BlueHealth Advantage - Managing Fatigue

Managing Fatigue

Managing Fatigue

A Guide to Beating Fatigue...

  • Getting Enough ZZZZZ’s
  • Conquering Insomnia
  • Recognizing Sleep Disorders
  • Overcoming Sleep Apnea
  • Beating Fatigue With Lifestyle
  • Testing Your Sleep Knowledge
  • Assessing Your Sleep IQ
  • Parting Thoughts

Getting Enough ZZZZZ’s

Surviving In A 24/7 World

Getting the right amount of sleep is becoming more difficult in today’s 24/7 world. It seems there just isn’t enough time to accomplish everything life has to offer, or demands. We are expected to work longer and harder than ever before, family demands have increased with all the activities and, of course, who wants to miss the latest video, television show or “surfing the web”.

Unfortunately, we are paying a price for giving up sleep to accomplish more. Experts tell us that we are becoming, as a society, so chronically sleep deprived that we don’t even realize that we are functioning at a lesser level. Irritability is affecting our relationships, fatigue affects our productivity and ability to think clearly and creatively and, importantly, our immune system is negatively impacted by lack of sleep. Even our children, and especially our adolescents, are suffering from our collective “workaholism.” We are teaching ourselves negative sleep habits that may, unfortunately, impact every aspect of our lives.

So, what do we do? First we acknowledge the problem. Then we begin to develop strategies to manage our sleep and our lives. What priority is our health? Must work and play always come first? How do we prioritize so that we maintain our careers and also manage to enjoy life while maintaining health? The purpose of this booklet is to assist you in developing strategies and priorities for a healthy sleep life. Of course, everyone is unique and everyone’s situation is different. Therefore, take the following advice and use it to your advantage. Craft it to fit your needs and situation. Remember the goal is to prioritize your life such that you remain healthy enough to enjoy it.

This booklet will address three critical concerns that prevent healthy sleep: insomnia, sleep disorders and lifestyle.


The first issue that needs to be addressed is Insomnia. Insomnia affects almost everyone at sometime. In fact, insomnia affects approximately 35% of Americans during the course of a year. Insomnia can be the result of other sleep disorders, medical conditions, mental disorders or some other form of stress. Insomnia can be of three types:

  • Transient — lasting less than a month and situational in nature,
  • Short-Term — lasting between one and six months,
  • Chronic — lasting over six months.

Most people experience some form of transient insomnia, usually related to stress or other short-term life issues. Practicing good sleep hygiene will assist a return to more normal sleep patterns. Those experiencing the more chronic forms of insomnia should visit their physician and specifically describe their sleep difficulties. Prior to the physician visit one should be prepared to describe all aspects of the problem and perhaps maintain a sleep diary for about two weeks prior to the visit. Sleep diaries can be obtained through the National Sleep Foundation at Or you can create your own from the example shown in this booklet.

If the insomnia is not caused by another medical condition, the best way to manage the problem is through behavioral methods. Medication may be prescribed; however, this is usually a short-term solution. The behavioral change methods on the following pages represent more lasting solutions to insomnia.

Conquering Insomnia

13 Essential Tips

Used with all forms of insomnia these 13 tips should be the first response to the onset of insomnia. Indeed, these should be the primary tools in dealing with transient insomnia and as a way of preventing insomnia in general.

  • Establish a regular sleep schedule. This sleep schedule should include both bed-time and wake time, whenever possible.
  • Establish a consistent pre-sleep routine. It’s important to do the same things each and every time before you go to sleep—this way, you can establish a routine.
  • Avoid caffeine within 3-4 hours of bedtime. It is best to avoid caffeine altogether from early afternoon on if you are caffeine sensitive.
  • Avoid alcohol near bedtime. While alcohol may make you drowsy, it will disturb overall sleep.
  • Avoid nicotine near bedtime. Nicotine acts as a stimulant to delay sleep while nicotine withdrawal may awaken you later.
  • Eat a light snack—primarily light carbohydrates—prior to bedtime. Being either too full or hungry can disrupt sleep.
  • Create a comfortable sleep environment. Here are some recommendations...dark curtains, white noise, comfortable temperature (cooler is better), comfortable bedclothes and bedding.
  • Stick to your routine while on the road. When traveling take as much of your rou-tine with you as practical.
  • Strive for a bedroom friendly environment. Insomnia, in part, results when we teach ourselves that the bed, or bedroom, is unfriendly —a place to worry. Therefore, don’t use the bedroom for work or worry. Deal with worries prior to bedtime—in a different room. Write down your concerns, consider an action plan and avoid worry while in the bedroom.
  • Get up if you can’t sleep. If you can’t fall asleep within approximately 30 minutes, or wake up early, don’t lie in bed. Get out of bed, go to another room and read or indulge in some other activity that induces sleep. Also, if you have been unable to sleep because of worrying, write down your concerns, and establish an action plan in another room.
  • Move your clock. Turn clocks in your bedroom so they are not viewed from the bed. Checking time can be a barrier to sleep.
  • Facilitate sleep with activities. Exercise or a hot bath, about 2-3 hours prior to bedtime, can help facilitate sleep. However, exercise too close to bedtime stimulates and prevents sleep onset.
  • Practice healthy habits. Having an appropriate exercise program and eating a nutritious diet generally aid in good sleep.

