Why Do Hospitals Hate Sleep So Much? | Hacker News Reader

Why Do Hospitals Hate Sleep So Much?

motherjones.com

689 pointscurtis509 comments

I recently had a family member in the intensive care unit (ICU) for over a month in Austin, Texas. I quickly learned my main contribution would be protecting her sleep when I saw she hadn't slept in days because of the constant interruptions. She went from reasonable and compliant in taking her medication, to extremely irritated and noncompliant with the doctors. Of course I could see this was due to sleep deprivation, but when I kept bringing this up to the doctors and nurses, they gave me blank stares and didn't seem to believe or care. When they started suggesting another surgery due to her not improving, I nearly lost my sanity. Ultimately, I had to become a very vocal and unpleasant protector of her sleep - if a nurse came in, I quickly took him/her outside the room and asked what they were planning and whether it was absolutely necessary. This annoyed them quite a bit and they hinted that they could have me removed. It was one of the worst experiences of my life. Just being in the ICU for a month with a loved one is hard enough, but having to battle the staff to protect something so basic as SLEEP so she could recover, made it a true nightmare. Something is truly broken if trained medical staff see sleep as optional - the data and science behind sleep is so compelling, and they don't understand these basics? Desperately frustrating...

There is a fantastic book, "The Circadian Code," which describes this exactly. I don't know what I would have done in your situation, it sounds absolutely infuriating. It is amazing how ignorant some of the best educated people can sometimes be (including myself, I'm sure)!

To get up to speed on how dramatically sleep affects our cognitive performance, listen to this excellent interview with Matthew Walker (Professor of Neuroscience and Psychology at UC Berkeley, and Director of the Center for Human Sleep Science)

https://www.youtube.com/watch?v=pwaWilO_Pig

https://podtail.com/en/podcast/the-joe-rogan-experience/-110...

I’m always sleep deprived (typing this up at 1:30am) but I’ll watch that tomorrow. Just wanted to say, as a chronically sleep derived person I typically feel like crap, everything aches. One day I got 9 hours of sleep and I felt amazing. No aching, total clarity, just felt like a new person. I’ll probably drop dead soon, off to bed now but will watch the video tomorrow! Thanks.

> intensive care unit (ICU)

There are only two reasons for someone to be in an ICU: they require a therapy no other floor will administer, or their condition/therapy requires very frequent administration/titration/observation. These two reasons frequently overlap.

Sleep isn’t optional in general. It’s optional in the ICU, because the premise is “if you don’t need this level of attention to survive, you absolutely shouldn’t be on this unit.”

I think it is absolutely standard in that situation to at least take vitals every couple/few hours, no way around it. It's annoying to be woken up so often, but it's done for good reasons.

First observation every few hours is fine, but their is little coordination between hospital workers so people are often interrupted multiple times an hour which cuts the time for the next interruption.

That’s cost effective for the hospital but simply not viable longer term. To be clear waking someone up every 2.5 - 3 hours is very different from waking them up every 2.5 hours and another 2+ random times during the night.

As long as somone is only in the ICU for 72 hours it’s not a huge deal, but start talking a week and it’s a significant issue.

So, my partner had the option of either going home directly after surgery or spending the night in the hospital. The hospital staff wanted her to go home. She wanted to stay. (She has issues with post-surgical pain.)

If the hospital staff had sent her home, she would not be woken every two hours. The medical staff were fine with that.

It would have been perfectly reasonable for them to let her sleep; it would have been no more risk than they were advocating for.

Clearly it was optional.

> Clearly it was optional.

Unless there was some regulatory, legal, or hospital requirement that she receive a certain standard of care. They may have been fine with her sleeping through the night at home, but if she's in the hospital they need to take care of her.

It would not be an easy sell in a courtroom to explain that while you checked everyone except her every 3 hours, you let her sleep through the night and there was an issue that cost her life.

Not that the physicians and nurses should have been taking that into account but the folks crafting the regulations or hospital policy very well may have.

Clearly there was an organizational reason, but those reasons had nothing to do with what she actually needed according to her physicians, which was rest and painkillers.

What you've just said supports the article's argument that hospitals are designed to prevent people from sleeping.

Yes and there is an added benefit to frequent interruptions: despite all the monitoring equipement, a human assessment can go a LONG way in detecting trouble. My wife used to be an ICU nurse and her first code (CPR) in her career was when she was doing some routine stuff for the patient and noticed the color of their skin "looked different". When the patient's heart stopped beating, she was already there to get it back going, saving some precious delay.

For non-ICU stuff, yes there could be some better coordination around sleeping time, but again there's so much non-verbal stuff going on in just a physical assessment.

What would really be useful is having cleaning services and admin/billing services come at the same time (well, right after) a nurse comes, to take advantage of that interruption.

Agreed, but even the medical services aren't coordinated. I was in for 4 days earlier this year -- in addition to being woken for blood draws, I was woken on a diff schedule for meds and still a third for breathing treatments..meaning every 2 hours I was woken up 3 different times...then early am they'd come to get a breakfast order.

Nor are they going to be coordinated, because each of these services addresses a number of different units in the hospital. In order to have all of these services available for each patient in concert, we'd need to multiply the staffing by four or five fold. That holds as true for coordinating physician visits as it does for the other services.

I don't want to make it sound like it's impossible. It's not. But it is incredibly inefficient - which is why it doesn't happen - and the answer to "How can we make it happen?" is "Pay for it."

That is a fair point, but if, as this story implies, by the end of the process sleep deprivation was the main impediment to the patient's recovery, and might have led to additional procedures and the problems they bring, then there would be an issue here.

I also wonder if, like 'emergency room', 'ICU' has lost some of its meaning in some places.

Wife recently spent a couple of days in hospital for surgery/recovery. She was in a normal double-occupancy room for recovery (i.e. not ICU), yet was still woken every couple of hours by someone taking vitals, drawing blood, doing respiratory checks, bringing food, etc. And the room was hardly ever really quiet because if someone wasn't there to see her, someone was attending to the person on the other side of the curtain that divided the room. She said she hardly slept.

You were dealing with doctors and nurses, right?

One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted.

I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting for sleep-dep survival traits; only people who can work insane hours make it through hospital medical training, and only people who can take shift work in their stride make it as hospital nurses.

(Also, my observation of hospital doctors is that anyone you see on a ward outside core office hours is relatively junior, i.e. aged about 22-35. Senior consultants and professors work normal hours like everybody else. As for the nurses ... my understanding is that ICU nursing burns them up.)

(Source of observations: former hospital pharmacist here, who just got a refresher course c/o a relative who spent three months on an acute stroke ward this fall.)

>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week.

I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.

I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates.

I'm sorry about your mother in law regardless.

This is the claim, but if you look at the experiments supporting it, they’re all bonkers. For example, care is no worse from doctors on 28 hr shifts vs 24. I would argue that both of these are so far from a well-rested baseline that they’re meaningless.

We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.

All this talk is insane. I have like maybe 4 top-performing hours on my best days. The idea of working more than 8 in a life safety critical situation boggles the mind.

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, yet it goes on?

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.

But could the increase in errors from increased hand-offs be smaller than the increase in errors from sleep-deprived doctors, nurses and patients combined with the increase in disease spread and disease progression from the effect of sleep deprivation on the immune systems of doctors, nurses and patients? Additionally, could there be benefits from getting more eyes on a patient's condition?

I've always wondered if the problem might be in the handoff procedures. Those studies about mortality in the event of a handoff always make it sound like obviously handoffs are an inherently dangerous thing, but perhaps the modern way of doing them is just poorly implemented? It feels extremely unlikely to me that absurdly long hours are the only solution.

I think this is a rational question to ask! Often people will jump to conclusions "handoffs cause errors", and while errors are a symptom of handoffs executed poorly, it seems uncommon for people to often ask for improvements to these processes.

There's just no way efficient way to capture, log, and communicate every single little detail a doctor observes while diagnosing and setting treatment for a patient. First impressions are often wrong, and little details can become significant later. Early treatment might be designed not only to address symptoms but to exclude other diagnoses.

In a plane in level controlled flight, there is very little to hand off between two type-rated pilots. Both folks understand the machine, and the machine is working the way it is supposed to. Humans work the same way! Parents "hand off" their healthy kids to schools or babysitters or relatives every day.

But imagine a plane that is in the process of crashing; it's in a dive, controls are not responding as expected, one of the engines keeps turning off. A pilot is fighting to regain control... how comfy are you with THAT pilot handing off the aircraft to another pilot in the middle of that situation?

It's a little silly as an analogy, since plane crashes tend to be resolved pretty quickly one or the other. But conceptually, just imagine a plane that is in the process of maybe crashing for 12 hours. There's a good argument for a pilot to just see that through instead of "clocking out" at 8 hours.

> Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks.

Are you aware that on long haul international flights pilots do in fact rotate who is actively "flying" the plane? Flying is in quotes because most of the work is done by automation these days. I won't draw any analogies between the autopilot doing much of the work for pilots and nurses doing it for doctors because I can't actually support the statement with any data.

Yes, but that's the whole point: there's little risk in rotating pilots, whereas rotating members of the care team carries a substantial risk of key information falling by the wayside.

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".

There's no error in hand offs. Attending doctors are detached and spend just a little time with a patient during their stay. Nurses and PAs do most of the work.

Flying a plane is way less complex than medicine. A pilot can hand off a flying plane way, way, way more easily than a doctor can hand off a patient with a complex set of symptoms and treatments.

I should also point out that the vast majority of doctors don't work 120 hours a week continuously, rather, they experience higher-than-usual clusters of working time vs. not working time. That is, they might be on rotation for 36 hours straight but then off for 36 hours or more. And some of their shifts might only be 8 hours. Residents work longer hours, but are supervised by doctors.

I know several ER docs and they all cite the dangers of patient hand-off as the main reason they continue to support long shifts.

Medicine is a conservative field - unfortunately that also includes ignoring anything harmful to their cult aspects even if it is trivially obvious like "wash your hands" after doing a damn autopsy before delivering a baby. Or yes infants can feel pain - not using anesthesia because the control isn't fine enough to not have a better chance of killing them is a grim but justifiable thing initially but inexcusable once it becomes possible to do so safely.

And the sleep deprivation and hazing "I did it so everbody else must too!" is definitely a cultic thing.

I use cult very deliberately to point at the reasoning being entirely irrational and social as opposed to underlying value. And also because actual cults use slerp deprivation.

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 necessary to. Heck, even 50 hours.

You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures.

Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to 5/6/7 years.

I believe the GP is talking about increasing the number of doctors, not their years in residency.

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.

>You would likely have to extend residency based on everything that you need to learn for a given specialty.

I would challenge that assumption because I don't believe there's any consistent number of hours worked by residents in rotation, is there? I mean there are published schedules and then there are actually the number of hours worked which at least according to the other posters is even more than scheduled. So if there's already an element of randomness here and different doctors are getting different numbers of in-rotation hours then it's plausible hours could be made consistent and reduced, isn't it?

You may want to look into why med school is so expensive, compared to other majors.

Here in the UK, the way I heard it from a friend who was doing their pre-med, is that there was a built-in cost incentive: hospitals paid doctors who were on-call at one third of their regular hourly rate for out-of-hours on-call coverage. (That's not regular hourly rate plus a third; that's one third of normal wages for hours after the first 40.) So the hospital administration had a solid reason to work their interns and house officers into the ground rather than hiring extra junior doctors.

The original rationale was that the "on call" hours were not supposed to be busy and the duty doctors could spend most of them sleeping in a bunk or studying: but by the late 1980s (when I heard about things) they were working more or less constantly through their shifts.

The EU Working Hours Directive was supposed to fix this by banning workers from putting in more than about 50 hours a week without very specific protections being enforced, but one of the first things the UK's Conservative government did in 2010 was to stop enforcing this.

I wonder how much of it is financially motivated in this way and how much is the inertia of this hazing-style culture. From what you've said, I'm sure hospitals would object to a change out of financial self-interest, but it seems the ingrained culture stops the issue from getting a big push to begin with.

I know labor unions (sometimes rightfully) get a bad rap, but it seems this is exactly the type of abuse they were designed to stop. There are some [0] but the rate is low, less than 15%, and there's a sort of self-censorship style of pressure against pushing harder for them.

[0] https://www.theatlantic.com/business/archive/2017/02/doctors...

But Doctors have a very strong labor union, which tends to advocate FOR this system. Probably even though the AMA represents residents, doctors who have succeeded in the residency system have more sway within it.

I'm in the US. After some searching, I can't find any information about most doctors having unions. I found one that appears to mostly work with California doctors, but that was about it. Either way, I was speaking about residents, who don't have particularly strong or ubiquitous unions. Again, that's in the US. Other countries may vary.

I was being tricky here but I mean the AMA.

