 Welcome. I'm Mark Goodsall, New South Wales head for the Australian Industry Group and a member of Safe Work Australia. Welcome to today's panel session on work-related fatigue as part of Safe Work Australia's virtual seminar series and National Safe Work Week for 2016. First I'd like to acknowledge the traditional custodians of the land in which we meet the Ngunnawal people and recognise and respect their continuing culture and the contribution they make to this city and to this region. Today's panel discussion is about work-related fatigue, fatigue in the workplace. And I know many of you will deal with that issue, issue of fatigue in your personal lives and you'll have strategies to manage it in your personal lives. But it's also a very important issue in workplace risk. And it doesn't only impact on the workers' mental and physical health, it can also impact on the health and safety of those around them in the workplace. At work, fatigue can be a function of many factors. It can be mental, result of mental and physical activity, organisational change, travel, exceptionally hot or cold working environments or work scheduling. It can be further compounded by personal and lifestyle factors such as sleep, health and family commitments. Causes of fatigue can be short term or they can accumulate over time. Every business and every industry is affected to some degree by fatigue, but there are some types of work in some sectors that have an inherently higher risk, particularly when you have shift work. Work schedules such as shift work schedules can impact the time workers have to physically and mentally recover from work. As sleep and rest are the usual way that we recover from physically and mentally demanding tasks, it's important that we get a good amount and a good quality of sleep. It's important to understand that the length and quality of sleep time and also the length of time since we last rested can impact on a worker's ability to perform efficiently, effectively and safely. Under Australian work health and safety laws, everyone in the workplace has a responsibility to ensure that fatigue does not pose a risk to the health and safety of themselves or to others in that workplace. In today's discussion, we're going to explore some of the ways that fatigue can, in a workplace, can impact on health and safety and how more effectively it can be managed. We'll explore the impact that sleep has on our physical and mental health and how employers can design working hours and rosters that encourage good sleep and recovery opportunities for workers. Our panellists will also take a look at the responsibility that employees have for making sure that their fatigue does not impact on the health and safety of others in their workplace. I'm looking forward to hearing today from the evidence and the data that the panel can share with us to help us all understand the impact of fatigue better. So, without further ado, I'm pleased to introduce our panellists for today's discussion. Dr. Carmel Harrington is an Australian sleep scientist. His insights into sleep have helped improve the health and well-being of many Australians. She is an honorary research fellow at West Meage Children's Hospital and a founding member of the Australian Sleep Foundation. Carmel has also authored two books on sleep, best-selling books, The Sleep Diet, and a complete guide to a good night's sleep. We're also pleased to have Professor Drew Dawson with us today. Drew is the director of the Appleton Institute and an internationally acclaimed sleep scientist, recognised for his work in the area of sleep and fatigue research, organisational psychology and human behaviour and the human implications of hours of work. Having worked extensively in a number of industries, Drew has instigated fatigue management programs, particularly in the contents of shift work. And finally today's facilitator is the internationally renowned Professor David Capel. David has over 30 years experience as an independent work health and safety consultant and 10 years in corporate and research employment. David is adjunct professor at the Centre of Ergonomics and Human Factors at La Trobe University and a senior research fellow from the Federation University in Ballarat. He's also a certified agonist in Australia and in the US. Would you please welcome me, join me in welcoming our panellists today as I hand over to David. Thank you, Mark. Firstly, welcome to our large audience here today. Thank you for making the time to join us. And also welcome to those who are viewing online. And this is part of the virtual seminar series and it's a pleasure to facilitate this discussion about fatigue at work. And I'd like to maybe address my first question to Carmel because of your extensive research on this area of sleep. Just for the audience, do you want to just highlight what have we learned from the research in relation to sleep in the context of just what do we need in our general health and wellbeing? There's some of us. I've got a colleague who seems to get by on four to six hours a night. I need eight. Others need it certain times of the day. And I'm sure there's a lot of individual variability, but tell us a bit about what the research has told us about sleep. Yeah, well, we know from population studies that the recommended amount of sleep is between seven to nine hours, but it is an individual measure. So as you know, you need eight. I know I need eight and a half. So you sort of need to know what you need and try to get that. But of