QUENTIN MCDERMOTT: Are you finding it hard to get a good night's sleep? You're not alone.
More than a million Australians suffer from insomnia or some other sleep disorder. It costs the community over $10 billion a year.
KAREN MORGAN: You feel dreadfully tired, but not able to get to sleep.
QUENTIN MCDERMOTT: Work hard and party hard is the accepted mantra of our modern, 24/7 lifestyle.
LIBERTY SANGER, PRINCIPAL, MAURICE BLACKBURN CASHMAN: Workers are being asked to work hours that lead to fatigue, and deaths and serious injuries are resulting.
QUENTIN MCDERMOTT: For many of us, sleep is a low priority - something to call on when we feel like it, rather than an activity to be treated with respect, like exercise and a good diet.
ANDREW FULLER, CLINICAL PSYCHOLOGIST: I think we live in a society that doesn't value sleep.
QUENTIN MCDERMOTT: But paying sleep so little respect can have disastrous consequences.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: In the United States 80,000 people a day fall asleep at the wheel, not per year, but 80,000 people a day fall asleep at the wheel. That's one person every second on average. And once every two minutes one of those people crashes.
JOHN SEWASTENKO: My brain was virtually dozing off but my body was still driving.
QUENTIN MCDERMOTT: Tonight on "Four Corners": are we blind to the importance of sleep? Are we living with our eyes wide open?
(On screen text: "Eyes Wide Open, Reporter: Quentin McDermott")
(Excerpt from UK program "Shattered"):
HOST: Welcome to the final of "Shattered". Tonight we're going to be revealing Britain's ultimate endurance champion. Last Saturday we put ten people in the "Shattered" lab; now, only three remain. They've endured an incredible 178 hours of sleep deprivation.
(End of excerpt)
QUENTIN MCDERMOTT: This British show, from the makers of "Big Brother", played on the fact that for many, sleep deprivation is now the ultimate lifestyle accessory.
FEMALE CONTESTANT: I can do this.
MALE CONTESTANT: Oh my god, we're in the final.
FEMAL CONTESTANT: We're in the final.
MALE CONTESTANT: We're in the final.
FEMALE CONTESTANT: We're in the last day.
(End of excerpt)
(Excerpt from old footage showing couples dancing):
PRESENTER: Just 12 couples are left in this big dance marathon after 1400 hours and they're all full of vim, vigour and vitality.
(End of excerpt)
QUENTIN MCDERMOTT: In a modern echo of the dance marathon contests during the American Depression, in which the dancers had to stay awake for as long as possible, contestants were offered 100,000 pounds as first prize for the man or woman who survived the longest on a ration of two hours' sleep a night.
The 19-year-old winner, Clare, was a trainee police officer known as "the terminator".
The program makers were advised about what tasks and games they could set the drowsy contestants by sleep expert Professor Drew Dawson.
QUENTIN MCDERMOTT (to Professor Drew Dawson): Is it an ethical thing to do to encourage people to stay awake for as long as they possibly can?
PROFESSOR DREW DAWSON, DIRECTOR, CENTRE FOR SLEEP RESEARCH UNIVERSITY OF SOUTH AUSTRALIA: Well I think ultimately the question is based on the risk that they are exposed to and I think that the risks to somebody in a TV programme in a highly structured environment where they're not driving a car or operating a 747-400 are pretty low.
QUENTIN MCDERMOTT: In his life away from television, Professor Dawson runs a sleep lab at the University of South Australia and advises companies and health authorities on fatigue management.
Australia has some of the world's leading sleep specialists. Their research is helping to develop our understanding of the role that sleep plays in our lives, and to find cures for insomnia and other sleep disorders.
As with the "Shattered" contestants, experiments into sleep deprivation may result in micro sleeps and even hallucinations.
KATIE MCCAPPIN, SLEEP DEPRIVATION VOLUNTEER: Well, they deprived us of sleep for 65 hours. I remember with the reaction time tests there would be moments where you would kind of blank out and you wouldn't remember what had happened especially towards the end, like you would, the clock would start counting and like all of a sudden it would be up to like 30 seconds or a minute and you just didn't remember getting there at all and you're just like, whoa.
BRAD COLEMAN, SLEEP DEPRIVATION VOLUNTEER: I started having like some really like, small but small hallucinations and like that combined with the, like the reaction time tests, just like my brain wasn't functioning at all so, yeah I think like there's a certain point you can push yourself up to and then after that it's just, yeah you can't go any further.
QUENTIN MCDERMOTT: Fatigue of course affects us all. But not getting enough sleep, the latest alarming research suggests, may contribute to a range of illnesses, including cardiovascular disease, depression, and the twin global epidemics of diabetes and obesity.
PROFESSOR RON GRUNSTEIN, WOOLCOCK INSTITUTE OF MEDICAL RESEARCH: Over the last 20 to 30 years it's been found that sleep is fundamental for brain function, for normal cardiovascular function, in fact normal function in most of the body. If you don't get sleep you run into trouble.
