Health e-News
April 2012
What Keeps You Up?
Shift Work and Sleep
Allergy Attack vs. Medicine Head
Sleep Apnea
Quick Links


How much sleep did you get last night? According to the National Sleep Foundation, only about a third of Americans get eight or more hours of sleep. One-fifth of us get less than six hours a night.

How does lack of ZZZ's affect us during our waking hours? In this edition of Health e-News, we're exploring that question and more!

Be sure to pass the news on to your employees. Their version of this month's newsletter can be found at

To your health... and a good night's sleep!
Lisa Kogan-Praska
Director, Employer Solutions and Urgent Care
InsomniaWhat Keeps You Up at Night? 
By Bruce Hoffman, Manager of Respiratory Care, Cardio-Pulmonary Diagnostics and Neurodiagnostics, Mercy Medical Center

According to the American Academy of Sleep Medicine, one in three people are affected by sleep disorders at some point in life. Recent research and better testing procedures have resulted in greater understanding and more successful treatment of sleep disorders.

Insomnia is the most common of all sleep complaints. It is estimated that 70 million people in the United States suffer from insomnia.

Insomnia can be described as having difficulty falling asleep or difficulty staying asleep, and is divided into two categories:
  • transient insomnia (less than three weeks duration)
  • persistent insomnia (greater than three weeks duration)
Usually, transient insomnia is the result of temporary stress, such as financial difficulties, family problems, loss of a loved one, a career change, etc. Once the stress is resolved, the sleep habits return to normal. In persistent insomnia, there may be a physical or emotional problem interfering with sleep. People suffering from persistent insomnia should see their physician or a sleep specialist to rule out physical disorders such as sleep apnea or restless legs and periodic limb movements. Pain, itself, can be a deterrent to good sleep.


How much sleep do we need?
The amount of sleep you need depends on various factors - especially your age. Consider these general guidelines for different age groups:
  • Infants: 14 to 15 hours
  • Toddlers: 12 to 14 hours
  • School-age children: 10 to 11 hours
  • Adults: 7 to 9 hours

Although some people claim to feel rested on just a few hours of sleep a night, research shows that people who sleep so little over many nights don't perform as well on complex mental tasks as do people who get closer to seven hours of sleep a night. Additionally, studies among adults show that getting much more or less than seven hours of sleep a night is associated with a higher mortality rate.

If you experience frequent daytime sleepiness, even after increasing the amount of quality sleep you get, consult your doctor. He or she may be able to identify any underlying causes - and help you get a better night's sleep.

Contrary to popular belief, you cannot train your body to function regularly on less than the recommended hours of sleep. Depending on the amount of energy you expend throughout the day, your body needs between six and eight hours of sleep every single night. And people with a high stress lifestyle often need even more!

Why do we need to sleep?
Our brains need sleep in order to recuperate and regenerate. Without the rest of sleep, it is impossible for us to function at our normal quality.

Sleep deprivation causes many mental health problems. Just to name a few:

  • long-term memory problems
  • decreased logical reasoning
  • longer reaction time
  • damage to the frontal cortex - where planning takes place in the brain
  • language and communication issues
  • decreased productivity

How to fall asleep
There are two main approaches to insomnia cures:

  1. In-the-moment exercises for when you're tossing and turning and not sleeping at all.
  2. And preparation practices to ensure that when you're ready to sleep, your body is, too.

Preparation Practices:

  • Avoid naps. Your body needs to find a natural sleep cycle. Napping will decrease your need for sleep at night, and increase your chances of insomnia.
  • Take vitamins! Eighty percent of us are experiencing a vitamin deficiency right now. Vitamins are vital to many parts of our health, and have been proven to help us fall asleep.
  • Fit some physical activity into your day. It's a simple concept, but it really helps. When you tire your body out with exercise, it will crave rest. However, do not exercise three to four hours before bedtime.
  • It may be difficult, but keep going to bed at the same time every night. Once your body gets into a routine, it will be beneficial to keep it there.
  • Try not to sleep in. Wake up at the same time every day, and the results will be amazing. Eventually, you might not even need an alarm!
  • Do not eat large meals or have large drinks within one hour of trying to go to sleep. Maintain a healthy diet. A small snack before bedtime such as milk and cookies, or crackers and cheese, is advised.
  • Do not drink caffeinated drinks after 2 p.m. The caffeine may remain in your body for hours and impede your sleep.
  • Don't use your bed for anything besides sleep. Don't read, watch movies, or talk on the phone while you're in bed. Save it for sleep.

