The Stress of Sleep

The Stress of Sleep

We need it, we want it, but we’re not getting it. As rates of burnout and injury rise, employers and employees face the risks of exhaustion.
Contributors
Dr. Mark Williams
Dr. Mark Williams, Medical Director, The Hartford
Brett Frazier
Brett Frazier, Senior Risk Consultant, Risk Engineering, The Hartford
Mark Beaumont
Mark Beaumont, Technical Manager, Commercial Auto Risk Engineering, The Hartford
Find yourself reaching for another cup of coffee in the afternoon to stay alert? (Check.) Forgetful, irritable or depressed? (Check.) Can't control your appetite? (Check.) If this is you, you may be one of the tens of millions of Americans suffering from insufficient sleep.
 
The Centers for Disease Control and Prevention (CDC) recommends that adults get between 7 to 9 hours of sleep a night, but more than a third of us fall short. The agency has declared insufficient and chronic lack of sleep a public health epidemic.
 
Various apps, gadgets and supplements have sprung up to serve the bleary-eyed masses, ranging from high-tech sleep trackers and apps (read our sleep wearables roundup) to oddball solutions (see: lettuce water).
 
“The amount of nightly sleep that individuals obtain has been decreasing since the invention of the light bulb," says Kimberly Fenn, an associate professor at Michigan State University's Sleep & Learning Lab.
 
Thomas Edison's invention was just the first in a steady stream of technological innovations that have rewired modern life. Television, air travel and smartphones have entertained us and made us more productive, but the always-on lifestyle they have created has upended our natural daily rhythms and a millennia’s worth of sleep habits.
 
There are deeper economic trends at work, too. Americans are busier than ever – some forced to commute long hours for low paying jobs, moonlight at second (or third) jobs to make ends meet and then serve as caregivers for children or elderly family members.
 
And it's not just frontline collar workers. At highly coveted workplaces, from Silicon Valley to Wall Street, there is often a culture of overwork. This issue spilled into the open in March of this year after a presentation created by a group of first-year bankers leaked onto social media. The group of employees worked for Goldman Sachs and documented how their 100-hour work weeks resulted in serious burnout. The presentation sparked a debate about the unreasonable demands put on junior employees and prompted the bank to ease some demands on them.
 
The toll of our go-go work ethic was evident in The Hartford's 2021 Future of Benefits Pulse Survey, where close to two-thirds of workers reported experiencing burnout at work.
 
The COVID-19 pandemic was another wake-up call. Work-from-home setups meant some people were able to sleep more. For others, especially frontline healthcare workers, the stress of the pandemic led to chronic sleep disturbances, or what's been called “coronasomnia."
 
A third of Americans aged 65 and older, a demographic that tends to report more sleep issues than the general population in normal times, reported an increase in sleep problems since the pandemic hit.1
 
Another consequence of the pandemic: an increase in deliveries. Since people began relying on online ordering, more delivery trucks and vans were being dispatched than ever before, sending overworked and round-the-clock drivers onto the roads. Mark Beaumont, technical manager for commercial auto with The Hartford's Risk Engineering division, explained.
 
The polling firm Gallup has tracked the national drift towards drowsiness. In 1942, 84% of Americans reported getting at least the minimum recommended 7 hours of sleep a night. Today, that number is down to 60%. And as you may have guessed, the most sleep-deprived groups are parents of young children and lower-income Americans.2
 
According to a 2019 study published in the Journal of Community Health, the most sleep-deprived groups by industry are protective service and military (50%), healthcare support occupations (45%), transport and material moving (41%) and production occupations (41%).3
 
“People are not deliberately sacrificing sleep," says Fenn. “It is simply just the easiest aspect of their lives to cut out."
 
Michael V. Vitiello, a professor with the University of Washington and an expert in sleep, circadian rhythms and sleep disorders in aging adds: “You may gain a few hours here and there, but down the line you may well pay for it, not just in day-to-day functioning, but in compromising your health."
 

