The monster under the bed: Sleep deprivation's long-term risks
Shift work sleep disorders are a very real risk for employees and their companies, and can affect thought processes and decision-making.
When I first started practicing law, I was part of the workers’ compensation claimants’ bar. After a manufacturing facility or warehouse closed, we started filing occupational COPD claims for all of the employees. At first, insurance carriers were dismissive of our efforts. Then, as the judgments started turning in our favor, their smug smiles disappeared.
Next, we started filing carpal tunnel claims (CTS) and our claimant pool increased to include food workers, bank tellers and keyboard operators. Carriers and their underwriting teams were caught by surprise as our victories seemed unstoppable. These were followed by tinnitus claims. New condition, same sucker-punch result to the carriers. Then came my personal favorite: Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS). The victories continued. Shortly thereafter, I jumped to the defense side and eventually left practicing law to become a risk manager.
Looking ahead to new risks
Lawyers and claims managers are tasked with cleaning up someone else’s spill. Risk managers make their living by trying to convince people to move the glass of water away from the edge of the table to avoid the spill in the first place. Risk managers are futurists. We try to identify or predict the future occurrences and then spend an inordinate amount of effort trying to convince those around us that we are not Chicken Little.
What we call an emerging trend is frequently dismissed as an unrealistic fear or a situation where “no court is ever going to give a claimant money for occupational COPD, CTS or RSD.” As a frequent presenter on emerging trends, people rarely want to know about the positive emerging trends. Instead, everyone wants to know where the next exposure lies. The conversation always starts the same, “What causes you to lose sleep?” My latest answer: Shift work sleep disorder keeps me awake at night.
Shift work sleep disorder (SWSD) is a condition that affects people who have non-traditional work hours such as overnight construction crews, third-shift manufacturing or service providers such as hospital workers, or any other operation with rotating shifts. In the modern economy, energy brokers, global stockbrokers and traders, and IT professionals also fall into the category. SWSD is not new. It has its very own ICD-10 diagnostic code that often gets missed because it is identified as G47.26: Circadian Rhythm Sleep Disorder, shift work type. For too many employers, SWSD amounts to a worker who is tired and after all, isn’t that what weekends are for, catching up on your sleep?
SWSD is more than being tired
According to Sleep (Vol. 27, Issue 8, Pg 1453-1462), in 2004, it was estimated that 10% of all night workers and rotating shift workers suffered from SWSD. While there are no reliable estimates as to the number of rotating shift workers, the number of night shift workers ranges between 14 and 15 million people. They work in certain industries and companies, and this means underwriting these companies or industries may be underestimated.
Addressing CTS is easy. Remove the irritating activity, maybe a CTS release surgery and you are good to go. SWSD is not that simple. Studies have tied SWSD to increased obesity, hypertension, diabetes, stroke, higher levels of depression, anxiety, irritability and cancer. Anecdotally, rotating shift work has a far greater impact than permanent third shift work. Employers, however, rotate shifts to give everyone who wishes to make the graveyard shift pay differential the opportunity to do so.
One widely cited study concluded that people who perform rotating shifts for a decade experience a loss of brain function equivalent to six-and-a-half years of age-related cognitive decline. Who are these people who perform rotating shift work resulting in loss of cognitive function, increased irritability, anxiety and depression? Police who have to make snap decisions and medical workers who make life and death decisions, amongst others.
My first experience with an SWSD claim involved a worker who fell asleep driving home from the third shift. Reviewing the medical records from the ER and the follow-up treatment records, I saw all the touchpoints of a pending SWSD claim: obesity, insomnia, depression, diabetes and hypertension. The claimant’s attorney did not realize what cards he held. Our conversation was artfully moved to a “going and coming” conversation with me questioning what is the difference between falling asleep driving home from the third shift and falling asleep driving home from the first shift.
I asked the claimant’s attorney if he was arguing that the employer should be responsible for the employee’s decision to do other things when he should have been sleeping. Wasn’t this the same as a first-shift employee who worked a second job or was out partying the night before? The case settled for nuisance value, and the employer dodged that bullet. The next time, the employer may not be so lucky.
It is foreseeable that in addition to workers’ compensation claims, third parties injured due to a worker falling asleep on the way home after the latest shift rotation could have a viable claim against the employer.
Mitigating the risk
Risk managers are influencers. We do not actually repair the leaking pipework or the broken walkway. We do not write the code that will patch the computer vulnerability or diversify the company’s investments. We identify the exposures and try to assist in fashioning a remedy. We often are up against greater competing interests.
In the case of repairing a bridge or interstate highway, the contract specifically mandates nightshifts when there is less traffic, and a requirement that the crew is gone before the morning rush hour. Emergency rooms can’t close down just because the sun sets.
From a human perspective, it would appear that eliminating rotating or third shifts are the answer, however, we want our favorite candy available at all times, or to know that when we pull up to the gas pump there will be gasoline waiting for us. There is no one-size-fits-all solution. Manufacturing is often constrained by the amount of equipment available and the prohibitive time and financial cost to increase production. Heart attacks and strokes occur at all hours of the day and night.
Shift work sleep disorder is an emerging trend. Not just for workers’ compensation, but for potential third parties who get hit by a tired employee driving home from a third shift, the patient who received the wrong medication due to a cognitively impaired hospital worker, or someone who received adulterated food due to an unfocused food worker.
Yes, there is a monster hiding under our bed.
Jeff Marshall is an independent risk and claims manager and a former board-certified workers’ compensation attorney. Contact him at imanagerisk4u@gmail.com. Opinions shared are the author’s.
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Anti-subrogation rule & workers’ comp 1B coverage in construction accidents