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Why Do Hospitals Hate Sleep So Much?

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Re: Why Do Hospitals Hate Sleep So Much?

#411

Post by esm »

ineedasername wrote: post #240
IB885588 wrote: post #230

Earlier quoted context omitted.

Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient. Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really neces…

The counter argument that I have heard is that patient handoffs are where a disproportionate number of errors occur. Increasing the number of shifts means that more patients in the ED or on the floor will have care fragmented between providers, making it more likely that results will not be followed up or that changes in a patient's status will not be recognized.

I don't know at what point the errors from sleep deprivation exceed the errors from patient handoffs. People seem to take different views depending on what side of the work hours debate they fall on.

Re: Why Do Hospitals Hate Sleep So Much?

#412

Post by gxespino »

billfruit wrote: post #293
random878 wrote: post #288

As someone on HN who is medical, not tech, this thread is as frustrating to read as it would be for many of you to read doctor's opinions on how best to run a software engineering firm. "I'm not a software engineer, but here's my full breakdown on where you are all going wrong based on using a BBC Micro for a week back in 1993"

But in your experience is there a problem with hospitals not understanding that patients need proper sleep?

Proper sleep is very low on the totem pole of things to manage when someone is in the hospital.

I'm almost always more worried about your vitals, your lab work, your physical assessment, etc. than the amount of sleep you are getting.

Re: Why Do Hospitals Hate Sleep So Much?

#413

Post by danielfoster »

CryoLogic wrote: post #12
legostormtroopr wrote: post #5

Earlier quoted context omitted.

> These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. > Your search - site:trycosmo.com peer review - did not match any documents Sounds promising. Untested sleep drugs, sign me up!

It's actually just melatonin, L-theanine and magnesium in one pill. So nothing sketchy but also not anything new or interesting. Just a combo pill like most other supplements on the market.

You're right, the formula isn't groundbreaking. We did this intentionally to focus on the tried and true. We've also found that many sleep aids contain these ingredients, but only in very small quantities (1mg or less).

Is there anything else you would potentially like to see included?

Re: Why Do Hospitals Hate Sleep So Much?

#414

Post by benj111 »

blattimwind wrote: post #160
benj111 wrote: post #132

Earlier quoted context omitted.

Yes. Having a different person coming in every 5 minutes to check something else. Somewhat tempered by having to go back in a week later, so all these things aren't useless. Child birth isn't the risk free thing we like to think it is.

> Child birth isn't the risk free thing we like to think it is. For almost all mammals it is, just not for humans, where gestation and partum are uniquely difficult and dangerous.

For Hyenas its even worse.

As I understand it they have a high level of testosterone so the females develop penises, which they have to give birth through.

The wikipedia page backs me on the penises but couldn't see the reason mentioned (but does mention penile spines?!) https://en.m.wikipedia.org/wiki/Spotted_Hyena

I'll stop mentioning penises now.

Re: Why Do Hospitals Hate Sleep So Much?

#415

Post by sxg »

jchanimal wrote: post #346
sxg wrote: post #301

Earlier quoted context omitted.

I'm currently in my 4th year of medical school, and I have to clarify your comment on the hours worked. We're held to the same hours limits as residents, which is 80 hrs/week averaged over 4 weeks and an average of 1 day off per 7 days. We most often come near these hours on surgical specialty rotations (like the ones you noted). However, these are completely voluntary rotations. I'm not interested in surgery, and I…

Where do we go to change that 80 to 32? This thread is making me feel unsafe.

So the other side of this problem is resident education. The ACGME in conjunction with medical specialty boards govern the requirements for graduating from residency. There are hard requirements on how many and which kinds of procedures you need to do and patients you need to treat over the course of your residency. Residents meet those requirements with the current average 80 hrs/week and ~3–5 years of training. Moving from 80 to 32 hrs/week would likely require an expansion of training time to ~6–10 years, which residents would be absolutely against (I know I would be). I've been in school forgoing a "real job" with a salary for nearly a decade, and I'll be in my mid-30s before I become an independently practicing physician under the current system. Although the work hours are abhorrent, I don't want to add more years to my training in exchange for better hours.

Re: Why Do Hospitals Hate Sleep So Much?

#416

Post by [deleted] »

cptskippy wrote: post #370
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 with…

[deleted]

Re: Why Do Hospitals Hate Sleep So Much?

#417

Post by ddingus »

timerol wrote: post #325
ddingus wrote: post #188

Earlier quoted context omitted.

Walking on the way to the bank, to get a loan, to start a business qualifies as economic activity. As does going to the store, and a whole bunch of other things. The USA built the Interstate Highway System for exactly the reason of economic growth. The ideas behind it are no different from the ones that justified sidewalks. Should any small town evaluate their sidewalk projects, like we have the Interestate Highway P…

Note that not all roads induce enough development to sustain the relevant maintenance, which leads to a fair amount of municipal funding problems: https://www.strongtowns.org/journal/2017/12/4/5-ways-federal...

That is almost all entirely do to people who should be paying more not doing so.

Re: Why Do Hospitals Hate Sleep So Much?

#418

Post by eyeinthepyramid »

topkai22 wrote: post #392
billfruit wrote: post #290

Earlier quoted context omitted.

Also apart from the Doctors, the military is also notorious for their practice of having too little sleep.

This is because their job absolutely requires performing on insufficient sleep. Combat isn't shift work. I think (without much data here) that medical training pushes insufficient sleep on doctors due to on-call schedules. While hospitals have doctors, many of their specialists come from private practice or multi-specialty clinics, which rotate being on-call between then (often in 12 hour shifts). The other cause of…

According to my doc cousin, it's to limit the number of patient handoffs between providers. Apparently error rates are around 5-10% per handoff, so the idea is that if the error rate from sleep deprivation is less than that, it's better to have sleep deprivation.

Re: Why Do Hospitals Hate Sleep So Much?

#419

Post by icsllaf »

DisposableMike wrote: post #398
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…

I actually went to a school corporation where this happened, about 20 years ago. I was in high school. School started at 7:38. We got up around 5:30, boarded the bus at 6:05, arrived to school at 7:00. Elementary school started at 8:55, with a similar length bus pre-schedule. Our corporation hired a firm to do a study, found that younger children performed much better during earlier hours, and flipped the schedules.…

Makes a little more sense in the parent's position as well. An argument that is normally made to stop school start times from being set later is that the parents have jobs which require them to normally wake up the same time as their kids. Elementary school children obviously need this parental help in the morning much more than high school students who can even possibly get to school by themselves by driving or simply being self-sufficient enough to walk to the bus stop.

Re: Why Do Hospitals Hate Sleep So Much?

#420

Post by GCA10 »

shados wrote: post #228

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter? - Elementary school starting so early all the kids are half asleep in class. - College + Sleep? Not gonna happen. - 24 hour construction in certain part of NYC, check! - Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, a…

We had a brave school superintendent a few years ago who tried to get our local high school started at 9 a.m. instead of the traditional much earlier start. (Classes at 8 a.m., with many extra-curricular activities like band practice and swim practice at 7 a.m.) This is in the western U.S.

All the sleep-cycle research is on his side. And he was friendly, focused and persistent. But his campaign failed.

A later school start would have cut into the available daylight for after-school sports practices and events. Perhaps 30% of students participated in these, and perhaps 10% in total (or their parents!) were adamant that anything that short-changed the football team was an evil that needed to be stopped.

Still, the don't-do-it crowd was vocal and implacable. Eventually everyone else gave up. So high school students continue to get out of bed, very groggy, at a time that's too early for them, and struggle to get a grip on their morning classes. We wouldn't have it any other way.

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