How Sleep Loss Costs Lives and Costs Companies
The COVID-19 pandemic and related lifestyle changes triggered a significant drop in road traffic across the United States in 2020, but that does not mean U.S. road travel was safer. Prior to 2020, road safety had significantly increased, and at the beginning of 2020 the number of vehicle miles traveled (VMT) was the same as the previous year, with a comparative decrease in March and April. But by the end of 2020, there were 38,824 lives lost due to motor vehicle traffic collisions on U.S. roads, in spite of the reduced traffic.
“This is the largest number of fatalities since 2007,” the National Highway Traffic Safety Administration (NHTSA) said in its report Overview of Motor Vehicle Crashes in 2020. “It also represents a 6.8-percent increase from 36,355 fatalities in 2019, or 2,469 more people killed in traffic crashes in 2020.”
Along with an increase in fatal crashes, the NHTSA also found that in these deadly crashes there was an increase in deaths where the driver was speeding, under the influence of alcohol, or someone in the car did not use his or her seatbelt. And while traffic fatalities occurring during the day only increased by 1.4 percent, nighttime fatalities jumped by 12 percent.
This trend has apparently continued past 2020, with road fatalities in 2022 estimated to be 18 percent greater than what they were in 2019, according to preliminary data from the NHTSA.
Along with speeding or driving while under the influence of drugs or alcohol, fatigue is another dangerous element that can contribute to a fatal collision.
In 2020, police reports indicated that 633 deaths resulting from a vehicle collision involved drowsy driving, according to the U.S. Centers for Disease Control and Prevention (CDC). “However, these numbers are underestimated, and over 6,000 fatal crashes each year may involve a drowsy driver,” the CDC says.
The number of fatal crashes each year in the United States that may involve a drowsy driver.
Getting a precise number on the scope of the issue is difficult because there are not always clear-cut signs after a crash that the driver fell asleep at the wheel. Agencies like the CDC and NHTSA rely on hospital and police reports to determine if a crash occurred because of fatigue.
But often, there are three common aspects of a crash that indicate drowsy driving was involved. These collisions tend to occur at night, either in the late afternoon or between midnight and 6 a.m. “At both times of the day, people experience dips in their circadian rhythm—the human body’s internal clock that regulates sleep,” according to the NHTSA.
More often than not, there’s only one person in the car, and there are usually no signs of brake use. These crashes also tend to occur either on highways or rural roads.
“We do know that driving fatigued is related to how much good sleep you get,” says Ryan Pietzsch, a subject matter expert on driver safety for the National Safety Council (NSC). Similar to other research into the issue, NSC’s own data indicates that a driver is three times more likely to be involved in a motor vehicle crash if he or she is fatigued, according to Pietzsch.
The Cost of Fatigue
A lot of these drowsy drivers are workers who are simply trying to get from point A to point B. The NSC estimates that more than 43 percent of workers are sleep-deprived, and the workers who face the greatest risk of sleep deprivation or fatigue are third-shift workers—those working the night shift—or employees working longer or irregular shifts.
Whether they know it or not, employers and organizations are already experiencing losses when their workforce is overtired. The NSC estimates that fatigued employees are less productive, resulting in approximately $1,200 to $3,100 in losses per employee every year. The average U.S. employer responsible for about 1,000 workers should expect an annual loss of $1 million thanks to fatigue—with $272,000 attributed to absenteeism and $776,000 because of presenteeism (where an employee is at the job but not fully functioning).
And the consequences can be even greater when it comes to employees who are required to remain vigilant as part of the job—whether it’s when someone is at the wheel of a vehicle or part of a security team. “These are going to be issues for you no matter what. So, if you address them, then you’re the one who gets the advantage. If you don’t, then you’re the one that’s at the disadvantage,” says Mark Rosekind, former administrator of the NHTSA.
