This section details the findings of Phase II of this project. In Phase I, qualitative research was conducted with two groups of drivers at risk for drowsy driving, (1) shift workers and (2) young men. This research revealed that shift workers appeared to be more motivated and ready to change their behavior related to sleep and the conditions that contribute to drowsiness and fatigue compared with young men. Therefore, shift workers were judged to be more likely to respond to an intervention.

The aim of Phase II research was to gather detailed qualitative information on (1) the nature of drowsy driving among shift workers, (2) the conditions that may contribute to drowsy driving, and (3) to explore potential interventions that may decrease the risk of drowsy driving. Shift work supervisors and upper-level human resource and safety managers were identified in Phase I as people who may exert some influence over the behavior of shift workers and these groups were included in the Phase II research discussions.

Potentially successful interventions with shift workers were identified through a search of the existing literature. The acceptance and utility of the proposed interventions were explored with each group. Group participants were asked to identify which intervention or combination of interventions might prove to have the most impact in reducing drowsy driving among shift workers and to anticipate potential barriers to successful implementation of each intervention in their workplace.

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Shift workers and Shift work Supervisors

We conducted focus group research in Boston, MA on February 2 and 3, 1998 and in Atlanta, GA on February 4 and 5, 1998. The sites were selected according to the following criteria:

  1. Geographic diversity.
  2. High concentration of workers scheduled to be working at night (e.g., health care industry, manufacturing, hospitality industry, airlines, shipping).
  3. High reliance on the automobile for transportation.
  4. Urban, suburban, rural mix.
  5. Existence of quality focus group facilities.

Two groups of targets were interviewed using focus group research techniques, (1) shift workers and (2) shift work supervisors. We conducted two groups on each night, one each of shift workers and shift work supervisors, for a total of eight groups. Each consisted of eight to twelve participants, recruited by field houses at each site. Each participant was a licensed driver. Most important, each participant has a history of driving while drowsy as evidenced by responding "Yes" to at least two of the following statements:

  1. Have you ever fallen asleep or nodded off while driving?
  2. Have you started to drive or continued driving an automobile when you felt very fatigued, drowsy or sleepy three or more times during the past year?
  3. Have you driven an automobile after being awake for a period of eighteen hours or longer three or more times during the past year?

A copy of the telephone screener appears in Appendix D.

Most of the group participants were employed in blue collar labor, service (24 hour customer service), and health care positions.

In addition to the focus group interviews conducted with shift workers and shift work supervisors, one-on-one telephone interviews were conducted with upper-level managers. Previous focus groups identified the company management as one of the barriers to implementing potential intervention strategies.


A moderator's guide was prepared to focus discussion on the topic areas to be covered. The guide included a warm-up and introduction, and in-depth discussion of various potential interventions to reduce the risk of drowsiness and drowsy driving.

Each discussion group lasted approximately ninety to one-hundred twenty minutes.

Subject areas discussed were:

The moderator's guide differed slightly for shift workers and shift work supervisors. Generally the discussion with shift workers focused on what the workers could do to make changes in their own lifestyle. The opinion of shift workers was also solicited about the type of interventions and support their employers could provide that would improve their working conditions. The discussions with supervisors were more focused on the opportunities for intervention or changes in the workplace environment or the effect of policies. A copy of the moderator's guide appears in Appendix E.

Upper-level Managers

Focus group interviews were not judged to be a feasible interview strategy for reaching upper-level managers. One-on-one telephone interviews were conducted with upper-level managers. Results from these telephone interviews are detailed in a separate section in this report due to the differing methodology.

One-on-one telephone interviews

One-on-one telephone interviews were conducted with upper level management during the month of April 1998. The purpose of the interviews was to determine (1) current levels of awareness of fatigue as an employee safety issue, (2) how that awareness could be most effectively raised, (3) the current state of safety-related policies and practices, and (4) what changes in the shift work environment could be made to prevent fatigue among workers and enable shift workers to get better quality sleep.


The interviewees were 15 managers whose organizations represented different types of environments, including hospitals, hotels, newspapers, airlines, factories, and a physical plant.

