Fatigue

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# Is fatigue a workplace issue? (cont.) ## How can a workplace address fatigue? (cont.) - develop administrative practices such as maximum hours of service, appropriate shift rotation, extended workdays, reducing or eliminating the need to do high risk activities between certain hours (e.g., between the hours of midnight and 6 a.m.), etc. - maintain a consistent work schedule, where possible. - assess physical and mental job demands. - provide appropriate work, where possible. For example, try to offer a variety of tasks that vary in interest and movement throughout the shift. - consider not scheduling any critical or demanding tasks following a time change or when workers have travelled (jet lag). - provide lodging or areas to rest or sleep, where appropriate and necessary - educate and train about fatigue, including recognizing signs and symptoms of fatigue, how to gauge alertness, or steps to help achieve better sleep - provide medical screening for health issues that may affect sleep - provide mental health services, including employee assistance programs (EAP), as needed - include fatigue as a possible factor and related causes of fatigue when investigating incidents For more information, please see the following OSH Answers documents: - Extended Workday: Health & Safety Issues - Rotational Shiftwork - Employee Assistance Programs ## How much sleep do people need? It varies, but on average studies say we need at least 7 to 9 hours every day. Studies have reported that most night shift workers get about 5 to 7 hours less sleep per week than the day shift. (You can accumulate a sleep "debt", but not a surplus.) Humans follow an "internal" or "biological clock" cycle of sleep, wakefulness, and alertness. Although these circadian rhythms are influenced by external clues such as the sun setting and rising, it is the brain that sets your pattern. Most cycles are 23-25 hours long and there are natural dips or periods when you feel tired or less aler…

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# MMH - Health Hazards (cont.) ## What are the immediate health effects of MMH? (cont.) Fatigue is a common and expected effect of MMH. The effort required to perform MMH tasks uses up muscular energy. Where the pace of work is not too high, workers can find enough time between individual tasks to recover their energy, and work can be resumed and continued safely throughout the whole shift. On the other hand, a fast pace of work shortens the time between tasks and does not allow the workers to restore their energy. As a result, workers who try to maintain a fast pace may become increasingly tired as the shift progresses. Even a moderate pace of lifting, not necessarily at the maximum lifting limit, if maintained for a prolonged time without breaks, can decrease the workers' lifting ability by speeding up their fatigue. Fatigue can also contribute to serious injuries to the musculoskeletal system. These injuries can later develop into chronic conditions that can become difficult to treat effectively. Additionally, fatigue decreases workers' alertness, making them more likely to act without due caution. This reduction in alertness, in turn, increases their risk for incidents. ## What are the long-term effects of MMH? More serious issues related to MMH are the long-term health effects, such as chronic back pain. Back pain can result from various causes. The most common causes are strains and cramps in the back muscles. Back pain can also result from tears in the tendons connecting the back muscles to the spine or from sprains and tears in the ligaments interconnecting the vertebrae (bones of the spine). Less frequently, it arises from direct damage to the vertebrae or the discs that separate them. A worker can sustain a back injury from a single episode, such as lifting too heavy a load, slipping and falling, or receiving a blow to the back. However, most often, it is not the single episode that causes back injury. It is the repetition that contributes most to th…

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# Is fatigue a workplace issue? (cont.) - failure to respond to changes in surroundings or information provided, - unable to stay awake (e.g., falling asleep while operating machinery or driving a vehicle), - increased tendency for risk-taking, - reduced physical capacity, - reduced performance, such as a reduced ability to do task or job - increased forgetfulness, - increased errors in judgement, - increased sick time, absenteeism, rate of turnover, - increased medical costs, and - increased incident rates. ## What are some factors that are related to fatigue? Work-related factors may include long work hours, long hours of physical or mental activity, insufficient break time between shifts, changes to jobs or shift rotations, inadequate rest, excessive stress, having multiple jobs, or a combination of these factors. Fatigue is increased by: - dim lighting, - limited visual acuity (i.e., due to weather), - high temperatures, - high noise, - high comfort, - tasks which must be sustained for long periods of time, and work tasks which are long, repetitive, paced, difficult, boring and monotonous. Sometimes, a sleep disorder such as those disorders that may affect the length or effectiveness of sleep, cause extended wakefulness, or cause disruptions to our circadian rhythms may result in fatigue. You should ask your doctor or health professional for more information. These conditions include: - insomnia - sleep apnea - restless legs syndrome Fatigue CCOHS

