More Sleep, Fewer Beeps: Hospitals Should Let Patients Rest

Alok S. Patel, MD


March 21, 2023

This transcript has been edited for clarity.

You know who doesn't get consistent, high-quality sleep? Obviously, nurses and doctors don't — as I have bags under my eyes — but I'm talking about hospitalized patients.

We preach about how sleep helps with health and healing, prevents chronic disease, and so on. However, there is no uniform conserved effort to help our patients get rest in a time of acute illness. A hospital is not exactly zen.

Sleep disturbances in hospitals are caused by many factors. There is hospital intervention, like all the lab draws, alarms, and vital sign checks, and the lights. Then there's the fact that some patients may have trouble sleeping because of an underlying medical condition. For example, sometimes I'll admit a toddler with respiratory syncytial virus (RSV) who is struggling to breathe, and I'll just straight up tell the parents, "Yeah, you're not going to get much sleep tonight."

Let's go back to those lab draws. When you order a test on the computer, what time does it default to? Is it 4 AM or 6 AM?

Researchers at Yale looked at 5 million data points from nonurgent blood draws and found that 40% of them took place between 4 AM and 7 AM. For nonurgent lab draws, do they really need to take place that early? I have patients and families ask me all the time to push labs back to later in the day or to consider doing them the night before. Often, I do, because a few extra hours of sleep for our patients can go a long way.

It's a real issue. There are studies showing that pediatric patients in the intensive care unit (ICU) get about a 50% reduction in sleep hours. On the general wards, it's about 25%.

For adults, it's no better. The studies are all over the place, with some showing about a 40%-60% reduction in sleep hours. One study cited that adults in a neurologic ward got only about 5 hours of sleep per night. Now, these numbers shouldn't surprise anyone. Based on my own personal experience, I thought they would be worse.

Why does all this matter? Well, aside from the fact that we don't want sleep-deprived, cranky patients, a lack of sleep may actually impair healing, prolong length of stay, lower patient satisfaction, cause hyperglycemia, cause autonomic dysfunction, and cause immune dysregulation, and it's terrible for mental health.

Anyone who's worked in an ICU is way too familiar with the dance between sleep disturbances and delirium.

I recently saw an article in the Washington Post discussing sleep as medicine, and I read a tweet by Yale cardiologist Dr Harlan Krumholz, which almost summarizes how I feel. His tweet, starting "Sleep as medicine…," asks: On behalf of hospitalized patients, what if we simply stopped ordering routine lab draws before 7 AM? What if we wrote an order to not disturb before 7 AM except for urgent need, or an order for 7 hours of peace and quiet? What an appreciated order that would be.

Sleep deprivation may even induce a posttraumatic stress disorder–like syndrome and leave patients at increased generalized risk after leaving the hospital. Krumholtz actually wrote an article about this "post-hospital syndrome" and how some factors, such as a lack of sleep, can leave patients weakened and at an increased risk for readmission.

Now, obviously, there are going to be some situations in which disturbed patient sleep is going to happen regardless of what we do. I don't understand why better-quality sleep isn't a front-and-center priority for hospitals or some metric we attempt to follow.

We can and should get creative at reducing middle-of-the-night hospital interventions while making sure that we're paying attention to medical reasons for disturbed sleep, such as pain control and addressing underlying sleep disorders.

There are even some small changes we can make in our own workflow to address this. Let's say, for example, a patient comes into the emergency department at 9 PM. They get seen by nursing staff, trainees, and an emergency medicine attending. Then there is a decision to admit the patient to the hospital. Transport comes, they get seen by more nurses, by more trainees, then by a hospitalist.

Let's say it's now 2 AM or 3 AM. The patient then gets a glorious few hours of sleep before vital signs, potentially lab draws, alarm bells, and morning rounds begin. There has to be a way to streamline this process, especially in noncritical patients.

What are your ideas and thoughts about disrupted patient sleep and why does it feel like hospitals don't care about this as much as they should? Maybe yours does. Regardless, I want to hear from you. Comment below.

Alok S. Patel, MD, is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco, as he is on faculty at Columbia University/Morgan Stanley Children's Hospital and UCSF Benioff Children's Hospital. He hosts The Hospitalist Retort video blog on Medscape.

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