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  1. As noted in previous qualitative research, shift workers report less quality and quantity sleep (approximately 4 to 5 hours per night) compared with recommended amounts of sleep (approximately 7 to 8 hours per night). They also report difficulty in sleeping. Shift work supervisors report sleeping patterns and difficulty in sleeping consistent with those of shift workers.
  2. Shift workers and supervisors recognize the potential for problems as a result of sleep deprivation. These problems include fall-asleep motor vehicle crashes. This recognition may be a general perception of the problem rather than something that they are actively thinking about or acting upon. However, awareness of the problem creates an opportunity for promoting a change in behavior.
  3. Several potential interventions show promise to be acceptable to shift workers and supervisors and may have an impact on the drowsiness of the workers. These include:
  4. Upper-level managers felt that education on the nature of the drowsy driving problem and tips to promote better adaptation would be the most effective intervention. They are supportive of promoting changes in the lifestyle of their workers, such as diet, exercise and increased sleep.
  5. Shift work supervisors appear to have the flexibility to implement some of the interventions. They also appear to be motivated to intervene to keep their workers safe.
  6. Night shift workers and night shift supervisors reported difficulty in receiving communications from management and often felt "out of the loop." Some reported that extra effort was required to stay informed, such as coming into work early to attend staff meetings.
  7. Shift workers and supervisors had several excellent suggestions for methods of communicating messages about sleep hygiene, drowsiness and fatigue, and drowsy driving. These include:
  8. Family members represent an important point of influence in the sleep behavior of shift workers. They have the ability to make sleep during daylight hours go smoothly or create problems for the shift worker. They can also motivate shift workers to improve their sleep habits.

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Problem Identification

Shift workers appear to be very aware of the problems of excessive sleepiness or drowsiness related to their shift work. They were ready to acknowledge that fatigue affected their personal life and their ability to drive. However, they were not ready to admit that their job performance suffered. Many participants had anecdotes of extreme drowsiness or tiredness while on the job or traveling home from their job. Most participants acknowledged having some personal experience with drowsy driving, such as falling asleep while waiting at a red light, head bobbing while driving, weaving in their lane while driving, and missing a freeway exit.

"My eyes are open but I'm not there."

Most of the participants readily admitted that drowsy driving could be a major potential problem for themselves and their co-workers. The supervisors also readily recognized the problem and seem to be very concerned about it. However, they felt powerless to address it. Some described situations where they had to violate company policy (i.e., no sleeping while at work) in order to keep their employees safe and functioning. Most had encountered employees sleeping on the job.

"Guy's snoring standing straight up."

Health care professionals, particularly nurses, represented a large number of the research participants and these people recognized the irony of the situation and conditions under which they were working.

"Here we are saving people's lives and we're putting our own people in danger."

Sleep Behavior

Shift workers reported that they tend to sleep on an irregular schedule and their sleep was dictated by other time demands. Sleep did not appear to be a high priority for most shift workers.

"Priorities keep you awake."

Very few shift workers or supervisors working the night shift among the participants of our

groups reported getting more than four to six hours of sleep on a regular basis during the work week. Many did not realize how much sleep they were actually getting until they were asked to think about it. At that point, they realized how little sleep they got and that it was typically poor quality sleep.

A common sleep pattern during the work week was falling asleep within an hour or two after returning home from work, sleeping for four hours and waking up in the early afternoon. Occasionally this sleep was supplemented with a 1 to 2 hour nap in the evening just prior to going back to work.

Many shift workers reported having a difficult time falling asleep. Various distractions such as daylight, increased temperature and usual environmental noises (e.g., traffic, birds singing) contributed to their difficulty in falling asleep. Some reported using alcohol to help them fall asleep, to varying degrees of success.

Shift workers also suggested that their younger co-workers were among the worst offenders of sleep deprivation.

"The younger people need sleep and they are the ones out being social."

A general observation by the researchers was that the participants who reported sleeping the late afternoon and early evening (prior to going to work) appeared to be better adapted to the shift work schedule. However, these workers also tended to have fewer family responsibilities.

Group participants appeared to fall into two categories with regard to their sleep behavior. One

group of people historically had difficulty sleeping (i.e., prior to starting shift work) or considered themselves to be light sleepers who require very little sleep.

"I sleep whenever I feel like I have to, to function well. I've never really had set sleeping hours. Four hours is the most I got anyways."

"I'm a night owl. That's why I prefer that particular shift."

"I think I've always been a night owl. It's hard to get to sleep and I don't sleep for long periods."

"I've always been a night person."

"The night staff are hard core night people."

The people that fit into this first group seem to have gravitated toward the night shift and appear to prefer the conditions of night shift work. This group seemed to get less than the average amount of sleep during the night shift and also encountered difficulties associated with sleep deprivation. Many of these people continue to face responsibilities that require their attention during the day (e.g., families).