course, there are variations, genetic variations, and there's a short sleep gene. So about three to four percent of the community actually only need about five hours sleep to do everything that they need to do in sleep that we mere mortals need seven to nine hours sleep. So you need to be aware of what you need and try to get that. If not, you will be sleep deprived. And Mark also talked about the quality of sleep. Do you want to just highlight a bit about what do we mean by quality sleep? Well, lots of us may spend a lot of time in bed and actually don't feel refreshed when we wake up. And it could be that there's an underlying sleep disorder there. Or indeed, we spend three hours in the middle of the night awake. So time in bed is not necessarily a good indicator of the quality of sleep. The big measure is that sleep is meant to make you feel refreshed and rejuvenated when you wake up able to meet the challenges and the joys of the day. If you feel like that's not happening, then maybe one of the things you need to be looking at is your sleep. So the segue is into what do we learn from this in relation to shift work? Have you got any particular areas of research in looking at the prevention of fatigue and how we approach shift work? Well, we know that all of us will suffer mental and physical health consequences if we don't get enough sleep or we increase our likelihood of suffering. And this is a little bit more exacerbated in the shift worker because not only do they generally get less sleep than they need, they also have circadian disruption because they have to work during the night hours. And these two things combined seem to increase the likelihood of developing physical ill health or mental ill health. Now, the other thing with shift workers, anywhere between five to 20% will develop something called shift work disorder. And the hallmark signature of that is inability to get to sleep and or to maintain sleep and excessive sleepiness during the day, which may not be connected to shift at all. One of the reasons this is really quite a negative thing for the shift worker to develop is because it absolutely affects their quality of life and increases their chance of developing severe depression. Drew, feel free to comment on your research on this relationship with shift work. But in doing so, do you want to talk us through about this, how we've tried to administratively manage it through originally this prescriptive approach towards shift work and movement towards a risk based approach? And maybe just tell us about your research in that area. Yeah, I think there's been a trend, perhaps for the last 20 years. 20 years ago, the assumption was that we will negotiate our, excuse me, our rules of rostering. And that if we agree on a set of rules for rostering as part of our enterprise bargaining agreement, then those rules will constitute a safe system of work. And I think what we saw historically happen was that third party representation rights disappeared from the industrial relations commission back in the mid 90s. And there has been a lot of economic changes in Australia over the last 20 or 30 years. The net result of that is lots of people agree to rules of rostering that are probably demonstrably unsafe. That is because either they wanted to make more money or the organisation wanted the productivity gains. From around about the parliamentary inquiry in 2000 called the Midnight Oil Inquiry, there was a recommendation to the government that we should approach shift work from a risk based approach. And the idea behind a risk based approach is to say that effectively fatigue is with us always. It's impossible to develop a shift work system that will have people not being fatigued. The net consequence of that is as a fundamental shift, that is instead of thinking about I'm compliant with my rules of rostering, therefore it's safe. It's about saying what's the likelihood that my staff will be fatigued and what level of control do I need to implement within the workforce in order to manage that risk. And we've seen this shift to what's called performance based approaches to safety since the Robins reveal in 1972. And it's been a very long process. HL Menken famously said for every complex problem there's a simple solution and it's usually wrong. And nowhere is that probably more relevant than the area of shift work and rules of rostering. It's been challenging for organisations to work out how to risk assess a roster and how to work out what controls I should or shouldn't have in place. And the reason for this is that the risk profile for different jobs can be quite different. And people don't like sometimes the complexity associated with this. So maybe Carmel, if the comfort is to say well at least we've complied with the regulations, how do we address this individual difference that you're talking about so that the individuals feel engaged in this process? And see this is the real risk, isn't it? We can comply with regulation without engaging in the spirit of the regulation which is actually to make us safer and the workplace safer. So how do we engage the individual? I think education is one of the keys. People make decisions about the hours they work and the amount they sleep based on perceived economic and performance benefits. But they often make those decisions without being fully informed of the true cost. So I think it's really important that we start to talk about the true cost and allow these people to make informed decisions. Now I liken it to when these days we