It controls a great deal about doctor's education and working conditions. It does not collectively bargain, so it's not strictly a union. But it's more powerful than most unions at this point. So a glib, "maybe doctors should get a union to represent them" answer to poor working conditions for residents doesn't really make sense. They already have a powerful organization that should represent them.

I think that there is at least some group of physicians who really think that poor working conditions for residents improves patient outcomes and doctor training.

That is very true, the AMA is not formally a union, but it does exert a significant level of control and influence in standardizing the practices of doctors.

As for patient outcomes, I'd love to see a study of them for the roughly 15% of residents that have a union and very modest work place improvements, compared to outcomes for the rest of residents. You're right, many doctors do seem to "feel" the traditional method is superior, but I'd like to see hard data.

I know I've seen some before, I think The Atlantic had an article about it in the past year.

I found this paper: http://www.acgme.org/Portals/0/PDFs/Position%20Papers/Commit...

It's citations have some hard data. Maybe the most interesting part for me was this:

"There exists instead a widespread belief that physicians can be trained to defy the biology of sleep and that safeguards are in place so that patients and residents are not harmed by work schedules that are unheard of in any other workplace, let alone a hospital. That belief is most evident today in the FIRST and iCOMPARE studies that set out to prove that there is no difference in patient outcomes from residents who work 16 or 30 hour shifts. The principal investigators were so convinced that no harm would come of these experiments that they determined it wasn’t necessary to obtain informed consent from either patients or residents in the hospitals where the studies were conducted. This determination has been widely disputed and is now under investigation by the Office of Human Research Protections."

> It seems like there's enough people trying to be doctors

Not in the US. The doctor per pop count is very low.

https://www.nationmaster.com/country-info/stats/Health/Physi...

I think the key word in the sentence is trying to be doctors. The doctor per pop count in very low because med schools have super low acceptance rates[1]. That would probably be the best place to implement some sort of reforms if we want more doctors.

[1] https://www.accepted.com/medical/med-selectivity-index

There are plenty of people trying to be doctors, but there aren't enough programs to train them at the moment.

I imagine if med schools made it easier to get through their programs, the end result would be a significant lowering of the average pay for their profession, as more doctor's hit the job market. It sounds like it's in the best monetary interest of doctors to keep their professional supply low, allowing the demand for them to be high.

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.

This would be easy to do a controlled experiment to compare.

My girlfriend is a second-year OB/GYN resident (which is a 4 year program) and while that field's residency is less insane than some other specialties like ER, she still works 12 hour shifts Mon-Fri (6a-6p on paper but generally 6-7:30), one 24-hour weekend shift a month, and one 12-hour weekend free clinic shift a month. This is on top of the "extras" that are not work but are required to graduate the residency programs. Weekly rotating presentations to the rest of her group (4 other second-year residents so one ~45 minute presentation every 4 weeks), research, generally keeping up with the state of the art in her field, etc.

So she's only "scheduled" for ~67 hours a week averaged throughout the month, but realistically it is in the 85-90 range.

It's easy to see how a more demanding or emergent field could seriously select for folks who are more able or willing to work on less sleep.

I used to work in hospital IT at a level 1 trauma center from 2004-2006. While I was there, an article was released which studied the relationship between time on shift and errors made by staff. As I recall (and it has been 10 years) the findings were:

* Through roughly 9 hours, the error rate was about the same. Say, x%

* In the 10th hour, the error rate increased. Say x + y%.

* In hours 11 and 12, the amount the error rate increase doubled the 10th hour's increase. So x + 2y%.

* In hours 13 and 14, the amount the error rate increase quadrupled the 10th hour's increase. So x + 4y%.

* In every subsequent hour studied, the error rate increase doubled again. x + 8y% in hour 15, x + 16y% in hour 16.

I want to say the study went to 18 hours, but I don't recall if it was 16 or 18 at this point. The paper made the recommendation that shift lengths should be limited to 10 hours maximum.

Every health care professional I spoke to about the article (resident doctors and nurses, maybe 10 overall, mostly in the ER) said the same three things:

1. They had personally witnessed someone make an error they could attribute to tiredness.

2. They themselves had never made a mistake due to tiredness.

3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.

2. They themselves had never made a mistake due to tiredness.

3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.

I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.

There's been some study(s) which suggest that medical error is the 3rd leading cause of death. This may have been debunked so if wrong please correct me.

https://www.cnbc.com/2018/02/22/medical-errors-third-leading...

Many sane minds would argue that, but the ACGME is actively arguing otherwise. They are actively building rules that allow residents to work longer shifts (up to 28 hours straight) while claiming these rules improve patient safety.

Patient hand-offs between shifts tends to introduce errors. Instead of finding ways to improve hand-offs, the ACGME is simply trying to have fewer of them.

These are supposed to be some of the "top minds" in medicine and that's the best they can come up with.

That's no really addressing the problem, it's just doubling down on the mistaken notion that the treating physician is the best one to tend to the patient under any circumstance. Doctors need to learn to be team players.

Nurses are a lot more than just shift change workers, and their nursing school requirements are a lot higher than you seem to believe.

I don’t think (s)he was commenting on education. I read their comment as only people who can do 12 hour shifts that may be required to occasionally be overnights followed by days, completely disrupting their sleep schedule, can make it as ICU nurses.

"Works on a shift schedule" is a shared trait between nurses and shift workers. "Has one thing in common with" is not the same as "is the same thing as".

Parent to that reply edited their post after my comment, and I can no longer edit my reply.

To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?

Yes.

Doctor's are notorious for not understanding their patients' experiences, and how that impacts them.

I've just witnessed this with my partner's recent bout with cancer. While her oncological surgeon completely understands, her reconstructive surgeon had no conception of what she was going through.

Those people spent many years learning to understand, diagnose, and treat thousands of medical issues. During that entire time, they were continuously sleep deprived as a matter of culture. Those that could not handle this environment dropped out. They're probably still sleep deprived. They may have learned about sleep's medical effects, but the personal experience of those who survived the selection process who work 120-hour weeks and have been waking patients up once an hour for years has a blinding effect on this diagnosis.

It's a bit like bringing someone from south Florida to northern Michigan this winter for some ice fishing. I understand that it's cold here, I intellectually know about, have observed the effects of, and can treat frostbite and other problems resulting from this cold - but all that would make it hard for me to intuit the problems of a visitor who was unable to control their fingers when they removed their gloves and dipped their hands into a minnow bucket to bait a hook. My fingers work fine in that bucket, everyone else on the lake is doing it, you're just going to dry them off in a few seconds and put them back in warm gloves...what's the issue?

People whose job is to treat human bodies should have enough sense not to constantly wake them up.

The mind does funny things. They also understand that exercise and good nutrition are fundamental to health. When I worked in a hospital I normally ate in the cafeteria. The physicians had horrible diets, including the cardiologists.

Let's not even get started on how many nurses smoke.

As someone with a father and a wife who are both physicians, yes. In both cases they started working to get into medicine in high school, pushed hard in college, and then had med school and residency.

That alone is 16 straight years of normalizing sleep deprivation. Time spent studying and working is regularly 80+ hours per week, certainly from med school onward and certainly the year spent studying for the MCAT.

If they start at 16 and finish their residency at 30 or 32, that's the only life they've ever known for all of their formative years. They cannot relate to people with a normal schedule because they have not experienced it.

A lot of people don't do their job perfectly.

It's my job to create applications and diagnose problems with software, but even though I've used the software in development and testing, I do not understand the experience the same way a daily user understands the experience.

Similarly, doctors and nurses do not have significant experience in being a patient, especially one who isn't around hospitals all day.

Why do doctors not get sleep? It is still the most ridiculous thing I've ever heard. Start up founders? Fine. Grocery store bagger? I don't care. BUT A PERSON IN CHARGE OF TOUCHING (inside) MY BODY? I want their Fitbit sleep records for the last month showing a consistent 7 hours of sleep.

Regarding the U.S., the reality is that it's mostly the students (med students, residents and fellows.. you're called Doctor by residency) that are sleep deprived. After that most doctors are on normal to normal-ish cycles. But because residents and fellows are such solid profit earners for hospitals and the hospital owns their life they opt to over-work them and charge you max dollar for their time. Once the doctor is board certified (post residency or fellowship) then the power shifts back towards the doctor and they can get more normal lives.

Exceptions are specializations that are essentially emergency/urgent but even most of them are on rotations like another poster mentioned where they've shifted their own sleep patterns to match their hours.

Since watching my friends become doctors (psychiatrists, uroligists, neurointerventional readiology) and my wife become a surgeon I have started telling friends and family "If your doctor looks under the age of 35 then you should ask them the last time they slept before they start treating you.

tl;dr : hospitals straight up own the futures of their med students/residents/fellows .. so they overwork them while paying them $40-55k year, and when they aren't working they have to study for their exams.

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

Yes! Sleep deprivation played a role in the two Navy crashes in the last few years.

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 insufficient sleep is that if a patient under care of doctor has complications, they will often be called, even if just for a consult.

Economically, this is likely efficient compared to having hospital specialists (which may end up with nothing to do many nights), but causes docs to train for worst case scenarios sleep-wise.

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.

I get terrible headaches if I sleep less than 8 hours and I'm 27. Always wanted to have more time in my day but I get no time if I can't focus or function.

I'd hope someone doing something as high risk and important as surgery would be getting as much as they need regardless of how much that is.

> during pre-med training: with on-call work hours up to 120 hours a week.

Can someone please tell me why they still put medical students through this institutional hazing?

Saying that "pre-med training" (whatever that means) consists of 120 hour work weeks is not accurate but it's probably just because we're using the wrong words.

Pre-med = college, and aside from the highly scientific work load is no different than any other college experience.

Medical school (no longer called "pre-med" by anyone) is typically 2 years of classes and 2 years of clinical rotations. The rotations are not going to be 120 hours a week but may be 60-80. But unless you go to a teaching hospital and consent to student contact (which may or may not be a requirement of treatment) no med school student is touching you.

Residency is after med school (they're full doctors now) where you train your specialty, and at least in the 4 year program I'm familiar with, their title is intern, resident, resident, senior resident for each of the four years. They have increasingly high levels of responsibility as they progress and by the 4th year they are basically oversight/management of the other residents who assist on complex cases and bring in at attending physician(s) for big stuff. Hours are typically 80+ and I'm sure you could approach 100 for very demanding or emergent specialties but it's certainly not "pre-med training" and 120 is pushing it for sure.

After you graduate residency you move to an attending, fellowship, or research position and the hours drop back down to the 60-70 range and decrease as you gain seniority.

And on top of those 60-80 hours per week you need to add all the time prepping for exams and boards, correct? That study time is work too, and that pushing up to 120 hours per week.

In medical school, 120 hour weeks really only exist for 4th year med students who are on sub-internships in surgical specialties like neurosurgery, orthopedic surgery, general surgery, etc. Students in those fields do 3 or so month long sub-i's at hospitals they want to do residency at. They basically function as month long interviews for those programs, and are also used to get letters of recommendation from prominent faculty in the field. People who are interested in those fields know about the hour requirements on sub-i's and in residency, and self-select in a way.

The reason resident physicians work so much is because residents make $60k working 80+ hour weeks, and the PAs or NPs who would be willing to cover the floors at night would make $150k+ working 40hrs/wk. Residents also have no collective bargaining power because of the residency match system. You can't easily leave one program and go to another because you don't like the working conditions, for example. If you want to leave, you're more or less blackballed unless you're switching fields. And you don't want to speak up about the conditions because you've got $300k in debt and a degree that's useless until you finish residency.

So they are being taken advantage of then.

Sounds like they should just legislate away the "Residency match system."

Ironically, congress passed a law in 2004 to give the NRMP, the organization that runs the match, immunity from antitrust legislation. https://en.wikipedia.org/wiki/National_Resident_Matching_Pro...

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 have no surgery rotations scheduled at all during this year. Most of this year is actually spent on residency interviews. I've been traveling to different cities in the US about twice per week since October, and will continue through the end of January with breaks for the holidays. I have no hospital duties from September–January.

The 3rd year of medical school is much tougher since we spend about 10 months of that year on rotations in the hospital. While some rotations are much lighter, others like surgery again get close to the hours limits. This is complicated by the shelf exams we take every 8–12 weeks. These require an additional ~2–3 hours/day of studying and most of a weekend day as well. Obviously, this study time is not counted towards the hours limits, but it definitely factors into fatigue and burn out.

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.

My mom was an ICU nurse for over 20 years, and yeah, the burnout is real. My mom always said that ICU is made up of a very small number of surgery recovery patients (who quickly get moved to a different section once they're past the critical part of their recovery), and the rest is people who are just there to die (especially here in Florida, where there are a large number of elderly).

