Why Do Hospitals Hate Sleep So Much? • Hacker News Board

Re: Why Do Hospitals Hate Sleep So Much?

#361

Post by rconti » Wed, Dec 05, 2018, 4:55 PM UTC

bzbarsky wrote: post #318

bpyne wrote: post #285

Earlier quoted context omitted.

My wife's background is in childhood development. Her job involves keeping up with studies in the field. I remember her talking about this issue. There's evidence that school start times should be flipped for elementary and high school students: elementary going in earlier and high school later. Teenagers need more sleep due to their brains re-wiring, so the reasoning goes. Keep in mind that in our school district, e…

As a counter-anecdote, we have to get our kids up by 7:30 to get them to their elementary school on time, and it's a battle every single morning. Left to their own devices, they would sleep to at least 8:30. Kids are different, and we really don't have very good ways of dealing with that in some ways...

Okay, but you don't have counter-evidence. Yes, kids are different, but YES, we also know that younger children generally desire sleep and wake earlier, and teens desire sleep and wake LATER than adults. Biologically. Why not start from there, and THEN acknowledge that everyone's different, rather than starting from the WORST principles and throw up our hands and say "we can't suit everyone, may as well screw as many people as possible!"?

Re: Why Do Hospitals Hate Sleep So Much?

#362

Post by AnthonyMouse » Wed, Dec 05, 2018, 4:56 PM UTC

BigChiefSmokem wrote: post #283

dahfizz wrote: post #279

Earlier quoted context omitted.

Why does the school bus pick him up more than an hour before school starts? That seems ridiculous.

To pick up the other kids on a long route.

> To pick up the other kids on a long route.

The obvious problem then being that the routes are too long.

You have to wonder if there isn't some kind of carpool incentive the school could give to parents to get rid of 90-100% of buses. How many stay at home parents with 9-passenger vehicles would be willing to make $500/month by filling their minivan with other kids when they deliver their own kid as they were going to do regardless?

Cheaper than buses, kids spend less time sitting in vehicles because there are 8 kids instead of 30, fewer vehicles (and especially fewer huge diesel buses) on the road because those parents were driving their kids anyway.

Re: Why Do Hospitals Hate Sleep So Much?

#363

Post by scott_s » Wed, Dec 05, 2018, 4:57 PM UTC

MereInterest wrote: post #338

pc86 wrote: post #295

Earlier quoted context omitted.

You learn how to do your entire specialty during residency. If you cut the number of hours, you have the same amount to learn in less time.

That's on the assumption that amount learned per hour remains constant as hours worked increases.

And that sleep deprivation has no effect on learning ability.

Re: Why Do Hospitals Hate Sleep So Much?

#364

Post by code_duck » Wed, Dec 05, 2018, 4:58 PM UTC

mrhappyunhappy wrote: post #337

IB885588 wrote: post #231

Earlier quoted context omitted.

And it's a known biological fact that during teenager years the circadian rhythm is affected and normal sleep is pushed later in the night. Having teens wake up early is literally fighting biology and can't but have negative results on their health, education, socialization, etc.

Sure, I barely remember high school seeing how I was half asleep most of it. There was not a day when I did not fall asleep in class early in the morning. I remember having to fake like I was looking down to pick something up just so I could sleep.

I had a math teacher surreptitiously call the office and report that I was a drug user, due to my falling asleep at his 10:30 class. I always felt extremely drowsy 3-4 hours after rising. Now I wonder if it’s related to how I have been diagnosed with celiac disease, which has caused extreme fatigue 2-4 hours after eating in my adult life.

Re: Why Do Hospitals Hate Sleep So Much?

#365

Post by longerthoughts » Wed, Dec 05, 2018, 4:59 PM UTC

reubeniv wrote: post #263

darepublic wrote: post #232

Earlier quoted context omitted.

I guess on paper going without sleep gives you some kind of competitive advantage? A company that believes otherwise could bet on giving their workers more sleep and they should gain an advantage by doing so.

I'd think so, if you're up against enough people willing to sacrifice sleep/social lives to get a job/project done faster

This assumes raw time spent guarantees faster delivery with comparable quality of work in spite of efficiency implications of low morale and insufficient sleep. I'm sure it does help to a point but I imagine there's an individual threshold where it seizes to be productive.

Re: Why Do Hospitals Hate Sleep So Much?

#366

Post by zelos » Wed, Dec 05, 2018, 5:01 PM UTC

Lordarminius wrote: post #357

dahfizz wrote: post #279

Earlier quoted context omitted.

Why does the school bus pick him up more than an hour before school starts? That seems ridiculous.

For this and most questions regarding school schedules, consider the point that the timing is for the convenience of the adults who need to go l get to work / back home / other tasks, not the children. A school system that puts kids first would start by 9am but how would society cope with that ?

8:45-9 is the standard school start time in the UK at least.

Re: Why Do Hospitals Hate Sleep So Much?

