Health and Safety ReportVolume 6, Issue 9 - September 2008

Sleeping is a basic need of human survival. What happens without it? Just ask anyone who suffers from sleep apnea, a disorder that intermittently stops the person's breathing during the night and prevents a good night's sleep.

This potentially life-threatening condition often goes unrecognized and undiagnosed. Sleepiness, the most common symptom of sleep apnea, affects a person's ability to function effectively at home, at work and in the community. It also poses several risks to the person's health and safety and that of others.

Risk factors for sleep apnea

Obstructive Sleep Apnea (OSA) is a breathing-related sleep disorder that causes brief interruptions of breathing during sleep. Soft tissue in the back of the throat briefly collapses, closing off the airway. This blockage may be caused by relaxed throat muscles, a narrow airway, a large tongue or extra fatty tissue in the throat. These pauses in breathing can last from 10 to 30 seconds and occur up to 400 times per night. With each pause in breathing, the brain automatically prompts the sleeper to resume breathing. These sleep disruptions result in a disjointed, poor quality sleep.

Obesity is a major risk factor for sleep apnea, therefore effective weight management is one of the best ways to prevent the disorder. Sleep apnea has also been associated with certain jobs that involve interruptions in sleep patterns. For example, people who work in shifts are more than twice as likely to get sleep apnea as those who work a standard "9 to 5" day, according to the National Sleep Foundation. Research studies also suggest that commercial motor vehicle operators have a higher prevalence of OSA than the general population.

Other risk factors include a family history of sleep apnea, smoking and alcohol use, and being 40 or older. Having a small upper airway, recessed chin, small jaw, large overbite or large neck may also be linked to sleep apnea.

Health and safety risks

Untreated sleep apnea, particularly obstructive sleep apnea (OSA) can significantly compromise safety and health. Sufferers of sleep apnea may experience health problems such as high blood pressure, stroke, ischemic (lack of blood flow and oxygen to the heart muscle) heart disease, irregular heart rhythms and mood disorders.

They are also at increased risk of a fatigue-related motor vehicle crash or other accident. Men and women with moderate or severe OSA are seven times more likely to have traffic collisions or work-related accidents because of daytime sleepiness. Anyone who works with dangerous equipment or materials needs to be alert to be safe. In fact, if you have sleep apnea and are not being treated for it, you probably should not be driving a motor vehicle.

Symptoms and treatment

It is difficult to recognize sleep apnea in yourself. If you live with someone, the other person(s) in your home can help recognize the signs of sleep apnea - if they hear you snoring loudly with pauses in breathing, gasping or choking while you sleep. Pay attention to other signs as well, including morning headaches and nausea, loss of sex drive, impotence, excessive daytime sleepiness, sleepiness while driving, irritability and/or feelings of depression, restless sleep, high blood pressure, concentration and memory problems, frequent night-time trips to the bathroom, and night-time chest pain.

If you have two or more of these symptoms, your doctor may send you to spend a night at a sleep centre for testing. There are three main levels of treatment for sleep apnea, depending on its severity:

Dental appliances that keep the airway open by pushing the lower jaw forward, or by preventing the tongue from falling back over the airway, may be an effective treatment for patients with mild-to-moderate sleep apnea who have minimal daytime symptoms.

Continuous positive airways pressure (CPAP) therapy is, at this time, the treatment of choice for moderate-to-severe sleep apnea. The patient wears a mask with tubing connected to the CPAP unit, which works by gently blowing room air through the airway at a pressure high enough to keep the throat open and prevent snoring and disrupted breathing (apnea). This is a treatment, not a cure, and only works when you use it.

Corrective surgery may be an option for patients that have tried CPAP or oral appliance treatment without success. The surgery opens the airway enough to eliminate or reduce obstructions, and may involve reconstruction of the uvula, palate or jaw.

If you think you have sleep apnea, don't lose any more sleep over it - see a doctor to get a diagnosis and treatment. In the mean time, limit activities such as operating dangerous equipment and driving, until you get help.

Back for its eighth year, Canada's Healthy Workplace Week is now a month-long celebration. The month encourages workplaces and employees to work together to create healthier workplaces and build a culture of trust and respect in which people are happy and healthy at work - and want to come to work. From September 29 to October 26, you and your organization are invited to participate in the many activities that are offered and to take the workplace challenge - a fun, friendly competition against others across Canada.