She eventually had to switch to another position, because it became too much. She said she lost a lot of her empathy for the people who had spent 60-70 years abusing their bodies, and now were just here to slowly die under her care (regardless of how good that care was). She also hated that so many people were kept alive on machines long past the point of having any life left, just to keep the families happy. She said after a while, she could tell the difference... that whatever made a person a person (the soul or whatever you believe in) was gone, and all that was left was a pile of meat being kept "alive" by the machines.

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, and all your neighbors do the same!

- Having attention deficit? Lets start with ADHD medecine, not with a sleep study, no sir.

- Bazillion jobs requiring on call, waking people up at all manner of time, as a standard thing.

- Neighbors woke you up? Toughen up bro!

- Myth around how so many people apparently can do just fine on 5 hours of sleep.

The hospital thing is just a symptom of a society built around lack of respect for sleep. No one seems to consider it an important thing. If you're drowsy because you couldn't sleep, it's considered a minor inconvenience and little more.

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 remember trying to sleep in between classes. Like, I would close my eyes and touch the wall in the hallway so that I could "sleep" while I was walking to my next class.

I had the same problem in college. Classes started at 0830 but for me it was still too early. I was always falling asleep and after a while I just stopped attending.

I just started attending the sections of the same class that started at 930, except on test days. The professors knew I was doing it, but didn't seem to mind.

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.

How many desks in high school did I drool on while sleeping I wonder?

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.

Most companies (not startups) don't have their employees work much more than 40 hours.

Lack of sleep is very rarely an issue with your employer.

In which fields? Financial/Law firms are routinely scrutinized because they overwork their employees, just to name a few. Doctors, EMS personnel, Police, all work more than 40 hours. There may not be mandated work hours over 40, but the culture/workload creates that environment anyway.

Even with an 8 hour day plus a long commute, there are at least 14-15 hours a day left for you. If you aren't finding time in there to sleep, that's on you.

Good thing that work is literally my only responsibility as an adult. /s

As others have said, sleep deprivation is the norm in certain fields like healthcare. There are also jobs where you work 40 hours but the schedules are so random that they can also screw with your sleep such as retail. And a lot of top performing companies in a variety of fields expect people to always be on.

People shouldn't be so beholden that they need someone else to give them sleep.

This can be done indirectly by reducing the work day from 8 hours to 6 hours, those who otherwise need to get up early to commute may have a bit more time to settle down in the evening.

And reducing the productivity of workers by 25% couldn't possibly have any bad effects. /s

In all seriousness, I've seen mentions of studies that suggest going from 8 hours to 6 does _not_ correlate with a 25% decrease in productivity, because most people aren't consistently productive for all 8 hours of a day. I know in my case, there's an extremely strong inverse correlation with productivity and how bored I am with a particular task. I'm sure I'm not alone.

Actually there was an interesting study done to show that most people in the office environment on average do 4 hours of work (actual work) and the rest is breaks, distractions, chit chat, bathroom breaks etc. I have found the 4 hour figure to be much too generous, I’d say on average people work less than 4 hours (maybe closer to 3) the other 5 are a total waste.

When I first started freelancing hourly, it was a sobering feeling to see how little of my time was actually billable for actual work. It takes random screen grabbing software to make you realize that most of the time you are not working. Of course those days have long passed for me but I’m always left to remember just how wasteful office workplaces are and how much time people waste away in their life. More than half of their working life is a total waste. Tell me, how does that make you feel? :)

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.

The Elementary school comment rings so true. We have to get my seven year old up at 6:15 to get to school at 7:30. That's if we take him, if he caught the bus he would have to be AT the stop by 6:15. Every day is a battle against exhaustion. On the days that school is delayed due to weather and he can get up naturally at maybe 7:30, he is so much better. He feels better, his attitude is more positive, and he does so much better with learning.

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.

All kinds of liability problems with that. School bus drivers are presumably vetted and trained to deal with not just getting from point A to point B, but dealing with students along the way.

School bus driver "vetting" is checking their driving and criminal record and "training" is essentially how to operate a large vehicle. The first could still be done, the second doesn't apply.

And the liability issues all seem to go the other way, don't they? Buses are less safe (they don't even have seatbelts), problematic incidents involve a larger number of students, the buses are more officially associated with the schools, etc. And actual parents obviously have better incentives to make sure their kids are safe than someone who is only doing it for a paycheck.

In 9th grade, my bus driver let an obviously angry man onto the bus.

Some kids threw peanuts out the window and into his car. He followed us to the next stop and pounded on the door. She courteously opened the door and in he came, shouting the whole way.

The awkwardness was compounded when I realized I had known this man for 10 years.

I don’t have a very high opinion of bus driver training.

I actually did the math on this in my district. Based on the cost data they published, it costs (roughly) $1.5-2/ride on our school bus system. Allowing 20 minutes for pick up and drop off, no current ride-sharing system I know about would be cost competitive, but its a relatively close thing.

RE carpooling, this probably cost competitive but their are other factors that make this harder than you think. Buses are allowed exemptions to booster seat rules, minivans aren't- do you leave the van full of car of booster seats all day? Do kids carry their own? My kindergartener still has issues buckling their self in in a crowded car, that really pushes up pickup/drop off time spent. How do you get kids to school if the primary driver is sick or has car trouble? Who is liable for accidents? Do you randomly drug/alcohol test your parents?

None of these are insolvable, but they also aren't easy.

School busing in the era of autonomous vehicles gets a lot more interesting- you could have much smaller and efficient pick up routes. However, I think it will take (US at least) society a while before they are willing to leave 4-8 children alone in a car for 30 minutes a day. It just takes a couple 5th graders fighting in a car before the district decides supervision is needed.

> Buses are allowed exemptions to booster seat rules, minivans aren't

Buses are allowed exemptions for pragmatic reasons, not safety reasons. Whatever the rule is, it should be the same for both, in which case there is no relative advantage. If you're not willing to allow it for a minivan, why are you willing to allow it for a bus? (This also doesn't apply to high school students who don't need them anyway.)

> How do you get kids to school if the primary driver is sick or has car trouble?

How do you do it when the school bus driver is? You maintain some level of reserve and you send someone else.

> Who is liable for accidents?

The insurance company. The better question is who pays for the insurance, but considering that the school would already be paying for it for a school bus, it still doesn't appear to be any disadvantage for the school either way.

> Do you randomly drug/alcohol test your parents?

They're voluntarily choosing to drive someone else's kids for money. If you want to do that and they don't, they don't get put on the roster and don't get paid. It seems like the only real question is whether (or how often) it's worth the cost given the expected probability of drug abuse in your parent population.

> Buses are allowed exemptions for pragmatic reasons, not safety reasons.

No, buses are safer, period, even without seatbelts. Occupants of bigger vehicles have much better outcomes in auto collisions, and buses are some of the biggest vehicles on the road.

Also, most school buses don't do much freeway driving... Not having a seatbelt in 25 mph collision is one thing. Not having a seatbelt in a 70 mph collision is lethal.

> No, buses are safer, period, even without seatbelts. Occupants of bigger vehicles have much better outcomes in auto collisions, and buses are some of the biggest vehicles on the road.

By causing much worse outcomes for occupants of the other vehicle or pedestrians in the same collision. Not really something you want to have around your schools and homes where your kids may be the pedestrians or occupants of the other vehicles.

It's also no help for single-vehicle collisions, which are nearly two thirds of auto collisions. 12 ton bus vs. 2000 ton overpass, overpass wins.

In addition to the unfortunate high center of gravity that increases the probability of rollovers (which are especially likely to cause injury without seatbelts).

> Also, most school buses don't do much freeway driving... Not having a seatbelt in 25 mph collision is one thing. Not having a seatbelt in a 70 mph collision is lethal.

Which is a reason why statistics make school buses appear safer than they actually are -- a minivan picking up the same kids would be on the same roads with the same traffic speeds, even if the "average" minivan would be on different roads traveling at higher speeds.

That may even be a good basis for the rule -- car seat required if traveling more than 35MPH.

> By causing much worse outcomes for occupants of the other vehicle or pedestrians in the same collision. Not really something you want to have around your schools and homes where your kids may be the pedestrians or occupants of the other vehicles.

This has nothing to do with whether or not bus riders need to wear seat belts.

> It's also no help for single-vehicle collisions, which are nearly two thirds of auto collisions. 12 ton bus vs. 2000 ton overpass, overpass wins.

> In addition to the unfortunate high center of gravity that increases the probability of rollovers (which are especially likely to cause injury without seatbelts).

You're making buses sound like deathtraps. And yet, per passanger-mile traveled, they, despite lacking seatbelts, are two orders of magnitude safer then personal automobiles. [1] 0.11 deaths/billion miles, versus 7.3 deaths.

Buses, the way we currently use them, are much safer then cars. This isn't even a point of debate.

https://journalistsresource.org/studies/environment/transpor...

You are right in "the way we currently use them", but that doesn't make buses inherently as safe as you imply. Buses get professional, trained drivers, subject to substance abuse testing and rest laws, consistently driving the same route. In the resource you shared, it looked like professionally driven cars (presumably mostly taxis and town cars? from 2000-2009) also had dramatically lower death rates, although they didn't give the deaths/passenger mile number.

> no relative advantage

Speed doesn’t kill, change in speed kills.

With significant mass at play, a bus in a collission doesn’t change speed as suddenly as a car, thus passengers experience less G force.

The rule does appear to relate to weight, and safety reasons:

https://www.citylab.com/transportation/2017/01/why-the-schoo...

Notable quote:

> Federal agencies like the National Highway Highway Traffic Safety Administration (NHTSA) have long maintained that even without seat belts, school buses are the safest mode of transportation for children. Between 2005 and 2014, NHTSA reported 1,191 crashes involving school buses or other vehicles functioning as school buses. That makes up less than 1 percent of the 331,730 fatal collisions in those 10 years. Among the 133 people who die each year on average in related crashes, only 11 are bus passengers or drivers.

However, that doesn’t help when the bus collides with an immovable object, so the rules are being reconsidered.

Sounds like my experience growing up in a rural area. My high school was on the other side of our county, so I was the first person on the bus every morning, 60 minute ride each way.

While on subject of school buses, my driver would not let me cross the street on the way home, so even though I was the first stop, I’d have to wait until we looped all the way around to the end. My stepdad had to scream down their throats and they finally caved, I came home an hour earlier. Talk about the stupidity of that situation!

Just realized I wrote basically the same comment as you. I wish my stepdad had yelled at them! It didn't even occur to me that I could complain.

Oh it didn’t occur to me right away either. This was in middle school and I was not the smartest cookie, so I must have wasted at least 5 trips before the revelation occurred.

Kind of off topic, but a fun story: Growing up, we were the last kids off our bus and the ride took an hour. The silly thing was, there was a different bus that drove past our literally five minutes after school got out. Eventually they figured it out and switched the route we were on, but by then we were old enough to not ride the bus most of the time.

For me it was often 90 minutes to get home, but about 30 minutes into the trip we would drive right by my house. Problem was, it was on the other side of the street, and they wouldn't let me cross. This was in middle school, on a street that I crossed by myself all the time.

Traffic? Traffic at that time of day can be crushing. Arounds here, anyway.

Small town America. The high school I attended in 9th grade was a 30 minute drive away if there was no traffic and first bell was at 7:00 AM. It also served 2-3 small towns in the area. I took the bus before I could drive, and my bus stop was one of the first on the route that had to pick up kids from all over the place because we didn't have a lot of busses. So in order to get me to school on time for 7:00 AM, I got picked up at 5:45 AM.

Jeez... couldn’t they spend a couple bucks more for extra service?

Now that’s in essence the whole problem with tax cuts and privatizations: public service is cut to the bone, and privatized ones maximize their profits together with the citizenry’s inconvenience.

more schools are consolidated these days. In some places, one large school serves 3 counties. I don't know why.

It's more expensive to run three schools. And if those three schools don't each have enough students, they're going to be underfunded as funding is largely based on the number of students.

So the problem starts multiplying.

1. Can't afford supplies, facilities, etc.

2. Can't afford to be properly staffed.

3. The school is invariably going to be under-performing and we've decided as a society that if your school isn't performing well we're going to penalize it by cutting funding, which exacerbates the funding problem.

4. You've got all sorts of people, fiscal hawks, tax payers, etc who don't really want to pay for education, let alone pay for half empty schools and all that overheard. No one really wants to subsidize a ghost town...

So the result is school districts that are too small to make sense being combined together to try and pool their resources and maintain quality and efficiency.

So if you live out in super rural or low population density areas, and families aren't churning out children like they're old school farmers or Catholics, then this is the sort of reality you'll have to deal with.

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 ?

> A school system that puts kids first would start by 9am but how would society cope with that ?

Do it like daylight savings time. Have everything start two hours later, all year. The issue for the kids is time related to sunrise, not time related to when the parents go to work.

> The issue for the kids is time related to sunrise, not time related to when the parents go to work.

Is that what it is? I thought it was total sleep duration. Do you have a link explaining more?

> I thought it was total sleep duration.

