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.