might have a bar of chocolate or a piece of cake but we know it's wrong. It's not good for us but we'll do it anyway. But lots of people are making decisions about sleep and their lack of without actually knowing the true consequences. So the very first step we need to do is engage them in that bit of information. Of course they can continue to make ill-informed and bad decisions from our perspective. But they may have very good reasons to ignore the information we're telling them. And the other thing I think we need to do is engage people in education in modern technology. So lots of not so many companies anyway actually provide education materials and there's little research to support that it works. But a lot of the research education materials actually don't get to the night shift worker. So how do we do it better? And I think we can use mobile technology. We can allow people with apps have been developed. There was a study published last year with pilots and they allowed them it was an app education. And so what they did is not only did they get information on sleep and fatigue management but they were given a very practical application so they could key in when was your flight going, what time zones you're going to move to etc etc. So they could move their organised sleep, their fatigue management and their nutrition so that a better outcome. And what they found at the six month mark the people the pilots that actually engage was only 50% that engage but the pilots that did engage actually had better fatigue management, better sleep quality and better nutrition. So we can do education better and we can engage the personal by making it personal. Do you want to comment on that? Yeah I think there's a couple of interesting points there. One I'd like to make is that the research tells us that half the time that somebody is fatigued in the workplace it's due to non-work related causes. They've been up with a sick child or they're driving back from somewhere after a holiday. Half the risk in Australian workplaces comes from factors that are under the control of the employees outside of the workplace. So I think one of the big areas the low fruit here is to start to think about how we manage that aspect of it and I think going back to Carmel's point about education if we look at what happened with alcohol and drug regulation from the 70s I remember going to work in the 70s where drink driving was funny and we've gone through a process over the last 30 or 40 years where that's fundamentally changed. I think from an education perspective we need to say to people this is how much sleep you need in order to work safely. In the same way as we say you can't have more alcohol or a certain type of drug in your system than this amount in order to work safely and people will say oh but we've have individual differences and there's a short sleep gene and all of that kind of stuff but I'm also going to make the point is there are huge inter-individual differences in the effects of alcohol on people or drugs on their cognitive capacity or error rates. It doesn't stop us as a community making that decision and I suspect the research tells us that somewhere between six hours on a regular basis most people most of the time if they fall below that threshold will be at about double the risk of accident or injury and in a single night they go below five hours sleep we can show measurable impairment that's inconsistent with a safe system of work. What's really interesting is from a cultural perspective the argument that was put forward in the 70s is we can't make blood alcohol 0.08 or 0.05 or 0.1 because everybody's different. We see exactly the same argument now with sleep and my point would be is we need to give people clear guidelines to say if you've had less than this amount of sleep tell someone. And the tell someone is the duty under the act to look after yourself look after your colleagues inform your supervisor in the context of what may be happening out of work. Yeah this has been a very controversial area because under a lot of workplaces the culture is not such that that may necessarily be well interpreted. Our general recommendations to workplaces are you may report it to your supervisor and you will manage it on the day but if it happens more often than one would expect then that needs to be managed by an employee assistance program or an occupational hygienist or somebody outside of the employee supervisor relationship mainly because the supervisors often aren't sufficiently skilled and there are authority gradients and power differentials that make that a very complicated conversation. So just in the context of those who do have to work 24-7 like a medical specialist in the hospitals and acute care you've talked about self-management of fatigue. Tim you tell us a bit more about that and how that assists them with their cognitive performance in looking after us as a community member. Yeah it's a difficult area but also one of the most exciting new areas in fatigue research which is in many industries we don't have an unlimited number of staff so for example with some work we did for Queensland Health we went to the community and said how many hours do you think a doctor should work and they said 12 to 16 should be the maximum and then we said well if we did that we're about 800 doctors short would you rather a tired doctor or no doctor at all and of course overwhelmingly the community said no a tired doctor will be fine thank you so again it's a really complex risk equation here