CIRCADIAN ( is the leading worldwide provider of employee fatigue risk management and workload/staffing, shift scheduling, training and risk management services. For over 30 years we have worked across every type of 24-hour industry and government organization in industrial (petrochemical, mining, manufacturing, call centers, pipelines, ) public sector (e.g. hospitals, emergency response, police) and transportation (truck, bus, rail, aviation, marine) operations.We are seeking an RFP researcher and business lead generator who will find, qualify and help us respond to requests for proposals in our area of expertise We need an energetic motivated and persistent person who can sign onto RFP listing websites and identify and research jobs relating to our skills and submit proposals, interact and build business relationships with these leads, and help us land the projects with them. This person will also write up RFP proposals based on our template and boilerplate language for submission to larger RFP competitions.We are open to discussing commission for higher budget projects in order to attract better quality work and attention.

  • Project Type: Ongoing project

You will be asked to answer the following questions when submitting a proposal:

  1. Where and how will you find RFP's relevant to CIRCADIAN's area of expertise
  2. What part of this project most appeals to you?


Contact Patricia Lever at



Sleep Problems & Work Injuries

Recent Research Findings

The dangers of a sleep deprived workforce have been clearly demonstrated throughout research; however, the association between sleep quality and work injury risk has been an open question of interest among researchers. 

Conflicting results have come from studies examining the variables that potentially modulate the association between sleep quality and workplace injuries. A recent meta-analysis of 27 observational studies found that sleep problems increase the risk of workplace injuries by 62 percent (Uehli et al., 2014). 

Because of this, Swiss researchers looked to better understand the relationship between sleep problems and workplace injuries. Their findings, which were recently published in the Journal of Sleep Research, provide valuable insights into the relationship between sleep problems and the risk of work injuries.

We summarize and highlight the valuable, key points this research publication.

Goal of Study

According to the authors, "the aim of the study was to provide further evidence for the relationship between sleep quality and work injury and to identify factors that may modify this association.

Factors considered for the effect modification were gender, age, job risk, shift or night work, sleep duration, weekly working hours and co-morbid conditions."

Study Population 

The case-control study included 180 cases and 551 controls, all of whom were recruited through the emergency department of the University Hospital in Basil, Switzerland.

To be included in the study, participants were required to meet the following criteria:

1. Age between 18 to 65 years 

2. Hospital admission from a work injury that had occurred within the previous 48 hours 

3. Moderate or severe work injury 

4. Proficient in German 

5. Adequate general mental condition to complete the questionnaire


The well-validated and scientifically accepted Pittsburgh Sleep Quality Index (PSQI) was used to retrospectively measure sleep quality in the four weeks prior to the work injury. Poor sleep quality was defined as a PSQI score greater than 5.

Work injuries were defined according to Swiss law, and excludes repetitive strain injuries and commuting accidents.

Variables that were measured included: 

  • Sleep quality based on PSQI Score (>5 = poor sleep quality)
  • Objectively diagnosed sleep disorders (self-reported) 
  • Reported sleep duration
  • Type of work injury (8 categories)
  • Sociodemographic factors (gender, age, highest education and occupational status) 
  • Work-related questions (primary job, shift or night work, weekly working hours and perceived work stress)

Research Findings 

There was a dose-response relationship between sleep problem severity and the odds of a workplace injury occurring.

Workers were 2x more likely to suffer a work injury if diagnosed with a sleep disorder. 

Workers with a diagnosed sleep disorder AND suffering from poor sleep quality had a 3x greater risk of a work injury.

For each 1 unit increase in PSQI score, work injury risk increased by 20-30% among participants who were: 

  • Males 
  • Older workers (>30 years) 
  • Participants with high risk jobs
  • Working 50 hours per week or more 
  • Daytime workers
  • Short sleepers (

Also, for each 1 unit increase in PSQI score, the likelihood of previous work injuries increased by 12%.

Research Implications 

These findings are relevant and valuable because:

  • An increasing number of older individuals in the workforce (Auer and Fortuny, 2000)
  • An increasing number of people working long hours (Jacobs and Gerson, 2004) 
  • A decreasing average sleep duration among the general population (Kronholm et al., 2008)

Help Workers Improve Their Sleep!

Download our white paper, "Shiftwork Lifestyle Training: Employee & Employer Benefits" to learn about the benefits associated with providing shiftwork lifestyle training programs.


CIRCADIAN® 24/7 Workforce Solutions

CIRCADIAN is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research, software tools and informative publications, CIRCADIAN helps organizations in 24/7 workforces optimize employee performance and reduce the inherent risks and costs of their extended hours operations.



