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WORK-SITE ACCOMMODATION IDEAS FOR INDIVIDUALS WITH SLEEP DISORDER
By Mayda LaRosse, M.A.

Preface
 
INTRODUCTION

The Job Accommodation Network (JAN) is an information network and consulting resource to enable qualified workers with disabilities to be hired or retained. Businesses, rehabilitation professionals, and persons with disabilities can discuss their concerns and information needs with JAN's Human Factors Consultants and receive suggestions on solutions to accommodation problems. JAN offers comprehensive information on methods to accommodation problems. Included will be names, addresses and telephone numbers of appropriate resources. You can make personal contact for additional insights. Information can be by telephone, mail or e-mail, and is available at no cost to the caller.

With the passage of the Americans with Disabilities Act (ADA), an increasing need to be knowledgeable about reasonable accommodations for people with sleep disorder has developed. Knowledge about reasonable accommodations can assist employers in hiring and retaining individuals.

Some employers have misconception that people who have disabilities are difficult to accommodate. However, this is not necessarily true. Accommodations are typically low cost and easy to implement. Data collected by JAN, provides evidence that employers who have instituted accommodations for people with disabilities have benefited financially. Reports show that more than half of all accommodations cost less than $500 and that most employers report benefits in excess of $5000.

When considering accommodations for individuals with sleep disorders, as with any other disabilities, it is important to remember that the accommodation process must be conducted on a case-by-case basis. (Technical Assistance Manual of the ADA, Title I, US Department of Justice, 1992). According to Title I, Section 3.7, "the employer and the individual with a disability should work together to identify the appropriate accommodations". Limitations and accommodations will vary from person to person and from job to job. Variations may occur even if employees have the same disability. Note that not all individuals with disabilities will need accommodations to perform their job, while many others may only need a few. Also, not all impairments are covered under the ADA.

Under the ADA (Title I, Section 2.2), an individual with a disability is a person who has:

 a physical or mental impairment that substantially limits one or more major life activities;
 record of such an impairments; or
 is regarded as having such an impairment.

The statute and EEOC's regulations provide examples of common types of reasonable accommodation that an employer may be required to provide, but other accommodations may be appropriate for particular situations. Also, a reasonable accommodation need not be the best accommodation available, as long as it is effective for the situation.
The following are some examples of accommodations from the ADA Technical Assistance Manual (Title I, Section 3):

 making facilities readily accessible to and usable by an individual with a disability;
 restructuring a job by reallocating or redistributing marginal job functions;
 altering when or how an essential job function is performed;
 part-time or modified work schedules;
 obtaining or modifying equipment or devices;
 modifying examinations, training materials or policies;
 providing qualified readers and interpreters;
 reassignment to a vacant position;
 permitting use of accrued paid or unpaid leave for necessary treatment;
 providing reserved parking for a person with a mobility impairment;
 allowing an employee to provide equipment or devices that an employer is not required to provide.



QUESTIONS TO CONSIDER IN THE JOB ACCOMMODATION PROCESS

Issues Related to the Individual

1. What are the individual's job duties?

2. What job duties are problematic?

3. What are the specific performance issues?

 Absenteeism?
 Missing deadlines?
 Difficulty concentrating?
 Falling asleep on the job?

4. How can the above issues be corrected? (This is where accommodation(s) will be considered.)

General Issues Related to the Work-site

1. What is the physical layout of the workplace?

2. What specific equipment is utilized in the work setting?

3. What kind of lighting is used and what is the noise level in the workplace?

4. Does the employee's workplace have visual or/& auditory distractions?

5. How can the physical environment of the workplace be changed so that the worker will be able to perform his/her job duties?

6. Can the job duties be restructured so that the worker can perform the duties that are easier for him/her?

7. What assistive devices or other products could be used that will help the individual perform his/her duties?



GENERAL INFORMATION ON SLEEP DISORDERS

Most Common Kinds of Sleep Disorders

 Insomnia - A condition which causes difficulty initiating or maintaining sleep for days, weeks, months, or years; may have other medical or psychiatric conditions present.

 Sleep Apnea - A condition in which a person stops breathing for 30 seconds or more, several hundred times a night. Heavy snoring can signal this condition.

 Narcolepsy - A disorder which causes irresistible sleep attacks; it might include sudden attacks of sleep, excessive daytime sleepiness, muscular weakness, hallucinations and sudden attacks of REM (Rapid Eye Movement - one stage of sleep).

 Restless Legs Syndrome - A discomfort in the legs which is relieved by moving or stimulating the legs; might feeling like a tingling, prickling or crawling sensation. The discomfort might keep the individual from getting restful sleep.