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# Anti-fatigue Mats (cont.) ## What should be considered first when a person stands all day at work? (cont.) - Changes in working/standing position: Work should be organized so that the worker has some choice about his/her working position and an opportunity to change position frequently. A workplace that includes an optional seat (chair, sit/stand stool) and some kind of footrest increases the variety of body positions and encourages frequent changes between them. - Footwear: Footwear is a factor which, if properly chosen, may further reduce the harmful effects of prolonged standing. There is no doubt that the choice of footwear is an important consideration for people who work on their feet. Shoes should ensure adequate arch and heel support and cushioning while providing comfort to the wearer. - Flooring: The type of flooring used in the workplace has an equally important influence on comfort, especially on tender feet. Hard, unyielding floors, like concrete, are the least comfortable surface to work on. Walking on a hard floor is similar to the impact of a hammer pounding the heel at every step. Wood, cork, carpeting, or rubber - anything that provides some elasticity - is generally gentler on workers' feet. More than that, softer floor coverings reduce fatigue and improve safety by reducing slips and falls on slippery floors. ## When should anti-fatigue mats be used? There are two options to alleviate foot discomfort where resilient floors are not practical. One is footwear with thick insulating soles and shock-absorbing insoles. Anti-fatigue matting is the other option. Anti-fatigue mats absorb the shock due to walking and this cushioning effect reduces foot fatigue. However, the use of matting requires caution because mats can lead to tripping and falling accidents when installed improperly. Another type of floor covering, namely, anti-slip matting, is useful in increasing foot comfort and safety. However, workers may find that their feet burn and fee…

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# Is fatigue a workplace issue? (cont.) ## Prevention If you suspect you may have a medical condition that interferes with your sleep, go to your doctor and have any concerns investigated. ## Sleep Hygiene There is no one way to get a good sleep - what works for one person may not work for another. In general, suggestions include: - Go to bed and get up at the same time every day. - Before a time change, such as daylight savings or travel involving time zones, try to go to bed 15 to 20 minute earlier each night before the change to help your body to adjust. - Exercise regularly. - Eat at regular intervals and consume a balanced diet of fruits, vegetables, whole grains, healthy fats and protein. - Use your bed primarily just for sleeping (e.g., do not watch television, use your electronic devices, read, or do work in bed). - If you are not sleepy, do not try to go to bed. Get up and read or do something quiet instead. - Avoid caffeine, tobacco or alcohol - especially before bed time. - Put your phone on "do not disturb" or turn off the phone ringer. - Ask family members to be respectful if one person is sleeping. Family members can use headphones for the TV and radio if necessary. - Make the room as dark and quiet as possible. Use heavy, dark curtains, blinds, or a sleeping eye mask. Soundproof the room where possible or use ear plugs. - Most people sleep better when the room is cool. Consider using an air conditioner or fan in the summer months. ## What are some tips for "good" eating habits that help encourage sleep? The Dietitians of Canada have made the following recommendations: Establish Regular Eating Times Fatigue CCOHS

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# Is fatigue a workplace issue? (cont.) Signs and symptoms of fatigue can vary, and include: - weariness, - tiredness, - sleepiness, including falling asleep against your will ("micro" sleeps), - irritability, - reduced alertness, concentration and memory, - reduced ability to be productive, - mentally tired, - physically tired, - lack of motivation, - depression, - boredom, - giddiness, - headaches, - loss of appetite, - digestive problems, and - increased susceptibility to illness. What are the effects of fatigue and their relationship to work? Consequences of fatigue can include mental and physical performance, Studies report the effects of fatigue as: - reduced decision making ability or cognitive processing, - reduced ability to do complex planning, - reduced communication skills, - reduced productivity or performance, - reduced alertness, attention and vigilance, - reduced ability to handle stress on the job, - reduced reaction time - both in speed or thought, as well as the ability to react, - loss of memory or the ability to recall details, Fatigue CCOHS