Relaxation Techniques

In addition to these 13 tips, there are other techniques that can be valuable to healthy sleep and general stress reduction. Find a program that works for you and use it automatically. Relaxation tapes, meditation, prayer, are among the many relaxation options for reducing stress and enhancing sleep.

Stimulus Control — For many, the suffering from insomnia is due to stimuli surrounding sleep that causes tension and arousal. The following rules are designed to help re-establish the ability to fall asleep quickly:

  • Go to bed only when sleepy. This will help associate the bed with falling asleep quickly.
  • Use the bed only for sleep.
  • Move to another room if unable to sleep.
  • Awaken at the same time every morning.
  • Do not nap.
  • Get support from professionals and family if you need more help.

Other Methods — If you are still unable to overcome insomnia, it is important to know there are additional steps you can take. However, the following methods should involve the supervision of a health professional:

  • Get counseling to address issues related to stress, depression, anxiety and other similar affective issues.
  • Use medications—whether prescription or over-the-counter should be under the su-pervision of a physician.
  • Restrict sleep—sleep restriction creates shorter sleep latency and encourages less arousals and a deeper sleep. Sleep restriction should be used only under the direction of a health professional.

Recognizing Sleep Disorders

Sleep Disorders

The second topic that needs to be addressed is the diagnosis and treatment of sleep disorders. Sleep disorders are serious medical conditions that require professional diagnosis and treatment. Since there are approximately 80 different sleep disorders, referral to a specialist is often warranted. Sleep apnea, for example, may affect over 18 million Americans and may exacerbate other conditions such as hypertension and cardiovascular disease.

How are these disorders managed? There are a number of treatments depending, of course, on the disorder and its severity. In each instance, however, good lifestyle habits and proper sleep hygiene are helpful. Also, with sleep apnea for example, behavioral changes such as weight management, smoking cessation and alcohol moderation are positive treatment options. Other options include behavioral therapy, medication, Continuous Positive Airway Pressure (CPAP) devices, surgery and even dental appliances. The first action, of course, is a visit to your physician. Be sure and describe all symptoms and bring a sleep diary, if possible. An example is provided for you on the following page. Also, information provided by bed partners may be useful in diagnosing a problem.

“Sleep is the golden chain that ties our health and bodies together.”
—Thomas Dekker, 1572-1632

Overcoming Sleep Apnea

What Causes Sleep Apnea?

Primarily, tissue structure problems in the breathing passage, or airway, result in sleep apnea. When muscles at the base of the tongue and uvula (u-view-la) relax and sag, the airway is blocked. (The uvula is that small piece of tissue hanging down at the back of your mouth). Apnea also can occur in overweight people when excess neck tissue narrows the airway. The sleeper has to work harder to breathe, and these efforts cause snoring and periods of no breathing.

These stopped-breathing episodes occur when the sleeper is unable to breathe in oxy-gen and exhale carbon dioxide, resulting in lowered levels of oxygen in the blood and higher levels of carbon dioxide. This alerts the brain to order the upper airway to reopen, an action known as an “arousal.” Then the sleeper, thrashing about and sometimes choking, struggles back to regular breathing. Throughout, the sleeper is unaware of what’s happening. But he or she certainly feels the consequences the next day, with effects such as general tiredness, loss of concentration, impaired work performance, and even falling asleep on the job or while driving.

Who Is At Risk?