Garrie Wright is the Emergency Service Consultant for Circadian. Garrie is a retired Deputy Chief from Toronto Paramedic Services with over 36 years’ experience in the emergency services industry.

Garrie Wright was a senior leader for the largest municipal paramedic ambulance service in Canada. The service is the sole provider of emergency medical response for Toronto, responding to over 250,000 emergency calls annually: with a daytime population of 3.5 million people.

Garrie led a project team that implemented a new work schedule for Toronto Paramedic Services. Garrie successfully navigated the project through several major issues in order to replace a 35-year-old schedule. By matching staffing with emergency call demand, the service was able to offer a variety of schedules to the staff and significantly improved response times and reduced their overtime budget.

Garrie has extensive experience in labour relations and contract negotiations. He was the lead for three consecutive contract negotiations and has experience in arbitration and conflict resolution.

In 2011, Garrie was promoted to Deputy Chief and was the senior management lead for three portfolios over his tenure. As Deputy Chief of Operations, he managed approximately 1,000 frontline paramedics, as Deputy Chief of Operations Support he successfully implemented a budget of just under $200 million dollars and finally as Deputy Chief of Communications he managed an emergency dispatch centre that was an Accredited Centre of Excellence.

Garrie played a key role in several major events affecting paramedic services in Toronto including the G7 and G8 Summit, the Papal visit and World Youth Days. Garrie has had the opportunity to speak at both local and international conferences about the SARs crisis and disaster planning.

Garrie was awarded the Canadian Governor General’s EMS Award for exemplary service in 2005 and the Toronto Exemplary Service Award in 2006. He also received the Toronto EMS Chiefs Award for his work in improving the publics’ health and safety in the community.

Garrie is a graduate of McMaster University and Humber College.


For many people, the 24/7 nature of our society has caused people to believe that chronic fatigue is an acceptable way of life. This has led many people to disregard their sleep issues (e.g. waking up in the middle of the night, difficulty falling asleep). However, what is often believed to be a simple sleep issue is actually a diagnosable sleep disorder.

A significant but commonly overlooked concern in 24/7 workforce health and safety is the high prevalence of “Obstructive Sleep Apnea Syndrome” (OSA), which is one of the roughly 70 sleep disorders listed in the International Classification of Sleep Disorders Diagnostic & Coding Manual. Obstructive Sleep Apnea can become a serious health issue if left untreated. Symptoms of OSA can include disturbed sleep and excessive sleepiness during the day (National Sleep Foundation, 2014).

The ripple effect of OSA can dramatically impact not only the sufferer, but also their spouse, friends, family, and even their employer. Most managers recognize that understanding and addressing the issues of a 24/7 lifestyle can dramatically improve the bottom line of the company; yet, health issues like OSA continue to be overlooked as contributing to excess costs.

How much do employees with sleep apnea cost their employers? CIRCADIAN conservatively estimates that each undiagnosed employee in the workforce costs an additional $6,000 per year in OSA-related expenses.

What is OSA?

Obstructive Sleep Apnea (OSA) is a disorder of the respiratory system manifested by repeated cessations of breathing during sleep that can cause arousal from sleep multiple times per hour. In OSA, the upper airways collapse during sleep so as to prevent the movement of air into the lungs. Obstructive Sleep Apnea typically develops with increasing severity over a period of several years.

The period of cessation of breathing called “apneas” prevent the oxygenation of the blood in the pulmonary capillaries and, as a result, the arterial blood oxygen levels rapidly fall. Carotid body oxygen sensors detect the drop in oxygen levels, causing an abrupt arousal from sleep and gasping for air before the sufferer falls back into sleep again. Because this pattern can repeat many times per hour, the result of sleep apnea is reduced sleep quality and quantity, leading to chronic sleep deprivation. The effects of sleep deprivation and the repeated episodes of blood deoxygenation affect the neurological and cardiovascular systems.

Animation of Obstructive Sleep Apnea

Risk Factors & Prevalence

Several studies have described the average prevalence of OSA in different populations as ranging from 2% to 33% (Young, 1993; Agency for Healthcare, Research and Quality, 2000).

The sleep specialist community conservatively estimates that 5% of the U.S. working-age population suffers from OSA. However, a steady increase in the proportion of obese people in the U.S. population may directly increase the prevalence of OSA going forward.

