. But it's, there's multiple tools that, or multiple levers that you could pull to try and get a handle on this because it is really difficult to identify both in an individual as well as in a group of people.

Gage Kohler: Absolutely.

Dr. Thiese: Absolutely. There's not a lot of. First off, there's not a lot of really solid data as to what exactly is going on. Right. There's several different studies looking at this from different perspectives.

So one of the things that several studies have found is that there's just more diagnosis, there's more awareness, both by individuals as well as by medical professionals about the challenges related to insomnia. Historically, you know, anecdotally it would be, oh, people just have bad sleep habits or they're just stressed. Right. There's. It was almost brushed off to some degree. But then because of the research looking into insomnia and the relationships that that has with some health outcomes like cardiovascular disease and other really impactful concerns, more people are paying attention to it.

Right. So I think that that's 1, 2 is our society has changed. More people are connected to their phones and always either expected to be responsive from their employer or feel obligated to be responsive to emails, to texts as well as just the interconnectedness component of it. Right.

So just the nature of our society and technology and how it's difficult now for people to. I use the term unplugged, but to. To sort of ramp down in the evening and so they can. Or whenever their sleep time is. Right. If people are on swing shift and that type of stuff, it's even harder when you're trying to go to sleep and everyone else is awake, sending you emails, you're getting texts from friends and family,

all of these different things, your people are more bombarded and connected now than they were 20 or 30 or 40 years ago. Right. So over that span of time, for that 11 fold increase, I think that there's multiple components that are related to this and result in this massive increase in diagnosis of insomnia.

Gage Kohler: I just have a question for you, Dr. Theise. Have you seen any worsened rates since like the COVID 19 pandemic or maybe related to like societal,

you know, stressors, political events, things like that?

Dr. Thiese: So all of those things play a role anecdotally. Right. There's not a lot of good data out there. So around Covid. Yes, Covid stressed people out, it messed with everyone's sleep schedules and it changed the way people work. Right. Working from home now and not having that bright dividing line between I am at home, I am doing home things and I am at work, doing work things. Right. So there's, I think some of that blurring of lines too also makes it can make it challenging for people to have good sleep habits. And then also once you start down a challenging sleep path of not getting good sleep, it's hard to get back onto that, a good sleep pattern and have good sleep hygiene. So anecdotally, yes, to answer your question, Gage, there's definitely things out there, but whether it's pandemic related or politically related or just multiple jobs, gig economy, environment related, all of those things I think play a role into it. But there's not really hard solid numbers that you can hang your hat on.

Gage Kohler: Interesting. Thank you.

Dr. Thiese: Yeah.

Heather Grimshaw: So that leads me into my next question, which is that there are a lot of issues that managers and supervisors struggle with in terms of how to approach an employee to who is showing signs of personal health issues, which might include sleep hygiene. I like that term, sleep hygiene. What's the guidance for knowing when it's appropriate to step in and how to do that safely?

Gage, you talked a little bit about this earlier and I'm hoping that you'll provide some insights here and then we'll see if Dr. Theise wants to weighing as well.

Gage Kohler: Yeah, absolutely. That's one of the difficulties with a condition like insomnia. It kind of also mirrors like mental health issues and that these issues look and feel very personal.

It's difficult for an employer to reach out if an employee looks fatigued or distressed, because obviously there could be a variety of ways and also this may be a boundary that the employee does not want crossed. So I think in general, the best place to intervene is before an issue is caused. But that might just be the public health in me. As we kind of mentioned earlier, as Dr. Thies mentioned and we kind of discussed in the article, there's a lot of tools that we can provide that employers can provide to their employees. And like the EAPs, the Employee Assistance programs, the wellness programs, educational programs, maybe like weekly small mental health breaks or meditations, things like that, those are just some simple ways that they can do it. But as Dr. Thies mentioned, you can, you can do run short surveys, you can like educate or just advise employees to put their phone away. Before bed or limiting their caffeine intake in the afternoon. Things like that get better physical activity during the day. And then another thing that I always kind of come back to is work culture and how that's kind of another important factor that can not only improve rates of stress, but also mental health issues in the workplace. But it can also create a culture where an employee feels more comfortable reaching out or using their available resources if these things are affecting their life. But if we're not talking about prevention, then obviously it gets a little bit more complicated. The guiding principle should be to focus on the tangible effects of the sleep if they're going to be trying to reach out.

