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Protecting Sleep in the Hospital, for Both Patients and Doctors

nytimes.com

101–110 of 113 posts

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#101
post #7

My wife has been in the hospital regularly over the past 18 months probably 20 days total. This is a renowned research hospital with a gorgeous, vibrant facility and spacious rooms. They absolutely 100% ignore any semblance of a sleep cycle for their patients (as well as proper nutrition but that's for another day). Constant interruptions to check vitals, ask if we want to pick a meal, beeping infusion pumps, a whole…

Any time my wife tried to sleep in her last hospital stay, the attached vital checkers got jostled and started beeping. She is used to sleeping in a reclined position and sleeps easily. I have no idea how a less-easy sleeper would get by.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#102
post #92
post #50

Earlier quoted context omitted.

Have you had a conversation to address concerns about your spouse’s care? There is always some flexibility around the care that she’d be receiving, and one core component to that is your rational/measured input, either in person or by phone. Framing your concern as rational helps immensely in establishing a dialogue with care staff. It sounds like your core problem is that you want to be bothered less. Nurses are not…

The nurses have been stellar and I’m sure would try to accomodate, but they would actually have to guard the room against all the other ramblers to gain a net benefit.

Absolutely. One strategy we’ve used is to literally put up “Do Not Disturb” signs when patients wanted rest.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#103
post #10

Earlier quoted context omitted.

All it takes is for one child to die overnight and the parents to sue and you can be sure all patients will get their vitals checked regularly. This is how healthcare works. Source: am a doctor and see this kind of thing on small and large scales

Isn't this why there's monitors? You can also do a visual checkup without waking up the patient.

What monitor are you thinking of? Not everyone gets telemetry.

BP cuffs get very tight and will probably wake you up. You may even wake up if a saturation probe is put on your finger.

>You can also do a visual checkup without waking up the patient.

You can get respiratory rate visually. What other vital sign can you get without touching the patient? Transdermal temp. maybe (inaccurate).

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#104
post #34

Earlier quoted context omitted.

An accelerometer based approach (which the fitbit uses) can't actually tell the difference between someone who is just lying there still and someone who is in deep sleep. All it can do is measure movement (which might mean they are awake, or it might mean they are in REM) and no movement. Then it can post-process it later and use the length of stillness and the patterns/amount of movement to infer probable sleep cycl…

Could EEG sensors be commoditizated ? I have sleep apnea and I find my fitbit + the CPAP readings lacking.

A proper EEG for use in sleep studies is available on ebay (last time I looked, maybe six months to a year ago) for $1000 for a USB model or $1500 for one with a battery (might require a prescription). There are also ongoing costs, since the standard usage is to stick the electrodes to a particular location and I'm not sure how accurate it would be if you didn't do that (it is possible that some of the long term EEG monitoring caps used for epilepsy might work with less setup time, but I don't know if it would be directly comparable to the usual method). IIRC, it takes about a half hour to get set up for a sleep study. Additionally, scoring the sleep study is not a fully automated process and without the same training that sleep doctors receive the results would not be comparable. Getting a reliable and useful result might be quite difficult and you would need to compare with regular sleep studies to see how accurate a particular method is.

There seem to be an endless stream of companies trying to make easier to use EEGs, either for clinical or home use, and it seems like almost all of them go bankrupt in a few years. I suspect most of them are also not very accurate. A couple of years ago I saw an interesting one that tried to automate most of the scoring but would send the more difficult cases for human scoring. I'd guess that one at least has a better chance of reasonable accuracy than most. I think it was dreem (dreem.com), although they only mention automated scoring at this point. Possibly they managed to train their automated system sufficiently or maybe it was a different company. In any case, I would be suspicious of claims that they are as accurate as a sleep study, although it is certainly possible that someone has come up with an actually accurate method. You would still be spending hundreds of dollars for a device that sends all the data it collects into the cloud and in most cases will be useless if the company goes out of business or decides to stop supporting older products. They usually aren't clear about what, if anything, will still work if the company goes out of business.

Of course, less than ideal results can still be interesting. Once a few years ago I managed to set up my laptop's microphone to record might sleep at just the right level and it was very interesting. Unfortunately, I didn't write down how I changed the settings to get the right volume and could reproduce it when I tried a couple of times, although I imaging there are online guides for this type of thing and I didn't go looking for them. For anyone who sleeps alone and does not use CPAP I'd recommend giving it a try. With builtin laptop speakers you can only hear when sleeping on one side (I never sleep on my back, so not sure if that would be covered), but I bet it wouldn't be too hard to set up two or three microphones to get a good recording in any position. It isn't trivial to review, but looking at the recording in audacity it is possible to see the regular parts and just listen to the less regular parts. You can't even fully tell asleep or not from that, but you can notice when your breathing changes and in my case it was very interesting to see how that often happened due to quiet noises (e.g. a dog barking in the distance, car going by quietly). You can also tell how often you move at night (about every 45 minutes in my case, at least that night).

