The Sleepless Syndrome

Profits and productivity throughout Michigan and across America are being challenged like never before as longer hours and more demanding schedules compete with a good night’s sleep
The Sleepless Syndrome
Illustration by Cathy Gendron

Gene Gilmore is a superstar insurance agent. Based in the Grand Rapids area, he has sold more than $1 billion worth of life-insurance policies for one company alone, he says, and he’s considered one of the nation’s top senior agents. He also owns and runs a 300-acre horse farm in Michigan and has traveled all over Europe and South America on his motorcycle, with his wife behind him. Imagine what he could do if he could stay awake.

“I’ve come awful close to car accidents — but for the grace of God,” he says, recalling occasions when he’s drifted off at the wheel. “I’ve [also] fallen asleep when I’ve been making presentations to clients.”

Gilmore is one of an estimated 70 million Americans who have sleep-related problems — either just not getting enough sleep each night or suffering from serious physical problems tied to sleep. Government and some business entities are at long last beginning to realize the financial magnitude of these sleep problems, and they’re recognizing the need to deal with them. The problem may be even more acute in Michigan, given the state’s challenged economy and high number of shift workers, especially in the automotive industry.

According to the U.S. Centers for Disease Control and Prevention, insufficient sleep and sleep disorders are associated with a number of chronic diseases and conditions — such as diabetes, cardiovascular disease, obesity, and depression — which threaten the nation’s health. Moreover, insufficient sleep is responsible for many truck, auto, and machinery-related accidents, causing substantial injury and disability each year, plus untold mistakes in offices and factories that damage productivity.

The CDC recently surveyed some 20,000 adults in four states. Ten percent of the respondents indicated they didn’t get enough sleep or rest every single day of the prior month, and 38 percent said they didn’t get enough rest or sleep in seven or more days in the prior month.

The U.S. National Institutes of Health estimates that sleep disorders, sleep deprivation, and excessive daytime sleepiness cost employers $50 billion a year in lost productivity. American employers are also facing higher health-care costs due to workers’ sleep disorders. Yet medical experts believe that most companies don’t know what to do about sleep-related problems, with some managers thinking that sleep-deprived employees are slackers.

One example of the growing cost: “Life-insurance companies charge double the premium” for people with sleep apnea, says Gilmore, who’s being treated for both apnea, which causes people to wake up choking for air, and narcolepsy, which causes people to fall asleep at any moment.

Darrel Drobnich, acting CEO of the National Sleep Foundation, an independent nonprofit organization in Washington, D.C., that promotes greater understanding of sleep and sleep disorders, says studies show people with sleep apnea use the health-care system three times more than normal.

Gilmore says he’s had sleep problems since high school, “but back then they just considered you lazy,” he recalls. “I’d fall asleep in class. In college, I couldn’t stay awake.” When he was drafted into the Army during the Korean War, “I’d fall asleep marching.”

But as an insurance agent, “I can control my own environment,” Gilmore says. “I couldn’t sit through lots of corporate meetings; I’d fall asleep.” In addition to medical treatment, Gilmore’s secret for coping is simple: Take short naps. “In today’s corporate world, napping is a no-no. But it’s very common in other countries,” he says.

Researching and diagnosing sleep problems is a relatively new field in medicine, less than 50 years old, says Dr. Flavia Consens, associate director of the University of Michigan Sleep Disorders Center in Ann Arbor. “The first sleep apnea was only diagnosed in 1965,” she says. Most Americans aren’t sleeping enough at night, Consens adds. “If you have something to do — study for an exam, or an office presentation — the first thing you cut is sleep.”

Sleep deprivation can also lead to driving while drowsy. According to the 2008 Sleep In America Poll conducted by the National Sleep Foundation, 32 percent of Americans have driven while feeling drowsy at least once a month in the last year, and 36 percent admit to actually having fallen asleep at the wheel in the last year. However, many people can’t tell if or when they’re about to fall asleep. And if sleepiness comes on while driving, many people say to themselves, “I can handle this; I’ll be fine.”

But they’re putting themselves and others in danger. What they really need is a nap or a good night’s sleep. The sleep problem is particularly acute for shift workers such as police officers, medical interns, and factory employees, who often don’t work the traditional 9-to-5 day and who are constantly battling the natural sleep rhythms of their bodies. “Lots of medical errors are caused by fatigue from lack of sleep on long shifts” in hospitals, Consens says.

Experts say most Americans get just 6 to 6.5 hours of sleep a night, although 7 to 9 hours is recommended. But the estimated 15 million shift workers average just 5 to 5.5 hours a night, Drobnich says. And as Michigan is the nation’s top light-vehicle assembler, the problem here is very likely more profound.

