Job Accommodation Network

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Sleep Disorders

How prevalent are sleep disorders?

According to the National Institute of Neurological Disorders and Strokes, it is estimated that 40 million Americans are diagnosed with a chronic long-term sleep disorder each year, and 20 million Americans have occasional sleep problems (About Sleep Disorders, 2005).

What are sleep disorders?

Sleep disorders are neurological conditions that can affect sleep in a variety of ways. The International Classification of Sleep Disorders (ICSD) lists over 84 different types of sleep disorders that affect the body's normal cycle of daytime wakefulness and night time sleep (About Sleep Disorders, 2005).

Sleep disorders are often categorized into four types: (1) Primary Sleep Disorders, (2) Sleep Disorders Related to Another Mental Disorder, (3) Sleep Disorders Due to a General Medical Condition, and (4) Substance-Induced Sleep Disorders (American Psychiatric Association, 1994). Examples of Primary Sleep Disorders are:

Primary Insomnia: The common complaint of primary insomnia is difficulty falling or staying asleep that is consistent for at least one month. Symptoms include decreased energy, lower concentration, and fatigue. Although symptoms are similar, primary insomnia should not be confused with insomnia related to a mental health impairment or another health condition. Insomnia, in general, often increases with age and affects women more (National Women's Health Information Center, n.d.).

Narcolepsy: Narcolepsy's primary characteristic is the occurrence of sleep attacks, which can occur at any time and during activity or conversation. Individuals with narcolepsy have abnormal sleep patterns and enter Rapid Eye Movement (REM) before going through their regular sleep sequence. Cataplexy (a weakness or paralysis of the muscles), sleep paralysis, and hallucinations are common symptoms of narcolepsy (Neurology Channel, 2005).

Hypersomnia: Hypersomnia's symptoms include excessive sleepiness for a minimum of one month. Excessive sleepiness is often characterized by extended sleep episodes or by daytime sleep episodes that occur daily. Individuals with hypersomnia often sleep 8 to 12 hours a night and have difficultly waking up (American Psychiatric Association, 1994).

Restless Leg Syndrome (RLS): The primary complaint of individuals with RLS is that sensations in the legs, described as pins and needles, crawling, and tingling, occur during sleep. As a result of these sensations, there is an overwhelming urge to move the legs. People with RLS are often sleepy during the day due to lack of sleep. Between 5-10% of Americans have RLS; iron deficiencies and genetics may play a factor in the occurrence (Haran, 2005).

Sleep Apnea: Over 12 million Americans have sleep apnea; it is more common in men over 40 years of age (National Institute of Health, 2003). There are two different types of sleep apnea: (1) central sleep apnea and (2) obstructive sleep apnea (OSA). Nine out of ten people with sleep apnea have OSA. The main characteristic of sleep apnea is that an individual stops breathing for 10-30 seconds at a time while sleeping. As a result, the individual never completes a full sleep cycle and has significant daytime sleepiness. The most common treatment for sleep apnea is the nighttime use of a continuous positive airway pressure (CPAP) machine, which is a mask that is worn at night to force air into an individual's airway. The CPAP keeps a person's airway open while sleeping so the person can reach a deep sleep (American Psychiatric Association, 1994).

Shift Work Type: Ten percent of all shift workers have been diagnosed with shift-work type sleep disorder. Shift work type is a result of disruptions of sleep and wakefulness patterns due to irregular schedules. Rotating shift work is the most disruptive because sleep is never habitual. Serious health conditions can arise out of this, including peptic ulcer disease and heart disease (Basner, 2005).

What causes sleep disorders?

Many causes can be attributed to sleep disorders depending on the type. In many cases, sleep disorders can be a symptom of an underlying medical condition or a side effect of medications. Often times, a family pattern can be shown in conditions such as hypersomnia and narcolepsy (American Psychiatric Association, 1994).

How are sleep disorders treated?

Depending on the type of sleep disorder, life style changes, medications, and surgery can be options (American Psychiatric Association, 1994).

Sleep Disorders and the Americans with Disabilities Act

Are sleep disorders disabilities under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with sleep disorders will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Sleep Disorders

(Note: People with sleep disorders may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with sleep disorders will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with a sleep disorder experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with the sleep disorder been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with a sleep disorder to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding sleep disorders?

Accommodation Ideas:

Daytime Sleepiness:

Provide a device such as a Doze Alert or other alarms to keep the employee alert
Reschedule for longer or shorter, more frequent breaks
Provide a shift change for when the employee is most alert

Maintaining Concentration:

Provide space enclosures or a private work area or office
Increase natural lighting or provide full spectrum lighting
Reduce clutter in the employee's work environment
Plan for uninterrupted work time
Divide large assignments into smaller tasks and steps
Restructure job to include only essential functions
Allow the employee to listen to music or white noise with a headset

Memory Deficits:

Post instructions with frequently used equipment
Allow the employee to tape record verbal instruction or meetings
Provide written checklists
Allow additional training time
Provide written as well as verbal instructions
Use notebooks, calendars, or sticky notes to record information for easy retrieval

Attendance Issues:

Provide a flexible start time and/or end time
Allow the employee to work from home
Provide a part time work schedule
Provide a shift change

Decreased Stamina:

Provide a flexible schedule
Allow longer or more frequent work breaks
Provide additional time to learn new responsibilities
Provide backup coverage for when the employee needs to take breaks
Restructure job to include only essential functions

Situations and Solutions:

A financial analyst with sleep apnea often fell asleep while working at her computer. The employer provided her with a small device called a Doze Alert that fits in her ear and sounds whenever her head starts to drop forward as she falls asleep.

A customer service representative with hypersomnia had difficulty waking up for his morning schedule, which resulted in him being late for his shift. The employer accommodated him by moving him to the afternoon shift.

A dispatcher with shift work sleep disorder worked rotating shifts that caused his sleep disorder to be exacerbated. The employer changed the rotating shift schedule for all employees to shifts that were assigned by seniority.

A clerical employee with insomnia had a hard time maintaining concentration on the job and his stamina was often poor because of inadequate sleep. This employee was allowed frequent breaks to help improve his stamina.

An accountant with restless leg syndrome was often 10-15 minutes late for work every day due to amount and quality of sleep. The employer provided this employee with a half an hour flexible start time. Depending on when the employee arrived, the time was made up either in a break or at the end of the day.

Resources

References

About Sleep Disorders. (2005). Types of sleep disorders, and how anxiety and diet may influence rest. Retrieved January 5, 2006, from
http://www.about-sleep-disorders.com

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Basner, R.C. (2004). Shift-work sleep disorder - The glass is more than half Empty. The New England Journal or Medicine, 353(5). Retrieved November 11, 2005, from http://content.nejm.org

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved October 28, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Haran, C. (2005). Iron works: A cause of restless leg syndrome. Retrieved November 4, 2005, from http://www.abcnews.go.com

National Institutes of Health. (2003). What is sleep apnea? Retrieved January 11, 2005, from http://www.nhlbi.nih.gov

National Women's Health Information Center. (n.d.) Frequently asked questions about insomnia. Retrieved December 12, 2005, from http://www.4women.gov

Neurology Channel. (2005). Sleep Disorders. Retrieved January 4, 2006, from http://neurologychannel.com