 Hypersomnia - A condition for which its predominant complaint is excessive sleepiness for at least one month, but not because there is anything apparently wrong with their sleep, and not because of narcolepsy or any other identifiable cause. The sleepiness usually begins late in childhood, during their teen years, or in their early twenties.

 Nightmare Disorder - A disorder that is characterized by repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams.

 Sleep Terror Disorder - A disorder that is characterized by recurrent episodes of abrupt awakening from sleep beginning with a panicky scream. No detailed dream is recalled.

 Sleepwalking Disorder - A condition which causes repeated episodes of rising from bed during sleep and walking. On awakening, the person has amnesia of the episode.

Daytime Symptoms That Might Occur

 Sleepiness
 Anxiety
 Impaired concentration
 Impaired memory
 Irritability

ACCOMMODATION IDEAS FOR INDIVIDUALS WITH SLEEP DISORDER


 Modify a schedule so the employee works a straight shift (preferably a day shift) instead of a rotating shift.

 Allow for a flexible schedule so the person can adjust to daily changes. The person may need to have flexibility in start and end times. For example, the option of starting between 7 and 10, and ending between 3 and 6 could be considered. This may need to be decided daily at the discretion of the worker.

 Allow for a flexible schedule that would allow the worker to take breaks as needed. If the person gets an hour for lunch and two 15-minutes breaks, give the break time as needed not as scheduled. An example of this is: the employee does not need the morning breaks, and only a 30-minute lunch but needs an hour break later in the afternoon. Or, the individual needs to take several 10-minutes breaks during the day and a 30-minutes lunch.

 Permit a nap time during the part of the day that the individual is most sleepy might be effective. Adjust the workday so the individual makes up the time at the end or the beginning of the workday.

 The employee might need flexibility to get up and walk around the work area. If the employee's job is sedentary, restructure the work environment so the individual can alternate sitting and standing for some tasks.

 Use a fan, "driver beep alarm" or other alarm-type device to keep the worker oriented.

People with sleep disorders might forget the purpose of a task after beginning it. Use a checklist, organizer, or pacesetter device with an audible alarm to serve as a task reminder.

 If the individual has cataplexy (loss of muscle tone, ranging from a slight buckling at the knees to a complete "rag doll" limpness throughout the body - might happen if person has narcolepsy), safety issues related to the immediate work area might need to be addressed. Not everyone who has narcolepsy experiences this symptom. If they do, it is usually associated with the expression of a strong emotion. If the worker is aware this might happen, steps might be taken to address safety needs in case the situation arises, such as keeping aisles clear.



ACCOMMODATION EXAMPLES FOR INDIVIDUALS WITH SLEEP DISORDER

To preserve the confidentiality of JAN callers the following scenarios are a compilation of
JAN cases and do not portray one specific situation.


 A customer service representative has a sleep disorder. The person had problem staying alert while speaking on the telephone. The employer purchased a "beep" alert and allowed the employee to take more frequent breaks. The accommodation cost $12 and was very successful.

 A social worker who has narcolepsy was tardy to work due to experiencing sleepiness while driving. The employer adjusted the employee's starting time, allowing the employee's morning medicine to take affect. The accommodation cost $0 and was very successful.

 A switchboard operator with narcolepsy reported using a "beep'" alert on the job. This device is worn behind the ear. When the head nods down (as it might when the person falls asleep), a gentle alarm sounds to awaken the individual.

 A telephone repairman with sleep apnea had difficulty staying alert on the job. The employer provided a CPAP Machine for the employee to use and leave at work. The employee used the CPAP machine during his nap time. It was successful in helping him stay alert when awake. The cost was unknown.

 A management level professional with narcolepsy needed a nap time. A place was provided in the employee's office to get the rest needed at certain times during the day. The employee still performed the duties up to the standard of the employer, but with periodic breaks in the day.

 A public contact representative with sleep apnea sometimes fell asleep on the job. The employer provided additional breaks for the employee. The employer also educated coworkers about sleep disorder so they would be more sensitive to the employee with disability. The accommodation was successful and the cost was $0.

 A clerical employee had narcolepsy. The employee experienced on the job fatigue, falling asleep at desk and in meetings, and difficulty awakening in the morning. The accommodations that were implemented were flexible breaks to nap, a specific location where employee could comfortably and discreetly rest, modified work assignments, ability to get up from desk and perform a variety of tasks in order to break monotony. All the accommodations were successful and the cost was $0.

 An employee of a telephone service company had narcolepsy. The employee needed a flexible schedule. The individual was given 1 and 1/2 hours of break time per day (two 15-minutes breaks and 1 hour lunch). The worker is allowed to divide that time as needed. The workstations of several workers were rearranged, thereby providing more of a visual barrier among the workstations, reducing the visual distractions and increasing productivity.


RESOURCES
(This is a non-inclusive listing)
 
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