“I can tell you the worst thing is when crashes actually happen, and lives are lost or people get injured. That’s a huge cost in a whole bunch of different areas,” adds Rosekind, who was also a board member at the National Transportation Safety Board (NTSB). “I can almost guarantee that if you’re a 24/7 operation, it’s very likely already happened to you and been misattributed to something else.”
The phrase, “I’ll sleep when I’m dead,” is commonplace enough in the United States. But a lack of sleep also contributes to significant health problems and strains employers providing health insurance. Fatigue can cost employers an estimated $136 billion a year in health-related productivity losses. Most of these costs were connected to less-than-optimal performance while an employee was at work rather than outright absences, according to study from the Journal of Occupational and Environmental Medicine.
But that study was from 2007, indicating that U.S. society has been aware of these consequences for more than 15 years. But employees are still tired, still getting behind the wheel, and still white-knuckling the drive—convinced they can beat the odds and defy science.
Sleep, or a lack of it, is crucial to a person’s performance. “It’s like food, water, air. You don’t get sleep, you literally could die,” says Rosekind, who, prior to being appointed to the NHTSA in 2014, started a consulting company that focused on sleep and performance. Although most death certificates don’t attribute death to sleep deprivation, if someone loses enough sleep then he or she will see a significant reduction in their capabilities. “So, all aspects of your performance—your reaction time, your decision making, your vigilance, all of those things are going to be degraded. And not by a little bit—we’re talking 20 to maybe 70 percent.”
William Shakespeare described sleep as a balm to the mind and body, calling it the “chief nourisher in life’s feast.” The Bard wasn’t wrong.
The average U.S. employer responsible for about 1,000 workers should expect an annual loss of $1 million thanks to fatigue.
When we get a proper night’s sleep, our cognitive, physical, and biological functions are restored and rejuvenated, all thanks to a part of our brain that we may not even realize works very hard to keep the human body alive. The hypothalamus is perpetually responsible for our bodies and ensures we remain alive—it controls and regulates hunger, body temperature, blood pressure, sex drive, and more.
Within that part of the brain is an even smaller section—the suprachiasmatic nucleus (SCN)—which programs when we sleep, wake up, and how alert we are throughout the day. It’s also where our internal biological clock can be found, which on average wakes us up at around 7 a.m. and signals that it’s time to sleep by 11 p.m. “That’s biology saying when you should sleep,” Rosekind says.
But when we ignore the internal clock and try to trick our own biology into getting less sleep than what we need, we’re setting ourselves up for decreased performance. “You can’t fool Mother Nature and just think things are going to be okay,” he adds.
There are essentially two different kinds of sleep loss: acute sleep loss and sleep debt.
Acute sleep loss occurs when someone gets significantly less sleep than what their body needs. Most people require seven to nine hours, and a loss of at least two hours is enough to make a person’s performance appear drunk, according to Rosekind. If someone need eight hours of sleep, but only got about five the night before, he or she will have a diminished capacity on par with a blood-alcohol content of 0.08, which is the legal limit for a driving under the influence (DUI) charge in almost every U.S. state. (In Utah, the limit is 0.05.)
“And the more sleep loss, the worse you are,” Rosekind adds. “Even one night is enough to throw that performance off.”
Sleep the following evening is sure to be welcome, but it doesn’t necessarily mean that someone with acute sleep loss is in the clear. Sleep loss accumulates, resulting in sleep debt.
“Think about it like your bank account and going into the red. For every hour (lost), it takes you further into the red,” Rosekind explains. For example, if someone is regularly only getting six hours of sleep on a weeknight when they need eight, by the time he or she gets to the weekend there is an accumulated sleep debt of 10 hours. But what about the debt accumulated within a month or a year? “Most people are bankrupt,” says Rosekind.
And while some people can chip away at that debt over the weekend, not everyone has that luxury, especially in high-performing roles or demanding environments including security, law enforcement, drivers, and others.
“Many of these people are going to carry weapons and have very fast decisions to make in certain situations—strategic as well as tactical kinds of decision making,” Rosekind says. “All of those things are reduced or impaired with sleep loss or circadian disruption.”
