1. Copyright Circadian Technologies, Inc. 2002 Myths and Realities of Fatigue Circadian Technologies, Inc. 24 Hartwell Ave. Lexington, MA 02421 Phone: 781-676-6900 Fax: 781-676-6999 Web: www.circadian.com

2. Copyright Circadian Technologies, Inc. 2004 IMPACT OF FATIGUE Copyright Circadian Technologies, Inc. 2003

3. Copyright Circadian Technologies, Inc. 2004 Myth or Reality? 1. 1. Fixed shifts (e.g. always working the night shift) are safer than rotating shifts. 2. 2. As long as its voluntary, there is no evidence that demonstrates a clear upper limit on overtime hours. 3. 3. Tired haul truck drivers (or other operators) can anticipate the onset of fatigue and take corrective actions to avoid it? 4. 4. Long shifts (e.g. 12-hours or more) are less safe than traditional 8-hour shifts 5. 5. Shiftworker training can measurably impact how shiftworkers spend off-duty time and family life.

4. Copyright Circadian Technologies, Inc. 2004 Effects of 24/7 on Employee Fatigue Disrupted sleep at home Chronic sleep deprivation Lack of awareness of extent of sleep debt Micro-sleep Automatic behavior syndrome Nodding off on the job Reduced alertness, vigilance and performance at work

5. Copyright Circadian Technologies, Inc. 2004 Reports of Nodding Off at Work Round-the-clock workers frequently fall asleep when working the night shifts. 182022 246 810121416 18 Time of Day (hrs.)

6. Copyright Circadian Technologies, Inc. 2004 Adapted from Dawson and Reid, 1997 Blood Alcohol Content Equivalence of Fatigue Impairment to Alcohol Impairment

7. Copyright Circadian Technologies, Inc. 2004 Human performance at many different tasks is most impaired between 1 and 6 am. % 10 5 0 -5 -10 -15 -20 1215182124030609 Psychomot. Perf. Cancellation Digit Summation Simulator (a) Simulator (b) Time of Day 12 Effects of 24/7 on Performance

8. Copyright Circadian Technologies, Inc. 2004 Costs In Extended Hours Operations Productivity 16 Productivity decreases at night by 5%. This equates to $3,300, or $79.4 billion a year Study A shows productive hours when a person is excessively fatigued (burnout). Study B is after working 4 weeks of long hours. Studies C and D are from just 1 week of long hours.

9. Copyright Circadian Technologies, Inc. 2004 Business Costs: Average Tonnage by Time of Day

10. Copyright Circadian Technologies, Inc. 2004 Results of Improvement in Nightshift Performance Alone Total Tonnage on Nightshift: (Current) Total Tonnage on Nightshift: (Minimizing 4:00am dip) Total Increase: 1,971,702 tons 2,023,896 tons 52,194 tons =3% improvement for nightshift =1% increase in total tonnage ADDITIONAL 3.29 DAYS OF PRODUCTION/YEAR

11. Copyright Circadian Technologies, Inc. 2004 Trends In Extended Hours Operations Health Care Costs 3-4 times higher rate of Obstructive Sleep Apnea 3-4 times higher rate of Obstructive Sleep Apnea 2-3 times greater rate of Gastrointestinal Disorders 2-3 times greater rate of Gastrointestinal Disorders 2-3 times increased rate of Cardiovascular Disease 2-3 times increased rate of Cardiovascular Disease 1.5-2 times more Musculoskeletal Problems 1.5-2 times more Musculoskeletal Problems Probable increased risk of Mental Health Illnesses Probable increased risk of Mental Health Illnesses 2-3 times higher overall Health and Wellness Costs 2-3 times higher overall Health and Wellness Costs 18

12. Copyright Circadian Technologies, Inc. 2004 Trends In Extended Hours Operations Accidents and Injuries 19 Workers comp claims 20% higher in shiftwork operations Workers comp claims 20% higher in shiftwork operations 29% of extended hours employees fell asleep several or more times a week while at work. 29% of extended hours employees fell asleep several or more times a week while at work.