ASSOCIATE PROFESSOR MATTHEW NAUGHTON, PRESIDENT AUSTRALASIAN SLEEP ASSOCIATION: What has been shown in a in a 20-year-old, if a 20-year-old is deprived of sleep from eight down to four hours, they develop a pre-diabetic state similar to that of an 80-year-old.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: Loss of sleep also increases the level of the hormone ghrelin, which is a hormone that makes us hungry; and it decreases the level of a hormone called leptin that is released by the brain and makes us feel satisfied with what we've eaten.
QUENTIN MCDERMOTT: Dr Charles Czeisler is a renowned authority on sleep. His lab at Harvard Medical School is state of the art. He backs the theory that lack of sleep may trigger obesity.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: It puts us almost into a starvation state in which we're gobbling up all the sweets and everything else in our environment as much as we can. And it's thought to be potentially responsible for the epidemic of obesity that is sweeping the world. You can chart as the number of hours of sleep per night has declined over the past decades, the waistlines have gone up.
DOCTOR SARAH BLUNDEN, CENTRE FOR SLEEP RESEARCH, UNIVERSITY OF SOUTH AUSTRALIA (to client - woman with young daughter): What brings you here today?
WOMAN: I'm having problems with getting Ella to sleep through the night.
DOCTOR SARAH BLUNDEN, CENTRE FOR SLEEP RESEARCH, UNIVERSITY OF SOUTH AUSTRALIA (to client): Okay. And how old is Ella now?
QUENTIN MCDERMOTT: In children, new and startling research reveals, the risk of illness from lack of sleep is equally serious.
DOCTOR SARAH BLUNDEN, CENTRE FOR SLEEP RESEARCH, UNIVERSITY OF SOUTH AUSTRALIA : There is increasing evidence to suggest that children who sleep less are more likely to be obese. There have been studies who suggest that children who sleep less than 10 hours at the age of three, that's a lot of, that's not very much sleep for a three-year-old, those children have shown to be much more likely to be obese at seven years old.
QUENTIN MCDERMOTT: Up to 35 per cent of children have a sleep problem of some description. Some children snore and that can be a symptom of sleep apnoea.
Children with sleep apnoea may have pauses in breathing and have difficulty breathing when they're asleep.
ASSOCIATE PROFESSOR MATTHEW NAUGHTON, PRESIDENT AUSTRALASIAN SLEEP ASSOCIATION: It's not normal for a child to snore, and we believe what happens to a snoring child is that the heart muscle thickens, it can't relax properly and as a result of that a snoring child will often develop very subtle cardiac changes which may only become evident as that child goes into adolescence, in adult life and for example it may just simply be they're more breathless.
PROFESSOR RON GRUNSTEIN, WOOLCOCK INSTITUTE OF MEDICAL RESEARCH: There is mounting evidence that particularly in children sleep apnoea can affect not only their performance in school and their behaviour, but in fact things like their metabolic function and their cardiovascular function.
WOMAN (to Doctor Sarah Blunden, discussing daughter's sleep problems): She doesn't like me to use a firm voice. It does upset her, yeah.
QUENTIN MCDERMOTT: Children with sleep problems come to see Doctor Sarah Blunden in the Centre for Sleep Research at Adelaide's University of South Australia.
WOMAN (to Doctor Sarah Blunden): She's waking up anywhere between one and seven times a night which means that my husband and I are really tired, and I guess I'm worried as well that it's teaching her a sleeping pattern for when she gets older.
QUENTIN MCDERMOTT: Dr Blunden doesn't believe children should be allowed to get distressed at bedtime, but does believe they should be taught to put themselves to sleep.
QUENTIN MCDERMOTT (to Doctor Sarah Blunden): How do you get a baby to sleep? What's the latest theory?
DOCTOR SARAH BLUNDEN, CENTRE FOR SLEEP RESEARCH, UNIVERSITY OF SOUTH AUSTRALIA : The latest theory, I think that across the board from the 50s to now, the best way for an infant to develop good sleeping patterns is to be able to what we call self-soothe, that is, to put themselves to sleep alone. So there is the choice of feeding, rocking, nurturing the child, the infant and then putting them into their sleeping pattern, into their cot, into their bed awake - drowsy perhaps but awake so that they are able to understand and their body learns that they can self soothe, they can put themselves to sleep.
ADAM KLEMKE: Then these two arrived, and that was it. We've gained no sleep, one hour's sleep, some, most days, for the first three, four months easy.
MELISSA KLEMKE: Yeah, mmm, one or two hours' sleep.
QUENTIN MCDERMOTT: When twins came along for Melissa and Adam Klemke, their lives changed dramatically.
Teaching their babies to self-soothe wasn't high on the agenda - simply trying to survive on the most basic level, was.
QUENTIN MCDERMOTT (to Melissa Klemke): Melissa, what was that first year like for you?
