All About Fatigue: The Causes and Effects

(Reprinted with permission)

What is Fatigue:

• Fatigue is also known as sleepiness, tiredness, or exhaustion, and is a feeling of lack of energy or wanting to sleep.
• A number of medical conditions might cause fatigue but the most common cause is insufficient, high quality sleep (i.e., sleeping uninterrupted the entire time you’re in bed).
• When sufficiently fatigued, a person may experience very short, unremembered instances of sleep, called micro-sleeps, which can contribute to accidents.

Fatigue Impacts 40 million Americans with Sleep Disorders and Inadequate Sleep Causing:

• Increased health risks: high blood pressure, heart disease, stroke, and diabetes;
• Lack of energy to exercise and resulting weight gain;
• Sexual dysfunction;
• Mood swings, depression & irritability;
• Stresses on family & social life.

Consequences of Fatigue in the Workplace Includes:

• Impaired alertness & memory, inability to concentrate;
• Impaired judgment & poor decision making;
• Decreased motivation & productivity;
• Increased absenteeism;
• Increases by 3 to 5 time the likelihood of an accident.

Self-Management of Fatigue Is Important for Holders of Commercial Driver’s License (CDL):

• Being well rested is a requirement for being fit for duty.
• The hours-of-work requirement does not eliminate the driver’s responsibility for getting their needed hours of sleep or being treated so they are fully-rested while driving.
• If you drive while fatigued it is similar to having a blood alcohol content of .06 - .08. Nine out of 10 police officers have stopped a driver who they believed was drunk, but was later determined to be drowsy.
• Studies have shown that as many as 40% of commercial drivers have an undiagnosed sleep disorder that causes fatigue.
• It is the CDL holder’s responsibility to seek medical attention to ensure they do not have a sleep disorder or to obtain proper treatment.

Vulnerability to Fatigue:

• You are most vulnerable to fatigue when driving between 2 and 4 PM or 3 and 6 AM.
• The largest percentage of fatigue related accidents occur when a person is within 5 miles of their home or destination, when the brain’s drive to keep you awake begins to relax.
• The ability to perform adequately when fatigued is highly dependent on the individual. Some people need more hours of sleep to be fully rested. Others may become impaired sooner as a result of a lack of sleep.

Contributors to Poor Quality Sleep that Result in Fatigue:

• Having difficulty falling asleep can be influenced by factors that are difficult to control include:
  • Trying to sleep when the sun is up;
  • Falling asleep when you’re on a rotating schedule and the time that you go to bed keeps changing.
• Factors that make it difficult to fall asleep that you should try to avoid include:
  • Noise or interruptions;
  • Excessive stimulation prior to bed, such as an argument, physical exercise or eating;
  • Watching TV, using a computer, eating or reading/working while in bed. You want to avoid creating an association between activities that do not relate to sleeping while in bed.

Sleep Disorders that Contribute to Fatigue:

• Insomnia – can’t fall asleep, approximately 30 mm Americans affected, generally affects women more than men. Many of the environmental and behavioral/emotional conditions which affect high quality sleep contribute to the diagnosis of insomnia.
• Obstructive sleep apnea (OSA) – can’t breathe properly during sleep. Approximately 1 out of 5 men (20%( over age 40 have some degree of OSA, especially those who snore, are overweight or have large neck sizes. Among commercial drivers, the likelihood of having undiagnosed sleep apnea two times greater than the general male population. The severity of OSA ranges from 5 occurrences per hour to over 100. Each time an event occurs, the sleep is interrupted. OSA causes hypertension and if untreated reduces life expectancy by 10 years. 95% of those suffering from OSA are undiagnosed. Several treatment options exist. OSA is associated with lifelong diseases like diabetes or high blood pressure that should be diagnosed and treated for a driver to be “fit for duty”.
• Periodic limb movements in sleep (PLMS) – a less common disorder than OSA, often referred to as restless leg syndrome because the person needs to move their legs to be comfortable, but each time the legs move the sleep is interrupted. Not usually reported and diagnosed, a drug treatment is available.
• Narcolepsy – a rare disorder when a person will fall asleep in any place at any time. Is easily recognized and diagnosed, must be treated with a drug.

CDL Requirements for Diagnosis and Treatment of Obstructive Sleep Apnea (OSA):

• Department of Transportation guidelines require drivers with moderate to severe OSA to be treated in order to be fit for duty.
• You must disclose at the time of your DOT physical if you have been told that you snore loudly, or if you have awakened gasping for air or choking, or have been told you stop breathing, or are fatigued because these symptoms indicate you may have OSA. To avoid delays in being recertified, you should seek medical attention to determine if you have OSA and to receive treatment. Legal Implications of Driving while Fatigued:
• If you knowingly continue to drive when you’re fatigued or drowsy and have a collision, you will likely be liable for the injuries and damages caused to others.
• If you have a collision you could lose your CDL, and in the worst case be charged with vehicular manslaughter if you kill another person and it is shown that prior to the accident you:
  • Continued to drive while fatigued (even if there is a medical reason for the fatigue).
  • Did not seek medical attention to try and resolve the fatigue.
  • Did not report your fatigue at the time of your DOT physical.
  • Provided inaccurate or misleading responses to questions intended to determine if you have fatigue

© Advanced Brain Monitoring, Inc. 2007