The Steep Cost of Toxic Sleep Cultures

by Dr. Aaron Halliday

As a species that’s virtually obsessed with shorter load-times, fewer delays, life-hacking and enhancements to productivity the overwhelming majority of us are falling victim to a somewhat ironic but truly catastrophic error in judgement when it comes to our understanding of the dynamics between work and sleep. In 2012 the World Health Organization announced the world was in the midst of a global sleep deprivation epidemic and although this announcement and associated concerns have been echoed by scientists and evidence-based practitioners little is being done to ameliorate the disastrous effects that a sleep deprived population is having on experiencing individuals, organizations, and societies. People aren’t getting enough sleep, it’s causing terminal illness, obesity, long-term cognitive impairment, a degradation in functional ability, driving reductions to work engagement and productivity and this all equates to substantial financial losses to all community stakeholders. It impedes customer satisfaction, degrades employee performance and satisfaction, costs organizations and the economies millions of dollars every year and strips individuals of their health, wellness, and in some cases, their lives.

The findings are both consistent and grim. Humans are designed to optimally function with somewhere between 7 and 9 hours of active resting sleep per day. This doesn’t include the time you spend in bed thinking about what you’re going to do tomorrow or the time you spend tossing and turning to get comfortable. Active resting sleep refers exclusively to the time you actually spend asleep. Reducing this time to just 6 and a half hours and your performance begins to become stunted and your health begins to wane in a myriad of ways. However, surviving on a meagre 6 and a-half hours of daily sleep is both a reality and a routine way of life for most. Americans sleep an average of 6 hours and 31 minutes a day and one out of every three people globally sleep approximately 6 hours or less. And although many of us are painfully aware of our sleep deprivation, shuffling staggered-steps through our morning commute like zombies, an abundance of us don’t even realize our sleep deprivation, the impairment or the costs associated with it because the human species is not actually very accurate in assessing their own personal sleep deprivation and associated functional impairment. In fact, accuracy overall decreases with sleep deprivation.

Many of you may already be debating the source of this problem, whether or not organizations and workplaces contribute to it and may even be contesting that the responsibilities of health lie within the individual rather than broader entities. Both points are fair to constructively debate. However, I want to provide you with a few concrete examples derived from my scientific readings where I think it is entirely within the domain of responsibility and power of organizations and communities to make improvements. In “Weapons of Math Destruction” Harvard Doctor of Mathematics and ML & AI consultant Cathy O’Neil describes the sources and consequences of the inane practice of clopening. To “clopen”, if you will - is to be scheduled to both close a business location at night and then immediately return a few hours later to reopen the same business in the morning.

One barista recently told their experience of clopening on a public form as follows: “If [your workplace] closes at 10 pm and opens at 5 pm, that means you get out of there at 10:30 and have to open at 4:30; there's a 6 hour period between your shifts. You have to drive home and back, you hopefully shower at some point, and if you're anything like me, you have to unwind for a half hour before bed or else you're tossing and turning. Now you're down to between 4 1/2 - 5 hours tops to sleep between shifts. Those are the basics, but it sounds like maybe you're enough of a machine that you run on 5 hours of sleep. …[it’s] a very demanding job. As a shift, you've got 5-10 people who came in at different times that you need to break/lunch while pushing what are called "clean plays" to stop the store from looking like shit, but you're already given a skeleton crew that can barely maintain the less than 50 second drive times corporate expects from you, so something is going to suffer. Unfortunately, in my experience, this is almost always my shifts. They skip their own breaks and lunches no matter how much I try to tell them it's not fucking cool and even illegal, because [many employers don't] give them enough time/labour to finish all of the shit they're expected to do.”