A second group of people appear to have more difficulty adjusting to the night shift and did not appear to enjoy it . They work the night shift because of external motivating factors. Some are working on their education during the day, while others were creating more flexible time to take care of their children while their spouse worked during the day. Others were working nights for job advancement.

"I know it (working nights) is temporary. I have to climb the ladder within the company."

"I don't want to leave my kids during the day."

Many of the shift workers reported that they were good sleepers because they could "fall asleep right away" at any time. They did not recognize that this is a sign of sleep deprivation.

Motivations for Working Shifts

The participants readily offered reasons for why they like working night shifts. These reasons include:

Although these reasons are compelling and logical, it was not clear from the discussion whether these were conscious choices made by the workers to obtain this type of work situation or arguments to bolster or rationalize to themselves their current circumstance. Many of the shift workers seemed to be under the impression that night work gives them more time. They did not seem to recognize or directly link that extra time with overall less sleep or their own sleep deprivation.

The participants reported that the main reasons they disliked working the night shift were "staying awake," "being up all night," "being chronically tired" and "sleeping out of sync with the rest of the world."

Influence of the Family on Sleep Hygiene

Family members appear to have a great deal of influence over the sleep of shift workers. Many of the shift workers said that family was important to them and were motivated to work shifts to accommodate the needs of their family. Therefore, family members are well positioned to motivate shift workers change their sleep behavior.

"You don't want to let your family down."

However, in many cases the influence of the family has negative effects on the sleep of shift workers. They believed that working the night shift was more difficult for people with families. Many of the shift workers complained that family members often disrupted their sleep.

"My daughter hinders my sleep."

Disruptions to sleep ranged from people calling on the telephone or stopping by during regular daylight sleep time to children playing loudly or entering the sleeping room to ask questions.

"It's like if you get a call at 3am. They don't understand it if they don't live it."

In the groups there were a few examples of how family members can ease the difficulty of working night shifts. Good communication among family members appeared to facilitate adaptation to a night shift schedule.

"At my house we have rules. It makes it easier. They don't bug me and stay out of my room."

The shift workers who reported the best cooperation from family members were proactive in getting their help. Some said they enlisted their family members to help around the house with things like the cooking, cleaning and laundry.

"The most important thing (to getting sleep) is family and friends looking out, understanding the situation."

Reliance on Shift Work/Overtime to Maintain Lifestyle

As noted in earlier focus groups, many shift workers rely on the increased pay from working shifts and the availability of overtime hours to maintain a certain standard of living. It was also clear that many of the shift workers who did volunteer for overtime regularly were not eager to give up one of the few opportunities to make more money.

"It's always the same people volunteering for overtime."

A change in priorities (e.g., the importance of sleep, good health) prompted by education may be necessary before these workers begin to choose sleep over opportunities to make money. However, the supervisors indicated that the company actively encourages people to pickup extra hours and this seems to be an effective method for making sure the night hours are covered. Similarly, shift workers were motivated by the pay differential offered for working the night shift. The group participants were very quick to point out that although they knew that the extra money encouraged them to forego sleep, they did not want to lose the pay differential. Shift workers and supervisors were aware that their employees were working another job. They recognized that this can be a problem among night shift workers.

Interventions to Improve Sleep/Reduce Risky Driving

Education and Awareness

Many of the participants felt grateful for the opportunity to discuss the problem of fatigue and drowsiness related to shift work in the focus groups. In many ways discussing drowsiness and fatigue was cathartic. They were relieved that they were not alone in their experiences. They recognized drowsy driving and fatigue as a major problem for themselves and their co-workers, yet they perceived that few other people had interest in discussing the issue.

The shift workers and supervisors felt that educational interventions would be very beneficial. They suggested that in particular, class offerings on parenting, stress management, and time management would help to reduce the risks from fatigue and drowsiness.

Although both the shift workers and the supervisors had extensive experience with working shifts and sleep deprivation, they seemed to have a limited understanding of the effect of sleep deprivation on their health and the risks associated with chronic sleep deprivation. When discussing drowsy driving in the group, they admitted that they felt like they were on a dangerous course and if it continued they would have a problem.

"I know if I keep going I am going to crash."

Some talked about it with co-workers and felt that they were the only people who understood the problem. Most felt that their employer was not very concerned about the personal aspects of working the night shift to their workers. Even family members did not seem to be able to understand their predicament.

