Work-related Fatigue Reaches Beyond the Workplace

Posted on by Imelda Wong, PhD, and Anna Arlinghaus, PhD

Fatigue has been defined as “the body’s response to sleep loss or to prolonged physical or mental exertion.”1 As such, with increasing periods of insufficient sleep or physical/mental exertion, the more fatigued we become. This fatigue can only be reduced with sufficient rest.

However, for workers employed in nonstandard schedules, such as with shift work, early mornings and extended hours, opportunities for sufficient rest and recovery are limited2-4. Shortened or disrupted sleep is associated with fatigue and alters regions in the brain with short- and long-term effects on cognition. This can affect decision making, attention and concentration which can have significant negative impacts on performance and safety. Some studies have demonstrated similarities in cognitive and physiological impairment resulting from sleep deprivation with alcohol impairment. Not getting 8 hours of sleep has the same sedative effect as drinking 10-11 beers; and being awake for 17 consecutive hours resulted in the same performance impairment that occurs with a blood alcohol content of 0.05% 5-7. Sleep deprivation can affect short-term memory and performance speed; and increasing years of shiftwork can impair memory performance and accelerate brain aging8. Unfortunately, leaving nonstandard work schedules does not necessarily guarantee a quick return to normal cognitive functioning. Studies have reported that it can take up to up to 5 years to gradually regain regular cognition9.

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A recent survey reported that 43% of American workers admit that they do not get enough sleep such that it affects their ability to make critical decisions at work10. While 1 in 3 regular dayshift workers report not getting enough sleep, the prevalence of insufficient sleep is higher among those working night shifts: over 60% of night shift workers report not getting the recommended 7-9 hours of sleep per day11. Insufficient sleep, and the consequences of fatigue, not only jeopardizes their safety, but also the safety of their coworkers. Fatigue at work can also have a devastating public impact, particularly in occupations with high risk consequences. This is best illustrated in high profile disasters such as the nuclear meltdown at Three Mile Island and the grounding of the Exxon Valdez oil tanker12,13.

But fatigue at work doesn’t just stay at the workplace.

The effects can be magnified as a public health and safety concern, for example, when tired workers drive on public roads. The National Highway Traffic Safety Administration estimates that in 2017, drowsy driving was a factor in 91,000 police-reported motor vehicle crashes which resulted in approximately 50,000 injuries and 800 fatalities14. However, it is broadly agreed that this is an underestimation of the impact of drowsy driving, as not all crashes are reported to the police and fatigue can be a difficult causal factor to identify.

The Spillover-Crossover model of work-life interaction describes how work experiences can be carried over from an individual to their home life and family members15. Fatigue can affect mood and psychological well-being with negative consequences for the family16,17. Studies have reported that fatigue can extend from workers to their partners, by limiting personal resources and time to attend to household responsibilities and social recovery18. In addition, impaired cognition and decision-making abilities can jeopardize the development and safety of dependents. Shift work has been found to increase the probability of separation or divorce, especially for parents working nights19,20, and negative developmental and school outcomes for children17.

Ideally, non-work time allows for recovery from work. However, insufficient recovery due to household and other responsibilities can worsen fatigue21, resulting in workers returning to their jobs in a perpetual, or even accumulating, state of fatigue.

So what can be done to stop this cycle? Because fatigue can stem from a variety of work and nonwork-related sources, a multi-level, holistic approach to mitigation strategies at the community, workplace, home and individual levels is required. A shared responsibility among workers, employers and the community is needed to ensure occupational and public health and safety.

Does your work make you feel fatigued? Do you feel that you can fully recover from your work? How has fatigue from work affected your family or you during nonwork hours? What have you done to reduce the effects? Please let us know in the comment section below.


Imelda Wong, PhD, is the Coordinator of the Center for Work and Fatigue Research at the National Institute for Occupational Safety and Health and a Director for the International Working Time Society.

Anna Arlinghaus, PhD, is a Senior Consultant with Ximes GmbH, Vienna and an Executive Board member for the International Working Time Society.


See also What Workers and Employers Can Do to Manage Workplace Fatigue during COVID-19.



  1. Lerman SE, Eskin E, Flower DJ, et al. Fatigue Risk Management in the Workplace. Journal of Occupational and Environmental Medicine. 2012;54(2):231-258.
  2. Wedderburn A. Social factors in satisfaction with swiftly rotating shifts. Occupational Psychology. 1967;41(2):85-107.
  3. Walker J. Social Problems of Shiftwork. In: Folkard S MT, ed. Hours of Work: Temporal Factors in Work Scheduling. Chichester, UK: John Wiley & Sons; 1985:211-226.
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  5. Dawson D RK. Fatigue, alcohol and performance impairment. Nature. 1997;388(6639):235.
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  8. Niu S-F, Chung M-H, Chen C-H, Hegney D, O’Brien A, Chou K-R. The Effect of Shift Rotation on Employee Cortisol Profile, Sleep Quality, Fatigue, and Attention Level. Journal of Nursing Research. 2011;19(1):68-81.
  9. Marquié J, Tucker P, Folkard S, Gentil C, Ansiau D. Chronic effects of shift work on cognition: Findings from the VISAT longitudinal study. Occupational Environmental Medicine. 2015;72(4):258-264.
  10. Council NS. Fatigue in the workplace: Causes and consequences of employee fatigue. National Safety Council;2018.
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  12. United States Nuclear Regulatory Commission. Investigation into the March 28, 1979 Three Mile Island Accident by the Office of Inspection and Enforcement (Investment Report No. 50-320/j79-10). 1979.
  13. National Transportation Safety Board. Marine Accident Report PB90-916405. Grounding of the US Tankship Exxon Valdez on Bligh Reef, Prince William Sound near Valdez, Alaska. March 24, 1989. Washington DC: National Transportation Safety Board; March 24, 1989
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  17. Arlinghaus A, Bohle P, Iskra-Golec I, Jansen N, Jay S, Rotenberg L. Effects of shift work and nonstandard work hours on workers, family and community. Industrial Health. 2019;57(2):184-200.
  18. Demerouti E, Bakker A, Schaufeli W. Spillover and crossover of exhaustion and life satisfaction among dual-earner parents. Journal of Vocational Behavior. 2005;67(2):266-289.
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Posted on by Imelda Wong, PhD, and Anna Arlinghaus, PhD