that you need to think about and I think one of the things that we need to think about is for many organisations how to work safely whilst fatigued has become a very important area of redesigning workplaces in ways that people can work safely whilst fatigued. Our research for example in the aviation industry shows that is if the pilot tells the co-pilot or vice versa that the other person is fatigued they're much more likely to detect an error by that individual and therefore to reduce the risks associated with that. Similarly in hospitals if a team is doing a handover and lets other people know what the fatigue levels are people unsurprisingly are more conscious of that so we've been doing a lot of work in the last couple of years about how do you identify that you're fatigued and how do you redesign the work task in ways that you can operate in what we call fatigue mode so building on the threat and error management literature we have worked with a number of aviation partners and they will say at a certain level of fatigue we will operate in fatigue mode. I won't go into how we define that but to say in very simple terms if you reach a certain level of fatigue on the flight deck or in the operating theatre tell people and do things differently. So surgeons will consciously slow down and they will empower people to challenge them in the event that they make a mistake so this redesign or reproceduralisation of the workplace is a very significant way that we can reduce risk even when people are tired. So Carmel just in terms of say a simple analogy in the manufacturing industry where somebody does a particular sequence of tasks and they're fatigued what do you see in the researchers the consequence to their behaviour when something goes wrong with that particular model? Yes look we know when we're tired our ability to react to new pieces of information is quite impaired. So while we can do automatic tasks A, B, C quite comfortably if we go A, B, C, F we're not quite sure how to incorporate F so to put that in everyday language many of us have driven home tired and some of us may not remember how we got home because we've done the drive automatically and we do it we can do it night after night but if someone runs across the road or a new piece of something happens we can't react to it because cognitively we're impaired and that's what happens and that's how we have these people who do a job for 20 years really really well and on one night absolute catastrophe happens because a new piece of information has come across. So it really is important I couldn't agree more about alerting people about fatigue. We have conversations now about in fact we applaud people who exercise and who are fit. We applaud people who have a good diet and eat good food and we talk about in the workplace oh I'm having a salad today I'm doing this at the other. We need to have a conversation around I slept really well last night and rather than it being a demerit because you haven't slept well and I'm going to have to be performance managed because I'm not sleeping well. The declaration that I am taking my sleep seriously because I want to be the best version of me and be really productive and safe at work should be an open conversation and one that we encourage and we'll see if we start that and this start of that is actually this fatigue mode a declaration of okay I've too long on task or I haven't had the best lead-up period to this I'm fatigued how are we going to best manage it it's an open conversation we shouldn't try to put it under the carpet because that's the way big mistakes begin to happen. So just in that context where you do have people who work night shifts regularly there's a lot of debate about should we allow them to nap or power nap whatever the term is what's the research telling us about that? The research and napping is good for all of us so we can all benefit from a brief nap of about 20 minutes and the reason we say 20 minutes is because we want to stay in the light sleep we don't want to get into the deep sleep which will increase the likelihood of waking up with sleep inertia which is that feeling of disorientation and lethargy and it takes some time to dissipate. On balance the literature shows that a nap of 20 minutes in the early hours of the morning probably between one and three are quite beneficial and it will increase your alertness for a period of time. Naps taken after that time not as beneficial and increase the likelihood of sleep inertia. Certainly napping can be used to good benefit for night shift workers but also sleeping prior to your evening or night shift because of course fatigue is not just a matter of sleep duration but its length of time awake beforehand as well and so if we can actually have either a short nap before our shift or even a complete sleep of about 90 to 110 minutes of course the caveat is always be aware of sleeping inertia and it might take up to 60 minutes for that to dissipate if you wake up from deep sleep. You've done some research on this Drew. Yeah I mean broadly speaking I would agree with what Carmel says but one of the things that I think she hit on earlier which is quite important is the culture within the organisation and I think one of the things that's important to understand is that many organisations fatigue is what we call a forbidden topic or a taboo narrative. If you're an anthropologist these are the things that you can't talk about and the reasons for this are simple I've sat in many EBA negotiations and don't mention