Some of you may be thinking, “that’s what you should expect if you’re working for minimum wage.” However, in reality this toxic, calculated and deliberate sacrifice of sleep for time-on-task is pervasive in the working world. Consider what the average medical resident experiences on 30-hour shifts. Despite what they would argue with regards to continuance and consistency in patient care, this norm actually came into place because Johns Hopkins happened to idolize a cocaine-addicted professor of surgery so much that that he and teaching doctors everywhere tried to replicate his legendary ability to work for inhuman hours with boundless energy. 30 hour resident shifts became commonplace both locally, in the United States, and internationally and an uninformed trusting acceptance of tired and overworked doctors washed over the public as a result. Generally speaking, people trust their doctors. However, at least when it comes to teaching medicine, there appears to be some ignorance amongst the medical community when it came to sleep. As sleep neuroscientist and author of “Why We Sleep: Unlocking the Power of Sleep and Dreams” Matthew Walker PhD reports doctors themselves only receive about 2 hours of sleep education in their entire medical curriculum (the overwhelming abundance of general society receiving none) and it seems to be responsible for inefficiencies that could cost lives. If your surgeon has had 6 hours of sleep or less they are 117% more likely (than well rested surgeons) to commit major surgical errors (e.g., organ damage, hemorrhaging). Residents working a 30-hour shift are also 460% more likely to make diagnostic errors in the intensive care unit relative to when they’re working 16-hour shifts. Patient care is just the tip of the iceberg as sleep deprived doctors themselves are also at risk as research indicates they are also significantly more likely to get into a car accident after these long shifts then when they are not. Matthew Walker describes the situation with refreshing candour “… You would never accept treatment from a doctor who started looking at your child who’s sick with appendicitis at 3:00AM in the morning, who then swigs some whiskey and says ‘yeah, I’m gonna do the operation. It’s fine.’ You would… You would go ballistic… After 20 hours of being awake you are as impaired as you would be if you were legally drunk… One in five medical residents will make a serious medical error due to insufficient sleep. One in twenty medical residents will kill a patient because of a fatigue related error.” These numbers add up in a number of ways. People are dying, medical residents are being treated inhumanely by these misguided practices that are classically reflective of a toxic sleep culture, and hospitals are risking millions in legal fees.

From doctors and baristas to lawyers and hotel workers - people are literally working themselves to death for mere illusory gains. Chronic sleep deprivation is linked to degradation of your DNA, and a wide array of health problems stemming from scrambled biological processes and compromised biological functioning. Your body compromises for a lack of sleep by shifting hormone levels and reducing non-essential biological systems. For example, the ratio of your ghrelin and leptin hormones shifts causing you to gain weight. Similarly, your immune system rapidly degrades and you are less able to fend off common illnesses like the flu and more severe illnesses like cancer and heart disease. Even if you discount the costs associated with having a sick and ailing workforce that you may have to replenish more frequently with new employees, organizations often pay for a portion of all healthcare costs and these costs aren’t cheap.

The world is increasingly transitioning to a knowledge and service based economy and as we progress through this transition it’s similarly increasingly difficult to provide a substantiated arguments for the up-side of refusing to allow people to go home and sleep when they require rest and allow them to come to work refreshed and able to perform at their maximum ability when they are on task. Organizations that needlessly demand their people work for long hours or during peculiar sleep disturbing shifts (like those of medical residents and service workers) are burning out their people and diminishing their maximum possible return from these individuals over time. Estimates indicate that sleep deprivation costs organizations on average between approximately $2000 and $3500 per employee per year. This adds up to a cumulative $54 million in annual losses to organizations.

