As medical residents, we have spent the past five years becoming near experts at waking people up at unseemly hours. What has become increasingly ironic is that, despite these regular awakenings, we continue to find more scientific evidence that sleep is fundamentally a restorative and necessary process for the body. We know for certain that people who get a full night's sleep live longer and are healthier and happier than those who do not. Studies have shown that sleep not only affects concentration, but mood, blood pressure, blood sugar and even weight. Virtually every organ system and cellular process has an indirect link to sleep.
In defense of hospitals and healthcare providers, we have created this environment with patient safety and monitoring as a top priority—potentially sacrificing a few hours of sleep for better outcomes and more rapid identification of illness. But this has led to a hospital environment that, at times, can be anything but restfully healthy.
It is not so much that any wake-up for a lab draw, vital-sign check or examination is burdensome as a single event; it is rather the disjointed frequency of all of these interruptions combined. Certainly, there are many patients sick enough to require continual intervention—and we have otherwise met plenty of lonely patients who actually enjoy and look forward to odd-hour encounters. The other simple fact is that, despite extensive interruption, some people may still get more sleep in the hospital than at home. One memorable young patient slept unusually well—the challenge posed by her newly casted left wrist made late night Facebook and texting near impossible. She slept wondrously.
Modern medicine is certainly working to counter these inefficiencies and interruptions, with new digital technologies slowly replacing alarms and intercoms. Likewise, as medical residents, our training system has shifted to limit our work hours—though we still have had our share of 30-hour shifts. But is there perhaps still some irony in protecting resident sleep time before patient sleep time?
With these thoughts in mind, we offer a few simple suggestions to help foster additional rest and recovery in our hospitals. Start by slipping a sleep mask and a set of foam earplugs into the standard hospital toiletry package, just like the airline industry used to provide. Those noisy alarms? Forward them directly to nurse's stations, pagers or perhaps the digital smartwatch of the nurse providing direct care. Early morning lab draws? Only if patients request or require them. During admission, patients could be offered the opportunity to fill out a preferred schedule of events, including a regular bedtime and wake-up time. Based on these preferences, teams could attempt to consolidate care, including lab draws, nurse checks and clinical rounds within a set window. Obviously, the severity of illness would impact the integration of such preferences. However, combined, these adjustments have the potential to limit the extent to which the hospital experience is abrupt and jarring.
The educational component of teaching hospitals impels multiple learners to engage patients. These efforts could be coordinated in a way that inspires less interruption and more hands-on learning with direct supervision. Focused rounds at the patient bedside with specialty teams, social workers, physical therapists and others would foster clear, direct communication and place the patient at the center of the discussion.
Most of these ideas are not revolutionary, but viewing sleep as a vital medicine might be. Recognizing that rest and sleep are fundamental for health, we can and should be willing to do better. Certainly, complete personalization and customization of schedules for every individual patient is unrealistic. However, a genuine effort to empower patients and respect their need to rest may go a long way. With newly devised patient-satisfaction scores on the horizon, hospitals may be increasingly interested in just these sorts of interventions.
Sleep is one of the fundamental components of health and wellness that many of us totally ignore. So much so, that perhaps we should start to consider sleep a medicine both within the hospital and at home. Looking for anti-aging cures and wrinkle prevention? Sleep has been shown to improve facial appearance and attractiveness. Worried about gaining weight? Lack of sleep has been shown to be an independent risk factor for becoming obese, developing diabetes or high blood pressure. Feeling fatigue, muscle soreness or decreased sex drive? Lack of sleep has been linked to reduced levels of testosterone. A host of studies have shown that a full night's sleep can improve virtually any aspect of your health.
Perhaps the Asclepian docs were on to something in letting sleep and rest be the foundation of the healing process. Sleep is simply a lot more cost effective and easier than any pill you could ever dream of taking. Literally.
Dr. Aaron George is a third-year family medicine resident at Duke University Health System. He completed his medical training at the Philadelphia College of Osteopathic Medicine. His focus is on community and population health innovations, and he recently completed an Andlinger fellowship in health policy with the Center for Public Health in Vienna, Austria, in collaboration with the American Austrian Foundation and Duke University Medical Center.
Dr. Jonathan Bonnet is a third-year family medicine resident at Duke University Health System. He received his medical degree from the Ohio State University. His clinical emphasis is on lifestyle and personalized medicine, and he serves on the board of the American College of Lifestyle Medicine. He will be enrolling as a sports medicine fellow at the University of Florida this fall.
