Thursday, 21 August 2014 21:20

The Hidden Costs of Sleep Apnea

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?

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


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 and technology, software tools and informative publications, CIRCADIAN helps organizations with traditional and/or extended operating hours optimize employee performance and reduce the inherent risks and costs of sleep deprivation and fatigue.



Thursday, 10 July 2014 18:57

10 Dangers of a Sleep Deprived Workforce

tired sleep deprived worker With two-thirds (63%) of Americans reporting that their sleep needs aren’t met during the week, sleep deprivation is a societal epidemic that exists across all countries, economic statuses, industries, and seniority levels.1

Sleep deprivation is an issue that is often ignored, yet frequently the root cause of decreased productivity, accidents, incidents and mistakes which cost companies billions of dollars each year. Often companies are unaware of the impact fatigue or sleep deprivation is having on their operation until a tragic accident occurs… only then do managers ask the question: “What happened?”

Here are 10 dangers of having a sleep deprived workforce:

1. Decreased Communication
When workers are tired, they become poor communicators. In one study, researchers noted that sleep deprived individuals:

  • drop the intensity of their voices
  • pause for long intervals without apparent reason
  • enunciate very poorly or mumble instructions inaudibly
  • mispronounce, slur or run words together
  • repeat themselves or lose their place in a sentence sequence

2. Performance deteriorations
Performance declines frequently include increased compensatory efforts on activities, decreased vigilance, and slower response time. The average functional level of any sleep deprived individual is comparable to the 9th percentile of non-sleep deprived individuals.

Workers must notice these performance declines, right? Not quite. In fact, sleep deprived individuals have poor insight into their performance deficits. Also, the performance deficits worsen as time on task increases.3

3. Increased risk of becoming distracted
Sleep deprived individuals have been shown to have trouble with maintaining focus on relevant cues, developing and updating strategies, keeping track of events, maintaining interest in outcomes, and attending to activities judged to be non-essential. In fact, research suggests that there is a symbiotic relationship between sleep deprivation and attention-deficit hyperactivity disorder (ADHD) due to the overlap in symptoms.4

4. Driving Impairments
Due to federal regulations, the trucking industry is well aware of the driving impairments associated with sleep deprivation; however, plant managers are unaware of the ways in which sleep-deprived workers may be dangerously operating machinery (e.g. forklifts or dump trucks). In fact, 22 hours of sleep deprivation results in neurobehavioral performance impairments that are comparable to a 0.08% blood alcohol level - that’s legally drunk in the United States.5

5. Increased number of errors
The cognitive detriments of sleep deprivation increase concurrently with a worker’s time on a given task, resulting in an increased number of errors. These errors include mistakes of both commission (i.e. performing an act that leads to harm) and omission (i.e. not performing an expected task), which can wreak havoc at any work facility. Errors are especially likely in subject-paced tasks in which cognitive slowing occurs, and with tasks that are time-sensitive, which cause increases in cognitive errors.3

6. Poor cognitive assimilation and memory
Short-term and working memory declines are associated with sleep deprivation and result in a decreased ability to develop and update strategies based on new information, along with the ability to remember the temporal sequence of events.3

7. Poor mood appropriate behavior
Inappropriate mood-related behavior often occurs in outbursts, as most sleep deprived individuals are often quiet and socially withdrawn. However, a single one of these outbursts can be enough to destroy the positive culture of a work environment and cause an HR nightmare.

These behavioral outbursts can include irritability, impatience, childish humor, lack of regard for normal social conventions, inappropriate interpersonal behaviors and unwillingness to engage in forward planning.2

8. Greater risk taking behavior
Brain imaging studies have shown that sleep deprivation was associated with increased activation of brain regions related for risky decision making, while areas that control rationale and logical thinking show lower levels of activation. In fact, sleep deprivation increases one’s expectation of gains while diminishing the implications of losses.6

What does this mean for your workers? Sleep deprived workers may be making riskier decisions, ignoring the potential negative implications, and taking gambles in scenarios in which the losses outweigh the benefits.

9. Inability to make necessary adjustments
Flexible thinking, preservation on thoughts and actions, updating strategies based on new information, ability to think divergently, and innovation are all negatively impacted by sleep deprivation. A worker may be unable to fill a leadership role on request when sleep deprived, resulting in a frustrated management team.