13. Copyright Circadian Technologies, Inc. 2004 Trends In Extended Hours Operations Accidents and Injuries Relative risk of accidents and injuries on different shifts collated from five independent studies Relative risk of accidents and injuries on different shifts collated from five independent studies Increased cost of nightshift accidents based on insurance company claims data Increased cost of nightshift accidents based on insurance company claims data

14. HUMAN DESIGN SPECIFICATIONS Copyright Circadian Technologies, Inc. 2004

15. Design Specs of the Human Machine Humans were not designed for peak performance at night

16. Copyright Circadian Technologies, Inc. 2004 Well Established Scientific Research on Biological Clocks Suprachiasmatic Nucleus (SCN)

17. Copyright Circadian Technologies, Inc. 2004 Circadian Rhythm of Performance Over a 24-Hour Period Whether we are awake or asleep, body functions continue to follow their Circadian rhythms Body Core Temperature 98.5 96.5 11 pm7 am11 pm7 am Thermostat Down Thermostat Up Thermostat Down Thermostat Up SleepNo Sleep Maximum Sleepiness DuskDawn DuskDawn

18. Copyright Circadian Technologies, Inc. 2004 Circadian Rhythm of Human Alertness Full Alertness Reduced Alertness Drowsy 20 15 5 0 Alertness Level (MSLT) 121518212403060912 Time of Day Source: Circadian Technologies, Inc. (1993) 10 Moderate Alertness This is an average composite for all Circadian types. The curve can be shifted 1- 2 hours in either direction depending on whether one is an early or late riser, etc. (With Normal Quantity / Quality of Nighttime Sleep)

19. Copyright Circadian Technologies, Inc. 2004 Determinants of Human Alertness: Extended Hours Without Sleep Full Alertness Moderate Alertness Reduced Alertness Drowsy 20 15 10 5 0 Alertness Level (MSLT) 0 Successive Hours of Sleep Deprivation 510152025 1215182124030609 Time of Day Source: Circadian Technologies, Inc. (1993)

20. Copyright Circadian Technologies, Inc. 2004 IMPACT ON SCHEDULING Copyright Circadian Technologies, Inc. 2003

21. Copyright Circadian Technologies, Inc. 2004 Determinants of Human Alertness - Consecutive Nights on Duty Full Alertness Moderate Alertness Reduced Alertness Drowsy 20 15 10 5 0 Time of Night 2224246 Night 6 Night 3 Night 1 Night 2 Source: Circadian Technologies, Inc. (1993) Alertness Level (MSLT)

22. Copyright Circadian Technologies, Inc. 2004 A “ Free-Running ” Circadian Rhythm When External Time Cues (Zeitgebers) Are Removed When we are isolated from time cues, our internal biological clocks run on a 25 to 25.5 hour cycle. This is why they are “ entrained “ or reset by the light of each day to keep our circadian rhythms on a precise 24-hour cycle. That is why it is easier to shift forward to a later time than backward to an earlier schedule, and why forward or clockwise schedule rotations are physiologically less stressful to work. Day 1 2 3 4 5 6 7 8 9 etc. 24081624120420

23. Copyright Circadian Technologies, Inc. 2004 Bio-Compatible Schedules (Physiological Design Criteria) Bio-compatible schedules have the proper: Rotation direction: forward Rotation speed: slow or fixed Shift start time: 7:00-8:00 am Maximum schedule regularity Minimum consecutive shifts worked Maximum rest/recovery breaks between shift turns (48-hours min.) Periodic long breaks (3-4 days minimum) Minimum sleep (night shift) transitions

24. Copyright Circadian Technologies, Inc. 2004 Direction of Shift Rotation Preferred by Workers Who Have Experienced Both 806040200 406080 Counterclockwise 18% Clockwise 67% (14% stated no preference) Source: Circadian Technologies, Inc. (1993)

25. Copyright Circadian Technologies, Inc. 2004 Fatigue and Alertness Factors 8-Hour Schedules: Work more shifts Fewer rest and recovery days, less often More cumulative fatigue / sleep deprivation Shorter work day 12-Hour Schedules Work fewer shifts in a row (i.e., 2-4) More rest and recovery days, more often Less cumulative fatigue / sleep deprivation Twice as many days / weekends off Longer, harder work day Combination 8 & 12-Hour Schedules Compromise between 8 and 12-hour shifts