fatigue because it's going to cost 10% in the next EBA or its secret code for overtime reduction strategy or many of the other implications of it and I think organisations need to think really carefully about this one of the things that we've noticed is in terms of understanding the risk profile of people in a workplace just going to people and saying tell us the dumb stuff you do when you're fatigued. If you sit around with a group of 10 or 15 people they will tell you all of the dumb things that get done when people are fatigued and that provides you a very good starting point to start to think about how could we redesign or reproceduralise so these are less likely to cause an accident or the consequences are reduced. So I think it's really important for organisations to think how do we have this discussion how do we embark upon this forbidden narrative and I guess my advice would be do it out of the context of the EBA. Our experience is once you're in an EBA that's a really bad time because there are so many financial and cultural tensions around the topic the other point being is that if you do have that conversation outside of the context of the EBA people are actually quite happy to talk about it. They'll tell you all the dumb stuff they did and they'll tell you how to fix it but we just don't allow that conversation to happen within our workplaces. I suppose let's talk a little bit about the white collar workers who don't necessarily do shift work but experience fatigue. Have you got any evidence about fatigue in their industry sector? Yeah well not comprehensive evidence but we've done a number of consulting and research jobs with big oil and I remember very clearly the work with BP and Shell which showed that when we looked at fatigue related accidents they were much more likely to happen for middle level managers sales managers people on the road than they were to happen on the mine so to speak. That is unregulated working hours are much more likely to happen in junior and middle managers than they are in heavily industrialised workforces and again because there aren't unions there aren't EBAs and there are staff contracts as they say. The coercive pressure of the organisation to work long hours can actually lead to quite unsafe work practices particularly around extended commuting so people will work their day and then drive to the next place they have to be the following day and sometimes they can be clocking 16 to 20 hour days with extended commuting. So karma with 16 to 20 hour days I mean what's the research telling us about our cognitive capacities? Well after about 16 or 17 hours your cognitive capacity is at the same level as 0.05 alcohol consumption so clearly we're not thinking very well when we have see our body clock is set up so that when we awake in the morning expose ourselves to sunlight about 16 hours later our body is ready to sleep and we seem to forget that sleep forms a vital function and everyone wants to put sleep off everyone thinks oh I haven't got time to sleep but we have such enormous cognitive deficits when we don't sleep any performance gains that we think we're making due to not sleeping and staying awake are actually just in the air they're not actually happening we don't make performance gains and to the point of what's happening with the non-shift worker with the rise of the mobile office everyone's available we've all got our iphone we've all got our ipad and a study of Australian workers last year found that one in four day workers actually got less than the recommended seven to nine one in four of the workers only sometimes got seven hours sleep and one in four workers felt extremely tired or completely exhausted and thought it was really affecting their physical mental health and their social interaction so it's not just shift workers and again the commuting that these people do at that that level they're causing a lot of issues outside of their own particular selves yeah so you your researchers looked at the influence of the 24-hour cycle in building these rosters have you got any advice in relation to roster structuring and the relationship to your research on sleep yeah look there's no silver bullet like I couldn't agree with everyone knows that there's no silver bullet here and when we think about shift roster the shift roster itself is not going to solve the problem because there's so many other variables so how long is the person's commute to work what's their domestic situation do they have an underlying sleep disorder there's not giving them good quality sleep what sort of chronotype are they do they like mornings or the evenings because we know that allows them to tolerate shift better so we need to keep that into account when we think about shift rosters and put it in the design in a way if we can we also need to realize that optimal shift time and work-life balance for the shift worker may not play out against what it's best of the broader community because the longer time on shift if we have extended 12-hour shifts we're increasing the risk to the broader community when that person either is driving a big truck or a train or whatever so there is a tendency to the 12-hour shift length and whether or not that's a good thing or not is really to be debatable even though employees like it because it compresses their work week and gives them more time with their family employers like it because it makes their shift rostering easier but it actually increases their risk of injury at the end of the shift so it's all this