 What about the times when you're lying in bed, awake and frustrated for hours?

In-the-Moment Cures:

  • Don't try to stay in bed for too long. If you find yourself wide awake and far from sleep after 20 to 30 minutes, get out of bed. Go into a different room and read for half an hour. Then try again.
  • Try to clear your mind - often we experience insomnia because we don't shut our minds off. Actively try to think of nothing. Picture in your mind a blank chalkboard, or picture yourself erasing a chalkboard.
  • If you cannot stop worrying about everything you have to do, get out of bed and write a list. Making orderly lists will give your mind a sense of peace.
  • If you still cannot get your mind off of your worries, try a soothing thought exercise:
    • Count backwards from 100.
    • Concentrate on relaxing every part of your body. Start at your toes and gradually work up to your head.
    • Meditate. Relax your entire body and relax your mind.

Realize that sleep is vital - it's vital for your body and it's vital for your mind.
Insomnia is not a mere annoyance. It can be a danger.

Studies have shown that people who are seriously sleep-deprived often function at the level of someone who is legally drunk. That should horrify you. You wouldn't go to work drunk, would you? And of course you wouldn't operate a vehicle while drunk either.

It's your responsibility to your employer, your co-workers, your fellow drivers, and yourself to make sure you get the sleep you need.

What we can offer you
Affinity Sleep Disorders Services provides help for those suffering from sleep problems. It is an established, diagnostic service, offering objective and systematic diagnosis and treatment of clinical sleep-wake disorders for people age 13 and older. Registered sleep technologists utilize state-of-the-art diagnostic equipment. We focus on personalized care for each individual, and we consult closely with your referring physician. The sleep center offers both night and daytime testing. All patients must be referred by a physician, nurse practitioner or physician assistant.

For more information, please call (920) 223-1040. 

MoonShift Work and Sleep 
By Brian Harrison, MD, medical director of Health and Productivity Management, Affinity Occupational Health

We are a sleep-deprived nation. Everybody who works shifts, or who employs shift workers, knows this.

Now add this to your knowledge of the subject:
Shift Sleep Chart
(Source: Tepas DI, "Sleep Patterns of Shift Workers," Occupational Medicine - State of the Art Reviews, Vol 5 no. 2)

As you can see, PM shifts (that is, working from afternoon into evening) are associated with the most sleep. That's true whether worked as a permanent shift or while part of a rotation. And night shifts are the worst, as we all know. Besides the fact night shift workers average the least sleep, you can also see from the above table that they must "make up" lost sleep more than other workers, on days away from work.

But, it appears they don't make up the sleep deficit very well. Permanent night shift workers average only 20 minutes more sleep on days off than do day and PM workers, even though night shift workers average about an hour less sleep on work days. Remember, deficits accumulate: if you need eight hours but only average seven, then by the end of the week you are an entire night short on sleep!

Scheduling Tips
Employers who are savvy to this do what they can to encourage employees to come to work well-rested. Here are a few tips your schedulers should know:
  • The time off between the end of one shift and the beginning of the next one should be at least 11 hours. Remember that rule even when scheduling early morning meetings!
  • Limit eight-hour shifts to a maximum of seven in a row, and 12-hour shifts to four or five in a row.

Those tips come from CIRCADIAN, a fatigue-risk management system. Please see this Occupational Health & Safety article, "Workers Need at Least 11 Hours Off Between Shifts," for more of their advice. And get to bed on time tonight! 