Why should you get involved? Because, simply put, everyone benefits from a healthy workplace. When workplace health systems provide support on physical, social, personal and developmental levels, workers feel valued, respected and satisfied - and are likely to be more productive and committed to their jobs. When the workplace is unsafe, stressful or unhealthy, both the organization and its employees suffer.

Canada's Healthy Workplace Month is presented by Great-West Life and managed by the National Quality Institute (NQI), in collaboration with the Canadian Centre for Occupational Health and Safety (CCOHS). GoodLife Fitness is the official fitness provider.

Sign up for the free webinar

Gather in your meeting rooms and take the free webinar offered by CCOHS - Journey to a Healthier Workplace. Join Karen Jackson of Trillium Health Centre, and Allan Smofsky, Chair of the Canadian Healthy Workplace Council, for an inspiring hour. Learn how what started as a healthy workplace initiative has become part of everyday life at Trillium Health Centre in Mississauga. And discover what strategies you can use and steps you can take to help create a healthy workplace culture in your own organization.

The one hour presentation will be webcast live

Tuesday, October 21 at 1:00 PM EDT.

If you miss the live webcast, you can view the recorded webinar at your convenience.

Reserve your webinar seat now.

Put Your Workplace to the Test - Take the Healthy Workplace Challenge

Get your workplace moving, motivated and on the way to wellness. Each week's challenge highlights a different aspect of a healthy workplace. See how your organization measures up against others across Canada.

• Week 1: Fit at Work - Challenge your employees to increase their physical activity levels.


• Week 2: Healthy Culture at Work - Assess your workplace culture.


• Week 3: Green at Work - How environmentally friendly is your organization?


• Week 4: Keep it Going All Year Round - Share a story, complete an assessment, and keep the momentum going.

"We hope that employers and employees will take advantage of the challenges and activities each week of the Month", said Allan Ebedes, President & CEO at the National Quality Institute, an operating partner for Healthy Workplace Month. "Experiencing the joy and sense of well being from this celebration will hopefully encourage workplaces to sustain a healthy workplace strategy all year round."

Learn more about the Healthy Workplace Challenge and register your organization online now at www.healthyworkplacemonth.ca.

Learn about this unusual hand condition


For reasons little understood, some people develop a hand disorder in which the fingers bend in towards the palm and cannot be straightened. The little or ring fingers are most commonly affected, but any or all fingers can be involved.

A slow-progressing, usually painless disorder, Dupuytren's (pronounced De-PWEE- trenz) contracture develops when the tissues under the skin of the palm thicken, forming knots (nodes) and cords of tissue. When these cords shorten, they pull one or more fingers into a bent position, which cannot be straightened.

The disease usually begins with a palm nodule (can resemble a callus) that develops at the base of the ring or little finger. Gradually a prominent cord develops. Over time, the overlying skin puckers, dimples, and roughens. The thick cords gradually contract, drawing the fingers into the palm. Sometimes, they also draw adjacent fingers together.

Dupuytren's contracture can make it difficult to perform certain functions using your hand. Fine activities such as writing are still possible, as long as the thumb and index finger aren't affected. But as Dupuytren's contracture (sometimes called Dupuytren's disease) progresses, it can limit your ability to grasp large objects or to get your hand into narrow places.

Risk factors for Dupuytren's contracture

Progression of the condition is often erratic and arbitrary with no obvious cause. There are however, a number of risk factors:

• Age and sex (more common in males in their 50s and 60s)
  
• Family history
  
• Alcoholism and/or smoking (perhaps due to microscopic changes within blood vessels caused by smoking)
  
• Diabetes
  
• Epilepsy (possible association with anticonvulsant medications but this association remains controversial)
  
• Hand trauma

Some researchers believe Dupuytren's contracture may be work-related in certain cases, however studies are inconclusive. While some suggest that heavy manual work and vibration exposure may be associated with Dupuytren's contracture, other studies do not show this association.

Treatment options

For people who experience pain or have difficulty using the affected hand, doctors have investigated a few possible treatments for Dupuytren's contracture. These include medications, physical therapy, enzyme injections, vitamin E, radiation or ultrasound therapy, steroid injection, or collagenolytic agents. Some of these treatments have been more effective than others, however none are scientifically proven.

Another option is a minimally invasive procedure called needle aponeurotomy. The technique uses a needle to puncture and "break" the cord of tissue that's contracting a finger, allowing the finger to be straightened again. It is common for contractures to reoccur over time, requiring some people to have the procedure repeated.