According to the U.S. Department of Labor’s Occupational Safety and Health Administration, extended or unusual work shifts may be more stressful physically, mentally, and emotionally. Such uneven work patterns can disrupt the body’s regular schedule, leading to increased fatigue, stress, and lack of concentration. So it’s not surprising that such effects can lead to an increased risk for errors, injuries, and accidents. In turn, because the American work ethic is oriented toward traditional daytime hours, working at night may intensify fatigue and reduce alertness. Studies suggest that it can take up to 10 days to adapt to a nighttime work schedule.

As a new field of medicine, there isn’t much support from industry for research on sleep problems, Consens says. “It’s a matter of money vs. health. But untreated sleep problems cause more hypertension, heart attacks, and diabetes. You pay through higher insurance.”

Southeast Michigan, with its high concentration of manufacturers, is more susceptible to sleep-related problems. “Detroit is an area where shift-work impact is pronounced” because of the auto industry and its suppliers, says Dr. Gary Richardson, senior research scientist at the Henry Ford Sleep Disorders and Research Center in Detroit. “Some 15 percent of the shift workforce nationwide is tied to the auto industry. Plus, in Detroit, [people work the same or varying] shifts all their lives. So sleep problems are a major impediment to productivity.”

He adds that tasks that require close vigilance are most affected by sleep deprivation, “like staring at a computer screen or watching for bad parts” on an assembly line for hours on end. “Employers need to think creatively about allowing night workers to get some sleep” on the job, he adds.

“But it’s a rare company” that will spend money to make job changes to help workers focus and stay alert, Richardson says. “We used to do a lot of on-the-job studies, but I think our invitation has been revoked.”

No employer wants accidents, of course, “but the cost of fixing conditions becomes daunting when it means redesigning jobs and hiring more workers,” Richardson explains. Another aspect of the problem, he says, is that while working odd shifts can be hazardous, many workers like the extra money they make working unusual hours and even double shifts in auto plants, and unions support them. And night-shift workers often contribute to their own fatigue problems by trying to switch back to day hours whenever they get time off, Richardson points out, “so all the money a company spends may not help.”

The National Sleep Foundation offers a number of ways for businesses and industries to make the workplace safer and more productive for shift workers:

  • Educate managers and shift workers about the need for sleep and the dangers of fatigue.
  • Install bright lights in work areas. A well-lighted workplace signals the body that it’s time to be awake and alert. Provide vending machines with healthy food choices.
  • Schedule shifts to allow sufficient breaks and days off, especially when workers are reassigned to different shifts. Plan enough time between shifts to allow employees to both get enough sleep and attend to their personal lives. Don’t promote overtime among shift workers.
  • Develop a napping policy. Encourage napping by providing a sleep-friendly space and time for scheduled employee naps. A short break for sleep can improve alertness, judgment, safety, and productivity.
  • Be concerned about employee safety going to and from work. Encourage the use of carpools, public transportation, rested drivers, and even taxis.

When it comes to driving, “the goal is to raise awareness of the sleep problem,” says Jack Peet, manager of community safety services at AAA Michigan and the Midwest Auto Club Group. In partnership with the National Sleep Foundation, the organization has conducted studies that show driving drowsy is a “very big problem — a factor in well over half of road crashes,” he says. “People are working two or three jobs, doing more with less sleep. We’re all stretching ourselves thin. We lose the equivalent of a Garden City every year — 44,000 people”  — to highway fatalities, he says.

One industry that has highly publicized sleep and fatigue problems is trucking. The National Transportation Safety Board says driver fatigue is a probable factor in up to 40 percent of truck crashes, despite efforts to limit and regulate the long hours of truck drivers. Still, many truckers — for whom time is money — have been able to get around new rules.

“They have to break the rules in order to make a go of it,” Drobnich says. He adds that studies show 28 percent of truckers suffer some type of obstructive sleep apnea that leaves them fatigued.

Regular breaks and naps are one way to reduce fatigue and accidents, according to Dennis Holland, director of occupational health psychology at the Union Pacific Railroad, which has instituted a nap policy for freight teams as part of its risk-management program.

“A hundred years ago, before the light bulb, people slept 9-10 hours a night,” he says. “Today, operations are 24/7 — but people devalue sleep. With people trying to do more, the fatigue problem is growing geometrically in the workplace.”

But most companies are reluctant to pay people to sleep. So fatigue and sleep problems continue to affect virtually every aspect of science and industry. Dr. Ronald Chervin, director of the University of Michigan Sleep Disorders Center and the Michael S. Aldrich Sleep Disorders Laboratory at U-M, says his patients tend to fall into two broad groups: Those with insomnia who just can’t sleep well, and those who get sleep but who are tired during the day. Many of the latter suffer from sleep apnea.