If you're not trying to prevent, I should say this could be focusing on job performance, safety and observable behaviors, but not the health conditions themselves if they're missing deadlines or just you're seeing an increase in errors or risks that are being taken in workplace safety due to fatigue and difficulty concentrating. This is where a manager might be intervening, able to intervene by, you know, using neutral and supportive language, but expressing concern about how the organization can provide support again without asking any medical details, but not pressuring or like requiring disclosure from the employee, I think is an important thing that an employee should, an employer should keep in mind. And then there is sometimes cause for escalation. This is probably appropriate when safety is or could be compromised or if the performance issues continue persisting despite maybe coaching or discussion about these issues. And then in that case, you might want to bring in HR or occupational health professionals, maybe an absence management team to evaluate accommodations, leave options or at least safety conditions, not in like a disciplinary way, but in a protective way. I would love to hear from you, Dr. Theiss, if you have any other ideas.

Dr. Thiese: Gage, I absolutely agree.

Gage Kohler: Right.

Dr. Thiese: That you, you did a good job of stressing this balance between, okay, what can you do as a, as a manager or, you know, a leader in your organization? It doesn't always have to be managers, right. Leaders in organization to point out and work on the safety culture component of, look, you almost backed into something using your forklift or. Right. Like using specific examples and being able to say, okay, is there something else going on? There's other resources out here. I just want to make sure that you feel supported as an employee. And also that recognition component of you could probably be doing better. So there's that. But then there are going to be times where it is a safety concern. We need to recognize that there's specific challenges for different working situations. If you're in A safety sensitive position. There's a higher threshold there. And it is acceptable to do fatigue assessments in safety sensitive positions where if someone makes a mistake, it could cost someone their life. Right. Versus just a clerical error in accounting or something. Right.

So there's, there's. You have to you it's helpful to be able to tailor the different resources and approaches to these problems based on the specific work situation that you're in.

Gage Kohler: Right? Absolutely.

Heather Grimshaw: I think that's a great comment about the fatigue assessments and also the differentiation between the position and that safety sensitive piece. So that's really very helpful. Thank you both. One of the recommendations in the column is for employers to check with their employee assistance programs. This is something Gage, you've mentioned a few times, as well as wellness programs and medical plan partners for educational resources. I'm wondering if you have an example of how this has worked effectively that you might be willing to share. So, Dr. Thies, I'm hoping that you'll start us off here and then we'll see if Gage has anything to add.

Dr. Thiese: Absolutely. So a lot of that again is situationally dependent based on what your employee assistance plan looks like, what your specific work environment is, what your concerns are. Right. So things that I've seen that have been successful are having a sleep navigation pathway. So actually having a medical plan component that enables workers to go and talk with medical professionals about sleep hygiene, sleep habits, sleep concerns. And then ideally under that, you know, EAP confidentiality component, pair that with, you know, supervisor guidance or fitness for duty for reporting if it's a safety sensitive position or something like that. So actually having some partnership there, but maintaining that privacy confidentiality component between the medical side and then, you know, the policy side of the workplace. Other things that I've seen that have been effective are having interventions or education, so doing something right, whether that's changing work schedules, providing more sleep hygiene resources, just even just education about these are things to watch out for. And this is why sleep is important. Targeting high risk groups. So specifically for your swing shift or your night shift, your safety sensitive positions, your high stress, always connected type of positions. I do work with lawyers, and lawyers have lots of problems with this connectivity issue of always being expected to respond to clients 24 hours a day, seven days a week, on vacation, at their kids, you know, baseball games or whatever it is, and the toll that that takes psychologically being able to target interventions to those groups where, where individuals are more likely to have those challenges can be an efficient way to have some payoff and some return on investment. On that. And then a third one really is just measurement and feedback. Having anonymous assessment pieces and saying, okay, this is what we see as a group in terms of sleep quality and sleep duration. Here are some things that we can do, right? And just having that feedback loop and then seeing, hey, six months ago we implemented and had this education program and this is how our sleep profile has changed as a group, as an employee group, and that sort of individualized feedback. And if you can gamify that in some way, that can even be more powerful. So those are some things that I've seen. Gage, you probably have a great handle on some other aspects and probably some of the literature too.