The Third Shift
Some operations have to run continuously, whether it’s in a hospital or monitoring security feeds for high value environments. This means, inevitably, someone needs to be awake and alert during a third shift—typically running from 11 p.m. to 7 a.m.
Unfortunately, these are the workers who are most at risk for disrupting sleep patterns and seeing performance impacts down the figurative (and sometimes literal) road.
Anyone working a third shift is going to trigger a circadian disruption, ignoring or bypassing the SCN’s attempts to have the body go to sleep for the night. And naturally, when that employee tries to sleep later, it’s usually at a time when the brain is programmed to have you stay awake.
“People think you can adjust to a night shift. Most of the data show that physiologically you can’t,” Rosekind says. Once again, that’s thanks to the SCN.
Every morning, when we wake up and see the sunlight, the SCN resets the internal clock’s 24-hour cycle. And someone who has just wrapped up a third shift is likely to see some morning light on the trip home. The SCN will register it, too. Even if a third shift employee can sleep during the day, Rosekind notes that research shows the person is likely to get two to three hours less than what he or she needs.
Besides fatigue and sleep debt, there are other health repercussions that can occur for someone dealing with regular sleep loss, including heightened risks for the immune system and increased risk of cancer.
Rosekind admits that there are some extreme measures that can help with shifting a person’s circadian clock. When Rosekind was advising the U.S. men’s Olympics volleyball team for the 2008 Summer Games in Beijing, China, he helped the team find a middle ground for their internal clocks. This was necessary while the southern California-based team was trying to initially qualify for the Games, which meant weeks of flying to one of roughly six different European locales to compete for three days and then fly back home.
“There are certain light techniques that you can use to help adjust the circadian clock, so we kind of moved that to the middle of the Atlantic (Ocean),” Rosekind says. This helped minimize jetlag and allowed the team to continue performing at a high level.
When the team was getting ready for the Beijing Games, Rosekind used other strategies that allowed players to become biologically in sync with the local time within three days. “If we hadn’t done that, it would have taken one week to 10 days for them to biologically be on local China time,” Rosekind says.
Similar to other high-performing individuals and teams, the players and coaches wanted an edge that could help them not only medal but also avoid injuries and improve functions. And getting the best sleep possible helped with reaction times and alertness, allowing for split-second decisions that make a difference. Just like pilots, military personnel, security professionals, and others, that edge “makes a huge difference,” explains Rosekind.
But in real-world scenarios, employers and organizations cannot sequester their third-shift workers into caves or commit resources to controlling when they are in the light or dark. “That’s the thing with people in the real world—you don’t have that kind of control. So, when you work all night and drive home in the light, it’s resetting your clock,” Rosekind says.
Mapping Out the Last Mile
If your employees are traveling on the road, whether as part of a daily commute or a business trip, it also can help to plan out the journey in advance. This is because for tired drivers, the last leg of the trip can be the most dangerous.
“That’s where we really see a lot of those challenges—that last mile,” says Jeremy Prout, CPP, a security director at International SOS who specializes in global and travel risk.
The last mile is more of a general term rather than an actual distance, Prout explains. It indicates the relatively short distance to the final destination that—to a fatigued or even drowsy driver—makes pulling over for a nap seem unnecessary. “That last mile, or that last 10 miles, we’re now taking a lot more risk than we want to because it seems rather silly to stop and take a 40-minute nap when you’re only 10 miles from your hotel or destination,” Prout says.
Understandably, it’s hard to know when someone is too tired to drive, but the physiological impacts are incredible. “Losing even two hours of sleep is similar to the effect of having three beers,” the NSC noted. “Being awake for more than 20 hours is the equivalent of being legally drunk.” So, it’s not surprising that a driver is three times more likely to be involved in a traffic crash if he or she is fatigued.
“Fatigue changes your ability and awareness,” Prout agrees.