CIRCADIAN’s databases (containing data from more than 10,000 shift workers) show that 11% of shift workers have OSA and 15% display key symptoms of OSA or other sleep disorders related to excessive sleepiness. Given the increased prevalence of OSA risk factors among shift workers, it is not surprising that OSA is more common in shift work populations as compared to other populations.

Recognized risk factors for OSA include:

  • Smoking (Kashyap, 2001)
  • Obesity
  • Having a neck size of 17” or greater
  • Regular use of alcohol or sleeping pills
  • Moderate sleep deprivation (National Institute of Health, 2003)

Health Implications

Due to interrupted sleep patterns, many individuals with OSA infrequently have restorative sleep episodes, which can potentially manifest into excessive daytime sleepiness, increased accidents, and more frequent health problems, such as:

  • 40% increased rate of excessive daytime sleepiness (Ulfberg, 1996)
  • 2 times as many traffic accidents per mile (Horstmann, 2000)
  • 3 times greater risk of occupational accidents (Ulfberg, 2000)
  • 1.3 to 2.5 times more hypertension (Krieger, 2002; Smith, 2002)
  • 2.2 times increased risk of nocturnal cardiac arrhythmia (Smith, 2002)
  • 3.9 times more likely to have congestive heart failure (Smith, 2002)
  • 1.6 times increased chance of stroke (Mooe, 2001; Shahar, 2001)
  • 1.4 to 2.3 times greater risk of heart attack (Saito, 1991; Shahar, 2001)
  • 40% increased risk of depression (Smith, 2002)

In one study consisting of 421 patients being evaluated for possible sleep apnea, researchers found that up to 95% of people who were positively diagnosed with OSA thought that they just had a snoring or fatigue problem, causing sleep specialists to suggest that high-risk groups should be educated and screened (Baumel, 1997).


Given the myriad of health problems associated with OSA, it is no surprise that employees with untreated OSA cost employers significantly more each year than employees with treated sleep apnea or no apnea.

According to CIRCADIAN’s calculations, a highly conservative estimate of the yearly excess cost per employee with unmanaged OSA is approximately $6,091. This means that in a shiftwork population where 11.6% of the workers are unmanaged OSA sufferers, these costs would equate to $706,556 per one thousand workers every year ($6,091 x 116 workers).

These apnea-related excess costs are often accrued from increased physician and hospital visits, cardiovascular treatment costs, increased on the-job injuries, and absenteeism, to name a few. Table 1 details the discrepancies between employees with treated vs untreated sleep apnea in terms of the average yearly excess costs per employee.

Table 1. Yearly Excess Costs per Employee: Treated vs Untreated Sleep Apnea

OSA costs

In order to mitigate the risks associated directly with OSA, and lower the sufferer’s risk to the same level as a non-OSA worker, the obstruction of the airway during sleep must be prevented. In short, the individual with OSA needs to keep breathing.

General measures are often effective. These include weight loss, avoidance of alcohol and sleeping pills, use of medication to relieve nasal congestion, and use of oral appliances that modify the position of the tongue, soft palate or jaw. More extreme measures include nasopharangeal surgery, although the long term efficacy of this approach is questionable due to the accumulation of scar tissue. However, the medically recognized method for maintaining an open airway in those suffering from moderate to severe OSA is “Continuous Positive Airway Pressure,” or CPAP for short.

Most employees receiving CPAP treatment experience a dramatic improvement in their health and quality of life (Sin, 2002), and their health care costs return to normal levels. Performance (as measured by tests of simulated driving, daytime sleepiness, cognitive performance and mood) shows significant improvements (Weaver, 2001), while absenteeism diminishes after treatment (Servera, 1995). Adverse health and performance consequences and costs associated with OSA can be reversed in compliant, treated employees.

Managing Employee OSA

Though OSA can be a highly disruptive disorder in its unmanaged state, the costs of accidents and health problems are mitigated when OSA sufferers receive treatment to correct the airway obstruction during sleep. However, in order to receive a non-invasive, corrective treatment, the individual needs to know that he or she has OSA in the first place.

Company Sponsored Education Initiatives

There are several challenges to overcome in order to ensure a successful outcome for a company-sponsored OSA education initiative; however, the benefits of implementing a program can be substantial.

Managers report returns from reductions in healthcare, absenteeism, turnover, presenteeism, and overtime costs, as well as longer-term benefits in workers’ compensation payments, insurance premiums, and ultimately brand value.

Interested in learning more about employee education initiatives?

Download a free white paper titled “Shiftwork Lifestyle Training: Employee and Employer Benefits”.

Shiftwork Lifestyle Training





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