sort of balancing but there are some things that we know about shift rostering and design that we've learned over the last 40 years that this is a pretty new area of research you know sleep, shift work, fatigue management it's only really been around for 40 or 50 years and we're learning a lot we had to start implementing what we've learned so we know that fast forward rotating shifts probably work well because they minimize or reduce circadian disruption increase access to increased sleep duration morning shifts early start morning shifts are to be avoided because shifts that start before seven o'clock in the morning actually decrease sleep duration because people have the imperative staying up at night anyway and watching tv and socializing and it actually increases sleepiness so we shouldn't start shifts too early in the morning a number of consecutive shifts in a row actually decrease alertness and increased sleepiness and extending the 12 hour shift so you do overtime at the end of the 12 hour shift actually just increases your injury risk and should be avoided I think and so there's lots of things it's a complex balance of how we design shift rosters but it's also looking at the individual so I'm going about this individual story as well so what are the particular vulnerabilities of the worker so do they have an underlying sleep disorder if they do it needs to be addressed all right so they will feel better about themselves but they'll be more productive the other thing we know over the years is that whether you're an owl or a lark really affects your ability to tolerate shift work now giving the worker information about themselves as simple as do you prefer the morning or do you prefer the night actually engages the personal and may improve their uptake of fatigue management strategies which we know is probably not as good as it should be so engaging that personal is is really important and with shift design and rostering we should put in things that we know works so napping is something I think should be recognised in the workplace especially at night shift good lighting as well we know that can be alerting and there's some great research emerging research coming out showing that the red wavelength is the warmer wavelength is alerting but doesn't suppress melatonin as much so there's lots of things we can do and there's opportunities that we now have to start implementing things but at the same time making sure the individual is engaged in this and we can move forward together it's not just the roster it's not just the duration of the shift it's not just anything so I just wonder drew if you think back to the research over the 40 odd years have we come a long way in this space well I'm going to take a slightly different point of view and say people have been sitting around trying to work out the perfect roster for about 80 years and a lot of really smart people have sat down and they haven't solved the problem yet so maybe we need to think about this a bit differently and going back to what Carmel said earlier I would make the suggestion that people need a working-time arrangement including shift work for operational needs the secret is to then go back and say how much sleep are you getting and to get the answer to that question and that can be done through both formal risk assessment techniques but also by talking to people and I think if you're finding that there are significant periods of time where people are averaging less than six hours a night you've probably got a problem and you need to control those risks and if you don't then maybe it's less of a concern but I have come to the point after 20 years of looking at this the idea of thinking I can come up with a perfect set of rules that compliance will ensure safety the research tells us that there is too much variability between individuals between workplaces between tasks for that to actually be an effective strategy and I suspect like many things in life we should stop banging our head against the wall because it'll feel really good when we do let's take a little rest from that and just see whether I've got any questions from the audience who'd like to contribute to our discussion this morning would you would like to just introduce stand up and introduce yourself first thank you my name's Mark Smith and I'm from Safe Work Australia and my question is from the perspective of businesses who are looking for quick wins now what are some of the easily fixed mistakes that you see around managing fatigues from this from this perspective of these businesses I think the low fruit is around non-work related causes of fatigue that is for many organisations wrestling with the roster and the EBA is a lot of pain for very very little gain on the other hand thinking about the culture and saying to people tell us the dumb stuff when you do when you're fatigued and how can we stop that happening asking them about how much sleep that they can how much sleep people are getting enables organisations to do a pretty quick and dirty risk assessment and then to work out doing a little bit of control or do I need a lot of control and I think there are enough tools around now in the marketplace that enable people to do pretty reasonable risk assessment and to assess the likely effectiveness of controls but I would qualify that to say that we haven't done the research in enough detail to say this control will work like this in your organisation and for most organisations now we're recommending what we call post-implementation