They're related. If you go to sleep at the same time (relative to actual-midnight) and get up an hour before school, you get more sleep when school starts later.

Or else what difference would any of it make? If all you did was start school at 9:30 instead of 7:30 and then kids used that to go to bed two hours later, nothing has changed. But when people go to sleep (and are inclined to wake up) has a lot to do with daylight.

If you go to sleep at the same time (relative to actual-midnight) and get up an hour before school, you get more sleep when school starts later.

That still doesn't seem all that helpful. If my high school had started at 10 instead of 8, I'd be out of class at 5:30 instead of 3:30, done with fencing practice at 8 instead of 6, etc. I'd finish the night's homework two hours later, and finishing that was already well past sundown even on the original schedule. A later start time wouldn't have been an opportunity to stay up later -- it would have been an obligation to stay up later.

The only way you'll be getting more sleep is by doing less non-sleep. You can't add hours to the day. What you can do is to arrange the sleeping hours so that they're the ones that come more naturally to more of the people in that age group.

The total lack of unscheduled time is an independent problem.

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

Our middle schools start at 9:15am and society copes just fine.

Where I grew up the high school was a 45 minute drive away. We would get picked up an hour early so there was a little leeway in case of traffic.

Same, in Indiana. High school started at 7:45, bus picked up at 6:45.

My best semester in college I managed to have a schedule of classes that started at 2pm and finished by 8pm.

Pretty sure it's the only time in my life where I've literally slept as much as I wanted...and felt great.

Same. My dorm-mates were confounded that I was getting straight "A" grades and seemingly always sleeping.

My exams were regularly scheduled at 09:00 in the morning. I would regularly gasp when reviewing the errors I made, wondering how drunk I must have been to make such gross ones. Indeed I was drunk... from sleep deprivation. I wonder how much has this affected my overall performance as a student and later as a professional...

I've had some of the best lucid dreams I've ever had while my sleep was disrupted by living in the second story of a building smack dab in the corner of a very busy street corner during broad daylight. I had a night job so my sleep schedule was from 7am to 3pm. All in all I had half a dozen lucid dreams and one mindblowingly extreme out-of-body experience which left me breathless upon waking. I think I even had a night terror or two while I was there.

I didn't hate it. Sleeping during the day has taught me how to put a pillow over my head in order to block out all light, and now I can sleep in the brightest loudest room without trouble.

I haven't had lucid dreams since then, or if I have, they've been really really rare and extremely hard to remember. Now that I think about it... Could my lucid dreams and OOB have been triggered by smog from the traffic in that area??

>I've had some of the best lucid dreams I've ever had while my sleep was disrupted by living in the second story of a building smack dab in the corner of a very busy street corner

Though not during the day, I lived in a second floor apartment that overlooked a traffic circle that had an elevated subway stop, was a main route for ambulances going to the hospital a block away, and a crucial interchange for traffic entering/existing that part of the city. I barely slept for the first few days and then got the best sleep of my life. I rarely woke up for anything other than my nightly trip to the restroom.

Fast forward a few years and I now live in the suburbs. I've been woken up several times in the past month by the sounds of a mouse scurrying in the ceiling of an adjacent room.

School starts early because most adults have to get to work by 8:30 or 9, and they need to drop off their kids early enough to drive potentially a considerable distance to that work after the drop off.

To add to your list, a big one for me is the ritualization of coffee. Can't focus until you've had a cup!

Which is honestly a lot like not being able to calm down until you've had a cigarette. Doesn't seem to be a problem for those who just never do it.

Instead of elementary school did you mean secondary? Here elementary school starts the latest.

Dunno, don't have kids. I just know I see the little kids walking around with their parents whenever I'm unfortunate enough to have to be out that early, and I assume hundreds of 9 years old didn't all have to go to a birthday party at 7 am all at the same time.

The school thing is a challenge. If the parents have to be at work 8-5 plus time to drive there, the kids have to be up at the same time so they can be dropped off either at school or a day care setting to be put on a bus later. If the parent has a longer drive to work, the child must get up that much earlier. I don't really know how to solve this problem.

Our school district has a before school program starting as early as 7:00 so kids that need to be can be dropped off early, but most kids arrive much later. Classes don't start until 9:00 at our school.

Isn't that the same thing though? It's a very common problem without an easy solution.

Kind of the same, but at least it gives parents options. Most kids arrive just before classes start, instead of forcing everybody to get there really early.

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, elementary school students need to be in by 8:40 while high school students need to be in by 7:50.

Our neighborhood is setup for walking. The elementary school is a six block walk, so most people walk their kids to school. My daughter didn't sleep past 7:00 for most of elementary school. Our experience was that elementary really could have started closer to 8:00.

I'm with you on all your other points. But, I think our experience was significantly different for elementary school.

I would think that would be because teenagers are more likely to stay up late over elementary school kids.

It's a combination of a shifted sleep schedule and teenage brains going through significant, exhausting development.

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...

So, maybe they would benefit from an earlier bedtime? Not being snarky, am a parent myself.

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 in general.... kids are different.)

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

Scripture Lullabies is really great too - very peaceful & soothing.

One is of reading age, one is just about there.

The one of reading age is already reading after he's in bed. The hard part is getting him to stop and actually go to sleep.

I will look into the podcasts; thank you for the suggestion!

Anecdotally based on my kid (n=1), stopping screen time about an hour before bedtime helps.

However, she still seems wired to fall sleep at a certain time, and we finally decided that fighting biology is a losing battle. The strategy of moving bedtime a little bit earlier each day didn't work at all.

There's definitely no screen time involved anywhere near bedtime. But yes, I'm pretty sure it would not help if there were!

> maybe they would benefit from an earlier bedtime?

One can try but you will be limited by biology: The problem is that our internal clocks are reset by daylight. You can't just shift yourself to another timezone, since your circadian rhythm will always set itself back to the respective local time. So if your brain prefers you to go to sleep and to wake up at certain points it will always be relative to "local (sunlight) time", not relative to human clock time.

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!"?

Where did I suggest starting "from the WORST principles"?

What I would suggest is that there is not a Pareto-optimal solution here short of redesigning how schooling works entirely...

If the schools are fun and a great experience, the kids would wake up at 5 for school. The schools are so boring and useless, the kids obviously find no use or interest in attending them.

The kids are very happy to _go_ to school once they've woken up enough. It's that first 20 minutes after we start trying to wake them up that are miserable.

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. The next year, the high school started at 8:50, and the elementary school at 7:45, and the schedules have been essential unchanged since. I can't describe how much of a difference that 1.5 hours made to a 16-year old.

As a father of 3 young children, they rarely sleep past when I have to wake them for school anyway. The same is definitely not true of teenagers.

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.

I'm envious. My high school started at 7:17am. It was brutal.

I took zero hour PE to add in an extra class and mine started at 6:30 am

OMG! 7:17am, that's crazy. Mine started at 8:30am, it was ok most days, especially later years as I generally enjoyed going, depending on what class was first. But 9am would have been better. (as that's when primary school started for me), which suited me really well.

> Teenagers need more sleep due to their brains re-wiring, so the reasoning goes.

I work in the education industry, and the education experts in our company have been saying this for years.

A lot of elementary schools start early because of parent pressure to start early, because parents need to get their kids to school so they can get to work themselves.

We are lucky that our school district provides before and after school programs since my daughter's elementary school doesn't start until after 9:00 AM.

I don’t see a lot of evidence that elementary schools have started classes earlier as more households have relied on both parents working. I _have_ seen an increase in after-school programs to make up the gap between school letting out and parents getting off of work.

The battle to get up early is about as old as time. We aren’t that far removed from an agrarian-based economy, and farm work has always required very early rising (my father grew up raising dairy cows: he was fond of reminding us as children that the cows don’t care how tired you are).

“Early to bed and early to rise” is not a modern day mantra, but I fear we’ve kept the wake up call constant while continuing to push how long we stay up. I don’t know how to fix it: if your kid is in an after-school program until 6, comes home to eat dinner, and then still has to do homework... I don’t see how an early bedtime is even possible.

>I don’t see a lot of evidence

Have you actually looked? Ask some parents and see what replies you get.

I’m a father of three. I’ve had my kids in schools in four different cities. If we’re playing anecdotes, growing up my elementary school started at 8:00. My kid’s have had school start around 7:45. I don’t think that 15 minutes is the issue.

Continuing our story time, as a child a very small number of my classmates were part of after-school programs. Kids today are much more scheduled and for far later into the day. I grew up wandering the streets and maybe had baseball practice one day a week with a game on Saturday. I was home from school around 3:30, had homework done by 4:30-5:00, ate dinner around 5:30, and was put to bed (in elementary school) by 8.

I remember the thrill of having my bed time pushed to 9 around 8th grade. Bed time was 10 in high school except for weekends.

Very few people rode the bus to school: most had a parent drop them off.

This game changes significantly when both parents work. If both parents have to be in the office by 8, kids have to take the bus. Which means they have to get up very early. If both parents work until 5, then kids have to be in after-school programs. They’ll get home by 6-ish and have to fit in dinner, homework, and whatever activities they need to put on their resume to get into college.

Because civilizations are built and ruled by Type A people, who usually sleep less and get up super early, they are known to die younger though.

And %3.3 people have DSPS, who are just simply labelled as sleazy.

You forgot my favorite. In California (and probably other states), the building codes for apartment sound proofing are much weaker than for condos.

If you wanted to sleep, you shouldn’t have chosen to rent. Your landlord couldn’t be expected to pay $1000’s [1] extra to build your apartment, after all.

(1) https://www.remodelingexpense.com/costs/cost-soundproof-insu...

Counterpoint: regulations like these are part of what leads to an affordability crisis. It all adds up.

I don't have anything backing this up, buty personal experience is that NIMBY is partly because of the lack of proper building code. People are TERRIFIED of neighbor noise, most of which could be dealt with with better insulation.

I hear this claim thrown around a lot, but I've never seen the legal code pointing to a difference in minimum standards for apartments vs condo. Section 25 (http://mlacoustics.com/projects/multifamily/CA.noise.final.p...) treats them the same.

Do you know where the differing laws are?

Add time necessary to get to school when your commute isn't the best and it becomes even more fun.

I remember having to get up at 5:20 AM four days a week, to leave 20 minutes later to catch a bus at 5:58 AM to be get to high school in time for classes starting at 7:10 AM. And a teacher complaining to my parents that I often seem tired.

Tell me about it. We have to get our high school kids up at 5am to get to school on time while the middle schoolers don't have to get up till 8am or so (school starts at 9:15).

> College + Sleep? Not gonna happen.

Wait, what? I slept so much in college. Way more than at any other point in my life. You schedule your own classes and aren't actually in class that much, gives you plenty of time to sleep.

Probably depends what you study and at what rate. Alot of students work fulltime in addition to studying fulltime, which basically puts sleep and eating secondary or even tertiary. Socializing isn't on the radar for many.

Working full time and going to school full time is basically having two full time jobs... that would clearly hinder sleep.

The statement, however, said college means no sleep. That is a bit disingenuous to say that was meant to imply the person was working full time.

That would be like saying "living in an apartment means no sleep!" because you lived in an apartment above a 24 hour bowing alley.

Fair enough, but I understood your comment to mean that college was a "point in [your] life" that had ample time for sleep. I was just pointing out that that point in many people's lives has less sleep due to college, not more.

I worked 3 jobs, was on the newspaper, ran track, and took a full course load on top of commuting home when I could -- I probably slept more than I do now but it was def not enough!

Sounds like the college part was only a minor contributor to the no sleep... it was doing all the other things along with it that lead to no sleep.

My workload in college was insane. For one of my semesters I had zero social life and slept a day out of two, one out of three near the end. It was awful. I didn't have a job and lived with my parents who handled food too. Not many people made it through. Was a shitty community college. I would have had an easier time at MIT, heh.

Having to choose a schedule that irritates the least number of people is somewhat different than hospital staff poking and prodding people every hour or so throughout the night, don't you think?

No. My point is that I'm every bit of society we consider sleep as something you can cut as opposed to something critical. Yes my examples were different, but they have the same root cause: quality of sleep isn't considered a big deal.

Except your examples (several of them, at least) are essentially unsolvable. We can't find a time that everyone will agree on, so we collectively chose an arbitrary time that most people seem to deal with okay, and ran with it.

The hospital staff absolutely knows that sleep is important, but they have competing goals that are deemed important enough to interrupt sleep for. That seems very much different from societal-level / cultural priorities.

My theory is that there is an eternal secret war between morning people and evening people and the morning people are winning. Resistance must be done in secret but fight back in every way you can.

The first rule of the resistance is that we don’t talk about the resistance with people who find 5:30am tolerable.

;)

Cough. Timezones. Cough...