"(A big problem is) getting the rest of the world to respect that my day is your night."

The perception of the researchers was that the shift workers wanted others to recognize the special difficulties they have and try to empathize with them. They indicated that the process of other important people in their lives trying to understand would be an important first step in improving conditions and helping them to get more sleep. The participants suggested that if the company showed an initiative and demonstrated that it cares about its employees, the interventions would be more acceptable to the employees.

"They need to show that they care about us, not just the bottom line."

Many of the shift workers felt that management was in a position to promote positive changes for their sleep and it appeared that the initiative for a program may have to come from the company. Most of the group participants agreed, however that the motivation to change behavior had to come from themselves. The participants recognized that they were responsible for their personal behavior and lifestyle and conceded that things they did contributed to drowsiness. They seemed to push themselves to the limit of sleep deprivation and that sometimes they needed to regain perspective on their life.

"If you are falling asleep at the wheel, it's a wake-up call."

The challenge of a program is to catch the people before they reach this point.

Alcohol-Impaired Driving Comparison

One way to draw attention to the problem of drowsy driving is to compare the effects of driving while drowsy to driving performance under the influence of alcohol. The group participants recognized drunk driving as a serious traffic safety and health problem. Most of the participants responded very favorably to this comparison and in many cases felt that drowsy driving was worse or a bigger problem than drunk driving. The thought of having lots of other drivers on the road at the same levels of drowsiness they experience was frightening to the participants.

One participant reported that he had been pulled over by the police, who suspected him of driving under the influence of alcohol, when in fact he was simply very drowsy.

Comparing Chronic Sleep Loss to Staying Awake All night

Most of the shift workers and supervisors had extensive experience with chronic sleep loss and staying awake for periods greater than 24 hours. This comparison did not appear to be very meaningful or motivating to them or give them any information about the risks of driving.

Worker Involvement in Setting Schedules

Shift workers felt that there would be important advantages to their own lifestyle if they were able to participate with management and supervisors in the scheduling. This suggestion received very positive response from the shift workers. The shift work group participants felt that letting workers be involved in setting schedules would leave the impression that the company cares and makes the initiative. They thought it would make schedules more acceptable to employees and improve attendance.

"If they ask me, I'll probably give them twice as much as they expect."

However, many of the group participants recognized that total flexibility would be difficult to achieve from the perspective of the employer. Most doubted whether employers would be willing or able to allow flexibility. Others pointed out that union rules and seniority were important barriers to implementation.

Supervisors indicated that they were typically the person in charge of setting the schedule. Some of the supervisors said they took the initiative and involved workers in schedule setting on an informal basis and it seemed to work well. Many supervisors indicated that they were willing to consider personal requests when creating the schedule.

"You get better results when you do that."

In some instances, however, worker involvement was not practical. They said they felt uncomfortable doing it without the support of upper management. They also doubted that a formal system would work. This intervention may have to rely on the judgment of the supervisors.

Environmental Conditions in the Workplace

The participants were specifically asked about the effect of environmental lighting and temperature. Many participants reported that the lighting in their workplace was turned down during the night. This was especially true in health care settings where patients were asleep during the night. The health care workers reported that the lights were dimmed in non-patient areas (e.g., nursing station) as well.

The temperature in the workplace varied widely. Participants complained about extreme conditions (either too hot or too cold). These widely ranging temperatures may also contribute to general fatigue.

Many of the participants felt that regulating the temperature and increasing the lighting in their workplace would be helpful in managing their drowsiness. Others indicated that their workplace already used bright lights during the night shift and it seemed to help them to stay alert.

"Bright lights and cold temperature help you to stay awake."

Shift workers felt their employers needed to be educated on the importance of keeping the work area well lit and cool in order to ward off drowsiness. It was apparent that the night shift supervisors have some control over the lighting and temperature and they may be a good target for an educational effort. However many felt that they would need to discuss it with upper-level management before implementing it.

In addition, social support was viewed as an important part of the work environment. Many night shifts operate with a "skeleton crew" and workers who are on the job at night with no one else said they tended to get tired and drowsy. They suggested that another co-worker would help to keep them awake and alert.