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CCOHS CCHST Canadian Centre for Occupational Health and Safety Centre canadien d'hygiène et de sécurité au travail Safety Hazards # Exoskeletons On this page What are exoskeletons? Are there safety standards for exoskeletons? Are there hazards associated with using exoskeletons? What should be considered for exoskeleton safety? ## What are exoskeletons? Exoskeletons are wearable devices that can enhance, augment, or assist the user's posture, motion, or physical activity. Exoskeletons can reduce muscular stress in frequently affected body regions, such as the lower back or shoulders, and ease operator discomfort and fatigue. More precisely, exoskeletons would work together with the user's physical abilities to: - Reduce biomechanical load on the user's joints, muscles, and soft tissues - reducing risk of musculoskeletal disorders (MSDs) - Reduce the user's metabolic exertion - reducing worker fatigue and risk of overexertion Exoskeleton systems can be divided into two categories, active and passive. Active exoskeletons use force and torque-generating elements such as electric motors, pneumatics, or hydraulics to provide additional strength to the user. Passive exoskeletons use levers, springs, counterbalance forces, and other non- electrical means to support the user's posture or movement. Passive exoskeletons redistribute forces to protect specific body regions. The change in user performance results not from additional physical strength, but from the ability to maintain positions over a longer period (e.g., overhead work). Research on exoskeleton use in the workplace has examined its ability to provide: - Lower back support: to aid manual material handling tasks including lifting, lowering or carrying heavy loads while maintaining a variety of postures. - Upper body or upper extremities support: to aid manual above the shoulders work including sustained postures in forearms and upper arms. Exoskeletons CCOHS

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# Is fatigue a workplace issue? (cont.) ## What are some factors that are related to fatigue? (cont.) narcolepsy Illness, medical conditions, and pharmaceutical products (including over-the-counter medications) can also affect sleep length and sleep quality. For example, substances such as nicotine, caffeine, and alcohol can affect the quality of sleep. Caffeine can remain in the body for about 3 to 7 hours. Alcohol may shorten the time to fall asleep, but it disrupts sleep later in the night. Nicotine also can disrupt sleep and reduce total sleep time. ## Is jet lag or the change to daylight savings related to safety issues? Jet lag is the result of a mismatch between a person's circadian rhythm and the time of day in the new time zone. Similarly, this effect can be felt when there is a hour adjustment when clocks move ahead to daylight savings time. Employers may wish to help minimize the impact of these changes by educating workers about the hazards associated with fatigue, allowing flexible hours for a day or two, scheduling major changes or tasks for a different time, and checking in with workers to determine if they are experiencing any impacts. There are reports of increased incidents when daylight savings time begins (in the spring), especially incidents involving transportation and heavy machinery. There are also reports of increased traffic incidents following the end of day light saving time (the adjustment in the Fall). Factors may include that there is less light (visibility), especially during morning and evening rush hour drives. ## How can a workplace address fatigue? Fatigue can be addressed through the workplace's safety management system, or as a separate fatigue management program. Creation of a program that addresses both workplace and personal factors may include to: - identify the hazards and conduct a risk assessment for factors associated with fatigue - develop and implement the organization's response to when a person is experie…

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# Hand Tool Ergonomics - Workspace Design (cont.) ## How should one design the workstation for precision work? (cont.) - Provide anti-fatigue matting to reduce lower back and leg discomfort and minimize fatigue. - Consider using chairs or stools to allow work in a sitting or standing position. - Where feasible, provide the worker with a tilted workstation. This position reduces the static load on the back and upper body (Figure 1b). - Figure 1b - Use jigs or vices to hold the work object steady and secure at the proper height and position for optimum comfort (Figure 1c). - Figure 1c - Use vices to minimize pinching and gripping forces. ## How should one design the workstation for assembly work? In assembly work, static load, awkward postures and forceful movements are major risk factors for WMSDs. Prolonged standing and the fatigue resulting from it additionally contribute to WMSDs. Use jigs and vices to hold the work object steady at the right height and position for optimum comfort (Figure 2a). Hand Tool Ergonomics - Workspace Design CCOHS