Sleep Impacts Health, Safety and Performance

Medical and public health officials have only recently come to terms with the magnitude of the problem. Insufficient sleep over a prolonged period is linked to obesity, diabetes, heart disease, cancer and mental health issues. A particularly alarming new large-scale study suggests that people who get insufficient sleep in their 50s and 60s may be more likely to develop dementia when they are older.4
 
Lack of sleep can also impact cognitive performance, leading to lower work productivity, errors and accidents. And according to Dr. Mark Williams, a medical director with The Hartford, 13% of all workplace injuries can be attributed to sleep problems.
The U.S. loses the equivalent of about 1.23 million working days, or almost 10 million work hours, each year due to absenteeism, “presenteeism” and other fallouts from insufficient sleep.
Shift workers, in particular – whether ER staff or late-night Uber drivers – are vulnerable to sleep disruption. “The incidence of injuries is 20% higher in evening shifts and 30% higher in night shifts," says Williams. It's no coincidence that the Chernobyl, Exxon Valdez and Three Mile Island disasters all occurred between midnight and 6 a.m. “It's just the way we're wired," he adds. “Our physiology is geared to being alert during the daytime and sleeping at night."
 
In 2019, an estimated 697 known deaths were caused by drowsy driving, according to The National Highway Traffic Safety Administration.5 In a survey of nearly 150,000 adults across 19 states and the District of Columbia, 4% reported that they had fallen asleep while driving at least once in the previous 30 days – that's 6,000 people.6
 
The U.S. loses the equivalent of about 1.23 million working days, or almost 10 million work hours, each year due to absenteeism, “presenteeism" and other fallouts from insufficient sleep. The economic costs to the U.S. alone are up to $411 billion a year.7
 

Why Do Our Bodies Require Sleep?

For an activity that consumes a third of our lives, little is known about sleep. It's an enigma wrapped into a 500-thread count sheet and tucked under a down comforter. Sleep health wasn't taken seriously by the medical community until relatively recently. The CDC only started collecting data on sleep habits 20 years ago at the urging of researchers like Dr. Vitiello. Today, smart watches and wearables are generating new troves of sleep data that are providing new insights.
 
In recent years, researchers have made significant strides deciphering the importance of sleep. Scientists may now be on the cusp of critical breakthroughs in understanding that could lead to solutions that someday could reverse the damage done by chronic lack of sleep.
 
A good night's sleep helps us learn and form memories, bolsters the immune system, regulates appetite, lowers blood pressure and sets us up for good cognitive performance.
 
The latest research has shed light on the critical role that sleep plays in flushing out the brain's metabolic waste. When not flushed out, these plaques, known as beta-amyloids and tau, can lead to cognitive impairment and dementia-related diseases such as Alzheimer’s. In the last 10 years, neuroscientists at the University of Rochester Medical Center discovered a glymphatic system that acts as a vital plumbing system for the brain.8 Their research showed that the waste removal is activated only during slow wave sleep, a deep sleep that typically occurs in the first half of the night.
 
With slow waves, the brain's neurons fire in a synchronized pattern. “It's like being in Yankee Stadium when they're cheering in unison," explains Vitiello. The slow, or delta waves, contrast with the unsynchronized fast-firing waves of rapid eye movement (R.E.M.) sleep associated with dreaming. “It's one of the most exciting findings in the sleep world right now because it's a direct relationship between not enough normal sleep and, ultimately, brain health," he says.
 
Researchers are experimenting with means of augmenting slow wave sleep with synchronized auditory stimulation, sometimes referred to as “pink noise," that may help clear away accumulated plaque.
 
There are other potential breakthroughs on the horizon, too. The Defense Advanced Research Projects Agency (DARPA), is working with several universities to create a smartphone-controlled implant to counter jetlag. Its intended use is for the U.S. military, giving service members the ability to quickly deploy and respond to developing threats while operating at peak performance.
 
These potential game-changing solutions are still several years out, at least. In the meantime, there are steps and interventions that can help improve sleep duration and quality for millions of drowsy Americans today.
How can you get better and longer sleep? Health experts recommend setting a regular bedtime and maintaining a routine.

Habits to Encourage Healthy Sleep Patterns

How can you get better and longer sleep? Health experts recommend setting a regular bedtime and maintaining a routine. That routine should include keeping your bedroom cool and removing electronic gadgets, making sure you’re cutting screen time in the evening. They also suggest not drinking caffeine after 2 p.m. and avoiding heavy meals and alcohol in the evening.
 
For chronic insomnia, cognitive behavioral therapy (CBT) has been shown to be effective. Vitiello calls it "the gold standard treatment for chronic insomnia. It should be the first line of treatment prescribed for people if they're seeing practitioners."
 
The therapy involves a five- to six-week program where practitioners work with patients to review and track their sleep habits, examine and counterprogram any harmful beliefs or anxiety about sleep, and teach them relaxation techniques. CBT is typically provided in person but receiving treatment via app or telehealth sessions is becoming common, too.
 