Sleep Aids

The participants were asked what kinds of things they used to help get better sleep. Some of the participants reported that they already used some sort of sleep aid. Examples included darkening shades, fans or white noise machines, ear plugs and sleep masks. Others indicated that they had tried a few things on their own or through the recommendation of a co-worker. Among the participants who reported that they had tried "something and it did not work" it appeared that they did not persist in their efforts to make the intervention work. The participants reported that they had to experiment on their own with various things to keep themselves awake, each to varying degrees of effectiveness. However, many said they had not tried anything to get quality sleep.

"I didn't try anything. But I'm willing to try."

These observations suggest that a need exists for a systematic education about sleep aides among shift workers. Sleep aides appears to be one area that has promise for promoting better quality sleep in shift workers. Educating them about the various types of sleep aides, possibly using testimonials from co-workers who use the different aides or strategies, may increase the use of the aides and promote better quality sleep.


A poor diet was recognized as a common fact of shift work. However, the shift workers and supervisors did not consciously recognize the impact a poor diet may have on fatigue level. However, when prompted to think about it by the moderator, they did believe that it could have an effect on drowsiness on the job. After some thought, the participants recognized that the type of foods they eat during the night shift and the way they eat tend to promote drowsiness. High fat, greasy foods and a high volume of food were common, as was frequent snacking to "stay awake."

"Nurses eat a lot of junk food."

An educational program highlighting the drowsiness risks of a poor diet and support in the workplace with healthy food offerings, plus social support from co-workers may have a positive effect on drowsiness.

Another problem shift workers face is a decreased range of choices for food. Late night fast food and pizza places are among the few selections available during the night. Work sites that have a cafeteria open during daylight hours are closed during the evening.

"All we have are vending machines."

Physical Activity

Many of the participants recognized that physical activity is an excellent way to promote regular sleep. They thought it would make them feel better, help them get better sleep and give them more energy when they were awake.

Some participants said their workplace either had a gym on the premises or provided incentives or discounts to use local gyms. Several shift workers said they knew people who take advantage of the services either before or after work. Many also knew of co-workers who used their break time to go for a brisk walk. However, they did recognize that most employees do not take advantage of the opportunity to get some exercise. Few people seemed to do any exercise during the shift. Others said that the gym at work was closed during the night.

Walking during break times may provide an easy and inexpensive way to promote physical activity in the workplace. One important barrier to physical activity in the work area is having a safe place to do it. People are able to get outside and walk during the daylight, but few are willing to go out at night.


The topic of naps appeared to be somewhat sensitive to both the shift workers and their supervisors. They reported that it was sometimes necessary to stay awake and be productive at the job. However, they had to be secretive about doing it. Many of the participants reported that their company has a policy against taking naps during scheduled work times. This was especially true for health care workers (e.g., nurses and nursing aides).

"Naps are frowned upon."

Breaks and "lunch" periods were frequently used for napping, however, even in companies that had policies against napping. Both shift workers and supervisors reported that their co-workers napped in break rooms or other available spaces. Some even reported going out to their car in the parking lot to get some sleep.

Shift supervisors seemed to recognize that napping occurred among their employees and most seemed to understand the need for it to happen. For the supervisors that did not have a policy against napping, they accepted the employees who did it as long as the employee was responsible and got his or her work done. The group participants reported that they watch out for each other on the night shift and were willing to wake each other up after a nap during a break.

Several members of different groups suggested that the company provide a special room that was quiet where people could take naps. They also suggested that a sleep room would be good for people who want an opportunity to stay at work and take a quick nap before driving home.

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In previous qualitative research we discovered that the shift worker target appeared to be highly motivated to change their behavior to get better quality and quantity of regular sleep. Many of the shift workers believed that drowsy driving was a problem caused by their chronic sleep deprivation. However, they seemed to be somewhat ingrained in their routine and did not stop to really consider the effects of their schedule or consider alternatives to improve their life. The process of engaging them in a discussion about the risks of drowsiness appeared to really get them to think about the issue of drowsiness and the risks it posed to their health.

After discussing the problem it became clear that in many cases the shift workers still offered many reasons why they stay awake and these reasons kept them from changing. A change in personal behavior will first require a careful consideration of the benefits they are getting from staying awake and a change in priorities.

It also appeared that shift workers were not ready to begin changing their sleep behavior on their own. Several potential motives were suggested, including family members, a tragic outcome to a co-worker or close friend due to drowsiness or fatigue, and the initiative of employers to promote systematic changes.

"Management needs to show the workers they know about the problem and that they understand and care."