And it might not even be due to an employee’s regular sleep habits—perhaps someone is traveling for work. A flight that would have normally taken five hours gets prolonged due to unexpected delays, so by the time the business traveler lands and makes his or her way to pick up the rental car, they have already spent 30 minutes getting to the airport, four hours waiting for the delayed flight, another five hours in the air, and are looking at another hour of road travel to get to the hotel. And that’s if you’re flying domestic. International travelers will also be required to go through customs and immigration screenings.
“The operational issue is that it’s the end of a long day. Your greatest risk is there,” adds Rosekind.
In his career as a sleep expert, Rosekind has found that most people believe that in these or similar situations, when their life is on the line, the adrenaline will kick in and the driver will stay awake when behind the wheel at the end of a long day. Perhaps he or she will use a couple of common tricks to keep driving, like rolling down the window or blasting the radio. While these tactics can work, they are only good for about 10 to 15 minutes, according to Rosekind. “That’s good enough to help you get off the road, but that’s not going to help you in your next half hour of the ride,” he says.
So, when it comes to mitigating these risks, Prout is a strong advocate for crafting and implementing travel risk policies, especially ones that consider issues beyond when and how to book flights and safe hotels.
“When it comes to cars…we want to start talking about when can you self-drive and when can you not,” Prout says. For travelers on long trips, or on trips that have run long thanks to delays, the journey can take up to or more than a day. Given the anticipated level of fatigue, Prout advises employers to not sign off on self-driving and instead have the traveler hire a taxi or a ride-sharing service.
If an employee is making a long drive, requiring a journey plan prior to the trip that includes rest stops at regular intervals can also help.
The operational issue is that it’s the end of a long day. Your greatest risk is there.
But beyond travel policies, there are additional steps employers can take to keep drivers safe and improve productivity. The first step is educating the entire organization—from the C-suite to frontline managers to employees, according to Rosekind. “You’ve got to get people to understand sleep, their circadian clock, and why they’re important,” Rosekind says.
With that understanding from the top and from managers, an organization is likely to see more support for schedules and practices that can promote healthy sleep or mitigate sleep loss.
“They can optimize work schedules, allow appropriate napping when feasible on the job—these are things that employers have done and things we encourage them to think about,” Pietzsch adds.
Employers can also be a source of information when it comes to workers learning about why sleep should be a priority. An organization can also offer its employees resources for addressing sleep problems or disorders.
“A lot of folks don’t get help because they don’t know where to go, so they just ignore it,” Pietzsch says. Making education and treatment easily accessible can optimize employees’ sleep and their performance while on the job.
Although health insurance can provide some support for employees who are already aware of a sleep problem, like apnea for example, there are additional resources that can assist organizations. Rosekind points to The Handbook of Fatigue Management in Transportation as a comprehensive guide for those crafting internal policies; Pietzsch recommends the efforts like the Sleep Matters Initiative, which offers education and screening programs for any organization.
“And then, of course, adopt a sleep health culture that is just the same as a safety culture. It’s the leaders in the organization demonstrating the expectation and practicing what they preach,” Pietzsch suggests. “Having a safe workplace starts at the top.”
While offering additional education and resources or adjusting schedules to allow for better sleep all seem to be measures that might eat away at a bottom line, it helps to remember that unless an organization has already quantified the cost of fatigue then it’s a hidden cost the employer doesn’t realize he or she is paying for.
“Most companies never quantify that,” Rosekind says, recalling his experiences at the NTSB. These costs are quantifiable and come in the form of insurance premiums, productivity, and lack of performance, as well as traffic collisions.
But some leaders are changing their approach, and like the 2008 men’s U.S. Olympics volleyball team—which took home the gold—they are looking for an edge for their organization. In this instance, it’s about holistic support for employees to ensure that the workforce is at peak production and performance, including the benefits of sleep. “This is one of the very few things that gives you an advantages in safety, health, and performance and productivity,” Rosekind says.
Sara Mosqueda is associate editor for Security Management. Connect with her on LinkedIn or X, @XimenaWrites.