SneezeAllergy Attack vs. Medicine Head 
By Brian Harrison, MD, medical director of Health and Productivity Management, Affinity Occupational Health

Recent research at a heavy manufacturing plant proved four important things about seasonal allergies:
  1. During their bad seasons, allergy sufferers have more work injuries, more Worker Compensation claims, less ability to concentrate and to work without mistakes, and rate their own work performance as being worse. Absenteeism, Worker Comp, and group health claims increase!
  2. The worse their symptoms got, the worse these risks and impairments became.
  3. And, when allergy sufferers used sedating antihistamines (allergy medicines that cause drowsiness), their impairment and their risks didn't improve.
  4. BUT, when allergy sufferers used non-sedating medications, their work performance improved dramatically and was nearly as good as people who had no allergy. Their risk of work injury also dropped to normal!
It is nice when research matches common sense! If you have ever suffered from severe runny nose, watery eyes, and sneezing from allergies, then you know you can't work as effectively and safely as you'd like. And, if you ever had "medicine head" from taking antihistamines that made you drowsy, you also know that makes it hard to work, especially to work safely. But, if you use an allergy medicine that does not cause drowsiness, you remain alert, make fewer mistakes, and work safely and effectively.

So, the take home message is "READ THE BOX!" If you use an over-the-counter allergy medicine, read the warning label before you take it! If it says it may cause drowsiness, you should not take it and go to work within 6 to 12 hours, depending on the product. Find and use something else to keep allergy troubles away while you work, for the safety and you and your co-workers.

Certain over-the-counter medicines are great for working people. These include loratadine (Claritin type) and cetirizine (Zyrtec type). You can buy these over the counter, including inexpensive generic or "store brands." Ask your provider what's best for you. Your doctor could also prescribe various other allergy medicines if needed, which likewise do not cause drowsiness. More severe allergies may require these prescriptions.

And, remember to tell your doctor what you do at work. That helps your provider choose the best and safest medicine for you. Again, the key is finding the right medicine. If your allergies are anything more than minor, treating them improves your safety, but you need the right medicine to help you feel better AND work better.

Be safe! Stay happy! Don't fall victim to "ALLERGY ATTACK or MEDICINE HEAD!"


Try This! Workplace Wellness Tip 
Eight-a-Day Challenge
Well-rested employees have their head in the game. Challenge your staff to get eight hours of sleep a day for one week. For people who struggle with poor quality sleep or sleep disturbances, invite them to evaluate their sleep using this Sleep Diary
What's Happening at Affinity?

MinistryMinistry Assumes Sole Sponsorship for Affinity Health System
On February 8, Ministry Health Care assumed sole sponsorship of Affinity Health System. Previously, since 1996, the sponsorship role was shared between Ministry and Wheaton Franciscan Healthcare.

Ministry's sponsor, the Sisters of the Sorrowful Mother, founded Affinity's Mercy Medical Center in Oshkosh in 1891. Wheaton Franciscan Healthcare's sponsor, the Wheaton Franciscan Sisters, founded Affinity's St. Elizabeth Hospital in Appleton in 1899.

What does this sponsorship shift mean to employers and patients? It means you can count on continued improvement and quality, personalized health care.

According to John Oliverio, president and CEO of Wheaton Franciscan Healthcare, "Ministry and Wheaton have had a long and successful partnership as co-sponsors of Affinity. In view of the pending challenges of health care reform and federal budget deficits, Ministry approached our organization last year with a proposal to assume sole sponsorship of Affinity. After thoughtful review and discussions, we reached an agreement that will allow Ministry to continue the strong tradition of delivering the Catholic health care ministry to the Fox Valley that was begun by our founding Sisters and fulfills the heritage of Wheaton Franciscan Healthcare and our founders."

"The assumption of sole sponsorship by Ministry will extend our health care delivery footprint into a contiguous geographic market," noted Nick Desien, president and CEO of Ministry Health Care. "Sole sponsorship brings additional assets to Ministry's delivery system, which will create cost-saving opportunities, provide additional medical management experience and infrastructure, and better position Ministry to address issues related to health care reform."