8 comments on “Work-related Fatigue Reaches Beyond the Workplace”

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    The fatigue experienced in education such as working as a nursing professor is requiring near 90 hours continuous work; with no “down time” and high expectations to answer student e-mails 24/7, and the fear of reprisal, non-renewal of one’s contract, and standards that include even at regional universities on top of teaching, to also conduct one’s own research. Yet, there is little to no “credit”given to one’s nursing practice especially in public/population health nursing, and it is devalued and not identified as critically important due to it not fitting the current view of tertiary care where our country’s funding priorities remain vs. in upstream preventive approaches. Fatigue and burn out as a nursing professional in education as well as in practice needs to be addressed.

    It is interesting that NIOSH has chosen this time, in the midst of a pandemic, to post this piece on work-related fatigue — and with only one small mention of “extended hours” in the second paragraph. Many “essential” workers are working beyond anything that could be called “safe” limits right now. Some of this has to do with the fatally mis-handled response to the COVID-19 emergency from the very beginning, including the lack of protective measures in workplaces leading to worker illness and death. This has left fewer workers doing more work over longer hours. But that pattern of fewer workers doing more work over longer hours didn’t start with the COVID-19 emergency – it started decades ago with “lean” production coming first to manufacturing and then into the public sector, healthcare, transportation, construction and every sector of the economy. Lean (“doing more with less”) is about getting more work done with fewer people (for a primer on this, see a book called “Japan in the Passing Lane” by Satoshi Kamata about the ravages of lean at Toyota, where it first began). As employers “leaned out” their workforce, mandatory overtime rose. A significant source of fatigue in the workplace comes from employers understaffing their workforce – not an “accident of design” – but “by design.” This often necessitates extended working hours, days and weeks for those who remain. In an age where “real wages” have been going down, too many workers rely on overtime hours and pay to pay their bills. A solution to this problem – now and in the future – is to hire more workers, not less, and pay all workers living, saving wages so that no one will have to depend on extra working hours to pay their bills. A pandemic is a dreadful, deadly emergency — but it is also an opportunity to see what has gone so wrong, where inequities and disparities have led to such dire consequences including ill health and death, and correct them.

    Thank you for you comment. This blog is part of a series on take-home (or spillover/crossover) exposures. The first blog can be found here The next in the series will cover take-home lead exposure.

    Also, earlier this month we posted a blog on Managing Fatigue During Times of Crisis: Guidance for Nurses, Managers, and Other Healthcare Workers

    Extremely well written. And pointed out many of the shortcomings of this article. IMO

    Es fundamental tener en cuenta a los trabajadores que se encuentran bajo un sistema de largas jornadas de trabajo como los policías, gendarmes, prefectos, personal de salud, bomberos, etc.


    It is essential to take into account workers who are under a system of long working hours such as police, gendarmes, some government workers, health personnel, firefighters, etc.

    This blog misrepresents the issue of work-related fatigue. (1) The references are weak about the comparison of sleep deprivation to alcohol: One reference (n=40) describes study subjects in an experiment kept awake for 28 hours (1997). The second reference describes 22 19-26 year olds in an experimental setting (1999). The third reference had only 12 young adult subjects ( up to 35 years old) assigned to the sleep deprivation protocol. Research should be sought on real-life experience of sleep deprivation and work-related fatigue. (2) The blog accuses workers of not sleeping enough, by using words such as “admit” they did not sleep enough, and “jeopardizing” the safety of coworkers, and “magnifying” the risk as tired workers drive on roads. (3) The blog acknowledges that nightshift workers do not get enough sleep–but does not address solutions, such as shorter nightshift hours with more employees. (4) The blog asserts that non-work causes of fatigue should be addressed, which may be true, but NIOSH should be the leader in addressing the more sophisticated solutions in the workplace. This blog does not provide the needed guidance. This is especially true and needed now, as the pandemic has led to extended working hours, at the same time that many are not able to work.

    The comparison of sleep deprivation with alcohol consumption is used for illustrative purposes to help readers identify cognitive impairment of sleep deprivation with a known, relatable measure. The studies we have cited were published in high impact journals such as “Nature” and “Sleep” by leading sleep experts. While any study has limitations, we agree that longer term studies in the workplace would also provide valuable information.

    The intent of the article is to raise the awareness that the effects of workplace fatigue can have impacts which reach outside the workplace. As such, a concerted effort among workers, employers and community is needed to find the best solution which works for each organization and individual. As we mention in the blog, any solution will need to be a multi-level, holistic approach. NIOSH has been at the forefront of research on sleep, shiftwork and fatigue. Please see our web page Work Schedules: Shift Work and Long Hours which includes resources, training and recommendations for employers and workers on fatigue management including work schedule design, staffing levels, promotion of quality sleep and examination of job tasks.

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Page last reviewed: January 27, 2021
Page last updated: January 27, 2021