Objective To examine the relationships between employees’ trouble sleeping and absenteeism, work performance, and healthcare expenditures over a two year period. Methods Utilizing the Kansas State employee wellness program (EWP) dataset from 2008–2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and healthcare costs as the outcomes. Results EWP participants (N=11,698 in 2008; 5,636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all p < 0.0005), have lower work performance ratings (all p < 0.0005), and have higher healthcare costs (p < 0.0005). Longitudinally, more trouble sleeping was significantly related to negative changes in all outcomes. Conclusions Employees’ trouble sleeping, even at a sub-clinical level, negatively impacts on work attendance, work performance, and healthcare costs.

Female undergraduates performed an easy (fatigue low) or difficult (fatigue high) scanning task and then were presented mental arithmetic problems with instructions that they would earn a high or low chance of winning a prize if they did as well as or better than 50% of those who had performed previously. As expected, blood pressure responses in the second work period rose or tended to rise with fatigue where the chance of winning was high. By contrast, the responses tended weakly to decline with fatigue where the chance of winning was low. The pressure findings support the suggestion of a recent fatigue analysis that success importance should moderate fatigue influence on CV responses to a challenge so long as fatigued performers view success as possible. They also conceptually replicate previous fatigue results and provide a special class of evidence that fatigue influence on CV response is mediated by effort.