Many of us suffer from some level of sleep deprivation. So it’s reasonable to ask, just what are the consequences, especially when you are are on the job? Obviously, individuals involved in certain public services are subject to guidelines to ensure their safety and the safety of others when on the job - but just how is sleep deprivation a special concern?
Let’s take a look at the ways sleep deprivation has affected some well-known professions.
In New Jersey, Maggie’s law was passed to address the issue of sleepiness in commercial truck drivers. Maggie was a college student who was killed when a truck driver, who admitted he hadn’t slept for 30 hours, crossed three lanes of traffic and struck her car. When the case went to trial, the jury was deadlocked because shockingly, there was no law against falling asleep at the wheel. It was a tragic accident, but there was no case for criminal negligence found. But as a result of the trial, law defines fatigue as being without sleep for 24 consecutive hours, and makes driving while fatigued, a criminal offense.
Years ago when I was training to be a doctor, we were subjected to a grueling 36 straight-hour shift every three nights during internship and residency. Staying up all night after a full day of work wasn’t as difficult as I had imagined. But certainly, moving into another 12 hours of work the following day should have been difficult to endure, filled with presenting our cases to senior residents and doctors - but we felt fully competent. Now we know we actually posed a hazard to our patients.
Libby Zion was an 18-year-old girl who in the emergency room was given a sedative drug that interfered with an antidepressant she was already taking. When she became agitated from the drug interaction, the nurse gave her another sedative. Libby died from what’s known as the serotonin syndrome. A later review of her case showed that very basic facts in her history, and subsequent behavior, were overlooked, due to the fatigue experienced by the residents in the emergency room. As a result, the New York State Department of Health mandated limiting the amount of hours per week that residents in training could work, setting strict limits.
Airline Pilots No profession is more regulated than commercial airline pilots. They are strictly limited with regard to their flight schedules - required to get at least 10 hours of rest between shifts, and 8 of those hours must be uninterrupted sleep. This explains why they stay in hotels close to the airport, so transportation time is limited. Commercial pilots are also required to take a test, (The Maintenance of Wakefulness Test) which assesses their ability to stay awake.
You might assume that commercial pilot rules would also apply to professionals with a commercial driver’s license, such as public bus and truck drivers. After all, statistics show that more fatalities occur on the highway from trucking accidents (specifically more occur due to drivers falling asleep at the wheel), compared to individuals driving under the influence of alcohol.
There certainly is a long list of health restrictions for these professions that could disqualify a person from getting the job. These include use of insulin for diabetes, use of anti-seizure medications, and individuals who use prescription narcotics for chronic pain. There is, however, no requirement that a driver who is suspected of having sleep apnea (which we know causes poor quality sleep and daytime drowsiness)be compliant with treatment with a CPAP mask. There are also no penalties for healthcare providers who do not report individuals suspected of having sleep apnea to the State Department of Motor Vehicles (they are required to report anyone who has had a seizure and even a fainting spell).
So far, there is general awareness of the dangers of public workers operating equipment without proper sleep. But what about nurses, policemen, air traffic controllers? They are currently all unregulated professions when it comes to sleep deprivation. That alone should certainly be of great concern. But It may take an informed public to drive lawmakers to issue more policies.
Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.