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Sleep Deprivation: A
Significant Cause of Error and Accidents
The
Exxon Valdez grounding in Prince William’s Sound, Alaska in
1989. The space shuttle Challenger disaster in 1986. The
Three Mile Island near nuclear meltdown in 1979. What do
these historic accidents in our nations history have in
common? All were related to personnel subjected to excessive
hours and shifting work schedules resulting in excessive
fatigue and sleepiness.
In the
case of the Exxon Valdez, the National Transportation Safety
Board determined that “the probable cause of the
grounding... was the failure of the third mate to properly
maneuver the vessel because of fatigue and excessive
workload.” The third mate was asleep on his feet and failed
to respond to the warning light signaling Bligh Reef.
Fatigued shift workers were responsible for the production
of defective O-rings resulting in the Challenger
explosion. A mechanical failure, unrecognized by tired shift
workers, almost led to a meltdown in one of the nuclear
reactors at Three Mile Island.
Sleep
deprivation has become one to the most significant causes of
error and accident throughout our society. Sleep-related
accidents in transportation alone claim over 5,000 lives
each year and cause hundreds of thousands of injuries. The
need to work long hours and sleep at odd times has resulted
in millions of Americans becoming functionally handicapped
on the job, in the classroom and behind the wheel. The
effects of sleepiness permeate all aspects of our lives, our
health, our education, our careers, and our overall quality
of life.
Each of
us requires a specific amount of sleep in each 24-hour
period to maintain optimal waking function. If we obtain
less sleep, we will be less alert the following day.
Moreover, sleep loss accumulates from one night to the next
as a “Sleep Debt.” The more sleep lost each day, the greater
the sleep debt and the larger the impairment. We are only
beginning to understand the importance of sleep and why
sleep occurs after a period of being awake. The consequence
of sleepiness costs the United States a minimum of $16
billion in direct costs alone. This estimate does not
include the billions of dollars in indirect and related
costs, such as those attributable to sleep-related tragedies
(e.g., Exxon Valdez grounding, space shuttle Challenger
disaster, countless motor vehicle accidents, and diminished
productivity in the work place).
More
than 50 million U.S. adults annually report having
difficulty sleeping (insomnia) or excessive sleepiness (hypersomnia). In
any given year, up to 10 million people will consult their
physician for sleep disorders -- half will receive
prescription drugs for sleep.
The
incidence of sleep disorders is staggering, but, since only
one in five seeks treatment, health care givers could easily
underestimate the incidence of sleep disorders in their
patients.
The
International Classification of Sleep Disorders (ICSD) have
recognized 88 disorders ranging from insomnia to excessive
sleepiness, to disorders that occur during sleep such as
sleepwalking, night terrors, snoring and restless legs. One
disorder worth mentioning has to do with obstruction of the
upper airway during sleep causing cessation of airflow
(apnea) and snoring. This obstruction may fragment one’s
sleep--resulting in excessive daytime sleepiness. OSAS
(Obstructive Sleep Apnea Syndrome) may account for as much
as 50% of those patients who seek help from a healthcare
practitioner.
Patients with OSAS are often told that they snore loudly. In
the morning, they do not feel refreshed and they may
complain of a headache. They always complain of excessive
daytime sleepiness. When snoring is associated with
obesity, high blood pressure, witnessed apneas and excessive
sleepiness, a formal sleep study (nocturnal polysomnogram)
is recommended.
Once
diagnosed with OSAS, one treatment method provides
continuous positive airway pressure applied through the
nostrils (nasal CPAP), thus, eliminating the obstruction.
Surgical approaches are also available. The initial surgery
for sleep apnea was a tracheostomy and is still used in
patients with very severe disease who will not respond to
other therapies. Newer surgical treatments are evolving such
as a modified uvulopalatopharyngoplasty (removal of
excessive tissue from the back of the throat) which is
effective in eliminating snoring, thus, pleasing the bed
partner.
It is
essential that health care practitioners begin to identify
and treat those suffering from sleep disorders. Previously,
complaints of lack of sleep, excessive sleepiness and
disturbed sleep were considered purely psychological. Some
were thought to be amotivated or simply “lazy” because of
excessive sleepiness or fatigue. We now recognize that many
sleep-related symptoms are indicative of more serious, even
life-threatening illness or injury and that sleep disorders
can and should be treated.
Content
of articles can only be used with writer attribution to Dr.
Kevin Weiland.
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