The Dangerous, Draining Hazard of Fatigue on the Job

Your fatigued, sleep-deprived workers may be costing you in accidents, injuries, and other consequences. One study estimated that fatigue costs U.S. employers $136 billion just in lost productivity.

According to the National Safety Council (NSC), a typical employer with 1,000 employees can expect to lose more than $1 million a year due to fatigue:

• $272,000 due to absenteeism,
• $776,000 due to “presenteeism” (employees who are at work but not fully functional), and
• $536,000 in healthcare costs.

Balance, coordination, and motor skills, as well as cognitive functioning, are all affected by fatigue. A tired worker also is a dangerous one, maybe even as dangerous as an intoxicated employee.

Fatigue has been cited as a factor in some of the biggest accidents in history, including:

• The 2005 BP Texas City oil refinery explosion,
• 2009 Colgan Air Crash,
• 2010 Deepwater Horizon oil spill, and
• Nuclear accidents at Chernobyl and Three Mile Island.

Increased Likelihood of Injuries

Fatigued workers are more likely to make safety-critical errors, resulting in injuries. Sleep problems are a factor in 13% of workplace injuries, according to one report. Fatigue was the probable cause or a contributing factor in 20% of crashes investigated by the National Transportation Safety Board.

According to OSHA, accident and injury rates are 18% greater during evening shifts and 30% greater during night shifts when compared with day shifts.

The human body’s natural circadian pattern, which is regulated by the hormones cortisol and melatonin, means that people naturally are alert during daylight hours and sleep at night. Evening and night shifts disrupt this pattern.

Workers most at risk for fatigue due to circadian misalignment include anyone over 40 years old, emergency responders, medical staff, military personnel, transportation workers like pilots and truck drivers, and shift workers.

Sleep Deprivation, Sleep Disorders

A culture that values long work hours and around-the-clock availability can result in widespread sleep deprivation. Those working more than 48 hours a week are more likely to experience insomnia, poor sleep quality, and short sleep duration. The Centers for Disease Control and Prevention (CDC) found 19% of working adults work 48 hours or more per week, and over 7% worked 60 hours or more.

Experts recommend adults get at least 7 hours of sleep daily. An NSC survey found 43% of workers are not getting enough sleep.

Sleep disorders like insomnia and obstructive sleep apnea (OSA) also lead to fatigue. About one in four Americans may suffer from chronic insomnia, an ongoing inability to either fall asleep or stay asleep. Some 25 million Americans may have OSA, a sleep disorder where a person’s airway is blocked, resulting in gasping or loud snoring and poor sleep quality.

Productivity may decrease up to 6% in employees who suffer from sleep disorders.

Work Factors

Aspects of work environments also can lead to fatigue. Mentally exhausting tasks that demand constant attention, quick reaction, or vigilance are physically draining. Assembly-line workers, baggage screeners, and those responsible for quality control frequently experience high workload fatigue.

Less mentally challenging occupations have their own set of problems. Underlying sleepiness can present itself in monotonous or unstimulating tasks like driving. Performance can decrease after 90 minutes of driving.

Ergonomics can also play a part. Repetitive tasks like assembly and data entry for extended periods can lead to muscle fatigue.

Even aspects of the workplace environment like air quality, lighting, and noise can affect workers’ alertness or fatigue. For example, workers exposed to bright lighting usually are the most alert and least prone to fatigue.

Shiftwork can be a huge factor in worker fatigue. Early morning, irregular, night, and rotating shifts all have fatigue risks. Nightshift workers are at their drowsiest between 4 a.m. and 5 a.m., according to the National Sleep Foundation.

Other fatigue risk factors include long commutes, long shifts, long workweeks, no rest breaks, quick shift returns, and sleep deficiency.

Safety risks increase with length of shift and number of hours worked per week. Experts agree that the longer an employee works, the higher the risk of an accident or injury. One study found there is a twofold increase in safety risk in a 12-hour shift compared with an 8-hour shift.