MELISSA KLEMKE: If you asked me to relive it for a million dollars I wouldn't. It was difficult, it was really hard. It was very, it was really a test of my character, I have to say. I felt that I really knew myself before then, but I didn't. It really pushed every button; it really pushed my limits. Yeah, definitely.
QUENTIN MCDERMOTT (to Adam Klemke): Did you drive to work?
ADAM KLEMKE: Yes.
QUENTIN MCDERMOTT (to Adam Klemke): What happened when you were driving?
ADAM KLEMKE: Oh, I've woken up at traffic lights, I've woken up in different lanes, on roadways. Last week I woke up at a set of lights and there were people beeping me and going around me at the lights. I was like, oh I'm sorry, I've missed the green light.
QUENTIN MCDERMOTT (to Adam Klemke): There's a concept known as sleep debt, which is, you know where you build up sleep debt. Do you recognise what that means?
MELISSA KLEMKE: Oh yeah we're definitely, we're owed a lot of sleep! Somebody's bankrupt somewhere! Yeah.
QUENTIN MCDERMOTT: Another family, which is now paying off its sleep debt is Stella Barker's.
Unlike her older sister Esther, Stella Barker could never settle down.
STELLA BARKER: My problems were, I was up and down and up and down and that was the main fact. I wouldn't just lay in bed and think, I'm gonna have a great day tomorrow, how fun is it going to be? I was up and down, up and down. Mum when am I going to bed? Mum what time, Esther what show is on tonight? Is it "What's Good for You" or "Temptation"? I used to panic.
QUENTIN MCDERMOTT: Stella's sleep patterns proved to be highly disruptive.
LEANNE BARKER: My husband and I were really struggling. We'd find something that would work; we'd go with that. Then we'd, that would fall away and then we would try something else.
QUENTIN MCDERMOTT: Stella Barker's parents took her to the children's clinic Michael Gradisar runs at Adelaide's Flinders University. The clinic specialises in curing children with insomnia.
MICHAEL GRADISAR, CHILD PSYCHOLOGIST, FLINDERS UNIVERSITY: For the primary school age children that we see that there's a number of parents that probably aren't getting enough sleep themselves, that they're getting disrupted sleep. That's probably where it's hitting them the most. And after a number of months or a number of years they're sort of fed up with it finally and they want to do something about it.
LEANNE BARKER: We went down every Wednesday, didn't we Stell?
STELLA BARKER: Yep.
LEANNE BARKER: Down the hill, every Wednesday and we would sit for an hour with one of the child psychologists there and really try and work out what your issues were.
STELLA BARKER: Yeah.
MICHAEL GRADISAR, CHILD PSYCHOLOGIST, FLINDERS UNIVERSITY: What we're trying to do is use psychological treatments, almost like versions of what we do with adults.
LEANNE B: Very simple exercises like, Stella did a lot of drawing on her feelings - how she felt, did she feel sad, did she feel happy - when she woke during the night and she was concerned and she was upset and she was frightened.
STELLA BARKER: They told me how to deep breathing.
LEANNE BARKER: Relaxation, didn't they Stell? Things like you had to have happy thoughts.
STELLA BARKER: Yeah.
LEANNE BARKER: And also to be able to have that skill of being able to settle herself back down and go back to sleep and not wander the house.
QUENTIN MCDERMOTT: Teaching a young child sleeping skills is one thing - teaching adolescents with their 21st century distractions and their chaotic body clocks to get a good night's sleep is quite another.
MALE STUDENT: I usually fall asleep about two in the morning so I get about five hours' sleep, six if I'm lucky, about that.
FEMALE STUDENT: Have dinner, watch TV, may go on MySpace and then go to bed, but if I have work I might do homework before I go to bed.
QUENTIN MCDERMOTT (to male student): Why do you go to sleep so late?
MALE STUDENT: Well I have an over-stimulated brain, so it doesn't stop working or winding down until later.
ANDREW FULLER, CLINICAL PSYCHOLOGIST: There's about 40 per cent of students are chronically sleep deprived. And while that's boys, it certainly includes boys, it's also mainly girls and partly due to mobile phone usage and internet usage throughout the night.
MICHAEL GRADISAR, CHILD PSYCHOLOGIST, FLINDERS UNIVERSITY: Their body clocks seem to drift a bit later and so therefore they're having trouble falling asleep at the start of the nights. They're waking up too early for their body clocks and they're not getting enough sleep, and this sort of compounds during the school week.
QUENTIN MCDERMOTT: These Year 12 students from Wantirna College in Victoria are typical of their age-group. Most say they get enough sleep, but some certainly don't.
MALE STUDENT: Sometimes when I get to bed three, three thirty in the morning I'll be very grumpy the next day, then I'll just catch up with a bit more sleep and I should be back to normal.
QUENTIN MCDERMOTT (to another male student, Adam): Adam you get seven hours' sleep a night - is that enough?