I've also used a basic pulse oximiter (Contec CMS-50I, was about $90 new on ebay) with the Sleepyhead software. It has pulse, SpO2, and perfusion index. At quick count it looks like I've used it 24 nights over the past couple years and I'm not sure the device will necessarily last much longer, hopefully it will (the display has an always on line and there are sometimes issues with the sensor that might be due to an issue in the cord, although it is sometimes due to not being cleaned sufficiently or to my hand moving in the sensor; the sensor can be replaced for something like $20 and it came with a second "one time use" sensor that I haven't tried but I suspect might be possible to use more than once). The pulse reading seems to accurately show when I first get to sleep, but doesn't help determine when I am sleeping for the rest of the night. SpO2 is the main thing I use it for, but doesn't help determine anything about sleep. Perfusion index mostly seems to indicate how warm my hand is and so can sometimes indicate when I change position.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#105
post #76
post #66

Earlier quoted context omitted.

I'm really excited about [0], but as far as I know there is no way to take blood pressure without touching the patient. If someone here could invent it, I could probably provide a test environment for large scale investigations. Re: studies. I can't say I know the evidence that well, so I wouldn't want to mislead, this isn't my area. A google search for Hourly Rounding reveals lots of articles, but I haven't poked in…

For blood pressure, our experience was that the staff were perfectly happy to leave a cuff on our daughter's leg, which automatically took a reading every hour (or on demand).

For some patients, with vascular disease for example, the blood pressure cuff can be very painful... (What you describe is usually what we do.)

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#106
post #80

Earlier quoted context omitted.

> often shout at dead patients so they can hear me Do they usually respond? Have you ever had a reply "from beyond"?

I assumed he meant, recently deceased. I imagined this was part of trying to revive the very recently deceased person.

I suspect it's just a typo of "deaf".

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#107
post #73
post #67

Earlier quoted context omitted.

We ran into this with my daughter who needed multiple surgeries. Two different experiences in two different hospitals. First hospital was world renowned, ranked #1 in the world for the category of care she needed. This hospital seemed to spend all their money on what I would call “celebrity surgeons”. World renowned, only the best. I suspect the side effect is that they spent much less money on nursing care. There wa…

Our daughter was in for surgery at a world renowned hospital #1 for what she needed ... and our experience was like your second example. After she moved to the step-down unit from the ICU, she had the same day nurse for the next three days and the same night nurse for four, as well as a consistent overnight NP throughout. We had a private room with a separate vestibule containing a washing station & laundry bin for s…

That sounds almost exactly like the hospital we were at (Rainbow Babies, for the record). Hope your daughter is doing good, my daughter is also a heart baby -- coarctation and bicuspid valve.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#108
post #51

Earlier quoted context omitted.

If you need help developing the app, let me know! I do iOS and Android development so maybe I can help a bit. I haven’t worked in the sleep cycle field but we can figure out things maybe.

Hey that's extremely generous of you...thank you! It will probably take some time as I'm looking at various bits of hardware to experiment with, but if I get stuck I very well may reach out to see if you have a few cycles to assist. Much appreciated!

Ok, you can go through my submissions and you will figure out a way to contact me through that.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#109
post #46

I’m a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in…

I must confess that the main reason I'm replying is to correct the darkly amusing dead->deaf typo that I'm hoping you made. However, I wonder if you could comment on whether you think a) that you and your colleagues' approach is reflective of the broader medical community, b) you think earplugs could be feasibly issued in shared wards (from a financial/hygiene/other perspective)?

In the UK generally similar experience I think. No one does unnecessary work at night. I am a huge advocate of sleeping plugs, and try to get them introduced at any ward I work at. Usually they are not enough though, but it’s the only feasible solution currently.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#110
post #46

I’m a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in…

I must confess that the main reason I'm replying is to correct the darkly amusing dead->deaf typo that I'm hoping you made. However, I wonder if you could comment on whether you think a) that you and your colleagues' approach is reflective of the broader medical community, b) you think earplugs could be feasibly issued in shared wards (from a financial/hygiene/other perspective)?

And yes, I meant deaf people! Although to verify a death you do have to check a lack of response to loud verbal stimulus too...
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