It’s also incredibly peculiar that organizations would go to all the trouble of engaging in common contemporary business practices designed to source and hire talent that’s engaged, conscientious, socially adept, intelligent, proficient and able to problem solve only to undo all the hard work and spent resources by making them so tired that these benefits are all being negated. This isn’t to suggest that every workplace should adopt flex-time schedules and fill rooms with nap-pods, obviously, I fully recognize that for some occupations and industries these just aren’t viable options. But to force everyone - even those whose work doesn’t require them to be tied to fixed places or precisely regulated schedules - into a work structure that impedes them from performing at their maximum would be like shooting yourself in the foot. If you’re operating with a toxic sleep culture that promotes the sacrifice of sleep and health for time-on-task and the only reason why is “because we’ve always done it this way”, perhaps it’s time to consider some alternatives. If the only reason you are hesitant is because fixed regular schedules are the only way you can monitor whether or not your people “working” (by acknowledging their physical presence in the workplace) then you may need to consider and work on the sources of distrust that exists within your workplace to begin with. Monitoring them in this way often tells you nothing about them actually performing their work even at a minimum level of performance. Forcing people into senseless, unproductive work schedules and depriving them of sleep and thereby compromising their health and reducing their productive capacities only slows their progress and stunts the quality of their work they can produce. It all seems far too similar to the Greek tail of Sisyphus condemned to roll a boulder up-hill for all eternity. People are rightfully being asked by their managers to do their best and whether intentional or not, organizations with toxic sleep cultures (cultures that pride or mandate that employees sacrifice their sleep to maintain their position or advance within the organization) then subsequently strip their people of the very fuel required to achieve timely success. Sleep scientist Matthew Walker describes a toxic sleep-work cycle where people only have so much they can give and due to the lack of functional capability that these individuals have, they often fall more behind. People then push back their sleep even further to catch up on lost work and the cycle perpetuates itself. Framed in the context of a growing body of sleep research, it come as no surprise that we are in the midst of a work engagement epidemic. Gallup’s 2017 State of the American Workplace Study reports that 51% of employees are punching in only to be persistently disengaged and “checked out” of their work, whereas another 16% of employees are actively disengaging from their work. An engagement epidemic seems like the most natural evident symptom of a sleep deprivation epidemic rooted in a culture that dismisses sleep as though it weren’t a functional requirement for promoting health and overall recovery.

Sleep isn’t just a functional requirement for health, it rejuvenates us which is why when we are sleep deprived research also shows that people:

• Give less effort and are less productive
• Are less able to acquire new knowledge and retain it
• Are exhausted much more quickly than when fully slept – time to exhaustion decreases by 30% when rested vs. when sleep deprived
• Are more likely to be physically injured (a 60% increase when contrasting 9 hours vs. 5 hours of sleep)
• Are more unsatisfied with their work
• Are less motivated and proactive
• Are less creative and able to problem solve
• Are more likely to ride the coat-tails of team members and generally perform worse in work groups
• Are likely to behave more unethically (e.g., are more likely to steal, lie, take credit for good work that isn’t theirs and blame others for their own mistakes)

Matthew Walker also reports that if all the associated costs tied to sleep deprivation weren’t high enough, things are likely to be further compounded when leaders don’t get enough sleep. The cycle begins to escalate eliciting bigger costs and driving the cycle even deeper. Sleep deprived leaders are less persuasive, motivating, able to self-regulate, and are more likely to be abusive of their subordinates. It’s easy to imagine how subordinates of a sleep-deprived leader in an organization with a toxic sleep culture would, on top of all the regularly occurring effects of sleep-deprivation, also experience a great deal of frustration, supervisor-related stress and job dissatisfaction – each of which are known perpetuators of poor sleep health on their own. None of this is to even remotely factor into the equation the steep costs to individuals and organizations tied to mental and physical illness that are perpetuated by sleep deprivation. Given that organizations on average are responsible for up to 20% of all healthcare costs and that mental illnesses like anxiety and depression are on track to be the leading cause of disability worldwide – these aren’t small considerations. Simply ensuring that your people to get the rest they require to maximally recover and to optimally perform isn’t just a form of advocacy for workplace wellness and human rights, it’s also fiscally prudent. Illness prevention is consistently and repeatedly demonstrated to return dramatically higher return on investment than illness treatment. Organizations know this about wellness generally speaking they tend to be prioritizing wellness efforts on many fronts, they have just yet to apply these ideas to sleep health and organizational sleep cultures.