It's estimated that 18 million Americans are affected by sleep apnea. It is most common in males who are middle-aged and overweight. If you or someone in your family has trouble getting a good night's rest, check out this list of sleep apnea indicators:

  • Excessive daytime sleepiness
  • Heavy snoring
  • Age 40-60 (male) and over 50 (female)
  • Overweight
  • Shift worker
  • Smoking and/or alcohol use

The first two are the most significant. Excessive sleepiness shows that something is in-terrupting your sleep, and chronic snoring—especially the loud, explosive kind—also points strongly to sleep apnea, although not everyone who snores is affected. (By the way, if your spouse complains about your snoring, there could be good reason: Snoring noise may be as high as 65 decibels, which is louder than OSHA allows in the workplace!)

Can Sleep Apnea Be Treated?

Yes, indeed. If you or your spouse suspects that you might have the condition, see a doctor for an evaluation. You may be referred to a specialist who can use certain tests to either establish the diagnosis or rule out sleep apnea.

There are effective treatments, including changes in behavior such as losing weight. A weight loss of just 10 percent can reduce the number of apnea events for most patients. It’s also wise to avoid use of alcohol, tobacco, and sleeping pills.

The most widely used effective treatment is Continuous Positive Airway Pressure (CPAP). In this procedure, the patient wears a mask during sleep, and an attached device forces air through the nose. Just enough pressure is used to keep throat tissue from collapsing. Thousands of patients who use CPAP therapy say it has given them their first good night’s sleep in years. There also are surgical treatments available, such as removal of excess tissue from the uvula or other areas. The key thing to remember is if you have symptoms of sleep apnea, check with your doctor without delay.

For More Information...

For more information concerning sleep apnea, be sure to check out The American Sleep Apnea Association’s website. The ASAA is a 501(c)(3) organization dedicated to reducing injury, disability, and death from sleep apnea and to enhancing the well-being of those affected by this common disorder. The ASAA promotes education and awareness, the ASAA A.W.A.K.E. Network of voluntary mutual support groups, research, and continuous improvement of care. As part of its endeavors to increase understanding of sleep apnea, the ASAA fulfills thousands of requests for information from the public each year and answers a multitude of questions about diagnosis and treatment options.

Beating Fatigue With Lifestyle

Essential Lifestyle Tips

As previously mentioned, society puts considerable demands on our time. Unfortunately, many people are forced to choose between these demands and sufficient sleep. Moreover, if you are a shiftworker you are even more at risk. What can be done to ensure that proper and healthy sleep are a part of our lives? The following tips may be useful:

  • Be aware of the issues and the importance of proper sleep. Plenty of information on the subject is available through advocate groups such as the National Sleep Foundation and the American Academy of Sleep Medicine. You can learn more by accessing their websites on the WWW.
  • Share and discuss the information with all members of the family. Not only does this issue impact everyone, including children and especially adolescents, but changes in lifestyle will require the support of the whole family.
  • Make sure you are not suffering from a sleep disorder. If you suspect you may be suffering from a sleep disorder make an appointment with your physician imme-diately. Prior to the appointment utilize the sleep diary and knowledge quiz found in this booklet.
  • Practice good sleep hygiene. The 13 essential tips offered in this booklet should be learned and practiced by every member of the family. Like any other healthy behavior we should learn and implement these good habits early in life.
  • Good general health habits are also important. Proper diet, sufficient exercise, relaxation, routine checkups are all important to healthy sleep as well overall health.
  • Learn to set realistic priorities in life. We can’t do it all, whether it is work, fun or other commitments. Your children will also benefit from learning to prioritize and including health as an important life priority.

Living in today’s complex, fast-paced society presents real challenges to our physical and mental health. Sleep just doesn’t seem to be a priority. However, the paradox is that healthy sleep better equips us for the mental and physical challenges of living in today’s society. To see how well you’re functioning on a daily basis, take the sleep knowledge quiz found on the next page.

Testing Your Sleep Knowledge

Sleep Quiz

  1. Sleep is a time when your body and brain shut down for rest and relaxation.
    True False
  2. If you regularly doze off unintentionally during the day, you may need more than just a good night's sleep.
    True False
  3. If you snore loudly and persistently at night and are sleepy during the day, you may have a sleep disorder.
    True False
  4. Opening the car window or turning the radio up will keep the drowsy driver awake.
    True False
  5. Narcolepsy is a sleep disorder marked by "sleep attacks."
    True False
  6. The primary cause of insomnia is worry.
    True False
  7. One cause of not getting enough sleep is restless legs syndrome.
    True False
  8. The body has a natural ability to adjust to different sleep schedules such as working different shifts or traveling through multiple time zones quickly.
    True False
  9. People need less sleep as they grow older.
    True False
  10. More people doze off at the wheel of a car in the early morning or mid-afternoon than in the evening.
    True False