10. Effects of sleep deprivation compound across nights
Four or more nights of partial sleep deprivation containing less than 7 hours of sleep per night can be equivalent to a total night of sleep deprivation. A single night of total sleep deprivation can affect your functioning for up to two weeks.3 To your brain, sleep is money and the brain is the best accountant.

The Conclusion: Rather When Than If

The moral of the story is the following: when you have sleep deprived or fatigued workers, your productivity levels and quality of work will be compromised. Furthermore, you will be creating an environment where it becomes not a matter of if your workplace will have an accident or incident but a matter of when, and to what magnitude.

Clearly sleep deprivation is no laughing matter, no matter how frequently our society treats the issue light-heartedly. Eventually our biological drive to compensate for sleep deprivation wins at the end of the day, and the loser might be your workers, your company, or even yourself.

Luckily, there are a variety of ways to monitor, manage, and mitigate the effects of sleep deprivation, such as biocompatible shift scheduling or corporate sleep education seminars. Want to learn more about the ways to keep your workplace safe from fatigue-related accidents?

Premium Content.

myths realties thumbpxl72

Myths & Realities of Fatigue: Reducing the Costs, Risks and Liabilities of Fatigue in 24-hour Operations

To help you manage the cost of fatigue, this white paper will:

• Review business practices which increase fatigue risk
• Examine the consequences of fatigue in the pulp/paper industry and other 24-hour operations
• Calculate the bottom-line costs of fatigue
• Provide solutions for mitigating the costs, risks and liabilities of fatigue




  1. National Sleep Foundation (2011, March 7). Sleep In America Poll. Retrieved from:
  2. Harrison, Y., & Horne, J. A. (2000). The impact of sleep deprivation on decision making: a review. Journal of Experimental Psychology: Applied, 6(3), 236.
  3. Durmer, J. S., & Dinges, D. F. (2005, March). Neurocognitive consequences of sleep deprivation. In Seminars in neurology (Vol. 25, No. 1, pp. 117-129).
  4. Owens, J. A. (2005). The ADHD and sleep conundrum: a review. Journal of Developmental & Behavioral Pediatrics, 26(4), 312-322.
  5. Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639), 235-235.
  6. Venkatraman, V., Chuah, L., Huettel, S., & Chee, M. (2007). Sleep deprivation elevates expectation of gains and attenuates response to losses following risky decisions. Sleep, 30(5).

energy drinksWith sleep constantly challenged by the demanding nature of our daily lives. Many of us resort to energy drinks and other caffeinated beverages to power through the day. But do you ever wondering how your body is affected by these drinks? Are they healthy? Moreover, are they safe?

Below are five crucial facts that you need to know before consuming your next energy drink. Knowing these facts could benefit your health and potentially save your life.

1. Energy drinks require no FDA preapproval when choosing ingredients

Traditional sodas are considered to be beverages, and therefore are subject to strict FDA regulations on caffeine contents and ingredients. On the other hand, energy drinks are classified as dietary supplements, and have avoided many FDA regulations due to a loophole created by the Jolt Cola beverage company. Because of this, energy drink ingredients must be listed, however there’s no requirement to list the specific amount of each ingredient existing in these “drinks”.1

2. Per ounce, energy drinks can contain over 5x more caffeine than regular coffee

Energy shots, like 5-Hour Energy, contain 100 mg of caffeine per ounce as compared to regular coffee, which contains approximately 18 mg of caffeine per ounce.2 What does this mean for the typical energy drink consumer?

Well, unlike hot coffee, which is often sipped slowly, energy drinks tend to be “gulped,” and are finished quickly. Therefore, the peak caffeine level of an energy drink will be reached quickly. With a long half-life, energy drink users can quickly find themselves in danger of reaching very high levels of caffeine in the body, especially after consuming several drinks in a short amount of time.

3. The half-life of caffeine in energy drinks can last up to 10 hours

The human body absorbs 99% of caffeine, reaching peak levels within 30-75 minutes.3,6 How long does this caffeine rush last? Well the half-life of caffeine can vary dramatically, with its effects lasting anywhere from 2.5–10 hours.4 There are several factors that can influence the half-life of caffeine, such as: 3-7

    • Impaired liver function
    • High levels of caffeine consumption (increases half-life)
    • Cigarette smoking (decreases half-life)
    • Weight
    • Age
    • Medications (i.e. oral contraceptives, antibiotics, theophylline, Echinacea)
    • Health Status
    • Gender
    • Individual differences

4. A variety of physiological side effects are associated with heavy caffeine use

There are no hard and fast rules on how much caffeine is safe, as caffeine sensitivity can vary widely depending on the individual; however, several major medical organizations have published guidelines for caffeine intake. For example, the Mayo Clinic recommends that people consume no more than 200-300mg of caffeine per day, which equates to roughly one 5-Hour Energy Shot.

