Sleep isn’t a luxury. It’s a medical necessity.

Most hospitals are strapped with a massive amount of debt.  Not monetary debt, but sleep debt.   Amongst both the staff and patients, sleep is severely lacking.  In our busy society, we associate sleep with leisure and relaxation; a reward at the end of a long day.  But sleep isn’t a luxury.  Rather, it’s a medical necessity.

Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood pressure, increased insulin resistance, increased cortisol levels, increased risk of mental illness, and even increased mortality.  Although some of these sequelae come from long-term sleep debt, the ones that are most germane to the inpatient setting, such as decreased immunity and healing, begin the moment sleep quality deteriorates.  Our circadian rhythm, the 24-hour internal clock that dictates a myriad of cyclical biological functions, is exquisitely sensitive to a lack of sleep.  When it is running smoothly, it’s like a world-class orchestra performing a Beethoven masterpiece.   When it is out of sync, it turns into a room full of unruly kindergartners during music class.

Unfortunately, we don’t facilitate good sleep in the hospital.  There is the incessant beeping and chirping of various devices and voices throughout the hospital, which can prevent patients from even beginning to drift to sleep.  Additionally, patients are routinely awakened throughout the night and early in the morning.  If a patient had surgery, they’re likely getting their vitals checked repeatedly overnight.  If they didn’t have surgery, they’re still likely being awakened late at night for a blood draw.   Then, as early as 4 a.m., a disjointed parade of medical staff begins to enter and exit their room.

Even if we don’t notice, we hold the notion that patients are our subjects that should wake up when we want them to, but this is problematic.  Sleep is an important aspect of medical treatment.  Thus, waking a patient is a health risk that should always be weighed against its benefits.  For instance, consider the multiple post-operative overnight vital sign checks.  Awakening a post-operative patient to check vital signs can certainly save a patient’s life (hence the term vital signs).

However, saving a life by checking overnight vitals is much more likely to be in a high-risk patient with multiple comorbidities.  To avoid unnecessarily awakening low-risk patients, an evidence-based risk stratification system could decide the frequency of checks a patient actually needs.  An even better solution is to monitor vitals without walking into the room.  Costly but effective, wearable wireless monitors can retrieve vital signs without disturbing the patient’s sleep.

Even without extra costs, we can easily promote good sleep hygiene. Patients should be advised to avoid late night television, avoid taking multiple naps, and get out of bed during the day if possible.  Patients should also be exposed to sunlight during the day and darkness at night to calibrate their circadian rhythm.  Ultimately, we as health care providers have to acknowledge the medical value of sleep.  Maybe once we do, we’ll allow ourselves to sleep too.

Drew Kotler is a medical student. 

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  • JR DNR

    “An international team of researchers has found out that after 24 hours of sleep deprivation in healthy patients, numerous symptoms were noted which are otherwise typically attributed to psychosis or schizophrenia.”

    http://www.science20.com/news_articles/sleep_deprived_thats_what_psychosis_is_like-140031

    Funny enough, I read up on this topic 15 years ago, so I’m not sure why the article I linked presents the information as if it’s a new discovery and not just further confirmation of knowledge we already had. It certainly isn’t well known among the general population.

    Well, perhaps it’s the timing that is new. When I read up on it, they said that sleep-deprivation caused psychosis was generally impossible to reach without a physical illness, drugs, or outside force preventing sleep.

  • Patient Kit

    Ironically, the only kind of sleep that hospital culture seems to value is the apparently newly lucrative field of treating sleep apnea and other sleep disorders.

  • Ladyimacbeth

    I completely agree with lack of sleep being a problem in the hospital, but I’m not sure how you change that. If someone is stable enough to not be checked on or have vital signs during the night, then they are stable enough to be at home. There would be tremendous liability on the part of the physician and staff if they did not do vital signs or check on the patients during the night. There have been so many times at night where I checked on a patient, the patient was found to have declined and we rushed the patient to ICU. If a patient wants to accept the risk and liability to not have vital signs for long periods of time, then I support them accepting the risk that comes with that. But, that liability will have to belong to the patient. When patients insisted they not be disturbed during the night I respected this, but you better believe we documented their refusal out the wazoo. Had we not done that and the patient declined, we would have been liable for not intervening.

    Mr. Ballard commented about beeping alarms not being answered promptly. The chances are that the nurse is in another room giving meds or providing care to someone else at that moment. Unless you hire extra nurses to sit at the front desk and be available only for answering IV pump alarms, etc, then the alarms will continue to sound until someone can get there. Unfortunately, nurses cannot be two places at once. It sucks, but that’s the way it is. There just aren’t enough staff to be there immediately to silence everyone’s IV pump, etc. They do it when they can. In the ER they often put IVs in the AC, so any time the patient bends their arm the IV pump goes off. If you get an IV in the ER, ask if you can have it put somewhere besides your AC – your IV pump will beep less.