Gage Kohler: I mean, yeah, absolutely. I think you kind of nailed it on the head. I think I really love the idea of, you know, focusing in on the most high risk cases. For instance, like I was saying, like,

outreach during, like, the times of the most operational stress, such as, like maybe a peak workload, maybe like the busiest season should be like the best time to reach out and, you know, maybe provide people with these resources a little more. And as you said, just getting feedback constantly, seeing if people are using it, seeing if people have found it helpful, how can we reach out in a better way, things like that. But I think just in general, normalizing the use of these programs and also just kind of frame them, framing them as preventive tools rather than just like a crisis intervention, I think is a great way for these sleep programs to be used. And just kind of connecting all the different, like stress management, mental health management, sleep, kind of all of these different tools together. Not just focusing maybe just on insomnia, but, you know, how all these things are interconnected and can improve your health and your life and your productivity and things like that.

Dr. Thiese: I think you brought up a wonderful point about normalizing it. Right. Like depending on your work culture, there is a big stigma around being busy and being productive and being the first one in and being the last one to leave the office.

And I need to be there before my manager's there and I can't leave before my boss leaves. And. Right. All of these types of things and that stigma associated with those types of practices can really be detrimental to sleep as well as many other, you know, issues that employees have.

So I think, you know, trying to have something that is easy, something that's confidential, and something that is stigma free is really going to be a helpful program no matter what direction an employer goes.

Gage Kohler: Absolutely.

Heather Grimshaw: I love that. So. And I love the reference to being able to gamify some of These different interventions, I think that is increasingly appealing.

Matt Theis: That type of a situation is actually easy, relatively easy to gamify. Again, gamification is creating some type of playful interaction component related to the intervention or the tools that you're providing.

Gage Kohler: Right.

Dr. Thiese: So you can gamify that a bunch of different ways by having, you know, I, I don't think you'd necessarily want to have competition between like different segments of your, of your employer groups. Right. Like, I think that could be negative. But, but having something where you know it,

you have some reward system and it doesn't have to be financial rewards, but it can be, you know, a whole bunch of different ways. Additional break time, special snacks in the, in the break room. Right. Like there's different ways to, to have some reward component for engaging in the system. And I think that's one of the big challenges when you do a assess, intervene, reassess component, is really getting people to engage and feel comfortable engaging with that assessment piece. There's been several of my different employer relationships where an employer says, let's do this and we'll send out a survey and we'll get all this great information and then we can use that to make decisions.

If people don't fill out the survey or they don't fill it out, honestly, that is a complete waste of time and can actually be a detriment. So making sure that employees are engaged and feel safe in contributing that information so that everyone can make better decisions going forward,

that doesn't really address the gamification component, but that that type of a situation is relatively easy to gamify.

Heather Grimshaw: Okay, so then one of my last questions for you is if this is more acknowledged by employers as an issue that they need to address and if there are examples that you can share of some folks that are leading in this arena in terms of the employers. Gage, can you kick us off here?