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Shift workers were somewhat cynical about the likelihood of employers initiating a program to help them with drowsiness and fatigue.

"If you forced senior management to work the 3rd shift, then you'd see a change."

They believed that the employer would tell them a program to improve fatigue would not be "in the budget." They also questioned the motivation of the employers.

"They just want to see you work like a horse."

"The employer is after the bottom line."

"If you don't do the work, they'll get somebody who will."

Mostly the shift workers did not feel they could rely on management to take care of their needs.

"We try to take care of ourselves at night."

A successful intervention by the employer will have to present it carefully to the workers and involve them to establish a level of trust with the workers.

Supervisors thought that the employer might respond to an economic argument for promoting sleep hygiene in their employees rather than their employees health. Supervisors felt that drowsy driving was a major potential problem for their workers, but they did not think that upper-level management had a sufficient understanding of the problem. They believed that educating them about the potential hazards would get the company to act.

Extra Hour of the Day

At the end of each group session, the participants were asked what they would do if they were given an extra hour in each day.

"I would sleep! No ifs ands or buts about it."

Many of the group members said they would use the hour to get additional sleep. However, an equal number said they would take the hour to do a variety of other activities, mostly recreational in nature (e.g., shopping, relaxing, spend with family). This finding suggests that although increasing the quantity of sleep that shift workers get may be desirable (shift workers tend to get an average of 3-4 hours less sleep than workers on other shifts), improving the quality of the sleep they do get may be more readily achieved.

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Many of the group participants indicated that they would like to see an increase in the amount of time the electronic media devotes to the problem of drowsy driving. Some suggestions were news stories or news magazine programs.

"I notice that I really pick up on the stories about fatigue and drowsy driving in the media."

Most of the suggestions involved work-site communications such as posters in break rooms, brochures, tip sheets, payroll stuffers, newsletters, videos on safety monitors and safety meetings. The participants felt that meetings would probably be the most effective and they had the most enthusiasm for that method. Most reported that they had regular meetings prior to their shift with the supervisor and that would be an opportune time to discuss drowsiness and driving and ways to combat fatigue. They also suggested that special meetings during the work shift would be helpful.

Electronic mail also appears to be one very effective method for communicating brief safety messages. Many of the nurses who participated in the groups reported that e-mail was the most efficient way to reach them to deliver important messages. They recommended that the messages should be brief so they were not tedious to read in addition to all their other messages. E-mail messages should indicate where to go for further information.

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Most of the participants stated that they had worked on a rotating or night shift at some point in the past. Two participants had noticed diminished capabilities and alertness while working on the night shift, and one was involved in a fall asleep crash.

Problem Identification

Participants were asked about the problems their company had to deal with in regard to shift worker sleepiness or fatigue. About half stated that they were not aware of any problems. The problems mentioned by the others were production errors, noticeable employee fatigue, difficulty adjusting to schedule after a day off, absenteeism, tardiness and complaints of schedule.

Current Company Policies and Practices

Participants were asked what safety or health issues their company had previously been involved with, specifically in the area of traffic safety. Five of the participants said that their company offered a defensive driving course. Other health and traffic safety issues mentioned were drunk driving, safety belt use, safety education, wellness credits, environmental concerns, motorcycle safety and ergonomics issues.

When asked about fatigue, 12 of the 15 participants stated that their company did not currently have any programs/policies in place to deal with this issue. One company does offer training in physiology, exercise programs, food, health club discounts and sleep hygiene. Another company has a fatigue countermeasure program in the airline pilot recurrent training program, which now includes flight attendants and simulator technicians. The company conducted shift worker/fatigue classes, and has started a countermeasure program that addresses what fatigue is and its symptoms; countermeasures include napping, food and exercise. Another company has a health center on site and provides sleeping tips in its wellness program.

Next, the participants were asked about the decision making process and flexibility of their company's policies. Almost every participant said that decision making starts with the safety department or human resources and then goes to senior management. One respondent said that each individual plant has flexibility in decision making.

Intervention - Policies/Practices

The participants were asked to explain how changes in their company's policies/practices were made. Many companies have a safety department that will review policies/practices and will make recommendations to human resources or senior management. One company has a safety suggestion box where employees can place their comments and have them reviewed by the safety committee.

Next, the participants were asked what evidence or information would be needed to stimulate change in their company's policies/practices regarding shift worker sleepiness in the workplace. The managers stated that accidents, excessive use of health benefits, absenteeism, decreased productivity and employee suggestions might stimulate change in company policies.