And both groups don't even acknowledge the existence of 3rd shift workers. It's not even just businesses being closed or noise. As a night person even going on a walk can get you harassed by the cops or ticketed for being in a park. There's an implicit assumption, one that's been baked into law, that anyone doing things at night is up to no good.

It's because they keep getting the worm.

The trouble is that by the time the evening people get going, the morning people have already defined the world's schedules.

As father of three (a 3 year old and 1 year old twins), I've found that when we only had one kid, our schedule remained basically the same. But now with three, we are somewhat forced to shift toward being morning people. With multiple, good luck getting them back down to sleep if the sun is up. By the time you succeed, the others will decide to be awake. Also morning routines take longer, so you need to start your day earlier to compensate.

I feel like a big part of it is that very young children are geared towards being early (at least from my perspective) risers. Parents end up shifting their day to account for that. And then as kids get older, their rhythms start moving to starting the day later, but by that time the parents' routine is molded around being up early.

Not sure where I'm going with this exactly, just an observation of mine.

I think sleep is losing the war against staying awake, both in the morning and the evening. As a morning person, I often have a hard time participating in social activities when I'm trying to get to sleep by 9-10pm.

You might have forgotten to mention our society's addiction to caffeine... Am writing this sleep-deprived, on my fourth espresso, check. :-)

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.

Its always bizarre that they don't have activities involving daylight first so that school could run into the dark and nobody would care because you are indoors anyway.

Its basically that society used to require daylight to get anything done two centuries ago, and most people worked the farm by daylight, so fast forward generations and centuries and we are still structuring our lives around that - such that we are actually outside in the dark and doing our main activities indoors during the day.

Humanity is nothing if not set in its ways.

>Its always bizarre that they don't have activities involving daylight first so that school could run into the dark and nobody would care because you are indoors anyway.

Exactly!

Your last sentence could not be more true.

The other problem is do you have any idea of how much bureaucratic nonsense would have to be changed in order to make one simple change such as changing the schedule of a school start and stop time.

It makes you wonder how hard it is to change things that may be of higher importance than this.

Damn very nice summary. I do think the kids in school thing, however, is more of a symptom of our generation as parents- they love staying up late, thus keeping their kids up late. just sayin... that being said - NOT A PARENT!

When I've stayed over at friends house (who are parents) they have very strict go to bed times for their kids. THOSE darn crazy kids are up at 5 or 5:30 banging around the house full of energy.

> Elementary school starting so early all the kids are half asleep in class

Isn't the amount of sleep you get determined by when you go to sleep? So if elementary school kids need more sleep just... put them to bed earlier?

While I think most elementary school kids probably should be put to bed earlier (even if their school doesn't start so early), it's easier said than done. Imagine having to get home from your commute, feed your family, getting the older siblings to/from extracurriculars and then getting the elementary school ones to bed by 7:00/8:00pm.

Yeah but time is zero sum. Let's pretend school now starts at 9. Now everything is shifted by 2 hours. Extracurriculars are now 2 hours later, feeding your family is now 2 hours later, etc.

"Imagine having to get home from your commute, feed your family, getting the older siblings to/from extracurriculars and then getting the elementary school ones to bed by 9:00/10:00pm. It's easier said than done! School needs to start at 11!"

I must be missing something. How is your family life going to be less hectic after work with school being 2 hours later?

> Let's pretend school now starts at 9. Now everything is shifted by 2 hours.

(1) The school day is too long and the school year too short, anyway, so chopping two hours off the end of the day and making it up by extending the school year would be a win.

(2) Even if you don't do that, eliminating the end-of-school to end-of-typical-fulltime-work gap would be a different win.

Biological clock aside, the kids might not be able to sleep earlier. Can't go to sleep before 7 if the jack hammers are going on until 7, for example.

This is bullshit bravado, even when increasingly studies point out the correlation between all kinds of diseases and poor sleep.

what a good summary. so true.

> Elementary school starting so early all the kids are half asleep in class.

The primary purpose of K-12 education these days is to keep kids locked up so their parents can go to work. If Mom and Dad have to be at work at 8, as is often the case, the kids have to be at school before 8. Teenagers, who naturally sleep in later than younger kids, would be better served starting school at 9, but because our society still infantilizes teenagers and young adults, we can't systemically trust them to fend for themselves in the mornings.

This isn't to say that K-12 schools are entirely unconcerned with actual education, but it has to accomplish this goal within the constraint of keeping children locked up.

"Elementary school starting so early all the kids are half asleep in class"

That's the only reason I don't put my daughter on the school bus. I can save her an extra 30 minutes of sleep by driving her to the school myself.

I deadass pre-planned being asleep during my second hour of high school, after recognizing that whatever alertness I summoned in the walk, the bus, and first interactions of the day would dissipate by then. If a study hall was an option, I would take it and sleep at my desk. If it wasn't, I would still sleep at my desk and try to cold-test my way into a D.

One theory I've heard is that sleep deprivation is used as part of conditioning techniques. Doctors are conditioned to tolerate things most people would not (cutting people open, touching diseased people, dealing with people dying) and sleep deprivation may be one way in which their minds are made malleable. The same with grad students and soldiers. This may be one of the primary methods by which society makes young people behave the way it wants them to; mess with their minds, then tell them what to do, and repeat it long enough until they keep doing it on their own.

I spent a week in a German hospital a few years back. One thing that struck me is that they offered sleeping pills to ensure patients got a good night of sleep. Worked for me. Also didn't notice too many interruptions at night.

Another trend that I know of in the Netherlands (where I'm from) is that newly built hospitals have private rooms for all patients. These hospitals no longer have shared rooms by design. They also try to minimize hospital stays as being in a hospital exposes you to hospital infections, is expensive, and to be avoided unless explicitly needed.

That's a big difference with Germany, which is old fashioned on this front. The default attitude in Germany seems to be to keep people in a hospital much longer. In Germany you only get a private room if you need it medically or if you take private insurance.

I suspect a lot of this stuff is part cultural and part wrongly aligned incentives because hospitals just bill whatever to insurers and couldn't care less about patient comfort because their paying customer is the insurer, not the patient. The insurer cares about cost, the hospital cares about milking the insurer to the maximum of their ability. Between those two, patient comfort is not much of a concern.

The reason things have improved in the Netherlands is that they spent the last decade realigning incentives to cut cost between insurers and hospitals. People pick their own insurer (they are all private). However, all insurers are required to offer the same base packages (with extras if you want). So, people can easily switch insurance provider if they want and they do. So, insurers now compete on quality of service and cost. Which is why a lot of hospitals are actively concerning them selves with upgrading their facilities to improve customer happiness (still the insurers). Insurers are happy when their customers don't switch to another insurer and when hospitals don't waste their money.

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 contracts with the insurers, who have an incentive to reduce cost as much as possible. Out of the 4 hospitals I've visited for healthcare in my area, only 1 will currently be covered by insurers in their most basic plan next year, and that one is the most remote.

Basically, next year I cannot visit my regular hospitals to continue my current treatment plan without getting a more expensive basic healthcare plan (+15%, or roughly 220euro).

No it is not. Hospitals need to negotiate with insurers to get bills payed. So insurers have a strong negotiation position here. In a dysfunctional market like the US where insurers have near monopolies that basically means they get to screw people over and cut cost everywhere they can. Meanwhile hospitals maximize their bills to insurers while minimizing their actual cost. Patient happiness does not factor into this as they are at their mercy.

If you fix that by giving them the possibility to take their money elsewhere, insurers are incentivized to behave a bit better. Likewise, hospitals will want to make sure they attract patients from good insurers so they keep their revenue coming in.

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 family was charged $1000 for an ibuprofen for a perforated eardrum at an emergency room. We never even saw a doctor because we waited 7 hours and left. It was faster to get an appointment at our personal doctor the next morning. I can't imagine what it would have cost for a severe problem like a car accident...

>> 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.

As a potential future patient you think about the quality of care when you shop for insurance. An insurance plan that can show you get better care when you need it for only $[small]/month is something you will consider taking, particularity if "know someone" (including a random person on the internet) who got bad service and regretted it.

Of course if you are in the US you cannot shop for insurance, the law ensures that you take whatever your employer offers.

Possibly this has to do with the state assurance companies who need to justify the tax ( approx 15% ), so keeping someone in hospital longer works for them.

Single time when I was in hospital, but private assured, they did everything to keep me as little as possible, even skipping an OP for a non invasive procedure, because the recovery time was inexistent.

All "public" insurers in Germany are private companies as well. They are all required to provide the same level of service and they all cost nearly the same.

There are separate private insurers that are cheaper when you're younger and more expensive as you age, but that's a parallel system and you must earn over 40k Euro/yr. to purchase that (or be a state employee for some weird reason).

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 reasons:

1. My surgery affected my nervous system and thyroid; maintaining blood flow (especially in my legs) was important.

2. Knowing how I felt at the time kept the nurses informed about the dosage of medicine they should administer. Hormones and their effects can change rapidly.

3. Having a patient awake for blood draws, or an emergency, is useful. I’m not a small person; turning me over for some blood is much easier if I am awake and cooperative.

I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.

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.

I don't think all hospital patients meet all (or even any) of the three points you listed. Hospitals should wake up folks that actually need it (e.g. folks like you in your past situation), and leave those who don't need it alone to sleep.

I mostly agree. The author of the piece didn't go into much detail about their medical needs at the time - perhaps they were a high-attention patient and didn't know it? Hence my call to educate oneself about their own situation. When you're in a foreign bed/room, in some amount of discomfort, on (likely) new medicine, you probably aren't the best judge of neediness and intent. The best you can do is ask and see what you can do to make the situation better.

There should be an equal call to educate hospital staff, to inform patients about their requirements, and to apply their requirements on a case-by-case basis instead of applying it to all patients regardless of needs.

The author makes it pretty clear, hospital staffs should wake up patients if absolutely necessary.

"If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours." ..

"..I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don’t need your counts on a daily basis. And they certainly don’t need them at 4 am. That’s merely for the convenience of doctors, who want the results back by 8 am." ...

Tangentional, but why recent head trauma shouldn't be allowed to sleep?

I had a very severe head impact couple of years back, and while I was fuzzy at the time of impact, few hours before I go to bed, it was not until the day after when, my internal functions went half way south. I am not certain if the weakening of some of my external senses immediately happened or not.

Tangentional, but why recent head trauma shouldn't be allowed to sleep?

This was dead, but it seems like a sensible question so I vouched for the comment to resurrect it.

My understanding is that with any head trauma doctors are concerned about the possibility of bleeding into the brain, and it's much easier to detect the neurological symptoms of this in a patient who is awake. But I'm not a medical doctor; someone else here may be able to provide a more in depth answer.

My mother is a doctor (in a different specialty), and this came up when we watched 10 Things I Hate About You, which repeats the myth.

You're correct; as far as the patient is concerned, it's better for them if you let them sleep. But it's easier for everyone else if the patient isn't allowed to sleep, as sleeping and dying look exactly the same.

My son managed to get himself a concussion in kindergarden once. Our doctor told us that as long as he's able answer questions normally and focus on whatever he is doing, he's fine. Let him sleep, but it's wouldn't be a bad idea to wake him up once or twice and evaluate his situation. Using the excuse that he should go to the bathroom was the least intrusive way to do this.

> sleeping and dying look exactly the same.

I do not know how many dead people you've attended to, but the ones that I have seen generally lack pulse or breathing. Both of those vitals are monitored for inpatients. And if one of those goes, the other goes too in short order.

Sleeping patients, on the other hand, usually pulse at least once per second, and breathe every six seconds or so.

there is a difference between dead and dying

What do you think "dying" means, or looks like? What signs would such a "dying" awake person display, that a "dying" sleeping person wouldn't?

Choking? Pulse goes up and breathing becomes shallow.

Cardiac arrest? Aneurysm? Torn blood vessel? Shot in the head? Stabbed in the chest? Poisoned? Spider/Snake bite? Fell off bed and broke hip? All these "dyings" are easily detected by pulse and breathing monitors.

From earlier in the comment chain:

"and it's much easier to detect the neurological symptoms of this in a patient who is awake"

In this context, I imagine neurological symptoms would be things like cognitive function, spatial coordination, memory functions, and linguistic functions.

All of those are things that are not really possible to assess while sleeping, but would be possible to assess in a patient who is awake.

Cranial bleeding can be caused by blunt head trauma, can raise intra-cranial pressure high enough to kill you, and there are only three ways to detect it: a) medical imaging scans, b) changes in patient behavior, or c) drill a hole in the skull and insert a sensor.

If the patient is sleeping, you can't use a) or b). Now, there might be an argument that everyone should get c) and lots of sleep, but drilling into a person's head is not risk-free either.

I believe the parent comments are referring to the cognitive and behavioral changes that often accompany bleeding or swelling in the brain.

Sure, if there's a real medical need to wake the patient up, they should absolutely do so. But waking the patient merely to draw blood in the middle of the night when that could just as easily be done in the morning or evening, is stupid and harmful.