ADAM: No. I'd like to have more but I just find that I don't either go to bed early enough or can't get to sleep within like an hour or so.
FEMALE STUDENT 2: If I haven't had enough sleep and I come to school I'm all, I'm crankier and everything so it's a lot harder to concentrate if you haven't had enough sleep then, yeah.
ANDREW FULLER, CLINICAL PSYCHOLOGIST: Chronic sleep deprivation becomes almost like an avalanche really of consequences for young people and their families. They become crankier, they find it more difficult to concentrate. Their diet often changes as they as they eat higher sugared foods, particularly late in the night, or very early in the morning to try and give them a lift. They are, basically their concentration wavers and they're often unable to really steady themselves and perhaps perform in terms of exercise, physical activities as well.
QUENTIN MCDERMOTT: Psychologist Andrew Fuller has surveyed tens of thousands of adolescents about their lifestyles and sleeping habits.
ANDREW FULLER, CLINICAL PSYCHOLOGIST: I think we live in a society that doesn't value sleep. We live in a society that basically has this idea of you're accessible and alert and contactable 24 hours a day. And that's certainly a myth for young people and their friends. A lot of young people that I talk to say, "I can't switch off my mobile phone, what if my friend needs me at four o'clock in the morning?"
QUENTIN MCDERMOTT (to Andrew Fuller): So what are the activities or devices that are keeping kids awake?
ANDREW FULLER, CLINICAL PSYCHOLOGIST: Well the idea basically of having electronics in bedrooms is just a sabotage really for marks at school, but also for wellbeing for young people. So the idea of separating electronics and bedrooms is incredibly important. So computers, televisions, mobile phones, are all really sabotaging sleep.
QUENTIN MCDERMOTT: But beyond that, how can we reset a person's body clock? The answer is something called bright light therapy.
PROFESSOR LEON LACK, SCHOOL OF PSYCHOLOGY, FLINDERS UNIVERSITY: Bright light therapy is becoming more prominent as a possible treatment for certain types of insomnia – people who specifically have the problem of just getting to sleep at the beginning of the night. We'd use bright light in the mornings to try to shift their body clock back earlier so that they can fall asleep earlier in the evening and wake up at a normal time having obtained the right amount of sleep.
QUENTIN MCDERMOTT: Professor Lack and his colleagues are developing a deceptively simple bright light device which, they say, could in future help patients re-set their body clocks.
PROFESSOR LEON LACK, SCHOOL OF PSYCHOLOGY, FLINDERS UNIVERSITY: So this is an example of one. It just uses light emitting diodes as you can see now on my face, and we've used blue ones because blue has been shown to be the more effective colour.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: Just like the ear has two functions - one is hearing and the other is balance - the eye has two functions. One is sight, our ability to see each other, and the other is circadian vision. And we use two completely different photo receptive systems in the eye to mediate those two responses. And the circadian clock resetting is best done by this shorter wavelength blue light. So for example looking up at the blue sky has twice the resetting effect photon per photon as looking down at the green grass.
WOMAN (to Tammy Lawson, switching on light and waking Tammy): Okay Tammy, it's time to wake up now. How did you go that time?
TAMMY LAWSON (to woman): Yeah, good.
QUENTIN MCDERMOTT: Chronic insomnia affects about five per cent of the population and can make life hell for sufferers.
Tammy Lawson's insomnia was so bad it nearly killed her and her entire family when she nodded off at the wheel in the family car. Fortunately, they all survived.
She didn't want to take sleeping pills, and instead sought treatment here, at Flinders University's Sleep Laboratory in Adelaide.
The treatment Tammy Lawson underwent sounds like torture. Over the course of a single weekend, patients are allowed snatches of sleep and then woken up repeatedly. It's a sophisticated form of sleep deprivation as therapy, as another patient, Karen Morgan, recalls.
KAREN MORGAN: Part of the program is a weekend at the sleep lab. Every 30 minutes you're asked to lie down and go to sleep. And (laughs) it was it was good. What I didn't realise was that I was only sleeping for three minutes at a time, I had no idea that that was happening.
PROFESSOR LEON LACK, SCHOOL OF PSYCHOLOGY, FLINDERS UNIVERSITY: It's a bit like throwing people into the deep end and teaching them to swim. Over this period of 24 hours they might get 40 or 50 experiences of falling asleep very, very quickly and so in a sense we're trying to retrain their habits of when they go to bed and turn the lights out, that their body then becomes used to falling asleep very quickly.
QUENTIN MCDERMOTT (to Professor Leon Lack): And does it work?
PROFESSOR LEON LACK, SCHOOL OF PSYCHOLOGY, FLINDERS UNIVERSITY: Yes it does and it produces about as much improvement as the longer term behaviour therapies that we otherwise would be using.
QUENTIN MCDERMOTT (to Karen Morgan): And what happened that night when you came home?
KAREN MORGAN: I slept really well. I slept really well.
