This episode of the “Sleep Review Conversations” podcast features a roundtable discussion with Pamela Minkley, RRT, CPFT, RPSGT; Terry Cralle, RN, MS; and Nancy Rothstein, MBA. The panelists discuss important components of fatigue management programs as well as how sleep fits into corporate health.
Sree Roy, Sleep Review editor (SR): Hello and welcome. From healthcare publisher Allied 360, this is “Sleep Review Conversations.” I’m Sree Roy, editor of Sleep Review magazine and sleepreviewmag.com.
Today, we’re talking about napping at work, or, as I like to call it, mixing business and slumber. Many of us remember nap time from when we were kids, but is there a value for adults to nap? How can the conflict between nap time and work time be resolved? We speak to three sleep medicine professionals with expertise in workplace fatigue management programs to find out. Without further ado, I’ll let our distinguished panelists introduce themselves. Pamela Minkley, welcome.
Minkley: I’m Pam Minkley, and I have about 35 years’ experience in dentistry, oral surgery, respiratory care, and sleep medicine and technology. I hold credentials in respiratory care, polysomnography, clinical sleep health, and pulmonary function testing. During my employment, I’ve included management, technical educational research, clinical and industrial roles. During my time as manager in a sleep center for approximately 28 years, I developed and implemented a fatigue management policy for our sleep center.
SR: Glad to have you, Pam. I also just want to mention that Pam is a member of Sleep Review‘s editorial advisory board. I would also like to welcome Terry Cralle.
Cralle: Thank you, Sree; it’s a pleasure to be here. I’m a registered nurse and a certified clinical sleep educator, and I’ve been in the field of sleep medicine specifically for about 15 years now. My background is in clinical research specifically with insomnia, and I’m also the cofounder of a four-bed sleep disorder center, and I have done various work with public education in sleep issues, and I do continuing education for nurses in the field of sleep.
SR: Great to have you. Finally, I would like to also welcome Nancy Rothstein.
Rothstein: Hi, Sree, thank you for having me and my fellow panelists, who also do an amazing job in the field of sleep. As the Sleep Ambassador, I could say I’m on a quest to educate and train the public about sleep, the lack of which the CDC refers to as a public health crisis. I had a decades long career in financial risk management, and I have an MBA after my name as opposed to an MD, so my perspective is particularly corporate.
I began to recognize that sleep is a risk management issue for corporations, and about a year and a half ago—having already been consulting to major corporations—I partnered with CIRCADIAN who are the leaders in 24 workforce solutions to create our corporate sleep programs division. As I explain in my article that I’ll probably reference later, The ROI of a Good Night’s Sleep, sleep is integral to optimizing human capital and employee well-being. As we’ll discuss today, workplace napping is one of the many topics beckoning attention in the corporate arena.
I also wanted to mention that I’m honored to be a member of the NIH’s Sleep Disorder Research Advisory Board. I serve as an adjunct professor at NYU and teach an online course on sleep, and I served for 10 years on the board of the American Sleep Apnea Association. So I’m very excited to be in this world of sleep, and it all started with a snoring spouse. I wrote a children’s book called My Daddy Snores for Scholastic, and here we are today.
SR: Excellent story, and thank you for joining us. I want to dive right in with the big question. Should workplaces encourage employee napping? Why or why not? Nancy, let’s start with you.
Rothstein: My first question, and I get this question all the time, is: Why do people need naps? I think workplace napping is terrific, but I think the first question a corporation needs to ask is why do so many people need naps? Is it personal sleep deprivation caused by bad habits? Is it the corporate culture with 24/7 expectations with e-mailing and phone calls? But most important, and we can see, we can all read on the Internet and read in the paper, all the companies that are having napping spaces, and I want to really emphasize that there’s a critical missing piece. If a company has a napping room or condones napping, then they also need to provide sleep education and training for their workforce. Because I firmly believe that if people had better sleep habits, they wouldn’t need so many naps short of pregnancy, illness, or long hours, or some specific reason.