The U-M Sleep Center says there are dozens of serious sleep disorders; the four major ones are:

Insomnia: People with insomnia have difficulty falling asleep, frequently wake during the night, or wake too early in the morning. This is a fairly common problem in adults; up to a third of adults report periodic symptoms of insomnia and 10 to 20 percent report chronic insomnia that interferes with their daytime functioning. Women are affected more than men, and people over 65 are more likely to suffer from insomnia.

  • Obstructive Sleep Apnea: This condition occurs when a person’s airway partially or completely collapses repeatedly during sleep for 10 seconds or longer, resulting in brief awakenings to resume breathing. People with sleep apnea often snore loudly or experience choking arousals during the night. One of the most common consequences of obstructive sleep apnea is excessive daytime sleepiness. About 4 percent of adult men and 2 percent of adult women suffer from sleep apnea and admit to daytime sleepiness. More people have sleep apnea but do not admit or experience sleepiness. Eighty percent of men and 90 percent of women who have sleep apnea don’t know that they have it. It’s more common in people who are overweight, and is associated with an increased risk for vehicle crashes, high blood pressure, stroke, and heart attack.
  • Children are also at risk of sleep apnea; at least 1 to 3 percent of children have classic sleep apnea, while up to 10 percent of children have a milder form. Children with sleep apnea perform worse in school, and it may contribute to attention deficit hyperactivity disorder and aggressive behavior. Most children with sleep apnea aren’t diagnosed. Removing the tonsils of children with sleep apnea may help both nighttime sleep and daytime behavior.
  • Restless Legs Syndrome: This causes an irresistible urge to move the legs, often accompanied by uncomfortable sensations (e.g., creepy crawling), typically when seated for long periods of time, at night, and when trying to fall asleep. Roughly 10 percent of the population in Western countries suffers from this syndrome.
  • Narcolepsy: Narcolepsy affects about 0.03 percent of the population, or three in every 10,000 people. Typical features include excessive daytime sleepiness, cataplexy (loss of muscle tone in response to intense emotion, such as laughter), sleep paralysis, and sleep-onset hallucinations. Narcolepsy is debilitating, severely interfering with work productivity and social interactions.

Gilmore, the insurance agent, says he uses drugs to fight his narcolepsy and a CPAP (continuous positive airway pressure) machine to treat his sleep apnea. CPAP uses gentle pressure to hold the airway open. A small portable pump beside the bed sends air through a hose into a mask over the patient’s face during sleep. The air pressure pushes sagging tissue aside, widening the airway. In many cases, it’s often the most effective treatment for sleep apnea and severe snoring.

Chervin and other experts say anybody who has had a problem sleeping for six months or more should see a specialist. “When you’re a sleep-deprived person, it shows up in other areas when  you’re sitting at your desk, when you’re driving, and most of all, at meetings when you’re dozing off,” Chervin says. “Sleepy people don’t think as well. Their use of language is impaired, and [so is] their memory.”

The good news, experts say, is that there’s effective help for sleep problems.

John Candiloro of Goodrich, Mich., would certainly agree. Now retired, Candiloro worked for General Motors Corp. for more than 30 years, mostly certifying vehicles to be sold overseas. The job required frequent trips to Arizona, Ohio, Texas, Canada — “wherever firms made components for GM that needed to be tested,” he says.

Then, in the early 1990s, his sleep problems started. At night he would stop breathing hundreds of times. His wife, Patty, would lie awake waiting for him to breathe and “sometimes she would kick me,” he says. “But back then, people didn’t know what sleep apnea was.” As he drove the 50 miles back and forth between his home in northern Oakland County and GM in Detroit, “I started falling asleep and had to pull over and stop for five-minute naps,” he recalls. Once at work, “at meetings I’d hear what was going on, but I’d be nodding off. Someone would ask a question and I could answer, but I wasn’t fully awake. I always felt tired, always dragging.”

One day in late 1994, with his family in the car, he fell asleep and drove into the median strip on I-75. “I was out,” Candiloro recalls. “Fortunately I didn’t hit anything, but I was scared witless.” Shortly afterward, he went to a sleep clinic at St. Joseph Mercy Hospital in Pontiac.

Sleep-disorder patients typically spend two nights sleeping at clinics, hooked up to monitors that check respiration, heart rate, brain activity, and how often breathing stops. “I quit breathing so many times the first night that the observer called the doctor at home and wanted me hooked up to a CPAP breathing machine right away,” he says. “I didn’t need a second night.”

After a few nights on the machine, Candiloro says, “I was waking up refreshed.”