When asked if evidence that more/better sleep produces a better quality of life for employees would be more or less likely to stimulate a change, the majority of participants stated that yes, it would. Five participants said that it would not, or would be unlikely.

When asked if evidence that more/better sleep increases productivity, morale, quality of work, and retention on the job would be more or less likely/effective to stimulate a change, all but one of the participants said that it would. One participant remarked that the company cannot dictate personal practice.

Next, the participants were asked if evidence to the cost-of-injury employers sustain when an employee is injured in a motor vehicle crash whether on-and off-the-job and how this cost cuts into the bottom line of company profits would be more or less likely/effective to stimulate a change. Ten of the respondents stated this issue was very important and likely to stimulate a change. Three of the respondents felt that the evidence would be looked at. Only two participants felt that this issue would not likely stimulate a change.

When asked if evidence to the cost-of-productivity losses would be likely to stimulate policy/practice change, all but one of the managers said that they felt that it would.

The participants were then asked if they felt specific case studies from other companies' experiences would be likely to stimulate change. All of the participants felt that this would be likely to stimulate a change.

Participants were asked what of all the reasons discussed would encourage their employer to make a change in their corporate policies/practices regarding workers sleepiness in the workplace. Most participants felt that costs and productivity would be the most important determining factors in making a change. Quality of work, crash statistics, morale, and case study evidence were also mentioned as reasons.

Intervention - Employee Awareness

Next, the participants were asked what could be done to increase awareness among their shift worker employees about the importance of getting enough/better sleep to increase performance and safety on the job and while driving. Most managers believed that education programs would increase awareness. Other more tactical ways of increasing awareness that were noted were through e-mail, bulletin boards, materials distribution, lectures and supervisor training.

In previous discussions with shift workers and front line supervisors, there were a number of interventions they thought employers could do to encourage proper sleep habits and to reduce the risk of their employees from drowsy driving. Such interventions include:

The managers were asked about their level of interest in the suggested interventions and which ones they felt would be effective and would receive company support.

Installation of Bright Lights

Overall, most managers felt that companies provided adequate lighting at all times. The participants who worked in the health care field said that the lights were turned down in the evening for the benefit of their patients. One participant in the health care field felt that the company would look at installing brighter lights in the nurses stations if there was evidence to support that bright lights were beneficial. One company had recently increased illumination in break rooms, reservation areas, and on the shop floor.

Availability of Sleep-aid Supplies/Equipment to Shift Workers

This idea didn't generate much interest. The majority of the participants felt that this idea would not be supported by companies because of cost issues, even if proven effective. Two of the participants did say that their company supplied earplugs and one said the company may support if there was a demonstrated correlation with productivity.

Allowing Shift Workers to Be Involved in Setting Work Schedules

Self scheduling was allowed to some degree by a slight majority of the companies. Self scheduling did not seem to be a problem with most companies as long as the work was covered. Union contracts were mentioned as a limitation to flexible scheduling. Two of the managers said their companies would not allow flexible scheduling because of production needs.

Education on Physical Activity, Nutrition and How it Effects Sleep/Alertness

This idea was well received. Several companies are already providing this kind of information to their employees through e-mail, bulletin boards, newsletters, handouts in cafeteria, and wellness programs.

Availability of Safe Walk/Exercise Area

About half of the managers said that their company offers a gym or walking facility, but only two of them said they were opened at night. Others said that their company might look at the idea. Some participants raised concerns about security at an on-site exercise facility.

Increasing the Availability of Healthy Foods on the Night Shift

All but one of the participants stated that their company provided food during the evening. Most of the companies had vending machines that offer a wide variety of foods, including health foods. Five of the managers said that their facility has a late night or all-night cafeteria.

Sleep or Napping During Break

Most companies do not have a formal policy dealing with this issue. Three managers said that napping/sleeping while at work was against company policy. A few managers said that napping does occur, although the companies provided no place to rest. Three managers said that sleeping does occur in staff lounges.

Management/Company Support of Suggested Interventions

Education, nutrition, and exercise are the interventions most managers believed would be most effective and receive the most company support. Napping on breaks and lighting were also mentioned as being effective interventions. Scheduling and child care were also noted, but to a lesser degree.

Next, the managers were asked how much freedom/flexibility front line supervisors have in adopting practices to accommodate the needs of shift workers. Most managers felt that they had some level of flexibility of minor practices when it came to accommodating shift workers.

