June 10, 2019

What happens when patients (and doctors) miss out on sleep

Daily Briefing

    "[S]leep disruption isn't just inconvenient," it can have a serious effect on patients and doctors alike, and it's time for hospitals to consider proper sleep as part of patients' and health workers' daily routine, Amita Kalaichandran, a resident physician, writes for the New York Times' "Well."

    7 tools for implementing a holistic patient experience strategy

    Waking a sleeping patient

    The important role of sleep in a patient's recovery captured Kalaichandran's attention during a routine check on her two-year old patient. It was 11 p.m., and the patient, who had a rare disease that required her to be "poked three times a day for blood and taken to the MRI or CT scanner at various times" was "sleeping peacefully in her hospital bed," Kalaichandran recalls.

    "I hated to wake her, " Kalaichandran writes, "but recently, when I had offered to wait to examine a child until after a nap, my attending physician had scolded: 'You can't care about that. If you do, you'll never examine them. They have to get used to it—they're in the hospital, after all,'" she writes.

    The next morning, the patient's mother told Kalaichandran that it took her daughter an additional hour to fall back asleep after the visit. The mother asked if clinicians could let her daughter sleep through the night. Paraphrasing, the girl's mother, Kalaichandran notes the woman asked, "Wouldn't a good night's sleep help with her condition?"

    Can sleep help patients recover?

    The patient's mother "had a point," Kalaichandran writes.

    Research shows that sleep disruption not only increases the risk of disease, but also affects how well patients recover from the conditions that put them in the hospital, Kalaichandran writes.

    One recent study found that sleep disruption can influence patients' pain perception. Another study, published in Nature, found that a lack of sleep is associated with atherosclerosis, a buildup of plaque in blood vessels that can cause clogged arteries, and therefore can affect how well a patient admitted for a condition related to plaque buildup can recover in the hospital, according to Kalaichandran.

    Sleep also affects wound healing, according to a study published in the Annals of Gastroenterology last year. The researchers found that bowel wounds caused by inflammatory bowel disease took longer to heal in patients who received a low score on the Pittsburgh Sleep Quality Index.

    Matthew Walker, a professor of psychology and neuroscience at the University of California, Berkeley and author of "Why We Sleep," called sleep "one of the most powerful, freely available health care systems you could ever wish for." However, according to Walker, patients are least likely to get sleep in a hospital, even though that's when they need sleep the most.

    "If sleep were regarded as a continuous infusion of a medication that helped a patient heal faster, provided them with emotional stability, and ensured they were in the best mind-set to understand the risks and benefits of that care, we would think twice about disrupting it," Kalaichandran contends.

    Sleep impacts health care workers

    But patients aren't the only ones in the hospital suffering from a lack of sleep. Sleep deprivation in hospitals also impacts health care workers, particularly medical residents, nurses, ED physicians, and other hospital staff who work odd hours, Kalaichandran states.

    A study published in Anaesthesia found that sleep deprivation is linked to DNA damage in health care workers, and another study found that it can be a sign of depression among residents.

    Other studies show that sleep deprivation can also affect the level of care provided, according to Kalaichandran. For instance, sleep-deprived clinicians are more than eight times more likely to "omit a crucial patient-care issue," she writes.

     Sleep expert Michael Farguhar noted, "[A]fter being awake for 22 hours straight, you are as cognitively impaired as if you were legally drunk. Nobody would accept medical care from an inebriated doctor."

    How to address the sleep problem

    While most hospitals don't put sleep front and center, some are starting to take sleep more seriously.

    At Yale-New Haven Hospital, for instance, nurses administer medication to patients before they go to sleep, Kalaichandran writes. Walker suggests that hospitals give patients ear plugs and eye masks when they spend the night at the hospital and train doctors to be more considerate of patients' sleep schedules before waking them for an assessment.

    As for sleep-deprived providers Walker suggests the United States take a lesson from other countries. He said, "Countries such as France, Switzerland and New Zealand train physicians in the same amount of time despite limiting resident shifts to less than 16 hours, yet these countries continue to rank in the top 10 for quality of medical care and practice" (Kalaichandran, "Well," New York Times, 6/4).

    7 tools for implementing a holistic patient experience strategy

    Even with renewed investment in patient satisfaction, many institutions are struggling to improve, often because they define the ambition too narrowly or pursue a campaign-style approach.

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