Minkley: I’d like to agree with Nancy on her point. A big part of the fatigue management program that was successfully implemented in our sleep center was education. All of the staff was educated on fatigue management first and sleep disorders, of course, since they worked in that field. But in addition, anyone who felt they needed naps could take them to safely drive home, particularly midnight shifts, etc, and they were counseled on when they should ask for a nap. If they did use them, part of being able to nap at work was counseling and a screening to see if they had sleep disorders so we could follow up and solve the fatigue problem. But napping at work was simply a bridge to that and a temporary solution to make them safe at that point in time.
Cralle: I’d like to say that corporate wellness has been around for a while, but they’ve been slow to pick up on the concept of sleep. I think sleep has just taken such a backseat, and we can’t address employee health in any way, shape, or form without addressing sleep because we know that sleep, diet, and exercise are interrelated. We can’t effectively address this from a singular approach. They must be approached in total and collectively. In my educational seminars, I stress that sleep is foundational, and I think that’s a point that many people miss both in and out of the workplace. We need to make sleep, sufficient sleep specifically, a family as well as a workplace value.
Rothstein: May I jump in?
Rothstein: I so agree with what Terry said, and it’s so interesting. I’m finishing up a project for a Fortune 30 company right now, and one of the issues that came up yesterday in editing some things was the family aspect, which I included because you can have the world’s best sleep habits, and then you’ve got a crying baby or you’re caring for an elderly parent or a teenager who’s out too late. Then you’ve got to work the next day, and your sleep’s out the window. Addressing this as a family issue is also important, and I like the term “workplace value” because it really has to be a shift in the paradigm, and I think it’s starting to happen. I think the research about the issues of sleep deprivation is in a way ahead of the action in the corporate environment, but I do think that corporations have to recognize that how an employee sleeps at home, whatever the reasons they are or aren’t, directly impacts how they function at work.
SR: To get a little more detailed, to implement a successful napping at work culture, if a company wants to set up a nap area for folks who would like to use it, should it be a separate area, or should workers be allowed to snooze at their desks? What are your thoughts on that? Terry, let’s start with you.
Cralle: I think it should be a separate area for many reasons. Ideally, there should be flexibility in it, but it has to be sanctioned with appropriate policies. I think that a separate area is essential. I think we have to look at this: The workplace culture has to embrace this as a biological necessity, and I think the benefits of napping and providing a separate area outweigh the risks. Again, as Nancy said, it gets down to education of the employees and following proper policy and procedure like with anything else, and just have that available. We have workplaces that have coffee rooms and lunch rooms, gym memberships, and understanding that sleep is a biological necessity, I think having that should be a basic offering.
Minkley: Absolutely. I agree, and people also always have to keep in mind where they are working and in what environment. Perception is always a problem, and if the public is at all in any part of their work area, clearly people shouldn’t have their head down on a desk napping. It takes too long to explain how important that is to any visitor in the area. And for that reason, I think a separate room is most appropriate as well as the fact that if they’re going to be away from work for a 20 minute nap time, the best way to get the biggest bang for your buck sleep-wise is to have a dark and quiet room.
I think that’s really an important aspect, but I also agree on the corporate perception. If during lunch time you put on your sweat pants and tennis shoes and go for a walk, people say you’re a hero, and if during your nap time or your lunch time you take a nap, you kind of come back to work and people pretty much say “slug.” We have to change that perception.
Cralle: Nap time has almost been equated with sleeping on the job, and the negative connotations of that we all are familiar with. We need to, by educating everyone in the workplace, we can overcome that stigma, and treat it as it should be treated. Because the improvements in performance and even the safety improvements, these things are immeasurable and very worthwhile. It should be something available to workers everywhere. What we don’t want, Sree, is people taking naps, sneaking naps, falling asleep in places. That’s where the safety issues come in. That’s what we want to avoid, and by having sanctioned napping, we can avoid that.
Rothstein: You’re so on target with that, Terry, because I know of somebody who works at a company that has a lot to do with this topic, and one of the employees would go out to her car to take a nap because she didn’t have an office, and there was no place to take a nap, but it was the ultimate irony that she would go to her car. That’s really not the best place to go to take even a 10-minute power nap. It’s one thing if you’re on the road, and you’re so exhausted that you can’t drive anymore and you need to take a power nap. But I’m saying that in the company, however large or small, there should be a separate area—dark, cool, quiet—where people can go. I think another point that you raised that’s so important is the policies and procedures that go with the napping room or napping space.