Although as someone pointed out above, if the doctor gets the results in the morning because the bloods were taken overnight, they might be able to discharge the patient immediately and get a bed before lunchtime for another patient. If they wait to take bloods in the morning, the patient might be in another day for no particular reason.

Five years ago in Switzerland I could get a full blood panel from my Dr's office in the mall within twenty minutes. The blood came straight out of my arm, into the vials, and into vials went into the analysis unit.

Maybe there needs to be some investment in better analysis equipment for routine draws.

Or maybe an analysis of the analysis process to see what takes so long.

> 3. Having a patient awake for blood draws, or an emergency, is useful. I’m not a small person; turning me over for some blood is much easier if I am awake and cooperative.

> I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.

Well, yes, it would be enormously practical in a large number of situations if we wouldn't sleep. It would also solve a lot of problems if we didn't need to eat. Problem is, those things are biological necessaries with immediate adverse effects if we neglect them. I also believe there is a solid body of research showing the importance of sleep for recovery.

I'm not a doctor or nurse and the blood flow argument does sound reasonable - however, the other two arguments sound a lot like "it's more practical and less risky for us if you're awake", which I don't see is a valid reason. Also, by what medical school is >45 minutes of uninterrupted sleep "too much"?

> 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.

For both of our children, the hospital caused us more stress and discomfort than anything else. Newborn baby's finally asleep, wife is comfortable re pain, finally start to get some sleep.

Then the nurse comes in at 2 am, writes her name on the board, asks us questions that they should have the answer to, then leaves.

Nurse change 3x a day, baby doctor checking in to ask if were ok, mom doctor doing the same, house keeping, meal people 3x a day. Plus any legitimate and needed medical attention e.g. baby shots/bath /moms wound dressing change

With our second, insurance would've covered another 2-3 days in the hospital, but my wife nearly had a mental breakdown between normal post partum depression, nursing difficulties, and people interrupting every quiet moment we have with our new family member, so we left asap.

I hear it.

For our first child, for the first 24 hours or so postpartum, my wife and child both needed something checked every couple hours.

Our overnight nurse said something like "I'll be doing your wife's checks at midnight and 2am, and your baby's at 1am and 3am". When I asked if my wife and child could be checked in the same entries, it turned out they could. I was surprised the hospital didn't do it by default that way for less time sensitive checks.

Did you have your child in the US? If so I am curious, do the nurses come and visit your home the next day and a week after? I live in Canada and was very surprised when they came to check on the baby and my wife the next day, looking for jaundice, bleeding, etc. I'm genuinely curious if that is covered by insurance in the US?

I would guess it depends on the specific circumstance as well as the insurer. With that said, I'm not the GP (but am based in the US), but in our case the hospital arranged for a visiting nurse to do a check in the next day and it was covered by our insurance.

I've been in the hospital without insurance. They bill you for gratuitous stuff regardless of whether you have insurance. They don't mention that there will be a bill when they ask if you want your newborn's hearing checked or if you want to try the experimental sap-based wound sealer they happen to have (both things that actually happened). They seem kind and polite. Then they bill you. One doctor looks over another's shoulder for five minutes. They each bill you.

This is in the US, mind you. In fact, both stays were in Nashville, TN, in the early 2000s.

Sorry for missing this, I don't check HN every day!

Both medical systems that we had children with (in SF) do not do in-home followups, at least not for us. We had to go back the day after discharge for both of our children (for bilirubin draws). Would be nice so soon postpartum to have in-home visits.

A key lesson I learned with our first child was "just about everything gets easier once you leave the hospital", so with our second we prioritized GTFOing ASAP. It was a good decision.

Our experience would not have been different (Austria). Especially with the first kid going from hospital home was a bit regretful because of all the services you get in the hospital you need to replace at home.

We had a family room for me, my wife and the newborn. They served food, there were replacement clothes and diapers in unlimited supply, no washing etc.

With the second we opted for having only two days in the hospital because I have to deal with the bigger one going to daycare and then we had to go to the child doctor for the remaining tests since we couldn’t do all in the hospital.

If you have a good hospital I would do that over leaving early for sure.

I would have been happy to stay in a private room for longer too, I've been around young children a lot since I have a large family, but being responsible for a newborn was a scary prospect to get used to.

Regarding food my overriding memory of being the father in Finland was that we'd get food delivered to the room and each plate was labeled. Half the meals had the mother's full-name written on them. The other half just said "man".

I'm sure they took my name at some point, as I was registered as the parent in the country-wide population index, but as far as the hospital was concerned I was just "man".

(In Finnish the word for man & husband are the same, so perhaps I was "husband" rather than "man"!)

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 almost all mammals it is, just not for humans,

No, childbirth in nature is incredibly risky. But loss of life is expected in nature and disabilities, malformings etc. simply die whereas humans try to avoid life loss or any disadvantage for the offspring at any cost.

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.

We had our first child ~3 months ago. We had a room to ourselves and nurses/midwifes would only come in once or twice a day unless they were paged (which we did, they were a godsend). This made the stay as comfortable as could be, and we could get all the quiet time alone we wanted, although sleep was in short supply for other reasons.

This was in Copenhagen, Denmark, so the entire stay was free. Sadly, the central hospital is removing this practice and kicking out patients after 4 hours.

Similar situation in Finland; we had a baby over Christmas two years ago. We spent a few days in a private room with a checkup on the baby/mother around noon and 6pm.

We paid €250 or so for 3 or 4 days (genuinely can't remember I guess my sleeping wasn't so great. Oops!) for the three of us, so it wasn't free, but it was pretty cheap.

Similar experience here except the meal people were 9x a day, not 3. They would come in to take an order (as I recall there were generally two options) 30-60 minutes before the meal was delivered, and then again some time afterward to clean it up. Which I feel like I shouldn't complain about, since they're providing you with food (although only for the patient, not the poor, sleep deprived dad...) But man was it annoying when you were just trying to get a few minutes of sleep!

Yeah, my wife and I fled the maternity/recovery ward ASAP after both of our children, because it was so hard to rest and so unpleasant there.

The first time, my wife had preeclampsia during the labor and, fair enough, there were some significant interventions to make sure that her recovery was going apace. But the second time? She had a textbook uncomplicated delivery and fundamentally all we were doing was waiting to make sure that nothing crazy cropped up in the first 48 hours after birth. There was no reason for disruptions in our rest every hour or two.

This must differ wildly between hospitals. In Oklahoma City we were only bothered a few times a day and never at night during our 3 day stay with our newborn (plus the kitchen cooked us a 5 course gourmet meal to send of off on the last day). And I was often able to meet the nurse at the door and handle whatever they needed quietly without waking mom or child.

People die or suffer serious harm in hospitals all the time. This often happens during sleep, and in many cases it could have been prevented if the patient had been checked on more frequently.

It is much easier to confirm that the patient is ok if they are awake. When the nurse softly asks "do you feel ok?" when drawing blood in the night, it is not just meant as soothing, but just as much to check if further treatment is required.

It's a bit like the soldier checking if there is a bullet in the chamber when picking up a gun. Even if you experience a gun that goes off by acciden only once, it becomes really easy to understand the thousands of times the soldier will do this when he knows there is no bullet there.

Is that like how I constantly hit Cmd-S while working even though the chances of my system crashing are low?

This is interesting and not something I'd considered. I wonder though if they've got the balance right. These protocols were developed no doubt before it was really understood how incredibly dangerous poor sleep is to our health most especially during recovery from illness.

Its a mix of protocols, procedures, habits and personal biases, as are most such things in most workplaces.

But most of all, I think it is an attention thing. For the staff, a patient being sleep depraved for a couple nights is very low on their list of concerns. They see people die almost every day.

For the patient, the emphasis is different, especially for the ones that are there for minor issues.

Medically, a few nights with reduced sleep quality is unlikely to make a big difference.

Now, if it goes on for weeks or months, that is another matter. Still, more people are probably seriously injured or die from bedsores sleep depravation. Not to mention those that die from fall injuries caused by trying to walk to the bathroom unassisted. (The latter is the most frequent case of preventable fatal injuries aquired in most hospitals, at least in my country)

From my point of view, most complaints about loss of sleep in hospital are in the same category as complaining about the food. 1st world problems.

Except sleep is important to recovery for colds let alone serious ailments. It isn't like complaining about only bland vegetables and starches.

It is like complaining about hospital food being literally only a handful of breadcrumbs a day and lamenting their blood counts are so low, muscle atrophy and they have scurvy. Clearly the whiners should have been exercising more

Hospital food actually is quite unhealthy and not conducive to healing. I’d imagine that the only people who woild dismiss such concerns are the people who put such a system in place where they serve white bread and Jell-O with high fructose corn syrup and artificial food coloring to people who are barely breathing. Hospital patients need all the nutrition they can get. Providing the equivalent of a frozen dinner or fast food isn’t very responsible.

Hospitals are barely capable of providing appropriate foods for people with strict gluten-free diet. Also, their food basically follows 1950s American ideas the nutrition… Breaded chicken with Jell-O and canned peas. I don’t think allergy avoidance and food that actually has nutrition is a “first world problem“ and it’s not constructive to dismiss these concerns in such a manner. It’s especially absurd given that patients are surely paying enough money to provide decent food or any food they desire.

It does depend on what sort of ward you are in I have mostly spent time in low risk and high risk renal wards and intensive care.

If your in a high risk category they would rather be safe than sorry

Source? I've asked nurses why they constantly wake up patients and they always say it is because they are supposed to get X data ever Y hours. None of them have ever said they purposefully wake a patient to just ask how they're doing.

If they wake you up while they're checking something, obviously they are likely to ask is you need anything. But that is not the topic of the discussion.

Also, its usually phlebotomist, not nurses, who are drawing blood at night.

I did a text analytics project some years back, where we were scanning for signs that a (avoidable) patient injury had happened (such as bedsores, brain damage due to lack of oxygen or glucose, fall injuries for patients that should not walk around on their own, hospital infections, what have you).

All documents in the patient records were analyzed, including the ones filled out during routine checks etc, which included sections for checking for vital signs, mental state, etc.

There are pros and cons to waking a patient just to check for vital signs, but if you do have to wake her/him, basic monitoring should be performed. (whether or not it is recorded)

I don't know how widespread the use of phlebotomists is in my country, or if the occupation exists at all (separately from nurses/medical assistants).

When my wife was in the hospital after the birth of both our two kids (premature so they weren't in the room with her to care for, they were in the NICU).... I chose to go home to sleep as the nurses just came and went endlessly. Someone had to get sleep.

Then my oldest son was in the hospital for a while. He was sick so I wasn't too surprised he was napping all the time until spent a few nights sleeping at the hospital with him and realized he was probabbly napping constantly in the day because the nurses would wake him, and me.... constantly all night.

When we went home we both crashed and napped a bit and then slept all night... i swear he recovered faster after catching up on sleep at home.

There are preliminary results showing that when the NICU dims it's lights during the day and goes even darker at night babies recover faster. 5 weeks faster on average. (That's from "Why We Sleep")

Sleep is the best recovery. If everybody got enough sleep there'd be fewer sick days, too.

Yeah the NICU for my second child had a sort of day night light cycle. It was pretty nice... for parents too ;)

My wife just finished up a 22 hour labor and is desperately trying to get some sleep but the nurses refuse to stop yelling and laughing directly outside of her door.

It’s not even medical. Just rude.

Ask them to stop, perhaps?

Sure, just get out of bed and run them down and ask them to stop...

Use the buzzer button, wait for a nurse to come and express a complaint.

That's why you've got a partner there with you. The partner's job is to keep an eye on whatever the young mother needs and make it happen.

No, the facility’s job is to provide the best possible environment for healing and recovery.

Of course, but sometimes they need someone to tell them what is needed in order to provide that.

Which I’m doing. But we’re unfortunately stuck here and I’m just 1 person against an entire fleet of nurses, who also happen to be the caregivers.

I never said it would be easy, but it's important. Although honestly, unless the nurses want to be intentionally awful at their job, they will listen to you. They may not always be able to obey the letter of your request, but they absolutely should figure out a solution to any problem that's interfering with recovery.

Right, and I never said I wasn't doing it. But since this post was about how hard it was to sleep in hospitals, and I was in a hospital and my wife was struggling to sleep, I figured I'd share my story.

Maybe he felt awkward doing that?

There is also a possibility that their reaction would not favourable. Sure, they may shut up but, afterwards, the relationship between his wife and the carers could become frosty?

Rude people tend not to like their shortcomings being challenged.

The birth of our first child was a very good lesson in assertiveness for me. I learned that as the spouse, you're basically the only one with a full overview of the whole process. In the hospital, shifts change, they're taking care of multiple births simultaneously, and I'm the only one who knows how my wife feels.

