Fatigue management program wakes up workers

One-third improve sleep, health habits

The image of a bus driver or airline pilot "asleep at the wheel" is frightening for all of us. But for health and safety professionals at major transportation organizations it is an every-day issue they must confront with constant vigilance and preventive campaigns.

Even if your employees are not in safety-sensitive jobs, adequate rest is critical to their alertness, their ability to handle stressful situations, and to their overall productivity. In certain industries, it can literally be an issue of life and death.

"When you look at the nature of our industries, be it maritime, railroad, truck drivers, or NASA, everyone with 24-hour operations faces critical safety and health issues," says Joe Leutzinger, PhD, manager of health promotion at Union Pacific Railroad in Omaha, NE. "Last November, I went to a conference on fatigue in Washington, DC, and there were over 500 participants from 17 countries."

The big issue is the fact that lack of sleep or poor sleep can have a wide range of health implications. "Fatigue is a serious but largely ignored problem," says Nigel J. Ball, D.Phil, clinical director of the Sleep Disorder Center at Virginia Mason Medical Center in Seattle. "The seriousness comes both for health and safety, and the effects are felt in terms of productivity, morbidity, mortality, and quality of life."

Recognizing their common interests, Ball and Leutzinger teamed up in 1994 to implement an 18-month pilot program on sleep wellness, originally created by Ball. The program, which targeted train crews, had impressive results. "We found that 30% of the population improved their sleep or reduced inappropriate sleepiness," says Leutzinger.

Leutzinger had no doubt that his employees, like any in this line of work, needed help in combating fatigue, he says. "Nigel pointed out to us that sleep is closely related to 10 of the 11 major lifestyle characteristics, and employees who work in transient, unsupervised jobs have poor lifestyle characteristics. We are no exception, as demonstrated through our internal claims analyses and studies of lifestyle behaviors," he notes. (Sleep wellness is but one of six strategies Union Pacific is employing in its efforts to curtail employee fatigue. See the story, p. 46.)

The key was to hone in on those employees who could most benefit from a sleep wellness program. This was accomplished by distributing Ball’s "Sleepcheck" sleep assessment survey to the 878 targeted crew members in late 1994.

Sleepcheck is a specialized Health Risk Appraisal-type instrument. "We wanted to get a very clear understanding of daytime sleepiness — even at levels where it’s not causing direct problems, it tells us about the sleep health of an employee," Ball explains. The survey contains multiple questions about types and intensity of:

• sleepiness during the day;

• sleep hygiene (how well we look after ourselves where sleep is concerned);

• sleep schedules;

• issues that contribute to poor sleep (i.e., stress, lack of exercise).

The sleepcheck produces a computerized, individualized report that identifies specific items. "Even if you are not high-risk, there may be individual components you could improve," Ball says. For example, an employee may really like to watch late-night TV. But "He’s still sleepy and perhaps dangerous, the next day," notes Ball.

When the surveys were completed, 191 crew members were identified as requiring more intensive intervention.

The rest received Ball’s book, Top Tips, which addresses things employees can do for sleep wellness. It addresses sleep hygiene and how to prepare for a good night’s sleep regardless of where you are or what time you get to sleep, explains Leutzinger.

Those who went on for further intervention were enrolled in a telephone-based counseling program called "21 Nights to Better Sleep."

"The merit of ‘21 Nights’ is that the employee is given a structured program that systematically takes care of the basics, then moves through to more specific issues," explains Ball.

In the Union Pacific program, employees identified as requiring more intervention, were contacted by a counselor who reviewed the report with him. They were asked to spend 20 minutes each day on a specific activity such as when to go to bed, how long to spend in bed, or whether the bedroom environment is conducive to sound sleep, Ball says. Employees would write on worksheets what specific changes to make. The next component is a short preview about what will happen the next day. Finally, there is an assessment portion with questions designed to determine if the employee understood and complied. "There was then a weekly assessment, at which time the counselor might recommend repeating day three, four, or one," says Ball. "The advantage is the counselor is discussing the program with them."

Practical suggestions were given for improving sleep while on the road, adds Leutzinger. "When employees go away from their home terminals, they have to lay over for so many hours like pilots," he explains. There are things you can do in a lodging facility to approximate home, such as varying the degrees of darkness or adding ‘white noise.’ If you’re trying to sleep during the day, you can just get rid of the phone, switch to a beeper, and give it to the dispatcher, Ball says.

Both Leutzinger and Ball are pleased with the program’s results. "I found that people can change, people want to change, and there is some merit in broadly assessing sleep and fatigue and in structured intervention," Ball says.

"We helped people recognize that personal behavior has an impact on sleep, and that was our goal," adds Leutzinger.

[Editor’s Note: For more information on fatigue management, contact: Joe Leutzinger, Union Pacific Railroad, 1416 Dodge St, Omaha, NE 68179. Telephone: (402) 271-5814.]