In Trinidad and Tobago, heart disease and motor vehicular accident (MVA) are two leading causes of death. What is seldom highlighted, though, is the role of sleep deprivation and sleep disorders in increasing the likelihood of these two causes of mortality. Inadequate sleep and sleep disorders have consequences in these two major domains: excessive sleepiness with behavioral consequences, leading to risk including increased rate of motor vehicular crashes; and metabolic consequences, leading to an increase of obesity and insulin resistance.
Internationally, many studies explain the close relationship between the two. Sleep deprivation has become more prevalent in our modern society because of the situation and conditions in the demanding world of work and family life. As a result, people are not getting adequate sleep. The amount of sleep required by humans for good health varies from individual to individual. However, if a person does not get the required sleep for his/her age, sex and lifestyle, there will be negative impacts on their long term health a mentioned above. Sleep disorders on the other hand, involve problems with the quality, timing and amount of sleep, which cause problems with functioning and distress during the daytime.
There are a number of different types of sleep disorders, of which insomnia is the most common. Other sleep disorders are narcolepsy, obstructive sleep apnea and restless leg syndrome. It is important to note that, sleep deprivation due to lifestyle can result in a sleep disorder in the long term and sleep deprivation itself may be a symptom of a sleeping disorder.
In a recent study done in the US, it was found that there was a high prevalence of poor sleep and unrecognised sleep disorders among police officers. Not only were sleep disorders (especially sleep apnea) common among police officers, but the presence of a sleep disorder was associated with depression, occupational burnout and other adverse outcomes. Sleep apnea, in particular, was associated with increased likelihood of cardiovascular disease. In addition to the implications for their health, those police officers with sleep disorders were at somewhat increased risk for a number of work-related adverse outcomes. They had higher rates of administrative errors, safety violations, falling asleep at the wheel, uncontrolled anger toward citizens or suspects, citizen complaints, absenteeism, and other outcomes. Not only are police officers at high risk of having an undiagnosed sleep disorder, but the sleep disorder may have a detrimental effect on the officer’s health, productivity, and job performance.
Internationally, there research like this has now brought awareness of the role of sleep deprivation and sleep disorders in increasing morbidity due to cardiovascular disease (CVD) and MVA. As a result, attention has been focused on the public health implications of sleep deprivation and sleep disorders. The concern is so grave in the United States (US) that, the Department of Health and Human Services of the US in launching a project called Healthy People 2020 for achieving national good health, has included as part of its goal, adequate sleep as part of its national health policy. By such initiatives in the US, awareness of the public health implications of insufficient sleep has increased and has drawn attention to the public safety implications. This has resulted in considering appropriate policies regarding medical resident duty hours, work schedules for physicians and airline pilots, and screening for sleep disorders in commercial vehicle drivers and other workers in occupations that have round-the-clock operations that require continuous vigilance. Sleep disorders and sleep deprivation may not be directly linked, however, their treatment is an integral part of reducing morbidity and mortality.
The findings in such research has empowered the US public to address the risks associated with sleep problems. Relatives of victims of motor vehicle crashes resulting from the driver falling asleep at the wheel have started taking action. Advocacy for drowsy driver legislation and establishing the nonprofit organisation Parents Against Tired Truckers are initiatives in the US born out of this research. Initiatives in the occupational arena have also taken place.
Some employers are developing proactive educational programs, and a few are initiating programs for mandatory screening for common sleep disorders such as sleep apnea. The latter is likely to be the most effective approach, but employees may have concerns that if they are found to have a sleep disorder, their employment will be adversely affected.
As a matter of public health such pertinent research speaks to the issue of the general underdiagnosis and undertreatment of sleep disorders in the overall population in the US, with important implications for health and functioning. As a matter of public safety it illustrates that the public at large may also be at risk when employees are impaired in performing their duties because of sleep deprivation or an untreated sleep disorder.
In T&T there is need for research so that similar policy can be made to reduce ill effects of sleep deprivation and sleep disorders and their effect on the morbidity and mortality of CVD and MVAs. There is a need for additional research studies evaluating sleep problems in the occupational area, including screening employees for sleep disorders and evaluating different interventions in individuals who are diagnosed with sleep disorders. Such studies need to be large enough to allow evaluation of the health effects for the individual as well as the economic implications for the employee and employer and the larger effect on society as a whole.
Another aspect that we need to look at is the situation of public transport and the traffic congestion in our country which contributes to sleep deprivation and sleep disorders. People have to get up and arrive at work in the capital city hours before work starts at 8 am and get home at odd hours because of the evening traffic after work. Thus, seriously looking into improving public transport, decentralisation and occupational health and safety where sleep deprivation and sleep disorders are concerned, will be doing by the nation’s health in the long term.