That gives you a powerful mandate to do whatever is necessary to take care of your partner. So absolutely to tell them to please go somewhere else because people are trying to sleep here.

Some things I had to do:

* My wife's (artificially induced) contractions were coming so fast that she had no time to recover. I noticed she was crying, which she absolutely never does. I warned the nurses, and they lowered her oxytocin (or whatever it was) and gave her some morphine.

* Later, after enthusiastically encouraging her to push and saying that the baby was coming, for two hours, I asked if the baby was actually coming. They didn't know. "Could you check?" Turns out the baby was stuck and had to be pulled out. I really wonder when they would have noticed this if I hadn't asked.

And this was at a Dutch hospital that's known for their good childbirth and maternity care. I was quite surprised about our experience (though it was a very complicated pregnancy).

The birth of our second child was a breeze. I was all ready to do my job again, but the baby was already born.

s/oxytocin/oxycontin/

No. Oxytocin is used to artificially induce labour.

Yep. We did. And then another group came by equally as loud. And then the shift changed. Equally as loud. I would have to stand outside the door shushing people all night to be effective. And then we’re the annoying patients nobody wants to deal with.

Congratulations!

Talk to the charge nurse to change rooms, escalate to the admin on call if needed. Get the sleep now while you can.

When I was hospitalized they were playing poker the whole night. I get that it's just a job but jeez, keep it down.

Hey, congratulations!

This is a problem that a startup I’m involved with (www.snap40.com) is tangentially aiming to solve. The prime goal isn’t really to help patients sleep better, but to help healthcare professionals monitor them better and be proactively alerted when things are deteriorating. It’s an iPhone sized (but lighter) device that’s worn on the upper arm and once you’re wearing it, you forget about it. Instead of reading vital signs the patient can sleep, and we’ve caught instances where patients were in trouble before the normal rounds would have. Also applicable for home use as patients can be sent home earlier or safely monitored. It is up for approval by the FDA so it is a regulated medical device, and in most cases it does better than the gold standard ICU machines. Better sleep, more safety, and a faster return to home are just some of the benefits, and I’m really optimistic they can make a huge difference for healthcare.

>The prime goal isn’t really to help patients sleep better ...

so really, this is just a same-industry product plug.

I think you read the comment disingenuously. It is pretty clearly implying "...but it will have that effect because it neutralises the problem that the article is all about".

I realise this is slightly off for this thread but I'm really interested in this topic. A cursory glance at your website (You're in Edinburgh, Hi!) doesn't mention anything about how you use/keep the data.

I'm also curious how staff would interact with the data. Your website shows lots of iPhones, but I'm assuming Doctors/nursers/clinical staff aren't accessing patient data through their own iPhones?

This is really cool though!

> As Frakt says, solutions aren’t hard to fathom. In fact, they’re trivially easy to figure out.

Lots of things are "easy to figure out", and also "really hard to implement correctly".

Managing the care of a lot of different people with different conditions over long periods of time is complex and error-prone. You can't stand around all day in a hospital trying to figure out if you missed an edge case in a patient's customized care plan. Not only are you tremendously busy, but making a mistake in that customized plan could mean life or death. Routine is much safer and more reliable.

It's not impossible to improve patient care, but it is tremendously more difficult than a layman can observe just by sitting in a hospital bed.

Absoutely! My mum used to work as a Senior Nurse and there were numerous "simple things" that could save time and money but there were various reasons why they didn't happen:

* You don't have the authority to change it * The person who does have authority is too far removed to care * There is simply too much work to do to think about leaving the patients alone * There are frustrating restrictions on e.g. approved suppliers so that you can't simply change something that would seem to make sense * Although things like beeping IV machines are annoying, they also prove they are running correctly - no sound might mean nothing or it might mean broken!

There are low-hanging fruit.

My own anecdote... A few years ago, I spent the night in a cardiac ICU due to an arrhythmia. I also have a VERY low resting heart rate (<35bpm when sleeping). The alarm on the EKG is set at 35bpm. The alarm can ring in the room, the nurses station, or both. For an overnight stay, why on earth would they leave the room alarm on? After a long night of being awakened seconds after dozing off, the morning shift nurse stopped by and asked "why on earth wouldn't they switch off this silly alarm?" and walked back to her station to do just that.

Edit - the nurses on the overnight shift asked about my resting HR once, then ignored the alarm the rest of the night.

Anyone who claims making changes in healthcare is "trivial" doesn't know what they are talking about. Period.

The political forces that oppose change in an industry that is incredibly rigid and risk averse (for obvious, albeit frustrating, reasons - "move slow break nothing" is the rule when the risk of failure is death) are the actual challenge. The technicals are the easy part.

The article quotes a doctor speaking about nursing care. This is as accurate as asking an automotive engineer about automobile repair. Same field, different skill sets.

Nurses are trained to identify trends across many (sometimes too many) patients. Sure its inconvenient if a nurse monitors your blood pressure or oxygen levels every 2 hours after surgery, especially when you are sleeping, and especially if you recover perfectly.

But if you have a post-op internal bleed that occurs during the night, when you are asleep and unable to let someone know you are feeling woozy (because you are asleep), that's when trouble occurs. Frequent observations mean nurses can identify when things are going south before you get to an emergency situation.

Blood pressure drops sharply over 2 hours, monitor every 15 minutes, see if it stabilises. If it doesn't raise the alarm quickly.

Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids - silence on a night ward is a sign something is wrong, and quickly precedes an emergency alarm.

> Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids - silence on a night ward is a sign something is wrong, and quickly precedes an emergency alarm.

Sure, if there is one source of beeps, then no beeps would be conspicuous, but when there are many things all beeping, having one of them stop beeping may not be so obvious at all.

A simple technological solution seems appropriate here. Have each machine that needs to work check in every couple seconds with each of two centralized monitoring machines. Have each monitoring machine alert the nurse desk if a monitored machine stops checking in. This is silent and has no single point of failure.

The nurse desk is a SPoF. If something goes wrong with that area, then how can you tell each monitoring machine is working?

Failover to beeps?

The nurse desk is a desk. If the desk literally fails, you have serious issues, and your average multiple person desk is well enough engineered that there isn’t a single piece that can fail and take out the entire desk. But there are generally multiple nurses at the nurse desk, and there are often multiple desks, too. Also, you could hook the monitoring system up to the PA system.

edit: when I say hooking it to the PA system, I mean that, if no one acknowledges the light or computer message or whatever, then an announcement could play after a set delay.

Network failure in the desk room sounds like a complete outage for that.

How do you know if each machine is reporting in a consistent manner without being there 24/7 and making sure they beep all the time vs %40 of the time?

To me the beeping also seemed like a quality backwards solution where much better, seemingly obvious solutions exist. Reality is probably much more complicated though. In a solution like you described and I had in my head we'd need a agreed upon protocol between IV drip and monitoring device. Probably the same standard should be used by other, similar devices. If that doesn't happen we get vendor lock in. In addition we are taking about medical devices so everything has to be fool proof, audited, double checked and certified. So what might be cheap in a consumer device now probably made the IV drip an order of magnitude more expensive. That is, if we agreed on a protocol in the first place.

I’m sure you’re right, but being unable to sleep when you need to heal is bad. "It’s complicated" is not a get-out-of-jail-free card.

May I weigh in with an outside perspective? My impression is this is a cultural issue, i.e. Americans are very insensitive to noisy disturbances during sleep hours. Biggest examples for me are your freight trains. Deadly accidents? Sure, the only solution is to disturb sveryone in a 5 mile radius around each crossing. In my home country this is unthinkable. People get chewed up, sometimes called the police on, for even running the washing machine past 10pm.

I'll never forget the night I was visited by police in northern Norway because we committed the crime of ... haymaking at 11 pm.

I don't get this? What is haymaking?

sex

No, no. Literal haymaking. Cutting grass for hay.

I'm surprised you managed to fit the combine harvester in the bedroom

Do you know what parts of the world is hay used as a slang for sex?

I don't know the reach, but many agricultural activities can be a euphemism if you put a significant pause in front of them. "Where are alice and bob? Oh they're out... (gathering fruit|sowing barley|haymaking|looking for lost sheep|etc)"

To be fair - its a very suspicious time to be haymaking. Threshing maybe yes - but haymaking... A word of advice: Don’t burn the candle in both ends - you need your strenght to work on the jarls estate (unless you are on a tenth or headtax plan of course).

Ironically, in the US we have a saying: "Make hay while the sun shines."

This was in northern Norway, in June. The sun was defininetly shining, even though it was at 11 pm ;)

You must be from Switzerland... :-)

bingo ;)

Don't many Swiss buildings have shared washing machines in the basement?

Since someone already guessed that you live in Switzerland, may I also ask if you are in an apartment building with neighbors above/under/around you? We have similar neighborly complaints in Austria where (at least in cities) almost everyone lives in apartment buildings and thus when someone runs the washing machine, you not only hear it, you also feel it. In the USA, I think most people in cities are living in individual houses and therefore things like running a washing machine at 10pm would probably not even be audible by any neighbors.

We do, and yes, it's the most common form of housing, including upper scale units.

> In a solution like you described and I had in my head we'd need a agreed upon protocol between IV drip and monitoring device. Probably the same standard should be used by other, similar devices. If that doesn't happen we get vendor lock in.

And a vendor lock-in is the goal of the vendor, both in medical and consumer space! Which is why such protocols rarely happen in either.

The medical space has a surprising number of widely used protocols. If you’ve ever gotten a CD with the raw data from some scan, it probably had a crappy proprietary viewer and the raw data. The raw data is almost invariably DICOM, and there are plenty of open-source viewers.

I suspect there are strong economic factors here. When a hospital buys a $2M imaging machine, the vendor is making money on the machine, not on ads, and that $2M machine had better interoperate with the HIPAA-compliant image archiving and distribution system the hospital already has from some other vendor.

> The medical space has a surprising number of widely used protocols.

There are also a wide range of interpretations of a single protocol. See the horror of HL7.

In terms of DICOM viewers, I’ll be the one who mentions Horos. If it doesn’t do what you want with a DICOM or have a plug-in that does, you are doing something quite unusual. Before the psych department come at me - I work in radiology. Functional imaging is best served with other tools, and I don’t understand them.

Can we not repurpose CAN for medical purposes?

Technically yes but seriously just don't. CAN is a horror show for security that can't handle a radio without being a security liability and medical privacy violations are expensive let alone wrongful deaths.

absence of signal is not a good indicator of operation. it is the same signal as total failure of your system.

Interestingly that reflects Airbus vs Boeing cockpit philosophies.

In the early 1980s Airbus adopted Dark Cockpit where the default state of all annunciator lights is off. If one illuminates then it indicates something worthy of attention. The colour of illumination indicates functional state; blue is good, amber is malfunctional.

When would something illuminated blue? When it's both working smoothly and worthy of attention?

I assume that's for indicators of abnormal, but safe, state. One example could be the undercarriage being down, a situation that would usually not be expected, but when you're in the process of landing doesn't warrant attracting your attention as an error state.

According to [1] for the wing anti-ice system, Blue = Turned on, Unlit = Turned off, Amber = Malfunction

Of course, one might very well argue that 'turned on' is not 'worthy of attention'

[1] http://www.smartcockpit.com/docs/A330-A340_Overhead_Pushbutt...

Central monitors are quite common. There are even entire units based on it (telemetry).

Seems like it’s backward to me. The machine should be silent if everything is ok and start beeping if things are going wrong.

but what if the alarm isn't working when something is wrong?

so same as train brakes in a way

Trains slow down and use the engine at a slower pace. You don't have a back up heart.

their braking system is passive, no energy means error means brakes engaged; unlike, say, cars where no energy means .. nothing and any accident can occur.

How are cars relevant? I was specifically pointing out trains.

How would you tell the difference between a machine that's working and a machine that's been switched off?

Make it play a quiet calming music to the patients taste

This makes me think about data backups. It might make sense to only get a notification if a backup failed, but then how do you know the backup system is actually functioning at all?

Regularly restoring from backup?

You can't regularly restore a patient from death unfortunately

That was my first thought too.

However, the downside of that solution is that the failure signal relies on correctness of the machine. In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.

Monitoring over the network exists, and should be the preferred way to detect failure.

> In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.

I can easily imagine software bugs that make the machine continue beeping even if the normal function doesn't work anymore.

Somehow, this sounds like an excuse for lazy design.

It sounds like an excuse for not networking at all really. Or upgrading equipment. Just a primitive cables to a data station on a cart outside the room would handle it better on every level than trying to figure out which thing isn't beeping when it should. Have it beep if it loses a signal. Better yet it can handle triaging far better when networked. Signal lost and "patient definetly not breathing" are two very different triage levels for one. You want to restore signal as soon as able but it isn't a mobilize a crash team to resuscitate situation. Nearly everything else has abandoned beeps as the sole indicator with good reason.