QUENTIN MCDERMOTT (to Karen Morgan): And what's happened since?
KAREN MORGAN: Well my life's just changed. It's just changed totally. It changed my whole life. It was the best thing that has ever happened to me. Yeah, I just live a a full life, I just jam as much into my life as I I can. I just love it. I go to the gym three or four mornings a week at 6:00 o'clock, I choose to before I go to work.
And I just think it's absolutely wonderful.
QUENTIN MCDERMOTT: Insomnia and other sleep disorders don't just cause chaos at home; they can impact on the workplace and in some cases, be caused by long and irregular shifts.
Shift-work is essential to the running of the economy. But according to the consultancy Access Economics, about nine per cent of work-related injuries are caused by sleep deprivation.
LYNNE PEZZULLO, ACCESS ECONOMICS: Shift workers would possibly be tired at work and that's a sleep disorder when you're not sleeping well at night. For example if you have obstructed sleep apnoea you can be tired during the day, that tiredness can affect your performance and increase your probability of having a work related incident and that then is reflected in terms of increased mortality, fatalities at work as well as disabling injuries.
QUENTIN MCDERMOTT (to Lynne Pezzullo): Were you able to measure that in economic terms in relation to shift workers?
LYNNE PEZZULLO, ACCESS ECONOMICS: We certainly estimated the productivity losses from work related injuries and they were around $2 billion per annum.
QUENTIN MCDERMOTT: Night shift-workers on average lose two hours of sleep compared to other workers. Research suggests they also run an increased risk of colon cancer, breast cancer, prostate cancer, and gastro-intestinal disorders.
Alan Barkley worked shifts driving coal trains. He says the hours he worked made him seriously sleep deprived.
ALAN BARKLEY: I don't think I was as safe a driver at work obviously because I wasn't getting the sleep to keep that level of concentration up that you need. I mean an 11,000 tonne train can get away from you very quickly.
DOCTOR MARK HOWARD, RESPIRATORY AND SLEEP PHYSICIAN, AUSTIN HEALTH MELBOURNE: After you've been awake for 17 to 18 hours your performances deteriorates to a similar extent as your performance at an alcohol level of .05. And after you've been awake for approximately 24 hours your performance is similar to that of an alcohol level of between .08 and point one. And there are several studies that have now shown that.
QUENTIN MCDERMOTT (to Alan Barkley): Did you ever find yourself having a micro sleep when you were driving the train?
ALAN BARKLEY: Yes, yes.
QUENTIN MCDERMOTT (to Alan Barkley): How often did that happen?
ALAN BARKLEY: Frequently.
QUENTIN MCDERMOTT (to Alan Barkley): So you were literally sleeping on the job?
ALAN BARKLEY: Yeah.
QUENTIN MCDERMOTT (to Alan Barkley): When you were driving the train.
ALAN BARKLEY: Yes. It was a big problem, a big problem for me.
PROFESSOR DREW DAWSON, DIRECTOR, CENTRE FOR SLEEP RESEARCH UNIVERSITY OF SOUTH AUSTRALIA: If it's not okay to be at work with impairment due to alcohol and we can demonstrate that there's the same level of impairment due to fatigue, why is it that we permit people to be at work under the influence of fatigue and in many cases reward them with over award payments and shift work allowances? I mean it's kind of the old fashion notion of danger money which is actually illegal under the Occupational Health and Safety Act.
QUENTIN MCDERMOTT: Ian Little is a bus driver. In the past he too had to work shifts which he found exhausting.
QUENTIN MCDERMOTT (to Ian Little): Have you ever suffered from fatigue while driving?
IAN LITTLE: Often.
QUENTIN MCDERMOTT (to Ian Little): Tell me about that.
IAN LITTLE: Well, you're driving. You're tired, you know that you're tired. You're having difficulty keeping your eyes open and you know that you shouldn't be driving but you have to. And talks about 20 minute power breaks, which, power naps, which would be great, you can't do. You've got 25 passengers who want to get where they're going. You've got a schedule to maintain and people to get to work.
QUENTIN MCDERMOTT (to Ian Little): So what do you do?
IAN LITTLE: What do you do? Well, you carry on and you shake your head and you try to concentrate and you get through because you have to, and I've managed to do that.
JOHN SEWASTENKO: I use to drive interstate. I'd done it for about nine years.
QUENTIN MCDERMOTT: Truck driver John Sewastenko used to doze off at the wheel. He wasn't sleeping well at night.
JOHN SEWASTENKO: I could drive day and night and it didn't really affect me and I didn't know how I was doing it but people use to say to me, you know, "Aren't you tired?" And I'd say, I used to jokingly say, "Oh no, I sleep when I'm driving." And that was my, you know, that was my reaction as a joke. But being a joke it was a fact and that's exactly what I was doing. I was sleeping whilst I was driving.
QUENTIN MCDERMOTT (to John Sewastenko): It's a pretty sick joke.
