Fatigue has played a key role in some of the world’s major industrial disasters including the Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster, the Three Mile Island crisis and the Chernobyl nuclear accident.
Fatigue is a factor in up to 25% of driving accidents and is four times more likely to contribute to workplace impairment than drugs or alcohol.
However, unlike drugs or alcohol, which can be measured to assess risk, measuring fatigue in the workplace is more difficult.
As a significant Occupational Health and Safety (OHS) issue, fatigue management becomes crucial where workers are driving, operating heavy machinery, or working shifts.
What causes fatigue?
A number of interrelated factors contribute to fatigue – stress, poor or insufficient sleep, medical conditions, and shift work.
One of the major causes is sleep disorders and in particular sleep apnea.
Sleep apnea is a condition where the sufferer’s airway collapses during sleep and breathing stops sometimes hundreds of times, from seconds to up to a minute.
The prevalence of sleep apnea is high, with around 24% of men and 9% of women experiencing sleep apnea.
About 28% of transport drivers suffer from sleep apnea.
Symptoms may include excessive fatigue, excessive sleepiness, slow response times, a tendency to fall asleep inappropriately and loud snoring.
The resulting performance impairment is likened to that seen with alcohol impairment or sleep deprivation. Studies have shown that people with sleep apnea have between two to seven times the number of motor vehicle crashes than people without sleep apnea, while the risk of being involved in an occupational accident increases by 50% for male sufferers.
As well as increased accident rates, sleep apnea is linked to serious, life-threatening conditions including stroke, heart disease, high blood pressure, type II diabetes, and obesity.
Despite the serious health problems, many people with sleep apnea are unaware they have it, and only around 10% of sufferers are actually diagnosed.
If sufferers are fortunate enough to see a doctor who recognises the symptoms they are then referred for an overnight study at a sleep laboratory. However, overnight studies at sleep laboratories aren’t always convenient, especially in remote areas.
It is a situation that Consultant Occupational Physician to Rio Tinto, Dr Andrew Marsden, had to contend with.
“Sending someone for a sleep study in a laboratory means travelling to Perth and spending the night there at great expense. The company loses a guy for three days, a day to get there, spend the night there and a day to travel back,” Marsden said.
The issue has prompted some of the mining companies to look at alternative methods and Dr Marsden is now carrying out a home screening program in the Pilbara using an ApneaLink screening device.
The device is “like a mobile telephone that you take home, strap around your chest and sleep with,” he said. The device records data that is then sent to sleep professionals who analyse the results to determine if sleep apnea is present.
The device was introduced to Dr Marsden by Rhonda Russo, the director of Sleep for Health and Safety, a company that provides sleep health education and screening.
Russo believes all employees in high-risk situations, should be checked for sleep disorders.
“The program allows faster, more cost effective and measurable means to check for sleep apnea, which is at least as common in the mining industry as elsewhere,” Russo said.
“The ramifications in the mining industry are more serious since their fatigue could cause terrible accidents and lost productivity.”
The screening programs are designed and implemented for companies using their existing resources and a network of professional support is put in place for necessary follow up.
BHP Billiton Consultant Occupational Health Physician Dr Martyn Flahive is carrying out home screening at Newman and Ravensthorpe mines and says it enables him to quickly and cheaply test if workers have a problem or not.
“You can give workers graphical data showing they stop breathing overnight and immediately treat those who are severe,” Flahive said.
Treatment of sleep apnea is simple but effective.
Continuous Positive Airway Pressure therapy (CPAP) involves a small bedside device delivering air at positive pressure to the nose through a mask.
The air pressure keeps the airways open and prevents blockage, enabling sufferers to sleep properly, sometimes for the first time in years.
Numerous studies show that CPAP therapy reverses the adverse effects of sleep apnea and reduces the risk of motor vehicle crashes in sufferers.
In Australia, the annual cost of work-related injuries attributable to sleep disorders is estimated at $2.9 billion.
Now the problem is gaining recognition; assessment of sleep disorders is a requirement in the National Transport Commission’s (NTC) Heavy Vehicle Driver Fatigue (HVDF) reform that came into force on 29 September 2008.
The new laws are based on the results of leading fatigue research and focus on the causes of fatigue rather than just regulating hours worked.
The NTC has put forward a submission sharing its learning and experiences with developing the HDVF laws to the current National Review into Model OHS Laws.
The review is the first step in developing a model OHS Act in order to harmonise OHS legislation by 2011.
According to Russo, the mining companies are leading the way with the home sleep apnea screening programs.
“Programs provide a cost-effective means to meet regulatory requirements and directly support wellness programs in the mining industry,” she said.
Sleep for Health and Safety
02 8213 3241