surveillance put it in place and look at it don't assume compliance equals safety and don't assume that a control will work just because you put it in place so that normal process of put it in place evaluate it corrective action and that do loop make a lot of sense and enable you to deal with the complexity of workplace individual task etc Carmel do you want to make any quick win comments Yeah I think with quick win sometimes it especially in the white collar worker it comes from the head so if the person deems if your employer is deeming productivity equals time behind the desk then you're going to spend a lot of time behind the desk and you're going to be sleep deprived so really it means taking on board that probably somebody can't work efficiently much more than 45 hours a week so don't expect your worker to do that because you're going to have burnout and all the consequences lost productivity so I'd be looking at don't wear lack of sleep on your a heart as a badge of honour because it isn't you made the point before about the grainness between work and life balance do you see that as an emerging issue we need to think more about in particular with the accessibility of technology Absolutely and I do a lot of work with children and they observe their parents always on the iphone or the ipad or whatever and they deem success as this that's what kids are doing and we're seeing right down to little ones not getting anywhere near enough sleep and I go back there's a quote from one of the grandfathers of sleep that says that if sleep doesn't serve some vital function that it's the biggest mistake the evolutionary process ever made and that's true and we know that little kids need more sleep than big kids and that and big kids need more sleep than adults and we're seeing this complete grainness around sleep because life is so exciting and we have a thing now called FOMO fear of missing out so even when you think oh I'm not going to look at my emails till tomorrow morning you know you might just sneak a look just in case you've missed out on something chances are the world is not going to stop or blow up because you haven't looked at your email overnight so we're losing our respect for sleep and we're losing the discipline around sleep and we had it 50 years ago because 50 years ago if anyone rang your house at at eight o'clock at night someone had died they didn't do it at 12 o'clock at night the TV went off you know they'd say good night from us and good night to you and we had nothing to keep us awake we would sleep we don't do it now and we're seeing the consequences do you see these social pressures changing sleep yes but I think part of the thing is to respect those choices and to understand that in many cases the decision for a student to study all night and end up in a fabulous course and to have a fabulous career may be a good short term arrangement and I think part of the difficulty I see and this is probably a little controversial is that there is a kind of a catastrophizing that goes over sleep and I'd point out that anything that we do that's important asleep will be a very plastic behaviour otherwise we wouldn't have evolved to the point where we are so I think when we look at education programs I think telling people the world will end if they don't sleep is a bit like telling kids drugs will kill you and I think a harm minimization model rather than a model of catastrophizing it to people it's probably likely to be more successful because it allows people to say well you know every once in a while I'm going to stay up all night and party and the effects on my social life will be fabulous and I'd also make the comment and a couple of very famous sleep researchers have worked in this area which is to say people slept a long time in the olden days because there wasn't anything else to do and we used to exercise a lot because we had to that is the world is changing and I suspect if you approach kids in particular catastrophizing sleep they're just going to look at you at the same way that they do when you try to talk to them about drugs and alcohol and all of those kind of things so I think it's a complex cultural thing that we need to look at and I'd say the same thing with employees is that you know sometimes going on holiday and getting back the last thing before you start work does have advantages I think if we think about it from a harm minimization perspective we're probably going to get a better reception than catastrophizing the world's going to end Couldn't agree more but I think again along those same lines information is key choose not to make the decision for all sorts of reasons I want to have the best party tonight and I know alcohol interviews with my sleep but I'm going to have a drink anyway you know make the decision but make it on an informed basis rather than just thinking it's okay and I've got no idea why I didn't sleep very well last night which is what happens with people so that level of information is really key and again you make everything dire and everything's going to end everyone switches off anyway you know they don't engage so it's not all it's not black and it's not white but information I think is key in this set I think one of the other things that's quite interesting is pay it back that is yeah have a big night pay it back so catch up go to bed early the next night when that sleep was not displacing fun activities and I think that's part of the challenge about how do we get people to think about it in a culturally sophisticated way