Sleep Conditions | Insight
Sleep occupies roughly one third of our lives and is critical to our physical and mental health. When we’re not getting enough sleep, we can be adversely affected in many ways.
Sleep conditions are a complex and broad area — and this article provides an overview of four of the most-common conditions, along with advice on how to support employees suffering from them.
- Sleep disorders can leave sufferers tired and unable to concentrate, but are also associated with a range of other health issues
- Insomnia is thought to affect up to a third of the adult population at any time
- Lifestyle changes are usually sufficient to remedy insomnia
- Sleep apnoea sees sufferers’ breathing start and stop while they are asleep
- Narcolepsy causes sufferers to fall asleep at unexpected moments
- Restless legs syndrome (RLS) sees sufferers unable to resist moving their legs
- Sleep disorders can affect performance and attendance at work, and can result in safety issues
- Equality legislation may apply, depending on the nature and severity of the condition
- Some sleep conditions require the patient to inform the DVLA, and potentially to stop driving until clinically assessed
- If an individual is suffering from excessive daytime sleepiness of unknown cause, they would be advised not to drive and to discuss with their GP
- Occupational health can provide you with bespoke advice, where required
People suffering from insomnia are unable to get enough sleep, finding it hard to get to sleep and waking during the night. They often lie awake during the night and wake early, struggling to get back to sleep.
As a result, they feel tired after waking up and throughout the day, can become irritable and often find it difficult to concentrate.
Insomnia is divided into short and long-term categories, with long-term cases lasting more than three months. In chronic cases, the worry of not being able to sleep may itself keep sufferers awake.
Insomnia is rarely isolated, and is usually a symptom of another condition or issue.
Common causes include:
- Stress, anxiety or depression
- Menopausal symptoms
- Sleeping area being too hot, cold or uncomfortable
- Substances such as alcohol, caffeine, nicotine or recreational drugs
- Shift work
- Jet lag
Insomnia is usually addressed with lifestyle changes such as going to bed and getting up at regular times, exercising during the day and other sleep hygiene measures.
Specialised cognitive behavioural therapy (CBT-I) can be used to help sufferers change their thinking around sleep.
This condition sees sufferers’ breathing start and stop while they are sleeping, and the most common form is called obstructive sleep apnoea.
As well as breathing stopping and starting, sufferers can also snore loudly and make gasping, snorting or choking noises. They also tend to wake up frequently.
Sleep apnoea can leave sufferers tired, unable to concentrate and can be accompanied by headaches or mood swings. Untreated sleep apnoea is also associated with other health issues such as raised blood pressure, increased risk of heart disease and stroke.
The diagnosis is made through a specialist sleep clinic. Once it is diagnosed, more serious cases can be successfully treated with a device called a CPAP machine, which pumps air through a mask, stopping the airways becoming too narrow. This device is worn during sleep.
Where relevant, sufferers are also often advised to lose weight, sleep on their sides, cut down on alcohol and refrain from smoking or taking sleeping pills (unless prescribed).
DVLA require notification in cases of confirmed moderate or severe obstructive sleep apnoea syndrome (OSAS), with excessive sleepiness. If an employee is in doubt they should discuss with their specialist.
Caused by a rare and long-term brain condition, narcolepsy causes sufferers to suddenly fall asleep at unpredictable moments.
Because the brain is unable to regulate sleep normally, sufferers can:
- Feel very drowsy through the day
- Fall asleep suddenly, without warning
- Temporarily lose muscle control, leading to weakness or collapse
- Experience sleep paralysis
- Dream and wake more than usual during the night
Narcolepsy is often associated with a lack of a brain chemical called hypocretin — and triggers for its onset include hormonal changes such as those which occur during puberty or the menopause. Major psychological stress and infections such as swine flu have also been recorded as triggers.
There is no cure, but sufferers can alter their sleeping habits — including taking daytime naps — and take medication to manage the condition.
If uncontrolled, narcolepsy is likely to affect sufferers’ ability and entitlement to drive — and there is a requirement to report the diagnosis to the DVLA.
Restless legs syndrome
Restless legs syndrome (RLS) is a reasonably common condition which causes an irresistible urge to move the legs.
This is often accompanied by an unpleasant crawling sensation in the feet, calves and thighs. It is often worse in the evenings or at night, and the arms can sometimes be affected as well.
Some only experience RLS occasionally, while others have it every day. Twice as many women as men are affected, and it can happen at any age.
There is no obvious cause in most cases of RLS, however some experts believe it is related to the way the body handles a chemical called dopamine, which helps us to control our movements.
In a minority of cases, RLS can be caused by iron deficiency anaemia or kidney failure, when it is known as secondary restless legs syndrome. It can also occur during pregnancy.
Treatment is often restricted to recommended lifestyle changes for minor cases of RLS, including sleep hygiene, exercise and stopping smoking.
In more severe cases, medication can be prescribed to regulate the levels of dopamine and iron in the body.
The condition will usually subside if an underlying cause is treated, but without treatment it can get worse and severely affect sufferers’ lives.
Sleep conditions and work
Sleep disorders can impact on an employee’s performance and attendance at work in many ways, for example:
- Fatigue and daytime sleepiness can lead to impaired concentration and focus, with increased risk of errors and accidents, or reduced pace of work
- Lateness due to sleeping in
- Related irritability or mood issues can affect relationships in the workplace
- Poor coping skills
- Impaired social function
- Increased risk of heart disease, stroke, metabolic syndrome and delayed recovery from illness have all been linked to sleep issues
- Increased risk of drug and alcohol issues as a coping mechanism, and the subsequent associated risks
Employers are encouraged to cultivate a culture of openness. Employees reporting sleep issues should be encouraged to discuss with their GP, and to undertake a safety risk assessment for their role.
For example, are they in a safety critical job such as driving or working with machinery, where immediate restrictions may be warranted?
Occupational health can provide advice on individual cases — and you may wish to consider a referral.
Potential aggravating factors in the workplace, such as shift work or work stress, should also be considered.
Research has identified the types of shift patterns which tend to be better tolerated by workers. For example, a forward-rotating shift pattern — moving from day shift, to evening to night shift.
Employers should also:
- Think about the working environment and keep it bright at night
- Be aware that some people tolerate shifts very poorly, and as individuals age they may find it more difficult to adjust to changing work patterns
- Consider a work stress risk assessment if stress is raised as an issue
- Use the assessment to identify supports or adjustments which might reduce stress, utilising occupational health advice if required
- Inform the DVLA of employee difficulties, if relevant and necessary
- NHS Every Mind Matters – Sleep
- Sleep Apnoea Trust
- The Sleep Charity
- Mind – Sleep problems
- Gov.uk – Excessive sleepiness and driving