"We are supportive of this new sole sponsorship agreement," said Daniel Neufelder, president and CEO of Affinity Health System. "Our patients and members should expect a continuation of personalized care from our physicians and care teams in the same close-to-home clinics and hospitals they currently visit."


Breakfast CerealBreakfast With the Experts 
Injury Prevention Strategies for the Workplace
Presented by Alex Garcia, MD, Affinity Medical Group
Orthopaedics and Sports Medicine

Wednesday, May 9
7:30 - 9:30 a.m.
Bridgewood Resort and Conference Center
1000 Cameron Way, Neenah


Are the physical demands of the job keeping your employees from performing tasks at an optimal level? Join us for this session, in which Dr. Alex Garcia will discuss common overuse injuries and the role of strengthening exercises to help prevent injuries from happening on and off the job. Dr. Garcia will explain why injuries such as rotator cuff, elbow tendonitis and low back pain occur and how to enable the same prevention strategies used for athletes to help reduce the number of days lost to injury.

Dr. Garcia, an Affinity Medical Group orthopaedic provider, specializes in sports medicine and non-operative medical treatment of joint and back pain. His goal is to return individuals of all ages as quickly and safely as possible to full function, minimizing disability and time away from sports, work or school. Dr. Garcia also has a special interest in promoting lifelong fitness and wellness, and counseling on injury prevention.

To register for this free seminar, contact Tammy Davis at (920) 628-1532 or


SleepCould You Have Sleep Apnea Without Knowing It? 
A true story from the office of Dr. Brian Harrison

"Doc, I'm glad you made me have that test. Now I feel better than ever. I just didn't realize how tired I really was!"

A truck driver told me that. He had seen me for his Department of Transportation (DOT) required certification exam. That was his parting comment as we exchanged a hearty handshake, and he left with his certificate, satisfied.

Although we were seeing eye-to-eye by then, things didn't start that way. I had surprised him a month earlier when I required him to have a sleep study to screen for sleep apnea.

I had explained how this very common condition causes people to momentarily but repeatedly stop breathing while asleep, disrupting normal sleep cycles. He understood that, and admitted his wife once mentioned she noticed pauses in his snoring pattern while he slept.

Then I covered the connection between untreated sleep apnea and health conditions, including how it can lead to high blood pressure, heart failure, and even sudden death. He said he'd heard that, too, and knew his own blood pressure had been borderline.

I went on to say that, because sleep apnea sufferers never reach deeper levels of sleep, they are prone to excessive daytime drowsiness, which could lead to falling asleep at the wheel. That's where he stopped agreeing with me. More accurately, he clammed up. He pled the 5th, so to speak. But, to his credit, he went along with my request, as a professional driver should, albeit reluctantly.

His test confirmed severe sleep apnea. He started nightly use of a CPAP machine, and noticed results right away. "I should have done this years ago!" he told me. Ironic, I thought. I should have started requiring these tests years ago.

Sleep apnea isn't new. But requiring tests for it, in people who don't feel they have it, is new. This has created no small amount of controversy, particularly among truck drivers, who are under scrutiny because of the obvious public safety implications of their job.

A Sad Story
There are more than 5,000 deaths due to large truck crashes in the U.S. annually. Somewhere between 7 percent and 20 percent of these crashes are due to truck drivers falling asleep behind the wheel. Their job is very demanding and would be stressful for anyone. But it's a killer for someone with untreated sleep apnea, which may increase crash risk by two to seven times. And it is estimated that 17 percent to 28 percent of truck drivers have that condition. (Reference: Parks, 2009).

Still, those same statistics mean most truck drivers don't have sleep apnea. And, most truck drivers finish long careers without ever being in any accident. So, how can doctors decide which drivers need to go through this inconvenient and expensive process, simply to remain eligible to drive a truck?