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# Fatigue (cont.) ## What is fatigue? (cont.) - Physical state: - Physiological weakness or degradation - Physically exhausted - Weak - Subjective state: - Tired - Drowsy - Weary - Sleepy - Lethargic ## What are the causes of fatigue? There are many causes related to fatigue, including conditions, disorders, medications, and lifestyle factors. Fatigue can be temporary or chronic (lasting more than six months). Causes of fatigue include: - Situational events such as time change, jet lag, shift work, and extended work hours (overtime) - Disorders or conditions such as insomnia, sleep apnea, or narcolepsy - Use of certain medications or treatments, such as benzodiazepines, antipsychotics, opioids, anticonvulsants, or beta-blockers, over-the-counter drugs (including antihistamines), chemotherapy, etc. - Infections such as mononucleosis, influenza, pneumonia, Lyme disease, etc. - Heart and lung conditions such as heart disease, chronic obstructive pulmonary disease, emphysema, congestive heart failure, etc. - Mental health conditions including depression, anxiety, and post traumatic stress disorder, etc. - Autoimmune disorders including type 1 diabetes, lupus, multiple sclerosis, rheumatoid arthritis, etc. - Other conditions such as hormone imbalances, cancer, chronic fatigue syndrome, etc. Fatigue CCOHS

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CCOHS CCHST Canadian Centre for Occupational Health and Safety Centre canadien d'hygiène et de sécurité au travail # Health Promotion / Wellness / Psychosocial # Fatigue ## On this page <table><tr><th>What is fatigue?</th><th>Is jet lag or the change to daylight</th></tr><tr><td>What are the causes of fatigue?</td><td>savings related to safety issues?</td></tr><tr><td>Is fatigue a workplace issue?</td><td>How can a workplace address fatigue?</td></tr><tr><td>What are the signs of fatigue?</td><td>How much sleep do people need?</td></tr><tr><td>What are the effects of fatigue and their relationship to work?</td><td>How can I get a "better" sleep?</td></tr><tr><td>What are some factors that are related to fatigue?</td><td>What are some tips for "good" eating habits that help encourage sleep?</td></tr></table> ## What is fatigue? In occupational health and safety, there is not a single definition of fatigue. Fatigue is often thought of as the state of feeling very tired, weary or sleepy resulting from various sources such as insufficient sleep, prolonged mental or physical work, or extended periods of stress or anxiety. Boring or repetitive tasks can intensify feelings of fatigue. Fatigue can be described as either acute or chronic. However, fatigue can include mental, physical, or subjective states. For example, as summarized by the CSA Group's report on workplace fatigue, these states include: - Mental state: - Reduced mental capacity - Inattentive - Indecisive Fatigue CCOHS

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# Is fatigue a workplace issue? Everyone should be concerned about the impact of fatigue as it can be considered a form of impairment, making fatigue a workplace hazard. However, fatigue levels are not easily measured or quantified; therefore, it is difficult to isolate the effect of fatigue on incident and injury rates. Workplace factors that may influence fatigue are shift rotation patterns, balanced workloads, timing of tasks and activities, availability of resources, and the workplace environment (e.g., lighting, ventilation, temperature, etc.). However, be sure to consider other factors beyond a lack of sleep including mental fatigue, such as mental workloads, demanding mental activities or stress, long periods of anxiety, or long periods of monotonous tasks, etc. Many studies focus on the amount of sleep required. Some research studies have shown that when workers have slept for less than 5 hours before work or when workers have been awake for more than 16 hours, their chance of making mistakes at work due to fatigue are significantly increased. Research has shown that the number of hours awake can be similar to blood alcohol levels. One study reports the following: - 17 hours awake is equivalent to a blood alcohol content of 0.05 21 hours awake is equivalent to a blood alcohol content of 0.08 (legal limit in Canada) - 24-25 hours awake is equivalent to a blood alcohol content of 0.10 Fatigue is regarded as having an impact on work performance. Government of Alberta, Labour* reports that most incidents occur when people are more likely to want sleep - between midnight and 6 am, and between 1 to 3 pm. Government of Alberta, Labour also reports that fatigue affects people differently but it can increase a worker's hazard exposure by: - reducing mental and physical functioning, - impairing judgement and concentration, - lowering motivation, - slowing reaction time, and - increasing risk-taking behaviour. *Source: Fatigue, Extended Work Hours, a…