that will actually result in behaviour change yeah absolutely okay another question yes Helen Wright and also from Safe Work Australia just following on on that last point actually in terms of paying it back how much is there is there a research quantifying how much you need to pay back per hour missed or any other way of knowing when you've actually caught up yeah and how do you do it how do you get that time this is the good news everybody says you can't play sleep back we ran a series of studies over the last five years where we sleep deprived people up to 48 hours of continuous sleep loss and some went as far as 64 hours all of those people return to normal normal cognitive function with two nine and a half hour sleeps so you don't actually have to the body is very good at sleeping efficiently or sleeping faster as we like to say so the good news is you don't have to necessarily pay it back hour for hour if you can that's great but we would suggest if you're short your sleep by a certain amount you probably only have to pay back half of that to regain the function because there is some plasticity if you're tired the brain sleeps faster that's a controversial view because some people want to catastrophize things but I suspect if you pay it back at 50 cents in the dollar you're probably going to be fine and the point at which you know you've paid it back is when you feel well you feel good so you wake up thinking I'm okay that's really important sometimes we miss the most obvious we talk about fatigue measures and risk and that's really important but are you yawning are your eyelids dripping or chances are you've got a fatigue issue on your hands let's make some things quite practical and when we wake up and we've had we've all had say for example when we have young children or we've got a big exam or a big you know we've got a great party holiday we come back or whatever we feel really exhausted and then we have a few sleeps and we feel good well we know we've rested sufficiently but my thing though is too to realize on a regular basis what you ideally would require try to get it your body is really adaptable and it does adapt to situations but if you get what you need on a pretty regular basis you're going to be optimal health and um you'll have a very simple strategy which we'll talk to people from a clinical perspective is do you need an alarm clock to wake up absolutely if you need an alarm clock to wake up you're not getting enough sleep and that's a very simple way of making that decision so what about those of us that do need an alarm clock because we've got a long way to drive or we've got to catch an airplane or go to bed earlier and that's not without its challenges because there's lots of fun things to do in the evening but the other thing is too I mean some people they have a four o'clock flight to catch or you can't catch a flight four o'clock can you but a really early morning flight so they need to get up at four o'clock in the morning and they think they're going to go to sleep really early and they go to bed say at eight o'clock eight thirty hoping you go to sleep but at that point in time you're circadian alertness is on the rise so you are not going to fall to sleep very easily and the longer you stay in bed not falling asleep due to your physiology of alertness the more anxious you become so you start reducing these anxiety hormones so you get the worst night's sleep possible rather than the best night's sleep possible so sometimes I think more practically is okay if you can't you've got to make sure you go to sleep or go to bed after the peak of your alertness that night and if you get a slightly shortened sleep that night make sure you sleep more than next night so it's this idea of balance isn't it always yeah I've been amazed when you go to China how many people sleep on the train that they got up early for and in fact if you catch many of the red eyes or the early morning flights in on Qantas you'll see a lot of people sleeping yes and that's not such a bad thing we're running out of time so I'm just wondering for each of you if you want to leave the audience here and watching online some key messages of where we are in 2016 at the moment on the research on fatigue management shift work work sleep yeah I think probably the single most important thing for an organisation to do is to say managing fatigue is not an industrial enterprise bargaining agreement issue it's actually a safety issue and it's okay to talk about it that is our experience is once an organisation makes the decision to talk about fatigue as a safety issue they're pretty good at solving it it's only when it gets tied up in money and productivity and all of those factors and becomes a forbidden narrative that then everybody ignores it and it creates problems and I think maybe the take home message it's not just about the employer providing a safe workplace because most are engaged in doing that it's about the individual engaging as well in their own personal safety and fatigue management because it's a collaboration between the two we can't have someone saying this is what you're going to do because we'll find ways around it so let's engage the individual in the whole story and we may well move forward with fatigue management great so thank you for the studio audience for your interest and participation and thank you to all those that are watching us online and thank you to Drew and thank you to Carmel and I'll ask you to join me to thank you all together so thank you very much