In fact, one study found that people given a 300 mg shot of caffeine experienced the following symptoms (in order of prevalence):

    • Restlessness or muscle tremor
    • Heart palpitations
    • Dizziness
    • Headache
    • Diarrhea
    • Wakefulness
    • Polyuria (excessive urination)
    • Increased sweating
    • Abdominal pain
    • Ear/eye problems
    • Vomiting or nausea
    • Delirium

5. Energy drinks have been linked to death and cardiac failure

Between 2004 and 2012, 5-Hour Energy amassed 92 incident reports with 13 fatalities, Monster had 40 reports with 5 fatalities, and Rockstar had 13 reports with no fatalities. Over 50 of the incidents for all three energy drinks list heart problems (chest pain, arrhythmia, cardiac arrest, etc.) in the events, according to the U.S. Food and Drug Administration.

In 2012, Monster Energy received a great deal of attention, when the FDA published a report listing

Monster Energy drinks as a possible contributing factor to the deaths of five people over three years. One of those people was a 14-year-old Maryland girl, whose death certificate stated that she died of “cardiac arrhythmicity due to caffeine toxicity” after drinking two 24-ounce cans of Monster in 24 hours, which exacerbated a pre-existing heart condition. The family of the girl is now suing Monster Energy for failing to provide adequate warnings about the risks of consuming their drinks.

It can’t be all bad, right?

While the majority of studies published on energy drinks focus on the negative effects, not everyone agrees with their assessments. For example, energy drinks do appear to enhance physical performance. Drinking energy drinks also improves driving performance in sleepy subjects – including reducing driving mistakes, swerving, and self-reported sleepiness and alertness.9

So is it safe to have an energy drink?

Bottom line: Yes, but use energy drinks in moderation. If you can’t get going in the morning or are dragging during the middle of your night shift, an energy drink now and then is fine. But remember, whether you get your caffeine from energy drinks, soda, or coffee, read the labels (or do some research) and be aware of the levels of caffeine and other ingredients you’re putting in your body. As long as you use caution and keep track of what you’re consuming, feel free to enjoy the benefits of energy drinks – without ignoring the risks.

Want to learn more about energy drinks? Visit CIRCADIAN to download a free white paper titled

Energy Drinks: The Good, the Bad, and the Jittery that provides further information about energy drinks.


1. Energy “Drinks” and Supplements: Investigations of Adverse Event Reports. U.S. Food and Drug Administration. Accessed June 20, 2014.
2. Caffeine in coffee: US Food and Drug Administration
3. Carrillo JA and Benitez, J (2000) Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clinical pharmacokinetics, 39: 127-153.
4.Kaplan GB, Greenblatt DJ, Ehrenberg BL, Goddard JE, Cotreau MM, Harmatz, JS and Shader RI (1997) Dose-dependent pharmacokinetics and psychomotor effects of caffeine in humans. Journal of Clinical Pharmacology, 37:693-703.
5.Caffeine. How much is too much? Mayo Clinic. Accessed on June 20, 2014.
6.Mandel, HG (2002) Update on caffeine consumption, disposition and action. Food and Chemical Toxicology, 40:123
7.Magkos F, and Kavouras S (2005) Caffeine use in sports, pharmacokinetics in man, and cellular mechanisms of action. Crit Rev Food Sci Nutri 2005, 45: 535-562.
8.Carrillo JA and Benitez J (1996) CYPlA2 activity, gender and smoking, as variables influencing the toxicity of caffeine. British Journal of Clinical Pharmacology, 4(1): 605-608.
9.Reyner LA, and Horne JA (2002) Efficacy of a ‘functional energy drink’ in counteracting driver sleepiness. Physiological Behavior, 75(3): 331–335.
Page 3 of 3

Home  |  Privacy Policy  |  Terms of Use  |  Sitemap  |  Contact Us

Sign Up to Receive CIRCADIAN News.



Circadian Headquarters
2 Main Street, Suite 310
Stoneham, MA, 02180, USA

Contact Information
Local: 1.781.439.6300

©2020 Circadian ZircLight, Inc.
All rights reserved.