I looked at a Systematic Review of 219 publications and most reported that employee efforts to encourage improved sleep hygiene and healthier habits results in improvements in sleep duration, sleep quality and self reported sleepiness complaints. I read a stat that said as many as one in four large employers offer programs to help workers get better sleep and even more planning on implementing. So you kind of see like people are taking it seriously. I'm not able to find as many of these corporate case studies but it's a where you see the financial impact, we see the impact on employee health and productivity and people are trying to address it and we see the evidence from the literature we know it is effective. It can be helpful even in an employer setting. So I think obviously it could come about in a variety of ways whether it's these like I mentioned the tech products or just these eaps and the screenings, wellness programs, things like that. But I think in general just reminding employees of the importance of adequate sleep is just extremely important. I saw a quote online that said promoting a good night's sleep for employees is as important as making sure their blood sugar or cholesterol are under control. And just in general a lack of sleep promotes can promote an unhealthy lifestyle that results results in less exercise and a poor diet. I saw that online as well. So I think it's just continued education, continued reminders of just how sleep can improve both their lives and their careers is I think it's just a key part. But Dr. Thies, if you have any better examples, please let me know.

Dr. Thiese: So Gage, I like the Truck driver example, I was going to bring that one up.

Cpap, the constant positive airway pressure treatment, is super effective for sleep apnea, which is a relatively common sleep problem. There are good treatments out there and these treatments have meaningful impacts. Right. A couple of other examples that I thought of, I was working with a manufacturing company that has a 24 hour production cycle. So they have a day shift, a swing shift and a night shift. And they use a data driven approach, which was really, as an epidemiologist, I am supportive of data driven approaches of being able to. They looked and said, okay, we are having a cluster of near miss accidents within 30 minutes after the shift change, particularly from,

from day shift to swing shift and then swing shift to night shift. And so they dug into it and found that they attributed at least part of it to sleep challenges. Not necessarily sleep insomnia, but just challenges. They said, all right, let's implement some schedule changes where there's. We're going to do a little bit more of a staggered rollover instead of a complete line shift plant wide.

And then they also used some of the online tools like you mentioned. There's a bunch of them out there, but the ones that they recommended and used were cognitive behavioral therapy based cbt,

which can be self directed. You don't actually have to have a provider there. There's several different modalities. So you can do it online and it's relatively effective for sleep. So one of the concerns that I have about programs out there is many of them have less data supporting their intervention than I would like to see. Right. Again, I like data driven decisions and being able to say, okay, what are effective things that people can do treatment wise? Cognitive behavioral therapy is a great one.

Some of the wearables the jury is out, there's not a lot of, there's not overwhelming evidence, there's not great evidence to say, you know, all of these wearables are a good thing in terms of tracking and being able to change. They can actually be distracting and cause problems. So I think being cognizant of a program, if you are going to use some outside entity or thing, what is the evidence behind that before you implement it? But doing things within a program like changing schedules and trying to be a little more adaptable that way I think is really helpful. Also, I mentioned working with attorneys and attorney adjacent individuals. Right. So people who work with attorneys who are expected to be always responsive, even just changing the culture and saying, okay, you're going to be on shift, right. Or you're going to Be on call for any emergencies that come in for any of our clients on this night, that night and the other. Right. So dividing up some of that, it's been successfully done in medicine of divvying up those priorities and those responsibilities so that way people truly can disengage from work and enjoy their life outside of work. I don't like the term, you know, work life balance is used and I think that that is challenging because you don't always have opportunities to have work life balance depending on where you are in your career and what industry you're in.

So being able to prioritize at different times your work versus your non work activities, I think is something that is effective that other people can do. Right. That doesn't have to have a large intervention. But just saying, hey, I'm going to be on vacation or for the next two hours I'm going to be at my kids music recital or whatever it is, communicating that to others so they're not reaching out to you and you really can feel like you're stepping away from work and have some of that break time.