#367

Post by cbzbc » Wed, Dec 05, 2018, 5:02 PM UTC

TimTheTinker wrote: post #340

bzbarsky wrote: post #330

Earlier quoted context omitted.

It's possible. They are generally in bed by 8:30. We have tried experimenting with pushing it back to 8 and that did not have an obvious effect on their mornings and did make evenings a lot more miserable. Going even earlier than 8 is not really feasible given that dinner generally can't happen until 6pm. (Our no-longer-elementary-schooler, by the way, never really had this problem. He just seems to sleep a lot less…

Just an idea - you could try putting them to bed 15 min earlier every few days, and if they have trouble sleeping put on a short kids audiobook. Two of the most peaceful I know of from Audible are “The Tailor of Gloucester” read by Meryl Streep and “The Little House”.

Also depends on how young they are, if they are of reading age, then putting them to bed a little earlier and then allowing them to read for 15-20 minutes on their own can also be another way of calming them down.

Some of the kids mindfulness podcasts (Peace Out as an example) are also good for this kind of thing

Re: Why Do Hospitals Hate Sleep So Much?

#368

Post by lostgame » Wed, Dec 05, 2018, 5:03 PM UTC

foxyv wrote: post #233

nomercy400 wrote: post #174

Earlier quoted context omitted.

How does that work: insurers trying to keep as many customers as possible is disjoint from the customer satisfaction a patient has when receiveing healthcare at a hospital. As a patient I don't think about my insurer when I'm at a hospital. I just want to be treated. It's more likely to be the opposite, where the hospitals with the better healthcare and care of the patients have to spend more money and thus get less…

US is weird, you are usually stuck with whatever insurance your employer provides. If you try to buy your own we're talking $500 a month with a $3000 deductible. If your insurer doesn't cover a hospital there is no way you want to end up there. Down that path lies bankruptcy because the hospital will try to charge your insurer an arbitrary large amount who will then just hand it to you and go "Good Luck!" One time my…

>> One time my family was charged $1000 for an ibuprofen for a perforated eardrum at an emergency room

This kind of maddening injustice is why I left the USA after living there for 3 years, and will likely never return even to visit.

Re: Why Do Hospitals Hate Sleep So Much?

#369

Post by verelo » Wed, Dec 05, 2018, 5:06 PM UTC

GavinMcG wrote: post #221

verelo wrote: post #204

Earlier quoted context omitted.

Super intersting to see people discussing this! As someone that holds a pilots license and talks with a lot of commercial pilots about their jobs, sleep is often a hot topic of discussion. It would be illegal, not just irresponsible, for a pilot to try pull off a 120 hour work week. Why do we treat doctors differently? Their macho behaviour in my opinion is unacceptable, and likely reduces positive patient outcomes,…

Medicine has different concerns than piloting, though. Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks. Doubling the number of patient handoffs, on the other hand, significantly increases the risk of one of the more common sources of error.

I see your point, but i'd love to see a peer reviewed study to back up the claim that "it's better to have over-worked doctors and nurses than to introduce more handoffs".

Re: Why Do Hospitals Hate Sleep So Much?

#370

Post by cptskippy » Wed, Dec 05, 2018, 5:07 PM UTC

quwert95 wrote: post #9

I felt the question and answer to be a little flippant, which is fine, but hear this: Sometimes there are reasons, very genuine reasons. I've been recovering from a recent stay. I, too, was interrupted frequently - every 45 minutes in fact. After a few nods off and being woken up by a knock at the door repeatedly I asked 'why' and the staff gently explained that me sleeping for too long would be a bad idea for a few…

> Ask your doctor (and nurses!) to keep you informed and educated about your situation. You're responsible for yourself. Medicine isn’t always intuitive, especially if you’re not yourself yet.

This mentality is fundamentally flawed. We don't allow truck drivers to drive for more than 11 hours a day because lack of sleep impairs your cognitive ability. But we're expecting patients recovering with potentially days without rest to make informed decisions?

A counter to your example...

When my youngest was born, my wife had complications with delivery due to high blood pressure. They refused to release her or the baby until two conditions were met. One was that her blood pressure was lowered and the other was that the baby put on a % of weight. Without intervention neither would have been released. I had to pull the care team aside during a group visit to ask them:

"Is high blood pressure a symptom of insomnia?" Yes

"Is a REM cycle 90 minutes?" Yes

"Have we had more than 45 minutes in recovery without your staff waking my wife?" No

They left us alone for 3 hours straight and magically her blood pressure returned to normal.

We then had to have the attending pediatrician point out to them that the medications given during labor caused water retention and that apart from the lack of weight gain, the child was 100% on track and doing extremely well.

The hospital we were at, Emory, is highly regarded but their whole system seemed to be fundamentally flawed because it didn't take into account the continuous interrupts. Or rather there was no distinction between 3 uninterrupted hours of rest and four 45 minute periods of rest.