Employers are taking an interest in keeping their employees well rested and productive. So much so that nap rooms are now a standard at some companies, like Google and Ben & Jerry's. Other companies are even providing sleep consultants for new parents to help their infants get on a regular sleep cycle. Others, such as The Hartford, offer support services like the Sleepio app free to employees. Professional sports teams have hired sleep consultants to help their players manage travel schedules, time zone changes and night games.
 
Companies are doing all they can to help employees, experimenting with educational programs to help with sleep hygiene and fatigue management and even modifying environmental characteristics such as lighting and screens. “Most reports indicated that employer efforts to encourage improved sleep hygiene and healthier habits result in improvements in sleep duration, sleep quality and self-reported sleepiness complaints," according to a review published in the Journal of Clinical Sleep Medicine.9
 
Employers can also allow flexible work schedules to accommodate different chronotypes – employees who are night owls versus early risers, suggests MSU's Finn. Employee assistance programs (EAPs) can also help by providing assistance with legal, medical and childcare issues, which can be a significant source of stressors, says The Hartford’s Dr. Williams.
 
Ultimately, the most effective action that companies can take might be just simply cutting back work hours. Goldman Sachs did this for its overworked young bankers. This seems to be a beneficial option, especially for those who work continuous shifts. For example, studies have shown that reducing the hours that medical interns work per week reduced errors by as much as half.10
“We’ve been a lot better at getting the message out that sleep is crucial for health. I'd like to think that some of these efforts being made by employers and by policymakers and by the research and healthcare community are having an impact.”
 
– Michael V. Vitiello, Sleep Expert and University of Washington Professor
When shift work cannot be eliminated, it helps to rotate shifts so that workers are not always on a night shift, for example. And within shifts, changing up job tasks can reduce fatigue, says Brett Frazier, a senior risk consultant with The Hartford's Risk Engineering division.
 
Policymakers have a role to play, too. They already regulate the hours that long-haul truck drivers can drive in a shift, for example. And some states have pushed back school start times, allowing more sleep for kids to try and set them up for success.
 
“As a society and also as the sleep world, we've been a lot better at getting the message out that sleep is crucial for health,” says Vitiello. “I'd like to think that some of these efforts being made by employers and by policymakers and by the research and healthcare community are having an impact.”
 
 
1 “Americans Continue Struggling for a Good Night’s Sleep During the Pandemic,” American Academy of Sleep Medicine, April 12, 2021
 
2 “Getting More Sleep Linked to Higher Well-Being,” Gallup, March 2015
 
3 Khubchandani, J., Price, J.H. “Short Sleep Duration in Working American Adults,” 2010–2018. J Community Health 45, 219–227 (2020)
 
4 Sabia, S., Fayosse, A., Dumurgier, J. et al. “Association of Sleep Duration in Middle and Old Age with Incidence of Dementia.” Nat Commun 12, 2289 (2021)
 
5 National Center for Statistics and Analysis. (2020, December). “Overview of Motor Vehicle Crashes in 2019.” (Traffic Safety Facts Research Note. Report No. DOT HS 813 060). National Highway Traffic Safety Administration
 
6 “Drowsy Driving — 19 States and the District of Columbia,” 2009–2010, Centers for Disease Control and Prevention MMWR Weekly / Vol. 61 / Nos. 51 & 52, January 4, 2013
 
7 Hafner, Marco et al. “Why Sleep Matters -The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis.” Rand health quarterly vol. 6,4 11. 1 Jan. 2017
 
8 Iliff, Jeffrey J., et al. “A Paravascular Pathway Facilitates CSF Flow Through the Brain Parenchyma and the Clearance of Interstitial Solutes, Including Amyloid β.” Science Translational Medicine: Vol. 4, Issue 147, pp. 147ra111. 15 Aug 2012
 
9 Redeker NS, et al. Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce. J Clin Sleep Med. 2019 Apr 15;15(4):649-657. doi: 10.5664/jcsm.7734. PMID: 30952228; PMCID: PMC6457507
 
10 Landrigan CP, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004 Oct 28;351(18):1838-48. doi: 10.1056/NEJMoa041406. PMID: 15509817
Amy Cortese
Amy Cortese
Amy Cortese is a journalist specializing in business and tech. Her work has appeared in The New York Times, Businessweek and other publications.