JOHN SEWASTENKO: Yes, very sick especially when you find out exactly that's what you were doing.
SUE SEWASTENKO: Just basic things too like we'd drive through a set of traffic lights and then John would say, "Oh, I don't remember going through those lights." So it was happening on a daily basis as well.
QUENTIN MCDERMOTT (to Sue Sewastenko): Did it scare you?
SUE SEWASTENKO: Oh it did because if he was behind the wheel, that was me and the kids in the car as well so it was all our lives at danger.
QUENTIN MCDERMOTT: John Sewastenko was diagnosed with sleep apnoea. He was waking up tired but didn't realise the effect this was having on his family.
JOHN SEWASTENKO: You'd get up in the morning. You don't feel like going to work. When you do get up you're very irritable. Everything is a problem. Your kids, their making noise becomes irritable, you know, stuff like that.
SUE SEWASTENKO: I used to walk on eggshells24 hours a day, you know, not to upset him or same with the children, I'd run around keeping them quiet because everything, everything upset him. And he didn't just go off, it was a real outburst for just the smallest things so it was very, very hard to live with.
QUENTIN MCDERMOTT (to Sue Sewastenko): What effect did it have on your relationship with John?
SUE SEWASTENKO: Well put it this way there wasn't one day that I didn't feel like packing my bags and leaving.
QUENTIN MCDERMOTT: John Sewastenko went to this private clinic in Sydney where he was fitted with a continuous positive airway pressure - or CPAP device - to help him breathe at night.
The treatment transformed his own and his family's lives.
JOHN SEWASTENKO: It's a good feeling to wake up feeling good. It's, it's you know to wake up like Monday morning you know, great, oh beauty, I'm going to work today instead of saying, oh gees, you know, do I have to do this you know? But yeah that's the difference, yes.
SUE SEWASTENKO: I mean it is, it's just marvellous and if he got rid of his machine, I think I'd be packing following his machine.
QUENTIN MCDERMOTT: In the trucking industry, chain of responsibility laws will come into force next year making companies responsible for ensuring that their drivers are not fatigued.
Some though are sceptical of the will of the transport industry to properly police commercial drivers and to ensure the hours worked and distances travelled are safe.
PROFESSOR DREW DAWSON, DIRECTOR, CENTRE FOR SLEEP RESEARCH UNIVERSITY OF SOUTH AUSTRALIA: We characterised it as a conspiracy of greed. That is, there a vested interest by the community, the transport companies and the truck drivers to work long hours because it increases profitability, increases income and it reduces costs.
QUENTIN MCDERMOTT: Some long-haul companies are experimenting with a device designed to stop drivers nodding off.
Long-distance driver David Thorne works for Linfox, one of Australia's biggest trucking companies.
DAVID THORNE, DRIVER FOR LINFOX: They do prove to you that they work. when these monitor your drowsiness and then give you that warning well, yeah it sort of, it can't be a bad thing, it's got to be, it's got to be safety.
QUENTIN MCDERMOTT: The glasses, known as Optalert, are still being trialled in Australia and are not yet available to road-users in general.
Developed and marketed by sleep expert Dr Murray Johns, they monitor how drowsy a driver is getting by measuring the speed at which his eyelids reopen when he blinks.
DOCTOR MURRAY JOHNS, SLEEP DIAGNOSTICS PTY LTD: That slows down first of all even before you're aware of being drowsy, and of course then eventually your eyes will stay closed for some time. Eventually it might be for several seconds and that is a very dangerous state to be in, which some people would equate with the state of being, having a micro sleep. We can detect drowsiness before micro sleeps even begin.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: And it turns out that when you're sleepy the closure of your eyes is almost as quick as it is when you're alert, but the reopening of your eyes takes much longer, and this little device can track that.
QUENTIN MCDERMOTT: The glasses are linked to a computer which will warn a driver if he's about to nod off.
(Sound of beeping and then recorded voice saying: "Caution. You are showing signs of drowsiness.")
But despite its obvious mass market appeal, not everyone has wholeheartedly welcomed Optalert.
(Sound of alarm and then recorded voice saying: "Danger. You are now too drowsy to drive.")
PROFESSOR DREW DAWSON, DIRECTOR, CENTRE FOR SLEEP RESEARCH UNIVERSITY OF SOUTH AUSTRALIA: Where the problem arises is not through lack of insight into the effects of fatigue or whether you are fatigued, it's the organisational context. That is, I want to earn the money. I'm frightened of the boss yelling at me if I put my hand up and say that I'm fatigued. Or, I don't think it will happen to me. I've driven tired plenty of times and not had an accident. The difficulty with that particular argument is you usually only have one fatigue related accident and then you are removed from the gene pool.
So there are many quite sensible and logical reasons why people drive tired. I'm not convinced that a machine to tell you are tired necessarily will improve the outcome.