The Tale of the Tape/the Battle of the Bulge/Contents Under Pressure
The answer is: by using a tape measure, a scale, and a blood pressure cuff. This answer was given to us when experts gathered to answer these difficult questions. In 2006, a joint task force of three major professional groups was formed: The American College of Occupational and Environmental Medicine, the American College of Chest Physicians, and the National Sleep Foundation. One of their tasks was to decide how doctors could identify drivers who ought to have sleep apnea screening, even among drivers who didn't think they were drowsy. Their consensus was to require the screening test if two out of the following three criteria were met:
  1. Body mass index of 35 or greater
  2. Neck circumference of 17" or greater in male drivers and 16" in females.
  3. High blood pressure that was either new, uncontrolled, or requiring two or more medicines to control (Source: Hartenbaum et al, 2006)
So, these are the three things I look for when I evaluate a truck driver. These are what led me to ask the driver I described earlier to have a sleep study. And I was right, he had sleep apnea.

So, how often am I right? In this situation, at least nine times out of ten!

The Proof of the Pudding (It's in the Eating!)
I know those odds from my own experience, and from talking to colleagues. But more importantly, I know this because two recent studies have put this approach to the test, and found it is remarkably good at predicting sleep apnea. The first study found that 98.4 percent of truck drivers who had at least two of the three indicators listed above proved to have sleep apnea when tested (Talmadge, 2008). In the second study, it was 100 percent (Parks, 2009). I know of few other medical decision-making rules that work as well as this one.

The Moral of the Story
The moral depends on who you are. If you are a truck driver, staying alive requires that you can stay awake. The moral for you is to discuss sleep apnea with your own doctor, and have the test if they or your DOT medical examiner recommends.

If your work is not as safety-sensitive as that, talk to your doctor if you are concerned about feeling tired or sleepy. The "Epworth Sleepiness Scale" below gives you a way to measure that. And, know your body mass index (click here for a BMI calculator).

Ideally, it should be about 19-25. If it is over 25, set a realistic goal of gradually lowering it. If it is 35 or greater, you may be at risk for sleep apnea and not know it. Talk to your doctor, especially if your neck measures 17 or more inches around; 16 inches if you are female. If your blood pressure is a problem, you may also be at increased risk, if either BMI or neck circumference is increased.

The "Rest" of the Story
I expect to see my truck driver patient next year, knowing that in the meantime, he will continue to use his bedside CPAP device to keep breathing normally in his sleep, even when on the road. And I believe he is a safer, more alert truck driver because he is now treating a condition that was putting him at risk of drowsy driving, even though he didn't know it.

When I see him then, he will be better rested than when I met him. And I rest easier meanwhile!

1) Parks, Philip D. MD, MPH, et al, "Screening for Obstructive Sleep Apnea during Commercial Driver Medical Examinations"
Journal of Occupational and Environmental Medicine (JOEM): March 2009 - Volume 51 - Issue 3 - pp 275-282
2) Talmage, James B. MD; et al, "Consensus Criteria for Screening Commercial Drivers for Obstructive Sleep Apnea: Evidence of Efficacy"
JOEM: March 2008 - Volume 50 - Issue 3 - pp 324-329
3) Hartenbaum, N, et al, "Sleep Apnea and Commercial Motor Vehicle Operators: Statement from the Joint Task Force"
JOEM Sept 2006 Vol 48, No. 9 Supplement 


Your Affinity Occupational Health Sales Team 
Holly Tomlin, coordinator of account management for Affinity Occupational Health, enjoys building relationships with clients while finding creative solutions for their needs.  Holly's background includes 15 years of experience in the health care field, with a strong background in employee assistance programs and occupational health. 

Riley McDermid, employer health and wellness consultant, is passionate about identifying opportunities for local businesses to enhance their occupational health programs.  In addition to her role in new business development for Affinity Occupational Health, Riley is a certified tobacco cessation specialist.

Tammy Davis, customer account liaison for Affinity Occupational Health, provides immediate response to customer service requests.  She works closely with Holly and Riley to coordinate educational programs and provide clients with valuable services information.  Tammy has 14 years of experience in marketing, sales and customer service.

To contact Holly, Riley or Tammy, call the Affinity Occupational Health office located in Menasha, at 1-800-541-0351, or e-mail, or