I think that we’re all on the same page about this. It’s really about shifting the corporate paradigm….Pam, you’re so right. People go out to put on their workout clothes and go for a run, or exercise in the middle of the day even at a company-offered workout space. Somebody says, “I got to take a nap,” and the first thought that probably goes through the co-worker’s mind is “God, they’re so lazy.” We’ve got to change that.
Minkley: Exactly, and one caution I’d like to put out for any of our listeners who are thinking they’d like to start work on some sort of a policy is their very first thing should be communication with their human resources and their corporate leaders. Oftentimes, there is already an existing policy for immediate dismissal for sleeping on the job. That needs to be part of the education on why that’s inappropriate, and why that needs to be changed before they can even begin that work. Your first part of your education oftentimes is your HR department and corporate leaders and your safety and health department.
Cralle: Absolutely, and we also have to educate people on the duration of naps, and this has to be situational and specific to the job at hand. Because we have to touch on sleep inertia, which can be a problem if naps are prolonged. Based on what a person is doing in their job, education on the timing of naps, keeping the naps short to avoid the sleep inertia that can be experienced upon awakening.
Rothstein: I think you’re so right. There’s an article, I don’t know if any of you have seen it. I’ve sent the link to Sree. It’s just that one of my colleagues at CIRCADIAN wrote Is Workplace Napping the Key to Boosting Productivity?/Are you capitalizing on benefits of workplace naps? Since we won’t have time to get into all the detail, this actually talks about the types of naps, best nap length, what is sleep inertia. For those of you who are listening, where to nap, when to nap, it really offers a nice summary and some things to consider. But I do want to go back to what Pam said and Terry mentioned, and I think it’s really important is number one, look at policies that already exist at the company that may impact “sleeping on the job.”
That’s something that most people don’t consider, but in large manufacturing companies, I think this really needs to be looked at particularly with shift workers. I know with one of the companies I’ve consulted to, the topics of naps for them….They don’t even want to hear yet, and yet it’s the workers working all night and very tired; it just means that their safety, their productivity, and everything else can be enhanced by a power nap. It’s something that is a bit of a quagmire. There’s a lot of intricacies here, but the fact of the matter is, and all of us certainly know, that people are exhausted. People are sleep deprived, and whether it’s poor sleep habits or life’s circumstances, we have to find ways to address this. It’s too important not to be on top of this right away.
Cralle: I look at employer liability issues. I’ve talked to many employers who say, “Gosh, this seems a huge step. This is counter to our culture,” but what is the cost of not providing that? You look at a shift worker who works a 12-hour night shift who drives home and has a long commute in the morning. The liability issues of that employee driving home….We have to get back to: Sleep is a biological process. People can have local sleeps where parts of their brain literally shut down, but their eyes are open and they appear awake, or they can enter a micro-sleep. We all know that micro-sleeps are incredibly dangerous, especially when driving, and this issue of driving to and from work tired as an issue is as important as drunk driving. When we have tired people at work, that’s like having intoxicated people in the workplace. Those issues are huge considerations for employers.
Minkley: I agree with you. There are some employers who particularly have unique issues. Take for instance a utility company. Those employees typically are called out for disasters, storms. They often are loaned to different communities, so they have a long drive to get to where they’ll be working. Then they’ll work long hours with just short breaks, and when they get, let’s say, the electrical service reestablished, then it’s time to head home. I had found in working with the companies I’ve consulted with, very few of them had any policy on whether or not the employees can find lodging before they come home. And they’re coming down from a real adrenaline high, and working in this intense environment, and then they may have an hour or two drive home because they’ve been loaned to another county.
One of the groups I work with implemented a fatigue management program where they allowed them to assess their sleepiness, and after actually a certain number of [hours] working, they had them actually stay in a hotel and drive home the next day after a good night’s sleep. And that also included obviously counseling on a need for sleep and recognizing it. That’s a big cost to them, but yet they often are driving very expensive rigs, and all it takes is to crash one of those, and there’s a huge expense there, not even considering the human cost.