Assessing Your Sleep IQ

Sleep Quiz...Answered

  1. Sleep is a time when your body and brain shut down for rest and relaxation.
    False. Although it is a time when your body rests and restores its energy levels, sleep is an active state that affects both your physical and mental well-being. Adequate restful sleep, like diet and exercise, is critical to good health. Insufficient restful sleep can result in mental and physical health problems and possibly premature death.
  2. If you regularly doze off unintentionally during the day, you may need more than just a good night's sleep.
    True. Many people doze off unintentionally during the day despite getting their usual night of sleep. This could be a sign of a sleep disorder. Approximately 40 million Americans suffer from sleep disorders, including sleep apnea, insomnia, narcolepsy, and restless legs syndrome. An untreated sleep disorder can reduce your daytime productivity, increase your risk of accidents, and put you at risk for illness and even early death.
  3. If you snore loudly and persistently at night and are sleepy during the day, you may have a sleep disorder.
    True. Persistent loud snoring at night and daytime sleepiness are the main symptoms of a common and serious sleep disorder called sleep apnea. Another symptom is frequent long pauses in breathing during sleep, followed by choking and gasping for breath. People with sleep apnea don't get enough restful sleep, and their daytime performance is often seriously affected. Sleep apnea may also lead to hypertension, heart disease, heart attack, and stroke. However, it can be treated, and the sleep apnea patient can live a normal life.
  4. Opening the car window or turning the radio up will keep the drowsy driver awake.
    False. Opening the car window or turning the radio up may arouse a drowsy driver briefly, but this won't keep that person alert behind the wheel. Even mild drowsiness is enough to reduce concentration and reaction time. The sleep-deprived driver may nod off for a couple of seconds at a time without even knowing it—enough time to kill themselves or someone else. It has been estimated that drowsy driving may account for an average of 56,000 reported accidents each year—claiming over 1,500 lives.
  5. Narcolepsy is a sleep disorder marked by "sleep attacks."
    True. People with narcolepsy fall asleep uncontrollably—at any time of the day, in all types of situations—regardless of the amount or quality of sleep they've had the night before. Narcolepsy is characterized by these "sleep attacks," as well as by daytime sleepiness, episodes of muscle weakness or paralysis, and disrupted nighttime sleep. Although there is no known cure, medications and behavioral treatments can control symptoms, and people with narcolepsy can live normal lives.
  6. The primary cause of insomnia is worry.
    False. Insomnia has many different causes, including physical and mental conditions and stress. Insomnia is the perception that you don't get enough sleep because you can't fall asleep or stay asleep or get back to sleep once you've awakened during the night. It affects people of all ages, usually for just an occasional night or two, but sometimes for weeks, months, or even years. Because insomnia can become a chronic problem, it is important to get it diagnosed and treated if it persists for more than a month.
  7. One cause of not getting enough sleep is restless legs syndrome.
    True. Restless legs syndrome (RLS) is a medical condition distinguished by tingling sensations in the legs—and sometimes the arms—while sitting or lying still, especially at bedtime. The person with RLS needs to constantly stretch or move the legs to try to relieve these uncomfortable or painful symptoms. As a result, he or she has difficulty falling asleep or staying asleep and usually feels extremely sleepy and unable to function fully during the day. Good sleep habits and medication can help the person with RLS.
  8. The body has a natural ability to adjust to different sleep schedules such as working different shifts or traveling through multiple time zones quickly.
    False. The human body's biological clock programs each person to feel sleepy during the nighttime hours and to be active during the daylight hours. So people who work the night shift and try to sleep during the day are constantly fighting their biological clocks. This puts them at risk of error and accident at work and of disturbed sleep. The same is true for people who travel through multiple time zones quickly; they get "jet lag" because they cannot maintain a regular sleep/wake schedule. Sleeping during the day in a dark, quiet bedroom and getting exposure to sufficient bright light at the right time can help improve daytime alertness.
  9. People need less sleep as they grow older.
    False. As we get older, we don't need less sleep, but we often get less sleep. That's because our ability to sleep for long periods of time and to get into the deep restful stages of sleep decrease with age. Older people have more fragile sleep and are more easily disturbed by light, noise, and pain. They also may have medical conditions that contribute to sleep problems. Going to bed at the same time every night and getting up at the same time every morning, getting exposure to natural outdoor light during the day, and sleeping in a cool, dark, quiet place at night may help.
  10. More people doze off at the wheel of a car in the early morning or mid-afternoon than in the evening.
    True. Our bodies are programmed by our biological clock to experience two natural pe-riods of sleepiness during the 24-hour day, regardless of the amount of sleep we've had in the previous 24 hours. The primary period is between about midnight and 7:00 a.m. A second period of less intense sleepiness is in the mid-afternoon, between about 1:00 and 3:00. This means that we are more at risk of falling asleep at the wheel at these times than in the evening—especially if we haven't been getting enough sleep.
“Laugh and the world laughs with you, snore and you sleep alone.”
—Anthony Burgess, 1917-1993

Parting Thoughts...