QUENTIN MCDERMOTT (to Doctor Murray Johns): Isn't there a danger that some long distance drivers will use this device to allow them to drive further and longer than they otherwise would, in other words, to use it as some kind of fail-safe device?
DOCTOR MURRAY JOHNS, SLEEP DIAGNOSTICS PTY LTD: Well look that possibility is there, and I think we'll have to manage the problem that may arise because of it. We can't deny that possibility. However there are already very stringent rules and occupational health and safety regulations that determine how long you can drive on the road. We're not we're not superseding those rules. They still work. Now, if our device means that someone, some particular person may be able to drive 10 hours instead of nine hours a day, then so be it.
QUENTIN MCDERMOTT: More than seven per cent of motor vehicle accidents in Australia can be attributed to sleep loss or sleep disorders. An alarmingly high proportion of these are fatal.
(On screen text: "Northern Territory Road Safety Commercial")
DOCTOR NAOMI ROGERS, WOOLCOCK INSTITUTE OF MEDICAL RESEARCH: Drowsy driving, fatal accidents in Australia it's usually between about 16 and 20 per cent of all road fatalities in Australia and other countries in Europe and America that are due to drowsy driving. And people tend to be driving, fall asleep, might steer off the road. There's no signs of actually hitting the brake, so they're quite high impact accidents and quite horrific accidents.
QUENTIN MCDERMOTT: In the Unites States, with an estimated 80,000 drivers a day falling asleep at the wheel, the situation has reached crisis proportions.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: The statistics are staggering. Every two minutes someone crashes. In fact 20 per cent of all motor vehicle accidents in the United States are sleep related. And every three minutes someone is injured in a sleep related crash. Every hour someone dies in a sleep related crash.
QUENTIN MCDERMOTT: The message from sleep specialists like Dr Czeisler is, you take your life and the lives of others in your hands when you drive while fatigued.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: If you stay awake all night your reaction time will go up threefold. So for example if a kid runs out in front of a car as you're driving home your ability to, the length of time it'll take you to put on the brakes will be three times longer than it would if you had gotten an adequate amount of sleep.
QUENTIN MCDERMOTT: Increasingly, companies are co-operating with sleep experts to try and institute "fatigue friendly" ways of balancing work and sleep, like this Melbourne call centre where employees escape from a mundane, repetitive job by climbing into a pod for a few minutes' rest.
The irony is that one of society's worst culprits is the medical profession itself. In America, Dr Czeisler has charted the terrifying effects of sleep deprivation on interns who work marathon shifts in intensive care units.
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: We found that one out of five interns, and we followed 2700 of them nationwide, reported making a mistake that injured a patient that was sleep related in the previous year. And one out of 20 reported making a fatigue related mistake that resulted in the death of a patient. On nearly one out of 10 months the surgical trainees were reporting that they were falling asleep while in surgery, while participating in surgical procedures.
In fact we found that there were intrusions of, involuntary intrusions of sleep like states happening when they were standing up in the intensive care unit taking care of patients. Their eyes would begin rolling around in their sockets as they were standing. We didn't even realise that people could fall asleep standing up until we did this study so routinely.
QUENTIN MCDERMOTT: In Australia there are no formal caps on doctors' hours. Some doctors work for 39 hours on end, according to the Australian Medical Association, and serious fatigue can result.
In 2004 Dr Peter Nettelbeck worked as a medical officer at Latrobe Regional Hospital in Victoria. He himself had a medical condition - he suffered from epilepsy which was triggered by sleep deprivation.
Dr Nettelbeck and his wife had a small boy, and another child on the way. He told the hospital about his epilepsy and, according to his wife and his specialist, took great care in managing the illness.
KATIE NETTELBECK: We learnt what his trigger factors were, so things like keeping regular hours of sleep and getting enough sleep.
QUENTIN MCDERMOTT: Because of his epilepsy, Peter Nettelbeck asked not to work night shifts in the hospital's emergency department. The hospital agreed to this, but it wasn't popular with his colleagues.
KATIE NETTELBECK: Some of the other doctors that were on at the same time were unhappy about that so they requested a letter from Pete's epileptologist just to confirm that and that was sorted after that.
QUENTIN MCDERMOTT: When he joined the paediatric department, Peter Nettelbeck agreed to work evening shifts and to be on call during the night.
He had suffered nocturnal fits before and his wife could deal with them when she stayed with him. But in November 2004 she was at home, heavily pregnant, and her husband was staying at the hospital.
At the end of that month Dr Nettelbeck worked a mixture of day and evening shifts on twelve consecutive days and was called out during the night on five occasions. In accepting this arrangement, the couple had taken a calculated risk.
KATIE NETTELBECK: We weren't able to get a room for me to stay so it was a risk that we took. We had five weeks to go for him finishing that rotation and five weeks till the birth of our second baby. And, you know, we thought we'd made it. We thought we'd got there.
QUENTIN MCDERMOTT: Although the hours worked were unremarkable for junior doctors in training, Dr Nettelbeck was suffering.
