Restful Recovery: Addressing Sleep Issues in Injured Workers

Executive Summary

Addressing sleep problems in injured workers is essential for ensuring a successful and timely recovery, as sleep quality significantly impacts physical healing, mental well-being, and overall outcomes. 

Key Findings:

• Sleep disturbances are common among injured workers and can hinder recovery.
• Factors affecting sleep quality include pain, medication side effects, environmental issues, and psychological distress.
• Addressing sleep problems requires a holistic approach involving healthcare providers, claims examiners, employers, and injured workers.
• Improving sleep includes creating a conducive sleep environment, practicing good sleep hygiene, managing stress, and seeking medical treatment.
• Early intervention and ongoing support from healthcare professionals are critical in addressing sleep issues and fostering recovery.

When I underwent shoulder surgery, the most challenging aspect of my recovery wasn’t the pain (which subsided relatively quickly) or the six-week immobilization of my right arm. The real difficulty was getting enough quality sleep. Each time I turned over in my sleep, the pain would wake me. Like many shoulder surgery patients, I had to sleep sitting upright in a recliner for six weeks—a situation far from conducive to restful sleep. As a result, I became irritable, short-tempered, and unproductive, far from my typical disposition. Reflecting on this experience, I now realize that many injured workers face similar sleep problems during their recovery from industrial injuries.

The primary goal of the workers’ compensation system is to ensure the well-being and timely recovery of injured workers. Adequate sleep is crucial in facilitating recovery, yet it is often overlooked by claims examiners, employers, defense attorneys, and even treating physicians.

Sleep problems can severely delay healing, particularly for individuals recovering from surgery or severe injury. Encouraging injured workers to adopt proper “sleep nutrition” can accelerate recovery and reduce the chances of long-term disability.

Years ago, when sleep disturbances were a significant component of permanent disability claims under California’s AMA guidelines, sleep testing was frequently exploited by unscrupulous medical providers. As a result, the defense community became skeptical of sleep-related issues, ignoring the real need to identify and address sleep problems in injured workers.

The potential long-term consequences of untreated sleep issues—chronic pain, mental health deterioration, and delayed recovery—are serious for both the injured worker and their employer. By proactively addressing these problems, we can reduce the severity of claims and promote faster, more successful recoveries.

What is Quality Sleep?

Quality sleep is essential to health and recovery. One key measure of sleep quality is the amount of Rapid Eye Movement (REM) sleep, the stage during which memory consolidation, emotional processing, and learning occur. Adults typically need about 20-25% of their sleep time spent in REM, equivalent to 90-120 minutes per night. Cognitive and emotional well-being suffers without sufficient REM sleep, potentially impairing recovery.

Claims examiners should be mindful of the factors affecting sleep quality and engage in open, empathetic communication with injured workers to ensure they receive adequate rest. Simple questions like asking about sleep patterns can reveal underlying issues.

Wearable technology can help monitor sleep patterns, and if problems are identified, examiners should encourage the worker to consult their physician. Various devices—from fitness trackers and smartwatches to specialized sleep wearables—can provide valuable insights into sleep quality. Although their accuracy can vary, these technologies offer injured workers a starting point for understanding and addressing their sleep issues.

Factors Affecting Sleep Quality

Several factors can impair sleep, each of which should be assessed when working with injured workers:

• Environmental Disruptions: Noise, temperature, and light pollution can interfere with restful sleep. Creating a comfortable sleep environment is key.
•  Irregular Sleep Schedules: Inconsistent bedtimes disrupt the body’s natural rhythm, making sleep more difficult to achieve and maintain.
• Poor Sleep Hygiene: Late meals, excessive napping, and stimulating activities before bed can harm sleep quality.
• Stress and Anxiety: High-stress levels and worry can prevent relaxation, making sleep elusive. Techniques such as mindfulness and relaxation exercises can help.
• Uncomfortable Sleep Surfaces: Mattresses and pillows that fail to support proper alignment can lead to discomfort and disrupted sleep.
• Medical Conditions: Conditions like sleep apnea, chronic pain, and insomnia are common among injured workers and require diagnosis and treatment.
• Medication Side Effects: Some medications, particularly those used for pain management, can affect sleep. A review of medication regimens with a healthcare provider may be necessary.

Injured workers should be encouraged to communicate any sleep difficulties to their healthcare providers to ensure timely intervention.

Strategies to Improve Sleep Quality

To help injured workers improve sleep quality, both workers and claims examiners can take the following steps:

• Create a Conducive Sleep Environment: Ensure the bedroom is quiet, dark, and comfortable. If necessary, use blackout curtains or white noise machines.
• Establish a Consistent Sleep Schedule: Regular bedtimes and wake-up times help regulate sleep patterns.
• Practice Good Sleep Hygiene: Avoid large meals, alcohol, and caffeine close to bedtime, and engage in relaxing pre-sleep activities.
• Manage Stress and Anxiety: Relaxation techniques like deep breathing or meditation can promote relaxation before sleep.
• Invest in Supportive Sleep Surfaces: Ensure mattresses and pillows provide proper support.
•  Monitor Medication Use: Consult with healthcare providers to evaluate how medications may impact sleep quality.
• Promote Physical Activity: Regular exercise, even within the limits set by injury, promotes better sleep.
• Limit Stimulants and Electronic Devices: Reduce screen time before bed and limit stimulant intake, especially in the evening.

Steps for Claims Examiners

Claims examiners can play a crucial role in helping injured workers address sleep problems. Key actions include:

• Identify the Problem: Listen actively during conversations with injured workers, ask about sleep quality, and identify potential issues.
• Facilitate Communication with Healthcare Providers: Ensure injured workers raise sleep-related concerns with their doctors and advocate for appropriate medical attention.
• Refer to Sleep Specialists: If necessary, refer the injured worker to a sleep specialist for further evaluation.
• Support Healthy Sleep Practices: Educate injured workers on the importance of sleep hygiene and guide them in adopting relaxation techniques and stress management strategies.

Employers can also contribute by providing modified duties that accommodate the worker’s recovery and ensure they are not working night shifts, which can further disrupt sleep.

Recommendations

• Claims Examiners should assess sleep quality regularly and refer injured workers to specialists when needed.
• Healthcare Providers should prioritize sleep in treatment plans for injured workers.
• Employers should implement supportive workplace policies, including modified duties, to promote restful sleep.
• Injured Workers should adopt healthy sleep habits and seek treatment for sleep-related disorders.

Conclusion

Injured workers face unique challenges in obtaining the restful sleep necessary for recovery. Identifying and addressing sleep problems can greatly improve the chances of a successful and timely return to work. Early intervention, personalized support, and advocacy for healthy sleep practices can transform recovery outcomes and enhance the overall well-being of injured workers.