Fatigue: Much More Than Being a Little Tired!

Contributor: Sue Zbikowski, PhD
To learn more about Sue, click here.


image004.jpgIn recent years, there has been a focus on educating Americans on the consequences of sleep deprivation and suggestions for improving sleep. Sleep is essential and a biological need. Without adequate sleep, we can suffer physically, cognitively, and emotionally.

Last year, I attended a conference in Seattle on fatigue sponsored by the National Safety Council (NSC). According to the NSC, fatigue is a growing concern in the United States. Fatigue is the feeling of tiredness or low energy and affects every workforce. Fatigue can be driven by work schedules like shift work, long shifts or long work weeks, long commutes, job demands, sleep loss, or poor-quality sleep. At times we may not even be aware we are feeling off our game.  

Understanding and addressing fatigue is important because of safety issues at and away from work. Fatigue can lead to accidents, poor work performance, and reduced productivity. Many of us have powered through when we feel like we are dragging. But when chronic fatigue persists, it can be dangerous and even have health consequences. The National Highway Traffic Safety Administration estimates fatigue is a cause in 100,000 auto crashes and 1,550 crash-related deaths a year in the U.S.

Can you think of a time when you were so tired you struggled to stay awake when you wanted or needed to? Perhaps you felt your eyelids feel heavy or begin to droop. Then your head nodded and bobbed. Nodding off is a symptom of fatigue. In fact, those nods and bobs are episodes of “microsleep.” Yes, actual brief sleep episodes. And, in some instances, people don’t even know they fell asleep. These microsleeps can happen on the job, while watching TV or reading, or even when driving. Based on a survey of over 2000 workers published by NSC, 27% report microsleep at work, 16% on the road, and 41% off the job.

image002.pngThere are other symptoms of fatigue. Did you know fatigue and poor quality sleep not only make you feel tired or experience reduced energy throughout the day, they can lead to medical problems like heart disease, diabetes, hypertension, obesity, and an increased risk of Alzheimer’s as well as result in irritability and affect your performance at work? In the same survey mentioned above, 76% felt tired at work, 53% felt less productive, 44% had trouble focusing, 39% had trouble remembering, and 27% had trouble making decisions. These issues collectively can increase safety risk. In fact, 16% of individuals reported experiencing a near miss or safety incident due to fatigue. One meta-analysis (Uehli et al., 2014), showed that workers with sleep problems had a 1.6 times higher risk of being injured at work compared to workers without sleep issues.

Causes and Contributors

Medical Issues*:
One medical cause of sleep disturbances is obstructive sleep apnea, which occurs when the muscles in the throat relax and interfere with breathing, which can lead to excessive daytime sleepiness and other health consequences. Estimates of the prevalence of sleep apnea range from 2 -10% (Léger et al., 2012).

A frequent sleep challenge is insomnia. Insomnia can be a disorder or symptom. It includes self-reported difficulty falling or staying asleep, shortened sleep duration, or early waking and results in some type of daytime impairment. Estimates of the prevalence of insomnia range from 10 - 40% (Léger et al., 2010).

Work Schedules and Other Work Demands: People who work very early or late shifts can experience poor sleep or sleep deprivation. Even people who work in traditional office roles can find they are sleep deprived. Many work cultures promote and expect staff to work long or late hours. Some even reward it! These type of work demands can lead to employees getting inadequate sleep. 

Other: Work or life stress, excessive exposure to blue light from our technology-filled world, eating or working out before bedtime, and caffeine or alcohol use can interfere with sleep cycles and/or reduce sleep quality.

Most of us can handle a day of poor sleep, but it is when poor sleep persists that greater consequences occur. For example, research shows that as more days of sleep deprivation accumulate, so do safety and behavioral risk.  

Tips for Improving Sleep
It is important to get enough sleep and to have good quality sleep.  What can you do to improve your sleep?  Experts recommend sticking to a sleep schedule. 