KATIE NETTELBECK: The last shift before he went in, the last day before he went in he said, "I'm so tired Katie, I don't know why I'm so tired." I said, "It's because you've been doing 12 days of work and, you know, just get through this last day, one more day and it's the weekend." He was really tired.
QUENTIN MCDERMOTT: After midnight on the fourth of December, after finishing his evening shift, Peter Nettelbeck went to bed in a hospital room set aside for doctors.
Later that night he suffered an epileptic seizure and died. His death wasn't discovered until noon the next day.
A medical panel concluded that the roster he had worked contributed to his sleep deprivation and that sleep deprivation may increase the risk of seizures.
QUENTIN MCDERMOTT (to Katie Nettelbeck): Are you in any doubt at all that fatigue played a part in his death?
KATIE NETTELBECK: No. No, he was very tired and that was a large contributing factor to a seizure.
LIBERTY SANGER, PRINCIPAL, MAURICE BLACKBURN CASHMAN: Having looked at the medical evidence and acted on Katie's behalf I think it's clear that the sleep disruption and the disturbance suffered by Peter led to an aggravation of his constitutional condition, the epilepsy, which in turn led to his death.
ASSOCIATE PROFESSOR MATTHEW NAUGHTON, PRESIDENT AUSTRALASIAN SLEEP ASSOCIATION: It's been known for years that sleep deprivation can trigger epilepsy and in fact many a time when neurologists are looking for epilepsy to define whether someone's blackout for example was due to an epileptic seizure, they will often sleep deprive that individual to see if he can precipitate an epileptic seizure.
QUENTIN MCDERMOTT: Latrobe Regional Hospital and its insurers wouldn't accept liability for Dr Nettelbeck's death, but a court awarded his widow and two children the maximum compensation payable in a case of this kind. The hospital was also served with an improvement notice.
QUENTIN MCDERMOTT (to Liberty Sanger): In your view, could his death have been prevented?
LIBERTY SANGER, PRINCIPAL, MAURICE BLACKBURN CASHMAN: Absolutely. What I find most extraordinary about this case is that this was a hospital. If a hospital can't get it right I don't know what hope the rest of us have with other employers. Hospitals should be model employers when it comes to understanding the medical risks associated with fatigue and sleep disruption.
QUENTIN MCDERMOTT: Latrobe Regional Hospital has told "Four Corners" that Dr Nettelbeck didn't complain to the hospital of being tired or request a change of shift for that reason. It says that if Dr Nettelbeck or his treating doctor had asked that he not work late, that request would have been met.
The hospital confirmed however that it accepts the medical panel's finding and says it has acted on the improvement notice which was served on the hospital.
For Katie Nettelbeck, the action she took following her husband's death was aimed at exposing a systemic problem.
KATIE NETTELBECK: This is about trying to find some way of change, to advocate for other doctors that also feel like they don't want to rock the boat.
LIBERTY SANGER, PRINCIPAL, MAURICE BLACKBURN CASHMAN: This decision puts employers on notice that fatigue, sleep disruption and sleep disturbance can cause injury, and at times serious injury, and at times death, and that they need to put in place systems to ensure that they both acknowledge that risk, take steps to minimise that risk, and have fatigue control management systems that are regularly monitored to ensure that their staff, their workers are not placed at unnecessary risk of injury.
QUENTIN MCDERMOTT (to Liberty Sanger): And if they don't?
LIBERTY SANGER, PRINCIPAL, MAURICE BLACKBURN CASHMAN: And if they don't they'll be held to account.
QUENTIN MCDERMOTT: In our daily lives, sleep deprivation affects our health, our moods, our families, our performance at work and our safety.
As we juggle our work and social lives, how will we cope in the future with insomnia and other sleep disorders? Will we take more naps at work? Or spend more time in sleep labs? Will we manage our fatigue better? And will we ever truly recognise the importance of sleep?
PROFESSOR CHARLES A CZEISLER, HARVARD MEDICAL SCHOOL: Just as exercise and nutrition are critical for health, so sleep is also the third pillar of health that is necessary to maintain our health and safety. And once the impact of sleep on many other diseases is recognised then when a patient comes in for example with high blood pressure or heart disease, the first thing the doctor will think about is to screen that patient for sleep apnoea and find out if the cause of their high blood pressure is actually sleep disordered breathing, instead of waiting for years until it may be too late to make that connection.
JOHN SEWASTENKO: There is treatment out there and it's nothing, it's painless you know what I mean? And the result at the end, you've got a happy marriage, you've got terrific kids you, you know, you live a normal life.
QUENTIN MCDERMOTT (to Stella Barker): So things are better now and you're happier?
STELLA BARKER: Yep.
QUENTIN MCDERMOTT (to Stella Barker): And would you recommend it to other kids?
STELLA BARKER: Would I ever. Let me give you one tip: in the night don't, I mean don't, get the Tim Tams 'cause it never works.
(End of transcript)