Sleep Deprivation in Hospitals Is a Real Problem

Simple changes can make recovery more restful, and better overall.
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The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won't get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics.

Between 10 p.m. and 6 a.m., I did not go more than an hour without some kind of interruption.

Recently I was all-too-miserably reminded of the challenges of hospital sleep when I spent a fitful night recovering from surgery to remove a small kidney tumor. Unlike some patients in that situation, my sleep was not disturbed by pain or nausea; I was lucky to avoid both of those postoperative complications. Instead, my sleep was interrupted, hourly, by clinicians taking care of me. There were vital sign checks every four hours, a frequency that makes sense given that I had just had part of my left kidney removed. Sometimes sleep interruptions are necessary in order to monitor patient conditions. But those vital sign checks, at midnight and 4 a.m., were not the only interruptions I experienced that night. At 3 a.m., if my very foggy memory serves me correctly, someone came into my room to draw blood for follow-up laboratory tests. Several other times that evening, the machine hovering near my left ear beeped to tell me that one of my IV medications had run out; I would push the nursing button and tell the person at the desk about the beeping, and eventually someone would come in and either replace the empty IV bag or turn the alarm off.

Between 10 p.m. and 6 a.m., I did not go more than an hour without some kind of interruption.

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As I have already suggested, some of these interruptions are necessary. But many are not. And the consequence of too many sleep interruptions is that patients do not heal as quickly as they would otherwise, thereby not only reducing their quality of life but also driving up medical costs. Indeed, as I have written elsewhere: sleep disturbance is a leading cause of hospital complications, such as falls and delirium. Poor sleep has also been linked to reduced immune function,worsening blood pressure control and mood disorders. All of these problems potentially impair the ability of patients to recover from the acute illnesses that caused them to be hospitalized.

How do we improve hospital sleep?

First, hospitals could make simple organizational changes. During my recent hospital stay, for example, a major contributor to my interrupted sleeping was the specialization of tasks across different hospital personnel. When the IV machine beeped, it was the nurse who helped out, her training being necessary to monitor the IV lines and medications. When it came to measuring my vital signs, though, a nurse's aide was sent to accomplish the task. And a phlebotomist came to draw my blood. Specialization matters. The doling out of these duties to different people -- with different skills and different pay grades -- makes great economic sense, and in many ways improves hospital quality of care. But such specialization interferes with sleep, because the different people performing each of these duties enter patient rooms at different times of the night.

There is a better way to coordinate these various clinicians to reduce sleep interruptions. For example, phlebotomists could coordinate their work with nursing aides. Imagine that instead of coming into patient rooms one hour apart from each other, the two came in together: "We are here to check your blood pressure and draw some blood," they would say (maybe even in unison!). That little change would eliminate one interruption. A second change could also improve patient sleep: more flexibility in the timing of vital sign measures. If, for example, a patient's IV machine beeps at 11 p.m. and the next check of her vital signs is due at midnight, the nurse could bump up the vital sign measures by an hour, since the patient is already awake.

Indeed, it was an 11 p.m. vital signs wake-up call that led to research that proves the value of my second approach to improving patient sleep: increasing the use of sleep protocols designed to minimize unnecessary interruptions. More on sleep protocols in a bit, but first let me tell you about that 11 p.m. wake-up call.

Presented by

Peter Ubel

Peter A. Ubel, MD, is a physician and behavioral scientist at Duke University and the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choice Together. He writes regularly at PeterUbel.com.

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