Go to bed and wake up around the same time each day and get at least 7 hours of sleep.  If you have trouble falling asleep try one of the following recommendations. Reduce blue light exposure from devices and TVs a few hours before going to bed. Blue light disrupts circadian rhythms, reduces melatonin production, and promotes alertness. Limit caffeine before sleep, or longer, if you are sensitive to caffeine.  Do not eat a large meal or exercise hours before going to sleep.  Meditate, try deep breathing, or do something relaxing.  If you find your mind racing and thinking about your day, jot a few notes down in a journal and tell yourself you will think about it the next day.  

dog-1423766_1280.jpgIf you routinely have trouble sleeping, waking up during sleep, or have difficulty falling back to sleep, you may want to consult with your physician or explore using a sleep program.

Tips for Dealing with Fatigue
While you are working to improve your sleep or manage work/life stressors that may be leading to poor sleep and fatigue, there are a few things you can do to temporarily reduce or improve fatigue symptoms.  It is important to know that these are not solutions, but rather short-term fixes. To improve fatigue, you must address the root cause.  This may require exploring options with your employer to improve your work schedule, workload, or work-related demands on your time outside of work.  

In the meantime, try these recommendations: Take a short nap when you are tired. Even a short 10-20 min nap can boost alertness.  Another solution is to take regular short breaks. Short breaks during tasks or when driving can help to maintain or restore alertness.  Use some blue light to promote alertness.  Although blue light expose before sleep is problematic, exposure to blue light during certain tasks or at the beginning of one’s day can promote alertness.  

Get moving. Brief periods of physical activity can boost alertness.  Have some caffeine to boost alertness.  Caffeine can provide a short-term boost to alertness when used correctly. Don’t use caffeine all day to stay alert, but rather have some caffeine prior to certain tasks that require some additional focus. 

Try a Program: Psychological and behavioral interventions have been shown to be effective. There are a variety of coaching apps that address sleep, including CBTforInsomnia.com, Sleepio, and several stress and meditation apps like Calm, Breathe, Journey Live, just to name a few.

Fatigue can cost employers $1,200 to $3,100 dollars in lost productivity annually or more if it leads to a worksite accident. Despite the prevalence and impact of fatigue on companies, the majority don’t communicate with employees about fatigue. This is a missed opportunity to address a worksite risk factor. In addition, employers need to look internally at how their worksite policies, procedures, and culture contribute to employee fatigue. For example, employers expecting employees to work overtime or extended shifts to handle workforce shortages or absences or workplace cultures placing demands on employees to engage in intensive sprints to get products releases, meet short timelines, or respond to after work hour emails and texts need to be reviewed and modified to improve employee well-being and reduce fatigue.

Below are some resources if you are interested in addressing worker fatigue.



  • William C Dement and Christopher Vaughan (2000). The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health, Happiness and a Good Night Sleep.  Random House Publishing Group.
  • Matthew Walker (2018). Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner.
  • Ben Azadi (2018).  Power of Sleep: Effective Strategies to Switch Off Your Brain, Stop Hitting Snooze, Wake Up Energized, and Own the Day.  Kindle Edition


  • Léger D and Bayon V. Societal costs of insomnia. Sleep Med Rev 2010:14(6): 379-89.
  • Léger D, Bayon V, Laaban, JP and Philip P. Impact of sleep apnea on economics. Sleep Med Rev 2012:16(5): 455-62.
  • Uehli K, Mehta AJ, Miedinger D, Hug K, Schindler C, Holsboer-Trachsler E, Leuppi JD, and Künzli N. Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Med Rev 2014:18 61-73.
  • National Safety Council. Fatigue in the Workplace: Causes and Consequences of Employee Fatigue. https://www.nsc.org/work-safety/safety-topics/fatigue/survey-report.

*Speak with your doctor if you are concerned that you may be experiencing fatigue due to a medical condition.


Contact Sue at:
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