More than two decades ago, a Brigham team led by Charles Czeisler, PhD, MD, FRCP, Baldino Professor of Sleep Medicine at Harvard Medical School, chief of the Division of Sleep and Circadian Disorders, developed the Sleep Matters Initiative, the division’s first educational and screening program for first responders. Since then, the team has provided sleep health education and/or sleep disorders screening to more than 30,000 employees nationally, including physicians, nurses and other health care workers, police officers, firefighters, Federal Air Marshals and even astronauts.
This year, the Sleep Matters Initiative’s Sleep Health and Wellness (SHAW) Program comes home to the Brigham, with sessions open for Brigham faculty and staff to attend. Building on a strong research foundation laid by Brigham investigators, the program seeks to change the culture of sleep and improve health, safety, performance and well-being for employees at the Brigham and beyond.
“Sleep deficiency is a serious public health issue, and it is rampant among many employee populations. However, promotion of healthy sleep is a win-win for both employers and employees, enhancing quality of life and longevity for workers while improving productivity and reducing health care costs for employers,” said Czeisler.
Over the past 20 years, Czeisler has worked to change sleep culture and help first responders across the country. “Our work shows that an interactive, occupational health program can increase knowledge of sleep disorders, educate participants on the impact of reduced alertness due to sleep deficiency and teach fatigue countermeasures, as well as screen for untreated sleep disorders.”
Helping Those Who Help Others
Division faculty member, Laura Barger, PhD, first became interested in sleep medicine research after serving in the military as part of a flight crew. She and her crewmates would fly overseas and then work the next day. Now retired from the Air Force, Barger is dedicated to understanding the implications and impact of sleep, especially on first responders.
In general, Barger and her colleagues have found that sleep disorders are very common, affecting 30-40 percent of employees, and that approximately 85 percent of people with sleep disorders are undiagnosed and untreated. In 2015, Barger and colleagues published a study detailing how sleep disorders increase the risk of motor vehicle crashes and other adverse health outcomes in firefighters. In a national study of 66 fire departments, the team found that one-third of firefighters screened positive for a sleep disorder.
“Both physical health and mental health are at risk when a person has an untreated sleep disorder,” said Barger.
Czeisler says what amazes him most is how little people put into practice what they already know. That is why he and his team launched their initiative — to transform information that most people already know (for instance, getting enough sleep and keeping a consistent sleep schedule) into an interactive educational program that motivates individuals to get a little more sleep and, if necessary, get tested for sleep disorders.
The Sleep Matters Initiative is designed and implemented to include education and screening through a one-hour, expert-led program delivered to groups of about 50-100 employees. The team administers a sleep disorders screening questionnaire during these sessions, and those who screen positive are referred to a local sleep disorders clinic for follow-up diagnostic evaluation and treatment if needed.
When the team implemented their program among first responders from the Columbus Fire Department, they found that there was a 24 percent reduction in injuries and a 46 percent reduction in disability day usage over the following year — saving the fire department more than $2M annually in wages for replacement workers alone.
Several participants also wrote letters about how the diagnosis and treatment completely changed and improved their lives. ““The results are making a huge impact — even beyond our greatest expectations,” said Czeisler.
The investigators have rolled the program out at 67 fire departments across the U.S. Several departments took the program to the next level, implementing changes to improve the sleep health of their employees long after the research program was complete.
“You Changed My Life”
Senior project manager Conor O’Brien began working with Barger, Czeisler and colleagues on the Sleep Medicine Initiative more than two decades ago to develop what would become the Sleep Matters Initiative. O’Brien, who will be leaving the Brigham at the end of the month to join MGH, recalls a moment that stands out to him from the time he spent helping bring the program to first responders.
The team had begun hosting weekly clinics at the local union hall in a city in the mid-Atlantic. At the end of one of these clinics, a police officer marched up to O’Brien with something to say.
“He told me that he had been reluctant to attend a sleep training session and fill out a sleep screening survey because he hadn’t believed in the work that the Brigham team was doing and didn’t think that there were any changes he could make to improve his life,” said O’Brien.
The officer told O’Brien he had a strong family history of heart attacks and a personal history of high blood pressure and depression and didn’t expect to live past 40 — the age when both his father and grandfather had died. But his partner had persuaded him to come to the clinic for an evaluation. The officer was diagnosed with sleep apnea and went home with a CPAP machine. He said that, for the first time in a decade, he began getting a good night’s sleep. His blood pressure began going down. His mood began to change and his marriage, which hadn’t been going well, began to improve, too.
“Even now, years later, I remember him telling me, ‘You changed me. You saved my life.’ And then he gave me a big bear hug,” O’Brien recalled. “That’s one of the reasons I’ve worked on this for so long: not only do I get to do research, but I also get to help people.”
About half of physicians and nurses report symptoms of burnout, including emotional exhaustion, depersonalization, and perceived lack of accomplishment. Stuart Quan, MD, clinical chief and medical director of the Brigham’s Sleep Disorders Service, points out that the symptoms of burnout and sleep issues are eerily similar.
“Sleep and burnout are so closely related,” said Quan. “There are a lot of studies looking at how to make wellness improvements, such as offering benefits to help employees stop smoking or lose weight. We’re looking to demonstrate that there’s a return on investment of having a sleep intervention program. If we can improve the sleep health of health care professionals, we may be able to help improve the sleep health of society in general.”
In a 2011 study of police officers, Brigham investigators demonstrated that the risk of burnout (emotional exhaustion) and depression were more than two-fold greater among those who screened positive for a sleep disorder. In 2015, they published data showing a more than three-fold increased risk of anxiety disorder and depression among firefighters who screen positive for a sleep disorder.
Last year, the team received a Partners HealthCare Innovation grant to study the impact of fatigue in the workplace. In an interim analysis of nearly 1,000 Brigham employees, the team found that 94 percent of people who screened positive for a sleep disorder were previously undiagnosed or untreated, and that positive sleep disorder screening was associated with nearly four-fold increased odds of burnout.
So far, the team has conducted a limited follow-up analysis. While they have not yet seen changes in the prevalence of burnout, they have seen promising results. Six months after participating in the one-hour SHAW program, 86 percent of participants reported going to bed earlier; 53 percent reported prioritizing sleep; and 43 percent made sleep clinic appointments. And 90 percent of participants considered the program important and helpful and said they would recommend it to others.
“When you change the culture of sleep, it can make an extraordinary difference in people’s lives,” said Czeisler.
Sessions for Brigham faculty and staff are ongoing. To sign up, click here (filter by department and select “Division of Sleep and Circadian Disorders” to view upcoming classes). For questions, email firstname.lastname@example.org or call 617-525-2617.