26. Copyright Circadian Technologies, Inc. 2004 How Physically Demanding Is Your Shift? Percent of People 7 day, 8-hr schedule (7-2, 7-2, 7-3) 7 day, 12-hr schedule (2-2, 3-2, 2-3) Very Light ModerateHeavy Very Heavy 10.5 10.8 8.1 14.2 50.8 50 20.2 17.6 10.5 7.4

27. Copyright Circadian Technologies, Inc. 2004 How Mentally Demanding Is Your Shift? Percent of People Not at AllSlightlyModeratelyDemandingVery 7.5 11 13.3 17.8 37.5 32.1 20.8 24 20.8 15.1 7 day, 8-hr schedule (7-2, 7-2, 7-3) 7 day, 12-hr schedule (2-2, 3-2, 2-3)

28. Copyright Circadian Technologies, Inc. 2004 How Fatiguing Is Your Shift? Percent of People 6.5 6.2 9.7 8.3 50.8 46.2 25 28.3 8.1 11 Not at AllSlightlyModeratelyFatiguingVery Fatiguing 7 day, 8-hr schedule (7-2, 7-2, 7-3) 7 day, 12-hr schedule (2-2, 3-2, 2-3)

29. Copyright Circadian Technologies, Inc. 2004 How Boring Is Your Shift? 41 46 27.1 18.2 21.3 16.2 4.1 12.2 6.6 7.4 Percent of People Not At AllSlightlyModeratelyBoringVery Boring 7 day, 8-hr schedule (7-2, 7-2, 7-3) 7 day, 12-hr schedule (2-2, 3-2, 2-3)

30. Copyright Circadian Technologies, Inc. 2004 Case Study A: Mining and Chemical Company Problem: Low Productivity Low Productivity High Injury Rates High Injury Rates High Employee Turnover High Employee Turnover High Medical Costs High Medical Costs Low Employee Morale Low Employee Morale

31. Copyright Circadian Technologies, Inc. 2004 Case Study A: Large Mining and Chemical Company Result of Shift Schedule Optimization : Benefit: $800,000 increased net profit in Year One ROI:8:1 (first year)

32. Copyright Circadian Technologies, Inc. 2004 IMPACT ON ACCIDENT PREVENTION Copyright Circadian Technologies, Inc. 2003

33. Copyright Circadian Technologies, Inc. 2004 Fatigue-Related Human Error Inattention / lack of vigilance Inattention / lack of vigilance Impaired judgment / lack of awareness Impaired judgment / lack of awareness Carelessness / lack of precaution Carelessness / lack of precaution Failure to follow procedures Failure to follow procedures Miscommunication / misunderstanding Miscommunication / misunderstanding Inappropriate / slow response Inappropriate / slow response Microsleep / automatic behavior syndrome Microsleep / automatic behavior syndrome Chemical impairment (drugs, alcohol, medication) Chemical impairment (drugs, alcohol, medication) TRACK FATIGUE FACTORS IN REPORTING SYSTEMS!

34. Copyright Circadian Technologies, Inc. 2004 Fatigue Related Driving Accidents 6 times greater for night shift workers 2 times greater for rotating shift workers Other high risk factors   Working more than one job   Getting less than 6 hours sleep   Being awake more than 20 hours straight   Driving between midnight and 6:00 am Sources: AAA Study, J. Stutts, UNC 1999

35. Copyright Circadian Technologies, Inc. 2004 Microsleep Short bursts of sleep waves Short bursts of sleep waves Seconds or minutes long Seconds or minutes long Eyelid blinking slows down Eyelid blinking slows down Often precedes nodding off Often precedes nodding off Loss of awareness Loss of awareness Fatigue/monotony induced Fatigue/monotony induced Serious driving and work hazard Serious driving and work hazard

36. Copyright Circadian Technologies, Inc. 2004 Microsleeps: Potholes on the Slope of Drowsiness TOTAL INCAPACITY (Eyes closed) IMPAIRED JUDGEMENT Microsleeps Alertness Level ALERTNESS SLEEP Hours of driving