Safety Professionals Concerned

The American Industrial Hygiene Association (AIHA) included worker fatigue as one of the 15 issues in its first public policy agenda issued earlier this year. In 2019–2020, the AIHA plans to:

• Encourage the National Institute for Occupational Safety and Health’s (NIOSH) Total Worker Health program to maintain a focus on worker fatigue;
• Encourage policymakers to incentivize employer development, adoption, and use of comprehensive fatigue risk management systems;
• Support the adoption and implementation of American National Standards Institute (ANSI)/American Petroleum Institute (API) Recommended Practice (RP) 755, Fatigue Risk Management Systems for Personnel in the Refining and Petrochemical Industries;
• Encourage staffing agencies to help ensure that temporary workers have sufficient rest time between shifts at the same or multiple jobs; and
• Support requirements for employers to provide paid time off and paid sick leave for their employees.

The ANSI/API RP 755 offers consensus guidance for managing worker fatigue in safety-critical industries.

Resources for Employees, Employers

Federal agencies, industry organizations, and professional safety organizations have developed resources to help employers manage fatigue risks among their employees.

The National Sleep Foundation’s tips for staying alert on a night shift include:

• Avoiding long commutes and extended hours;
• Taking short nap breaks throughout the shift;
• Conversely, trying to be active (exercising, playing sports, or walking) during breaks;
• Drinking caffeinated beverages (coffee, tea, or colas) to help maintain alertness during the shift; and
• Not leaving the most tedious or boring tasks to the end of the shift.

The NSC has provided an online Fatigue Cost Calculator (www.nsc.org/forms/real-costs-of-fatigue-calculator) that estimates the bottom-line costs of worker fatigue.

The NSC suggests screening employees for sleep disorders (insomnia and OSA) and offering employees sleep health education. Options for employee education include in-person, expert-led, train-the-trainer, and online offerings. Research shows in-person, expert-led sessions have the best results.

The NSC also recommends asking supervisors to monitor and address worker fatigue. Supervisors may observe safety risks or decreases in productivity before employees notice their own fatigue.

Employers should consider adding sleep disorder studies and treatment to their health plans, according to the NSC.

The API developed RP 755 to address worker fatigue issues that contributed to the March 23, 2005, explosion at the BP Texas City refinery. The U.S. Chemical and Hazard Investigation Board (CSB) made several recommendations in its report on the explosion. The CSB recommended that the industry develop fatigue prevention guidelines to limit hours and days of work, as well as address shift work.

The CSB found that the day board operator at the Texas City refinery had worked 12-hour shifts for 29 consecutive days, sleeping 5 to 6 hours per 24-hour period, at the time of the explosion. The night lead operator had worked 33 consecutive days, and the day lead operator had worked 37 consecutive days. All worked 12-hour shifts.

The comprehensive fatigue risk management system in RP 755 covers hours of service, incident and near-miss investigations, individual risk management and mitigation, safety promotion, and workload balance. RP 755 was developed for petrochemical and chemical operations, natural gas liquefaction plants, refineries, and other facilities such as those covered by OSHA’s Process Safety Management Standard.

NIOSH offers free online courses covering fatigue in emergency response and healthcare:

• One to train nurses and their managers on the risks of shift work and long work hours and strategies to reduce the risks; and
• Another to help emergency responders and their managers better cope with the demands of emergency operations when they are deployed to a disaster site.

NIOSH issued interim safety and health guidelines for disaster responders following the April 20, 2010, Deepwater Horizon oil spill, which included fatigue risk management guidelines. Fatigue prevention recommendations included:

• Establishing at least 10 consecutive hours per day of protected time off duty in order to obtain 7–8 hours of sleep;
• Instituting frequent, brief rest breaks (every 1–2 hours) during demanding cleanup and response work;
• Planning for 1 or 2 full days of rest to follow 5 consecutive 8-hour shifts or 4 10-hour shifts and 2 rest days after 3 consecutive 12-hour shifts;
• Scheduling shorter shifts during evening and night hours and limiting weeks to 5 8-hour shifts or 4 10-hour shifts or 12-hour days if interspersed with more frequent rest days; and
• Scheduling shorter work shifts for days involving extreme environments, exposure to other health or safety hazards, highly cognitive or emotionally intense work, or physical exertion.

The institute also has developed fatigue risk management materials for commercial pilots in Alaska and long-haul truck drivers.

NIOSH is sponsoring a discussion symposium forum, “Working Hours, Sleep & Fatigue: Meeting the Needs of American Workers & Employers,” September 13–14, 2019, in Couer D’Alene, ID, following the 24th International Shift Work and Working Time Symposium.