Rothstein: Pam, you’re so on target with what CIRCADIAN has been doing for 30 years with fatigue risk management training and managing a shift work lifestyle. In that world—not that all companies have embraced it, but they’re certainly aware of it, and certainly there’s a lot of need for improvement—because whether you’re working days or you’re working nights, it’s one of the things historically that companies didn’t look at. They thought it’s one thing when you’re on the job, but what you do on your own time isn’t our concern. I think the research is showing more and more that it very much is a concern because while companies can outsource a lot of things, they can’t outsource an employee’s sleep. A person can’t outsource their own sleep. You can’t say, “Sleep for me.”
You can have people do a lot of things for you, but not sleep, and I think very much what Terry was saying about this being a biological necessity (that being sleep). That this has to be looked at a little differently even for companies who’ve been doing an excellent job at fatigue risk management; they have to start to promote and provide sleep education and training, because you can’t force someone to sleep, to encourage people to improve their sleep habits because that is going to impact how they are when they’re at work, whether it’s day or night.
The other thing that was mentioned earlier, which is so important, is to provide resources for people through their healthcare program, the direction as to how to go for prospective sleep disorder diagnostics and treatment. Some people are in denial about it, they don’t realize what they have is a sleep disorder, but that also from a legal perspective and liability can be difficult for companies. Because if they find out that an employee driving a forklift or a truck has sleep apnea, and the person isn’t compliant with treatment, now whose liability is it? There are a lot of issues that we can’t overlook, but I think the number one thing is the corporate world has to start to take sleep, employees’ sleep, as a very important issue, and as best they can, add it to their training and development. Back to napping, and provide napping spaces with procedures and protocols, but also with sleep education and training.
SR: Excellent roundtable discussion. We covered a lot about the sleep science and shift work. I want to elaborate a little bit on something that you all did talk about: Employers who may be resistant. Some employers would argue that they would accommodate workers who suffer from a sleep disorder, for example narcolepsy, but that they shouldn’t or won’t allow napping for workers who are simply suffering from self-imposed sleep restriction. For example, somebody who does have that teenage daughter who comes home late, and then the parents can’t get their 7 to 9 hours of sleep. How would you respond to this position? Pamela, let’s start with you.
Minkley: It’s a difficult one. One, it’s an investment in the future, in that as their workers get more sleep, you have a safer workplace, you have a more productive workplace, and there is a little easier measurement in manufacturing where you can look at safety violations or injuries. If you look at something, let’s say the banking industry, or a place where it’s primarily paperwork, we know people are going to miss important aspects of contracts, etc, when they’re sleepy. Particularly it’s their looking at documents that they repeatedly look at, so it’s familiar to them. They sometimes will see what’s familiar to them, not something that is out of line and shouldn’t be there.
There will be no doctor called or bleeding when an error occurs there. It may be quite some time down the road when something legal comes up and they find their contract either is invalidated or didn’t contain an important aspect. It’s tough to get companies where they can’t put a number on the improvement and show it where it’s difficult to measure it. You can’t measure the environment and culture in the workplace, which generally improves when the workplace is well slept.
There is a lot of resistance. They don’t often want to experience the cost of education and training for a return on investment that they’re not sure about, in spite of all of the literature. We’re all sure that making sleep a priority is just as important as all of the other plaques they have up for integrity and customer service. It’s a challenge, but I believe you need to, not only in every industry and every job, but every particular place you’re at because the culture is so different. That’s why it’s a worthwhile investment. Sometimes the best opportunity within the workplace is to work with their occupational health people or wherever their safety management or health group is because if you come from that standpoint, they can integrate sleep as we know into every aspect of the other things that they do.