When Attempting to Sleep Following The Night Shift:

  • Experiment with different sleep times. Keep a written log.
  • Experiment with different sleep period lengths. For example, find out if one long period is better for you than two shorter sleep periods for overall rest.
  • Consolidate to one sleep period, as early as possible after work. This is considered optimum, however, individual differences must be considered.
  • Use the afternoon “circadian dip” (period of sleepiness) as a nap opportunity to either supplement sleep or to prepare for night shift work.
  • Try to set a goal of obtaining the same amount of daytime sleep, as you would normally need when sleeping at night.

When Switching Back to Days:

  • Get most of your sleep on the night following your last night shift. Daytime sleep should be just enough for recovery purposes. For example, on the day off following your last night shift, minimize daytime sleep and focus on that night for the main sleep period.
  • Maintain the same pre-sleep routine—no matter what time of day you sleep.
  • Exercise daily, when possible, and eat a balanced diet. Heaviest meals should be after arising from the main sleep period with subsequent lighter meals. A light snack of carbohydrates is appropriate prior to sleep. Avoid caffeine, alcohol and nicotine within three hours of bedtime.
  • Develop a pre-sleep relaxation routine. This is based on individual preference. For ex-ample, some people use muscle tensing and relaxing techniques while others use re-laxation tapes, prayer, meditation, etc.
  • Try to avoid bright light during brief awakenings (such as trips to the bathroom). Light is an alerting mechanism that could disrupt subsequent sleep.
  • Get into the sunlight (or other bright light) early in the day. This will help reset your circadian clock to normal and may help nighttime sleep. Similarly, on days you work the night shift sunlight (or other bright light) late in the day may help alert you prior to work.
  • Discuss with your physician potential sleep disorders and/or the potential use of medi-cation. Even over-the-counter products should be discussed with your physician.

Alertness Management

HHonor sleep and wake times whenever possible.
OObtain at least two nights of adequate rest before going into a work period where you may not get adequate rest.
WWhen the going gets rough the wise get rest. Sleep during stressful times is essential.
TTailor your sleep environment. Make your sleep space dark, quiet and warm.
OObey your body signs. If you are feeling tired or groggy review your personal lifestyle habits.
SStress management is essential. A variety of stress relieving techniques can help you effectively manage fatigue.
TTell others your plans for sleep and work. Proper planning with family members can alleviate unscheduled disturbances.
AAvoid watching the clock while sleeping (turn clock away from you or set two alarms to reduce worrying).
YYour lifestyle (exercise, nutrition, stress, smoking status) and other aspects of your personal health affects your alertness and quality of sleep.
AAvoid too much sugar and caffeine before going to bed.
LLimit fluid intake two hours prior to sleep time.
EExercise on a regular basis to help maintain a healthy lifestyle and enhance the quality of sleep.
RRaise awareness with family members on the importance of sleep.
TTake time to eat right. Healthy eating is a huge step in managing fatigue.

10 Good Sleep Habits

In managing fatigue and staying alert, good sleep habits are essential. The following 10 recommended sleep habits are suggested.

  1. Keep regular sleep/wake times when possible.
  2. Develop and use a regular pre-sleep routine.
  3. Protect sleep time; minimize other demands.
  4. Avoid work/worry in the bedroom.
  5. Eat a light snack if needed.
  6. Maintain a dark, quiet environment.
  7. Regulate temperature for comfort.
  8. Obtain a comfortable sleep surface.
  9. Use relaxation techniques.
  10. After 30 minutes of tossing and turning, get out of bed until sleepy.

Managing Fatigue: A Guide To Beating Fatigue

Much of the information contained in this guide was submitted by Dr. Dennis Holland at Union Pacific Railroad and used by permission. All content is based on the best health information available and has been reviewed for accuracy. It is not intended to replace the advice of your healthcare provider. If you have any questions about managing your own health and/or seeking medical care, please contact a medical professional.

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