Injuries /accidents on the job related to fatigue can be costly. The direct and indirect costs of fatigue are astronomically high in the United States, affecting the health and safety of millions of Americans.
Employers should be aware of causes and signs of sleep deprivation as well as any medications taken by an employee, both legally and illegally, that cause drowsiness and fatigue which may impact safety.
Medications That Cause Fatigue
It is normal to expect to feel tired when taking a sleeping pill, but other kinds of medications can cause fatigue, too. It’s one of the most common side effects of prescription and over-the-counter medicines. When medicines make an employee tired, it is often because they affect neurotransmitters in the brain that can cause a feeling of drowsiness and reduce alertness. Some of the most common drugs that can have these effects are:
Allergy medications (antihistamines). This class of drugs include diphenhydramine, brompheniramine (Bromfed, Dimetapp), hydroxyzine (Vistaril, Atarax), and meclizine (Antivert). Some of these antihistamines are in sleeping pills, too.
Antidepressants. One type of antidepressant called tricyclics can make an employee feel tired and sleepy. Some are more likely to do that than others, like amitriptyline (Elavil, Vanatrip), doxepin (Silenor, Sinequan), imipramine (Tofranil, Tofranil PM), and trimipramine (Surmontil).
Anxiety medications. Benzodiazepines like alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) can make an employee feel drowsy or weak for a few hours to several days, depending on which one an employee takes.
Blood pressure medications. Beta-blockers, like atenolol (Tenormin), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL), and propranolol hydrochloride (Inderal), to name a few. They work by slowing down the heart, which can make a person feel fatigued.
Cancer treatments. Different types of cancer treatments can make an employee very fatigued by changing protein and hormones levels in your body. As they kill cancer cells, they also damage or destroy some normal cells which requires extra energy to fix or clean up the cells.
Gut medications. Drugs that control nausea, keep an employee from throwing up, or treat diarrhea can cause drowsiness.
Muscle relaxants. Most muscle relaxants don’t work on muscles directly. Instead, they work on the nerves in the brain and spine to make the muscles relax. Their effects on the nervous system can cause drowsiness. Some common muscle relaxants are carisoprodol (Soma) and cyclobenzaprine (Flexeril).
Opioid pain medications. Employers are now experiencing the nation-wide impact of opioid addiction. Opioids act like endorphins, natural chemicals produced in the body to control pain. Common ones are morphine, oxymorphone (Opana, Opana ER), oxycodone (OxyContin, OxyIR), fentanyl (Actiq, Duragesic, Fentora), oxycodone and aspirin (Percodan), oxycodone and acetaminophen (Percocet, Roxicet), and hydrocodone and acetaminophen (Lorcet, Lortab, Vicodin).
Seizure or epilepsy medications. Also called anticonvulsants, these medications can work on brain cells or the chemicals they use to send messages. Some of these drugs are the same ones that treat anxiety, like benzodiazepines. Other common seizure medications are carbamazepine (Tegretol/Tegretol XR/Carbatrol), phenobarbital, phenytoin (Dilantin, Phenytek), topiramate (Topamax), and valproic acid (Depakene, Depakote).
If the kind of medication an employee is taking is not listed here, check the label for words like “may cause drowsiness.”
What Can an Employer Do?
First of all, restrict the employee from any activities that can be adversely affected by fatigue such as operating machinery or driving a vehicle until the fatigue issue can be remedied. The employee should not be expected to stop taking the medication without consulting his/her doctor first. A doctor may be able to help the employee handle fatigue from prescription medications by:
Changing the medication
Changing the dosage
Changing the time that the medicine is taken, like in the evening or before bed
Prescribe a medication to help with alertness*
*An employee should not take any medications that are stimulants to stay alert or awake unless the treating doctor says it’s OK.
Alternative actions that the employee can possibly take to fight the side effect of fatigue/drowsiness and get an energy boost include:
Exercising, like a quick walk or some stretches.
Taking deep breaths.
Drinking caffeine, like coffee or tea.
If the employee is taking an over-the-counter medication, he/she can ask a doctor or pharmacist if there are “non-drowsy” versions of the drug that can be taken instead.