Cralle: I think it’s very difficult to get into self-imposed or volition sleep deprivation. I think that’s a very touchy place to go because it’s not always apparent and it’s not what you think. If you’re up with a crying baby, who’s going to label that self-imposed, or who’s going to make these decisions? I think the return on investment….Let’s put it just in a regular office setting. If you’ve got a tired worker for whatever the reason, you’ve got issues with we’re going to have higher absenteeism. We’re going to have presenteeism, tardiness. These things cost employers around $150 billion a year in lost productivity. And if you can take a worker and provide a nap, and this is what’s so amazing about naps: A 10, 15, or 20 minute map is restorative. And that’s such a small investment of time to bring that worker back up to the level of alertness where they’re going to be safer, smarter, making better decisions, more vigilant. It’s a no brainer to offer that because regardless of the reason they’re sleep deprived whether it’s a sleep disorder, the dog barking next door all night long…who’s to say? Offering just very small increments of time that could be taking the same amount of time to go get a cup of coffee or to go take a smoking break can be spent napping if that’s what the worker needs to have a productive, and effective, and safe day of work.
Minkley: I was thinking of that same aspect, and oftentimes the employer has some reluctance because they are dealing with work issues, but this sort of creeps into what workers do at home and on their off time. I think when we use the term oftentimes “fit for duty,” then it makes it easier to make that transition and that association, that it’s important that when you come to work, you are fit for duty. And if something that is occurring at home, difficulty getting enough sleep because there’s so much activity, whether you have a baby, anything, the ability to counsel people on how to make that work so they are fit for duty tends to sometimes go over better with the administrative folks than just talking about it. There’s hesitance to go into the home and into the off duty time.
Rothstein: What you said is so…You just hit the nail on the head just talking about it. It’s one thing to talk about all this. It’s another thing to take action. Much to both of your points, with my business perspective on all this, I finally said, “You know what? I really need to put this sleep language into corporate management language.” So I wrote an article, The ROI of Good Night’s Sleep, which Sree is going to provide for those of you who are listening along with the link to the podcast. There is a return on investment of a good night’s sleep. I took the seminal research that’s all been done so far.
Companies will say to me, “Well, what’s it going to save us per employee?” I can’t put an exact number on that, but a Harvard study showed that one in four US workers has insomnia, cost being $53 billion in lost productivity. That was that particular study, or about $2,280 per person a year, and that’s just for insomnia. We’re talking today about workplace napping. If these people had the opportunity for two things, first of all, a workplace nap that was condoned and that was encouraged, but at the same time, and I’m back to square one, that they had sleep education and training. That the paradigm shifted and that the company said, “Sleep is very important. In order for you,” as Pam said, “to be fit for duty, you need to come well rested, and we’re going to help you and encourage you to make sure that happens.”
There’s something also that I reference in “The ROI of Good Night’s Sleep,” a number of studies, but one is also the 10 Dangers of a Sleep Deprived Workforce. One of the big things is decision making, and I love what you said, Pam, about it may be months or longer before a company knows that somebody made a mistake in a document that cost them a tremendous amount of money, but looking back, they won’t know it’s the Challenger or another Exxon Valdez where there was something involved with sleep deprivation. Looking back, it very well may be that that error had to do with something, somebody who wasn’t focused because they were so sleepy.
Minkley: Absolutely, and I always think that if you want to put it in everyday terms, look at the research done with the Stanford basketball team where they controlled their sleep, made sure they got enough sleep so they were fit for duty to play, and they improved their free throw percentage, their 3 point percentage, as well as their field goal percentages. Sometimes the research studies are interesting to the corporate people, but when you can find a study that puts it into something that makes real sense to them and that is everyday to them like the Stanford basketball team, then they get hooked a little bit better.
Like I said, every employer, every industry, has this culture, so you have to find what fits for them to get them interested. Sometimes it may be even in order to institute a program like this, it may be challenging the key contacts there to try it. “Try it. You’ll like it Mikey.” You have to take naps and to make sleep a priority, and they find out how bad they really felt working those long hours and then become your advocate.
Rothstein: Sree, I want to go back to the conversation today, which was really about napping at work. I think that all of us are saying, “Napping at work should be condoned, but it needs to be in the framework of policies and procedures appropriate to it,” and per what Pam said, they need to go back and look at existing policies to make sure that there isn’t some stigma already attached with people falling asleep at work. Number 3, I think all three of us are saying that it’s critical that companies provide sleep education and training in conjunction with any napping availability in terms of space, or approving of it, or whatever. Then corporate culture has to really look at this much as, as Terry said in the beginning, along with fitness and nutrition.