Heather Grimshaw: Those are, that's great input. Thank you. Thank you both for that. So my last question kind of brings us full circle here in terms of navigating the balance between personal life and habits and then issues that are affecting someone's work. And so I think you both have shared some great input here. And Dr. Theise, the reference that you just made to prioritizing work and non work activities at different times is also very helpful. One of the things like sleep hygiene and stress management can play into insomnia. Yet those are things that frequently feel off limits to employers in terms of addressing with employees. And so I'm hoping that you can maybe close out our conversation today by sharing a few or maybe one example of the best way to navigate that delicate balance. So Dr.

Cease, I'm hoping that you'll start us off here and then see if Gage wants to add in.

Dr. Thiese: Absolutely. So when you're in a work environment, you need to keep those relationships professional and work related. Right. So talking about work expectations is totally appropriate.

Having universal options. Right. Not, not necessarily calling out an individual or a small group, but having education programs or any type of whatever you're doing to help promote sleep, healthy sleep hygiene, healthy sleep habits. Have those available to everybody unless there's a particular, unless you have data to support specific targeted groups. Right. Like I mentioned with the shift work as an example and then providing really destigmatizing sleep issues and sleep concerns and Then making sure that people feel comfortable working with eap, their employee assistance program or digital cognitive behavioral therapy, any stress management things. Right. Try and remove any friction points or barriers around those. I think are all positives. Things you don't want to do. Right? Are start policing individual habits. That's not a good thing. You know, telling employees what to do at home,

that's, that is off limits. Don't be doing that. Don't be giving medical advice. Right. If you're concerned about something, say I care about you as a person. What can we do to help? Here's eap. Here's other options, please. I encourage you to go get, get this taken care of or at least get it. Just investigate. And then third is, you know, stay away from intrusive questions. Don't ask like why are you not sleeping? Or why are you. You can frame some of those concerns from work related points. Right. I, I'm, I'm. Heather, I'm concerned you're showing up late to work repeatedly. Here are some options.

I care about you as a person and an employee. You're a great part of this team. I really encourage you to go look into. This is a better approach than saying, hey Heather, are you not sleeping? I mean you're showing up and you're showing up late. There's all sorts of problems. What's going on. Right.

The message there, the intention is probably similar ideally, but how it's perceived can be very, very different. So that tho those are my thoughts and those are things that I as a manager has worked well for me as well as what I've learned working with other, other employer groups. But Gage, what are, what are your thoughts?

Gage Kohler: I totally agree with just the destigmatization and the normalization of using these tools if they're, if they're an issue, you know, I, I think it doesn't even just go to sleep.

I think in general like the mental health is stigmatized too. It's like you should be using these,

these tools that are available to you if you feel like they would help. And I think,

and we've said it all day, but yeah, like not crossing that, that boundary and continuing to educate employees both on the tools themselves, but also just the importance of sleep and the importance of, you know, taking care of the important parts of your life are just like a key to helping a lot of aspects of your life, including sleep disorders. But yeah, I think you pretty much said everything I would have said, so thank you.

Dr. Thiese: Another thing that I thought of is an approach that I've seen work in some situations is also addressing it as if you have concerns about someone of saying, don't do this if you're not going to do this for yourself, think about just you're part of this work team or this work family going and getting something looked into or making a change or considering a change to help out your work family or your work team that you're a part of. It changes some of that focus a little bit. And some people are actually surprisingly responsive when it's like, oh yeah, I am part of the team. I wouldn't do this for me because I'm fine with my sleep habits, but I want to model good behavior for the new employee or my friends or whatever it ends up being. So, um, you can also sometimes, depending on the situation, tie in that team component as well.

Heather Grimshaw: You both have given some really actionable advice and really appreciate your time and your willingness to elaborate on this great column, which we will again unlock for listeners. So please check the notes section and thank you both again.

Gage Kohler: Thank you, Heather.

Dr. Thiese: Thank you very much, Heather. It was my pleasure.