In addition to the drowsy side effects of medication, another issue that causes fatigue is obstructive sleep apnea (OSA). According to a report from Harvard Medical School, the economic cost of unmanaged OSA in the U.S. is as high as $165 billion. OSA-related traffic accidents are estimated to cost between $12 billion and $39 billion per year (not including medical costs). The price of sleep deprivation goes well beyond these statistics, however, when the indirect costs are factored in. The Harvard study notes these indirect costs, among others:
Depression and other mental health treatment
Marital unhappiness: cost of counseling or divorce
Investigative and legal costs associated with motor vehicle accidents, as well as autopsies and funerals
The Harvard report also focused on fatigue that can be caused by circumstances other than sleep apnea. For example, the average work week for a medical resident is 96 hours, and one study found that sleep-deprived residents make 36% more medical errors than those who work a shorter week.
The American Academy of Sleep Medicine⁴ recent research states that the minimum number of hours of sleep required for a healthy adult is 7, (with a recommended range between 7 to 9 hours) yet those individuals who took part in the survey achieved an average of only 6 hours 28 minutes. The most senior individuals, those holding CEO, chair and senior manager level positions, slept on average for only 6 hours 20 minutes per night, with more junior colleagues (middle managers, professional specialists, front line managers and those with no management responsibility) managing an extra 10 minutes in bed (6 hours 30 minutes). Whilst more senior leaders did sleep for less time than their junior colleagues, the difference is smaller than one might expect, and both groups, regardless of seniority, were sleeping less than the recommended daily amount for a healthy adult.
Looking at the amount of sleep reported across the different age categories, the trend is much clearer, with individuals aged 20-34 years reporting the highest amount of sleep (6 hours 47 minutes), those aged 35-49 years averaging at 6 hours 24 minutes, and those aged 50+ years getting the least amount of sleep (6 hours 19 minutes).
Effects of Sleep Loss on Work Performance
Many of the working professionals reported that they were affected by sleep loss, particularly when engaged in tasks that required sustained attention. From the 30 aspects of cognitive behavior assessed in the research, the results indicate that the executive control functions of decision-making, creativity, processing, adaptability, learning and control of emotions, performed by the pre-frontal cortex within the brain, are all highly impacted by sleep loss.
Generational and seniority differences in the effect of poor sleep
Interestingly, workers over 50 years old reported getting less sleep than younger colleagues, they also consistently reported that sleep affected their work performance, physical health and social and emotional life substantially less than younger workers. In addition, workers who were more senior in the organization with senior management responsibilities, also reported that their professional performance, physical health and emotional and social wellbeing were affected less than those lower down in the organizational hierarchy.
Business impact of sleep deprivation and drugs
Fatigue from sleep deprivation and drugs appears to be an increasing characteristic of today’s working environment. It is common for managers and colleagues to look at a lack of focus or motivation, irritability and bad decision-making as being caused by poor training, organizational politics or the work environment. The answer could be much simpler – a lack of sleep and/or side effects of drugs.
This report calls upon employers to be aware of these issues and to try to understand the ways that sleep loss and drugs affect employees. By understanding the current issues related to fatigue and its impact on injuries and work productivity, employers can begin to address methods of assistance to enhance individual and organizational longevity and success. The most important actions that can be taken are to raise awareness, communicate the challenges of fatigue from sleep deprivation and drugs, and to bring discussions of these issues into the open.
¹ Sack, R., Auckley, D., Auger, R., Carskadon, M., Wright, K., Vitiello, M. and Zhdanova, I. (2007) Circadian rhythm sleep disorders: Part 1, Basic principles, shift work and jetleg disorders. Sleep, 30,1460-1483.
² Lanaj, K., Johnson, R. and Barnes, C. (2014) Beginning the working day yet already depleted? Consequences of late-night smartphone use and sleep. Organizational Behaviour and Human Decision Processes, 124, 11-23.
³ Culpin, V. and Whelan, A. (2009) The wake-up call for sleepy managers. 360° The Ashridge Journal, Spring, 27-30.
⁴ Watson, N., Badr, M., Belenky, G., Bliwise, D., Buxton, O., Buysse, D., Dinges, D., Gangwisch, J., Grandner, M., Kushida, C., Malhotra, R., Martin, J., Patel, S., Quan, S. and Tasali, E. (2015) Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38, 843-844.