I’ve been in major companies where they have fitness rooms, and they even have a massage room, and a Pilates room, and every calorie is counted for everything you can eat in the cafeteria, and there’s not a word about sleep. It has to be looked at as integral to employee well-being and employee performance…in a good way, not in a way that’s, say, demanding for people to sleep more, but saying, “This is really important. We want to support you.”
SR: Exactly, and that actually is the question I’d like to pose to all of you to close. I’ve seen a bit of an evolution with employers understanding sleep science, but I feel like there’s still overwhelmingly a stigma that employees who want to sleep while doing work hours are perhaps stereotyped as lazy. I wanted to ask each of you how you think this stigma or workplace culture might evolve in the next 5 or so years with regard to the importance of sleep. I’d like to ask each of you, so Nancy, will you start on this one?
Rothstein: As I said earlier, I think that the research is ahead of the action in many ways, and I think getting corporations to embrace something new, particularly how people are functioning with respect to their sleep or not functioning with respect to their sleep, out of the office, out of the workplace, no matter whether they’re a day or shift worker. It’s something they didn’t have to think about before. But what’s happening is they are carrying with them how they sleep or don’t sleep to work.
Companies can’t avoid this any longer, and you can say, “Is it the individual’s responsibility, or is it the corporation’s?” I think it’s both, but I also think that a corporation along with the billions of dollars spent on training and development needs to incorporate sleep wellness as part of that. I think over the next 5 years, we are going to see….I think we are seeing already, the beginning of a significant paradigm shift just because companies are sort of, as one article said, “Waking up the workforce.” I think they’re starting to be awakened themselves to say, “This is something we have to deal with,” but I do want to mention one important thing in this regard.
To date, there weren’t a lot of programs and products available for corporations to use. They’re not in the business of sleep education and training, and people like Pam, Terry, and myself have developed services that can help corporations and resources that can help corporations deal with this. As I said, they need to outsource sleep education and training unless they’re already in that business. I think what will help over the next 5 years is availability of resources for companies to actually enact programming.
SR: Excellent. Terry, would you like to weigh in on this question about what we can expect in the next 5 years?
Cralle: I think continued advocacy and honesty about sleep. This messaging I think will help change and drive change in the workplace and at home. We have to be unapologetic about our biological need for sleep. We have to have a culture of transparency. No matter if I’m in the classroom or the workplace, I need to raise my hand and say, “I am too tired to drive here. I am too tired to drive here or do this.” We have to treat sleep differently, treat our need for sleep differently. We have to respect it.
And analogous to the workplace is what we’re doing. We’re making great strides in starting schools later. We’ve started a national initiative across the country, and I was in on the beginning of it years ago, and people would just look at us like we were crazy when we were on Capitol Hill advocating later school start times. People thought we were coddling our children. Now the science has shown us though that sleep is so vital for health, for physical health and psychological health, and the science is astounding, and new things are being discovered quickly, and it’s exciting things.
SR: Excellent, and Pam, please weigh in.
Minkley: I think I’m really optimistic about it. If you pick up the newspaper, walk by the magazine section in a store, or turn on a TV, you literally now can’t go a day without something being in there about sleep and focusing mostly on the effects of not getting enough. I’m optimistic that hopefully sleep and fatigue and performance and safety will become household words. I’m reminded too that going into the off work hours in industry isn’t really new. They all typically have policies against drug and alcohol use. Although those are typically more on the disciplinary side, and we can come from a more positive side with the sleep and fatigue management, and hopefully advocate for having it part of a normal orientation process when they talk about being fit for duty, and including sleep and fatigue, and also approaching it as a family health issue and a benefit that they have training and expertise to help.
On that side, I’m seeing some changes too where with the changes in sleep medicine, people are focusing and getting more education on being able to educate and counsel people, being sleep educators. Because if industry lights up and demands this, we’ve got to, as a profession, make sure we have people adequately trained to provide for counseling them and working with them, and training their employees to have an adequate program in house to take it over. I challenge our own profession to work on that side of it.
SR: Excellent, thank you, and thank you to all of today’s panelists for your insights on napping at work. You can visit sleepreviewmag.com and click on Resources for a transcript of this audio file as well as links to the articles that were mentioned. Thank you so much for listening.