37. Copyright Circadian Technologies, Inc. 2004 Microsleeps: Potholes on the Slope of Drowsiness TOTAL INCAPACITY (Eyes closed) IMPAIRED JUDGEMENT Microsleeps Alertness Level ALERTNESS SLEEP Hours of driving

38. Copyright Circadian Technologies, Inc. 2004 Automatic Behavior Syndrome Sleeping with eyes open Blank stare, no eye blinking Deep sleep (brain) waves Loss of perception and memory Fatigue/monotony induced Inability to respond to changes Major cause of driving accidents

39. Copyright Circadian Technologies, Inc. 2004 The Missing Factor in Optimizing 24/7 Performance Source: The Twenty Four Hour Society (1993) Productivity Quality Safety PerformanceAttentiveness AptitudeEducation TrainingExperience Distraction Load Work Load Motivation ? Missing Factor

40. Copyright Circadian Technologies, Inc. 2004 Alertness: The Missing Factor in Human Reliability Source: The Twenty Four Hour Society (1993) Productivity Quality Safety PerformanceAttentiveness AptitudeEducation TrainingExperience Distraction Load Work Load Motivation Alertness

41. Copyright Circadian Technologies, Inc. 2004 Results of Performance-Based Fatigue Management – Trucking Fleet Before Before After Fatigue Scores Accident Rate Rate2.3/mm Accident 1.7/mm 23% Accident Avg. Cost Avg. Cost$14,100 Accident $4,800 66%* *p< 0.05 Χ 2 =68.1 P<0.0001 $32,430 / million miles $8,160 / million miles Accident Risk

42. Copyright Circadian Technologies, Inc. 2004 IMPACT ON TRAINING Copyright Circadian Technologies, Inc. 2003

43. Copyright Circadian Technologies, Inc. 2004 Managing a Shiftwork Lifestyle Training STUDY FROM KENNECOTT COLOWYO MINE: After training on managing a shiftwork lifestyle, employees at a mine site: After training on managing a shiftwork lifestyle, employees at a mine site: –Increased daytime sleep by 1 hour –Were less likely to stay awake for more than 18 consecutive –Were more alert –Had fewer gastrointestinal health issues –Found it easier to fulfill domestic responsibilities 2

44. Copyright Circadian Technologies, Inc. 2004 Managing Shiftwork Lifestyle Training Employees who provided lifestyle training had: Employees who provided lifestyle training had: –Lower rates of turnover compared to those that did not –Lower rates of absenteeism –Had cost savings associated with these lower rates of $1,892 per employee per year

45. Copyright Circadian Technologies, Inc. 2002 Addressing the Extended Hours Challenge

46. Copyright Circadian Technologies, Inc. 2004 Myth or Reality? 1. 1. Fixed shifts (e.g. always working the night shift) are safer than rotating shifts. 2. 2. As long as its voluntary, there is no evidence that demonstrates a clear upper limit on overtime hours. 3. 3. Tired haul truck drivers (or other operators) can anticipate the onset of fatigue and take corrective actions to avoid it? 4. 4. Long shifts (e.g. 12-hours or more) are less safe than traditional 8-hour shifts 5. 5. Shiftworker training can measurably impact how shiftworkers spend off-duty time and family life.

47. Copyright Circadian Technologies, Inc. 2004 Elements of a Fatigue Management Program Fatigue Costs, Risks & Liabilities Management and Supervisor Education Support Policies, Practices, and Procedures Pre-Employment Screening Goodsleep.com Web Counseling Staffing Levels Extended Hours Lifestyle Training + Support Heath and Nutrition Programs Sleep Disorder Screening and Treatment Alertness Recovery Strategies, Environmental and Ergonomics Practices Bio-Scheduling Optimization Fatigue Management Systems

48. Copyright Circadian Technologies, Inc. 2004 For More Information Upcoming symposiums: Shiftwork – Health & Safety (American Airlines) Developing alertness monitors (Fall 2004) Circadian Technologies, Inc. www.shiftwork.com dmitchell@circadian.com