To date, the widely accepted treatment for confirmed cases is surgery to remove the diseased fascia. By removing the tight cords and fascia, the tension on the finger is released. Surgical complications such as injury to nerves or arteries, infection, chronic pain, skin changes are a concern, however, especially in patients with severe cases of the disease.

A roll and a fall left one worker injured and another dead. Hazard alerts recently published by WorkSafe BC and Ontario's Ministry of Labour explain what caused these incidences and recommend safe work practices to help prevent them from reoccurring.

A young worker in British Columbia was working at a warehouse, moving a load down a loading ramp using a manual pallet jack. The ramp had a 9 percent slope. Walking backwards down the slope, the worker was guiding the pallet jack by its steering handle.

The 1,000-pound load was within acceptable limits for the pallet jack, but the downward pull of the slope caused the pallet jack to roll faster. The jack's wheel assembly struck the worker's foot and fractured his ankle.

WorkSafe BC recommends these safe work practices for warehouse workers to prevent similar incidents:

Ensure safe use of equipment. Provide the information, training and supervision necessary to ensure workers safely use equipment and follow the manufacturer's safety instructions. Equipment designed for use only on flat, level surfaces, for example, should not be used on slopes or ramps. Young and new workers may need additional training until they can perform their work safely. Each equipment operator's performance should be regularly assessed.

Ensure a safe work area. Identify work areas that pose risks to workers using equipment such as manual pallet jacks. Remedy unsafe conditions immediately.

Provide appropriate PPE. Ensure workers wear the appropriate personal protective equipment (PPE) for the job. Anyone working with or near pallet jacks should wear safety footwear.

Inspect equipment. Perform daily inspections and regular maintenance of equipment, following the manufacturer's instructions. Keep maintenance records.

In another incident, a worker in Ontario was fatally injured after falling from a power line tower that was under construction. As he ascended and descended the tower, the worker was wearing a fall protection system that included a retractable lifeline and safety belt that were attached to a shepherd's hook.

An investigation into the fall revealed that the bottom end of the pole on the shepherd hook can catch in objects, such as tool pouches, bolt bags or safety belts, and disengage from where it is anchored. This ability to inadvertently disengage was the likely cause of the fall. The hook was not equipped with a safeguard to prevent it from becoming disengaged.

Ontario's Ministry of Labour reminds employers that they are required, under the Occupational Health and Safety Act, to ensure the safety of their workers. Ontario's Regulation for Construction Projects says workers must be adequately protected by fall protection wherever they are exposed to falling more than three metres or are subject to other hazards set out in the legislation.

The Ministry says shepherd's hooks that may become disengaged from their attachment point, without workers' intentional actions, are unsafe for use in fall protection systems. Fall protection systems used in the workplace must provide adequate protection. Furthermore, any worker who uses fall protection must be adequately trained to use it safely. Under Ontario law, the trainer must prepare and sign a written training and instruction record for each worker.

Posters to help improve workplace safety

Want to keep those important safety messages front and centre with your staff and maybe add a burst of colour to your warehouse, plant or office wall? The new posters from CCOHS can help you do just that!

Posters can be an easy and effective way to reinforce health and safety messages that can help raise the safety of everyone in the workplace. CCOHS has released the first in a series of workplace posters: WHMIS Hazard Symbols and Cranes & Hoists Hand Signals.

The WHMIS Hazard Symbols poster identifies the six different classifications of chemical groups with similar hazards or properties, along with their symbols. The poster can help remind everyone at your workplace of the WHMIS hazard symbols and their meanings.

A crane operator should always move loads according to the established code of signals, and use a signaler. Cranes & Hoists Hand Signals provides signalers at your workplace with an easy reference to eight of the most common hand signals they use.

As part of your occupational health and safety program, posters can illustrate and promote safe work practices and help reinforce knowledge of critical hazard and safety symbols.

CCOHS is continually adding new posters in an effort to promote awareness of existing and emerging workplace health and safety issues. Two posters that are in development are "hand washing" and "air awareness" - both of which are planned for release late October.

These eye-catching posters are double-sided, giving you both French and English on each. They are available as free PDF downloads, or for sale as glossy 16"X 25" prints.

Safety posters can strengthen your awareness efforts and help spread the word by keeping the messages top of mind. However posters are no substitute for proper training to ensure workers know the hazards in their workplace and how to work safely.