Wrap Up

Next, the managers were asked if they had any additional or final ideas that they believed would help companies assist corporate support for shift workers to get more/better sleep. Most participants felt education through literature and videos would be most helpful. Other ideas mentioned were staff meetings on the issue, 24 hour confidential help line, carpooling, family education, and one-on-one discussion of topic.

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Shift Work Experience

1.  Have you ever worked on a rotating or night shift? If yes, tell me how this experience affected your quality of life? Family/relationships? Your driving?

Problem Identification

2.  What kinds of problems has your company had to deal with in regard to shift worker sleepiness or fatigue? (Probe for a concern about their employees lack of sleep and how it affects their performance on the job and while driving.)

Current Company Policies and Practices

3a.  What safety or health issues has your company previously been involved with? What had been done specifically in the area of traffic safety? (Probe: Has your company implemented any programs such as drinking and driving, drug or safety belt campaigns? How about any policies? Do you have a seatbelt, drug or drinking policy? What are the "hot" issues?) 3b.  What about fatigue? (Probe: Are there any programs/policies currently in place to deal with the problem of fatigue? Is this an area your company is involved in?) 3c.  How flexible are your company policies? (Probe: Who makes decisions on corporate policies? How are these decisions made?)


4a.  How are changes in your company's policies/practices made? (Probe: Who starts the process? What barriers have to be overcome to make changes? What is needed to make these changes happen? Who makes these type of decisions?)

What evidence or information would be needed to stimulate change in your company's policies/practices regarding shift worker sleepiness in the workplace? (Probe for unaided response, then discuss the following:)

Quality of life


Cost of injuries to employers

Cost of productivity losses

Specific case studies

4b.  What of all the reasons discussed would encourage your employer to make a change in their corporate policies/practices regarding workers sleepiness in the workplace? Why?

4c.  What can you do to increase awareness with your shift worker employees about the importance of getting enough/better sleep so they perform their best on the job and to ensure they are not a safety risk on the job and while driving? (Probe: If they feel they can't do anything, then ask if not them, who could?)

4d.  In previous discussions with shift workers and front line supervisors, there were a number of things (interventions) they thought employers could do to encourage proper sleep habits and to reduce the risk of their employees from drowsy driving.

Such interventions include:

  1. Installing bright lights in the work environment and encouragement to shift workers to darken their room during daytime sleeping hours. What is your level of interest in this idea? Would it be effective? Would your company support it? Why or why not?
  2. Making certain supplies/equipment available (or more affordable) to shift workers like darkening shades, white noise machines or ear plugs that would help the employee get better sleep during daytime sleeping hours. What is you level of interest in this idea? Would it be effective? Would your company support it? Why or why not?
  3. Allowing shift workers to be involved in setting work schedules in order for them to have a better acceptance of their schedule and better control over their lifestyle. What is your level of interest in this idea? Would it be effective? Would your company support it? Why or why not?
  4. Providing education on how moderate physical activity and eating low calorie, non-greasy, health foods can help people to get regular sleep and maintain alertness. What is you level of interest in this idea? Would it be effective? Would your company support it? Why or why not?
  5. Making available a place for employees to walk/exercise prior to work or during break (whether on company property or financial supplement at a local gym). What is you level of interest in this idea? Would it be effective? Would your company support it? Why or why not?
  6. Increasing the availability of health foods on the night shift. What is your level of interest in this idea? Would it be effective? Would you company support it? Why or why not?
  7. Allowing shift workers to sleep/take naps on lunch or breaks and provide a quiet and safe place for them to take these naps. What is your level of interest in this idea? Would it be effective? Would your company support it? Why or why not?
  8. Which of all these interventions would be most effective? Which would your company most likely support? Why?

4e.  How much freedom/flexibility do front line supervisor have in adopting practices to accommodate the needs of shift workers? What can supervisors do to help their employees get better/more sleep? (Probe: What level of permission is need for them to make changes in policies/practices?)

Wrap Up

5a.  Do you have any other ideas that you believe would help companies such as yours assist corporate support for shift workers to get more/better sleep? Anything else to add?

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Interventions to decrease the risk of drowsy driving among shift workers should consider the following recommendations:

Educational efforts should be aimed at the following targets:

[Sect 1]  [Sect 2]  [Sect 3]  [Sect 4]
[Appendix D]   [Appendix E]