Societies also suffer as societies and institutions (like education systems in the West) that adhere to poor sleep cultures cost dollars and lives. The brass tax of it all is that 2% of GDP is lost due to the results of sleep deprivation. Early school start times and traditional mandated adherence to cultural phenomena like daylight savings time are responsible for dramatic increases in accidents and life-threatening injury. There are things that governments and institutions (like academia) can do to improve the health and safety of their people while bolstering their economy, even if organizations happen to be slow to change. Starting school at a later hour to accommodate student's natural sleep and wake patterns and abandoning daylight savings time are just a few to start.

We need an updated scientifically informed but rational approach to sleep. We need to reform or abandon broken scheduling software that promotes poor sleep health of your valued people. We need to actively work to dissolve and replace toxic organizational and societal sleep cultures with new norms, symbols, stories and traditions oriented towards holistic health that includes sleep. We need to promote and educate people about good and bad personal habits that impact their health and support and facilitate effective lasting change with those who seek to improve their lives. We need to recognize that people have lives and needs when they are off the clock and to respect those boundaries and recognize the large costs that are attributed to failing to do so. Meta-analyses indicate that there are many approaches that organizations can take to improve the sleep health of their people. For example, research indicates that promoting psycho-social work variables like social support at work, perceived control and autonomy, and organizational justice and mitigating or reducing high work demands, reducing job strain, and bullying helps to promote the sleep health of organizational members. There is substantial evidence indicating that adequately rewarding people for their work goes a long way toward improving sleep health. Finally, research indicates that steps can be taken to improve scheduling of workers, broadly speaking, that improve the sleep health of individuals and thus the sleep culture of organizations. Even under constrained circumstances there are simple steps you can take to resolve this problem. We just have to prioritize it.

References - For those who wish to learn more, straight from the source

Walker, M. (2017). Why we sleep : Unlocking the power of sleep and dreams. New York, NY: Scribner, an imprint of Simon & Schuster.

Rogan, J. & Walker, M. (2018). Joe Rogan Experience #1109 - Matthew Walker.

O'Neil, C. (2018). Weapons of math destruction: How big data increases inequality and threatens democracy. London: Penguin Books.

Irwin, M. R., Olmstead, R., & Carroll, J. E. (2016). Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation. Biological Psychiatry, 80(1), 40-52. doi:10.1016/j.biopsych.2015.05.014

Lo, J., Cheng, G., Loh, K., Leong, R., & Chee, M. (2015). Associations between self-reported sleep duration and cognitive performance in older adults: A systematic review and meta-analysis. Sleep Medicine, 16. doi:10.1016/j.sleep.2015.02.078

Uehli, K., Mehta, A. J., Miedinger, D., Hug, K., Schindler, C., Holsboer-Trachsler, E., . . . Künzli, N. (2014). Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Medicine Reviews, 18(1), 61-73. doi:10.1016/j.smrv.2013.01.004

Linton, S. J., Kecklund, G., Franklin, K. A., Leissner, L. C., Sivertsen, B., Lindberg, E., . . . Hall, C. (2015). The effect of the work environment on future sleep disturbances: A systematic review. Sleep Medicine Reviews, 23, 10-19. doi:10.1016/j.smrv.2014.10.010

Ota, A., Masue, T., Yasuda, N., Tsutsumi, A., Mino, Y., Ohara, H., & Ono, Y. (2009). Psychosocial job characteristics and insomnia: A prospective cohort study using the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) job stress models. Sleep Medicine, 10(10), 1112-1117. doi:10.1016/j.sleep.2009.03.005

Christian, M. S., & Ellis, A. P. (2011). Examining the Effects of Sleep Deprivation on Workplace Deviance: A Self-Regulatory Perspective. Academy of Management Journal, 54(5), 913-934. doi:10.5465/amj.2010.0179

Supplemental Material for The Relationship Between Sleep and Work: A Meta-Analysis. (2016). Journal of Applied Psychology. doi:10.1037/apl0000169.supp

Mansbach, A., & Cortés, R. (2011). Go the fuck to sleep. Edinburgh: Canongate.