Union reps, trainers, and human behavior experts who have been campaigning to get police fatigue recognized and addressed as a critical professional and public safety problem have been given an armory of ammunition for their battle by a comprehensive and complex new study of cops and sleeping disorders.
A team of 13 sleep specialists, headed by Dr. Shantha Rajaratnam of the Sleep Medicine Division at Boston’s Brigham and Women’s Hospital in Boston, surveyed a broad range of nearly 5,000 U.S. and Canadian LEOs through online questionnaires or on-site screening and found that:
• 46% had “nodded off or fallen asleep while driving”;
• over one-quarter reported that this occurs 1 to 2 times a month and more than 6% said they typically fell asleep at the wheel at least 1 to 2 times a week;
• over 40% tested positive for 1 or more sleep disorders, most commonly (33.6%) obstructive sleep apnea (OSA), a potentially fatal affliction that causes the airway to close, leaving the victim choking or gasping for breath.
• by 1 screening method, more than half (53.9%) of officers working nights tested positive for shift-work disorder, which involves excessive wake-time sleepiness, moderate to severe insomnia, and repeated awakening during a sleep cycle.
• In most cases, the disorders, which also included restless-legs syndrome and narcolepsy with sudden muscular weakness, had not been previously diagnosed nor treated.
During 2 years of monthly follow-up monitoring, those identified with specific sleep disorders revealed significantly higher incidences of:
• important administrative errors;
• falling asleep while driving and during meetings;
• fatigue-related safety errors or violations;
• uncontrolled anger toward suspects or citizens while on the job;
• citizen complaints;
• frequent absenteeism; and
• mental and physical health problems, including depression, occupational burnout or emotional exhaustion, and increased likelihood of cardiovascular disease, gastrointestinal problems, anxiety disorder, and diabetes.
“Two hundred eighty-seven participants reported being in a motor vehicle crash during the follow-up period,” the researchers report. Not surprisingly, crashes occurred more often among those who reported falling asleep while driving.
In some categories, cops with sleep disorders were more than twice as likely to experience negative consequences than sounder sleepers.
“We have great treatments for sleep disorders, we have great screening tools, the technology is there,” said Dr. Michael Grandner of the University of Pennsylvania Center for Sleep and Circadian Neurobiology in an interview about the study by Reuters Health news service.
Sleep apnea, for example, can be treated with a breathing machine and mask used while sleeping, and insomnia, another common police complaint, often responds successfully to behavioral therapy.
But in law enforcement, as in much of society generally, there’s a “cultural attitude [that] sleep is for the weak,” Grandner observed. “When you’re in an environment where signs of weakness are particularly discouraged, there may be a social pressure to not address sleep problems or to shrug them off.”
Which, he pointed out, leaves not only sleep-impaired officers endangered but the public as a whole at risk because of the adverse effect of fatigue on tired cops’ decision-making and performance.
A brief abstract of the study is available free at: http://jama.ama-assn.org/content/306/23/2567.abstract. The full 12-page report, “Sleep Disorders, Health, and Safety in Police Officers,” which appears in the Journal of the American Medical Assn. (JAMA), can be ordered for a fee at that site.
Of the officers participating, most were male and white, averaging about 39 years of age and nearly 13 years on the job. More than two-thirds were patrol officers who worked predominately for municipal, county, and state agencies. About 25% were assigned to rotating shifts, with nearly 60% working at least some nights. Nearly a third (31.3%) worked shifts of 11-13 hours and a noticeable minority (14.5%) put in 14-16 hours per tour. Second jobs were reported by roughly 1 in 5.
The vast majority (94%) thought themselves to be in good to excellent health, although a great many (79%) were overweight. “Given that obesity is a major risk factor for OSA…the high prevalence” of that disorder among the study pool “could be anticipated,” the researchers noted.
Interestingly, a block of study participants came from the Massachusetts State Police, and those subjects showed a lower prevalence of OSA and a lower mean body mass index when compared to another bloc of officers from a major U.S. metropolitan PD.
Among factors that might have caused the differences, the researchers suggest, are a departmental fitness program by the State Police that “provides fitness facilities and the opportunity to exercise at all stations during paid work time,” plus an emphasis on regular physical fitness tests as a part of that agency’s job performance standards and bonus system.
“It’s an impressive program and perhaps a model for the nation,” one of the researchers told a reporter.
In commenting on its findings, the study team offers several important observations:
• Almost 90% of North American cops “regard drowsy driving to be as dangerous as drunk driving” and vehicle accidents are known to constitute a significant percentage of line-of-duty deaths. Yet excessive sleepiness at the wheel is “common in police officers.” The risk of a vehicle crash is heightened 2- to 3-fold among individuals with OSA, the most common sleep disorder discovered in the study.
• The increased frequency of “actual and near-miss administrative errors and safety violations” among officers with sleep disorders should be considered in this context: “The loss of even 2 hours of nightly sleep for 1 week is associated with decrements in performance comparable with those seen after 24 hours of continuous wakefulness…. [L]ong work hours are also associated with decrements in performance and attentional failures.”
• Uncontrolled anger toward suspects and citizens, as well as increased complaints reported against officers with sleep disorders, may be tied to changes in the brain’s amygdala that make sleep-deprived individuals less able to “appropriately govern behavioral responses to negative emotional stimuli.”
• Otherwise healthy individuals “scheduled to eat and sleep out of phase from their habitual times,” such as rotating shift workers, tend to experience higher rates of “impaired cardiometabolic responses,” which may “at least in part explain the increased risk of cardiovascular disease and diabetes” among shift-work officers.
• Depression associated with OSA and insomnia may be a factor of “significant implications” in the risk of suicide among LEOs.
More research is needed to explore the subtleties of sleep deprivation in public safety workers, the study concludes. But a pertinent question right now, notes a JAMA editorial, is “what police departments will do with [the] new information” this study already conveys.
Suggestions include on-the-job screening for sleep disorders, restraints on overtime and extra-long shifts, and mandates to assure that officers with sleep problems get help. Officers would have “a much better time doing their job if we were able to take better care of them,” says Dr. Grandner.
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