I understand where you coming from. However, would the patient know if machine is functioning correctly if it is silent? What happens if it's not plugged in correctly?

I disagree. If the monitor crashes, then its failure state is the same as "everything ok" state.

> Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids

This article is a terrible treatment of the issue. The NYT article [1] or actual research papers are far better.

To try and sum up the actual issue that's being discussed: it's a tragedy of the commons situation, where the commons is a patient's sleep.

Every device and procedure priorities derisking above ALL else. In aggregate, this results in a huge negative impact on sleep.

The suggested change in behavior is to simply prioritize quality sleep somewhere about "irrelevant."

From the original research, a few points (from memory):

- Outcomes for non-critical patients are not substantially improved by the "every 2(?) hour vital check" regime. It's followed mostly because of legacy medical inertia

- There is little effort to batch interactions

- A substantial amount of sleep-disrupting noise is a modern hospital is non-functional

From personal experience at a good cancer research hospital in a major city, one omnipresent alarm was a low battery warning... for a device that was plugged into mains power. No one knew how to turn it off or fix it.

[1] https://www.nytimes.com/2018/12/03/upshot/why-hospitals-shou...

> There is little effort to batch interactions

The nurses are highly incentivized to batch interactions, just like waitstaff. What you don't see is that if the nurse has is working on the batch for patient A, and patient B crashes, then the nurse is too tied down to respond and calls in a colleague, who shows up to crashing patient B and tries to get up to speed.

Can't speak for all arrangments, but with my mother's post-surgical care, it was typically different draws for different purposes.

E.g. This or that specialist wanted to run a test, so they sent someone or had a floor nurse draw. But none of this seemed to be sync'd to the regular interaction schedule.

  > Same with audio on machines, that constant beep is annoying to you,
  > but it means the machines are operating and you are getting your
  > prescribed fluids - silence on a night ward is a sign something is
  > wrong, and quickly precedes an emergency alarm.

Sure, but that stuff should be monitored from the nurses' station, not by patients who are trying to get some sleep.

Some of this stems from simple things. For example, most doctors are never trained in what nurses do, or what the implications of their orders may be. If a doctor waits til the end of a shift (when it is convenient) to write out a bunch of prescriptions and there is a frequency of dosage, then the start time is dictated by the time of the prescription, unless the doctor puts a specific time on it. This means that patients will be woken up at an inopportune time for the dose (end of a shift change), and usually a time when people would be asleep.

I learned about this by watching a video put out by a hospitalist who was showing the results of requiring new doctors to be paired up with nurses for a week or two to see how hospitals actually worked. The new doctors were very surprised that their mental model of things just wasn't grounded in reality.

This all stems from institution centric care rather than patient centric care.

I spent a night in hospital this year - My first ever hospital visit in 52 years on this planet!

I do agree with the OP. The thing that mystified me was that I was told I had to rest while under observation (for a non _too_ serious condition), but my night there was anything but restful.

I get that the nurses had to come around every 4 hours to change my antibiotic and saline IV drip, and to give me painkillers - but outside of that the constant beeping and general noise and chatter of the medical staff was incessant. IV drip controllers were left in 'alarm' state for 15 minutes at a time so I could hear constant loud beeps that are purely intended to get attention.

To top it off, the night staff forgot to turn off the main lights in the ward, and it wasn't until 4am that I heard someone say "Oops, we forgot to turn off the lights!" and they did so, making the ward finally dark enough to sleep.

Generally, the care I received was great, but I was mystified at how hard it was to actually get some basic sleep, which I consider vital for recovery, under those conditions.

Did you try earplugs and an earmask? They work wonders on (especially) daytime flights for me.

Being a hospital noob, I didn't even think of those (plus I was admitted via ER fairly suddenly and unexpectedly).

Next time I know I have to stay in hospital overnight I will (or get my wife to) pack those in my overnight kit.

My hospital has earplugs that you can just request. Not sure about sleeping masks - didn't ever see anyone with one, so I assume they don't have those to give out.

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?

In my experience, I don't spend more than a few days in the hospital, and when I do spend my time there, my whole life is turned upside down regardless of how much sleep I'm getting.

I am in a similar position, and the ... outright condescension is unbelievable.

The worst doctor is unbelievably educated in the US. They have had to go through a very difficult pre-med undergrad, a competitive process to get accepted to medical school (which is really tough), survive a residency, and then have continuing education requirements.

And then a bunch of assholes here are like, "don't they know that patients have to sleep???"

Of course the f--king know that. I bet that same worst doctor knows more about sleep than 90% of the internet experts on this thread.

I mean, do people heard even realize that you're not supposed to be in the hospital? It's the hospital. It's for emergent medical care, and you should leave as soon as possible. Sleep is the least of your problems, vs say, MRSA.

I'm very junior and UK based so I can only speak on my experience...

No, there is no lack of understanding about the importance of promoting sleep. To suggest that somehow medical professionals haven't got round to working out that there are benefits to having a good sleep is, to be frank, completely ridiculous and quite insulting.

A very specific example would be the importance of sleep in relation to delirium in elderly patients. This is taken very seriously.

In a wider sense, hospital staff will try to establish a reasonable environment for sleep. There is a need to be realistic though, and accept that (for many many reason not readily apparent to the lay person) it just isn't always possible to remove all the factors that disturb sleep.

Most patients on a ward are in multi patient bays. If a patient is unwell medical staff will probably have to; talk out loud, turn on a light, move some kit around, walk in/out of the bay... and so on. This would certainly wake me up. There's just very little can be done about it. Clinical need top trumps comfort.

There will of course be room for improvement, and some staff will be forgetful of the need to be mindful of quiet hours (it's very easy to forget it's 'night time' when your brain is in 'at work' mode).

So, a more balanced summary would be: "Medical professionals try to promote a good sleeping environment, but the very nature of a hospital makes this a challenge. However, there is always room for improvement and many local issues can be solved via improved patient-staff communication". Doesn't make for such a clickbaity whinge blog though when you phrase it this way.

>Clinical need top trumps comfort.

I think this is where the disconnect is. As a best faith interpretation, I don't believe you made the statement in a condescending manner -- I think it just flowed naturally.

The comment I quoted seems to imply waking a patient is akin to disrupting the comfort of the patient. I read the arguments being made in this thread and in the article as: waking the patient and/or disturbing sleep of a patient causes detrimental effects on the patient's health which lie outside the realm of just comfort.

Multi-patient bays seem to act as an architectural reinforcement that sleep is a comfort.

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.

I don't know how you can legitimately think this question is even worth asking? What do you think hospital staff do all day, deliberately try to ignore the obvious and torture the patient as much as possible?

Patients need sleep, but a week of sleep deprivation isn't likely to kill you or leave permanent effects.

Something emergent can develop while you're unaware of it in your sleep.

Left toes are tingling? You're probably not going to notice that in your sleep. However, that could be a sign of poor circulation and potentially serious complications if not further examined and addressed.

I can imagine how that is for the specifics, but what is the response from the medical community on sleep? We know it's damaging to be sleep deprived and that hurts patients and medical staff. We also know that being sleep deprived craters ability to do _any_ job after far less than the 18-24 hour shifts that medical staff are routinely working.

Why is this ok is medicine and not any other type of human endeavor?

You are conflating two separate issues. Sleep deprivation in doctors is an entirely different question to that of patients sleeping while admitted into hospital.

>what is the response from the medical community on sleep?

I can't answer such a general question.

>Why is this ok is medicine and not any other type of human endeavor?

It would be impossible to cover this without hitting a significant word count. It's also depends on the country. In the UK at least it's certainly a political hot potato.

Would you mind explaining then? We'll never learn if its never said

Totally, totally agree. The threads on healthcare are the second lowest quality content on HN (after cryptocurrency). Maybe this is because HN readers are pissed off by the healthcare system. Guess what, so are the people that work there.

Eg. Sleep in hospitals. Everybody including the patient, nurses, doctors and the janitor knows it is hard to sleep in hospital. I'm regularly told by the patient, the patient's family, the nurses, the music therapist etc that the patient can't sleep. Believe or not, my response is not 'Well I didn't get much sleep last night either' or other such nonsense. The team tries to do what they can, eg stopping IV fluids overnight, or reducing unnecessary observations, or giving a sleeping pill, or moving disruptive patients into their own room, or best of all just trying to get the patient out of hospital as soon as possible. But that doesn't make much of a news piece, people just trying to do what they can for the patient.

Instead one problem with inpatient care is singled out in a way that is designed to foment outrage, and everyone piles on with their individual poor-sleep-in-hospital experience.

I can attest to this issue first hand. In 1995 I was diagnosed with cancer and had to undergo major surgery, recovery from that in ICU, then several rounds of chemotherapy over the next nine months. While I was in the hospital for a week of chemo, I got maybe two or three hours of sleep per night with a half hour nap off and on throughout the day, and this was on sedatives and painkillers. I can only imagine how much better my recovery would have gone if I'd been allowed to sleep all night during my stays and didn't need sedatives to balance the constant interruptions.

I'm certainly not a medical expert nor a sleep expert, but I'd wager if nurses and doctors would let their patients have a full night of rest without interruption, they would see much faster recovery times.

I’ve been hospitalised 7 times. In New Zealand, Australia, Thailand, and Singapore.

Aside from the first day/night after surgery, I’ve never felt like Hospitals are against slept?!?

My Wife had a c-section in October. Again, other than first day/night after surgery, never felt like we were interrupted all the time.

Is this article about America or something?

Agree. I’ve been overnight hospitalised in Estonia, Sweden and the UK- and I feel like every measure is taken to avoid disturbing sleep.

Even heart rate monitor alarms are turned off/down locally;

I spent two nights in hospital in the UK after surgery for a broken arm. They were pretty good about not interrupting my sleep.... except for putting me in a ward with a bunch of sick people who were coughing and wheezing and groaning all the time.

It very much depends on what's wrong with you. I've been hospitalised multiple times. Most of the times were fine, but once was neurosurgery, and I'd be woken up at regular intervals throughout the night to answer "What's your name? Where are you? What year is it? How many fingers am I holding up?" At some point there must be a crossover between the risk of an undetected problem vs the risk inherent in lack of sleep.

Not to mention "PAGING RESPOND MET CALL CODE BLUE"[0] followed by a crash cart tearing off down the hallway at 4am, and of course once you've been in the hospital for a few days you know that "MET call" means someone is probably dying and "code blue" means it's from cardiopulmonary arrest, which doesn't really help soothe you back to sleep.

[0] the jargon is probably wrong

Or they wake you up to move your bed from the high risk side of the ward as they have an emergency admission - and overhear the nurses say "might die"

Anecdotal data point: I have been hospitalised a number of times in Europe (German, Austria) and this article really resonated with me. Every time I returned home, I was relieved to be able to get back to a regular sleep schedule and it really befuddled me during my stays that I never seemed well rested, as if this was somehow the hospital administrators task to ensure that I didn't just use my hospital visit as a pseudo-vacation.

I think the issue summarised the first line the author writes: "I’ve been hospitalized once in my life."

Same in Austria, we have "quiet hours" to allow patients to sleep without any interruptions.

> Is this article about America or something?

That was my reaction too. My wife was in and out of hospital for two years in Drammen, Norway (2015 to 2017), and I never got the impression that her sleep was interrupted. I spent quite a lot of time with her in the hospital and the staff were quiet, courteous, helpful, and kind. They weren't always as available as one might wish but that was fairly rare.

I just showed this to my mother, a nurse. She laughed and said “it’s pretty stupid, but they would rather fix it with a pill if that’s an option”.

Can you please elaborate on "it's stupid...?"

I think the parent refer to its own solution as stupid "it is stupid that they would use a pill if possible"

Yeah, that’s what she meant

Not only are they "designed to allow patients as little sleep as possible", but also doctors too. Residents and doctors frequently have take on 30-36 hour shifts.. How they could effectively treat patients with this level sleep deprivation is beyond me.

Maybe hospitals just have a vendetta on sleep in general?

Nah, overworked and understaffed because (in the US's for-profit hospitals) more staff == reduced margin.

It's because doctor handovers are surprisingly dangerous.

That's an interesting angle, and I'm sure you're right. I'd like to read more. Do you have a source for that?

[0] says: > Handover is clearly a time when errors or omissions in key information can have critical consequences. Statistics from the National Confidential Enquiry into Patient Outcome and Death showed that in 13.5 per cent of cases where patients died within four days of admission, poor communication − between and within clinical teams − was an important issue contributing to the adverse outcomes.

Might be a starting point at least.

[0] https://www.hsj.co.uk/technology-and-innovation/taking-the-r...

This is the usual answer but countries closer to the European Working Time Directive have better outcomes.

Well yeah, a handover after thirty hours at work would be incredibly dangerous.

That doesn't mean you should extend the shifts, quite the opposite. How can we get real data on work quality from well-rested doctors when the comparison is between thirty and thirty-four hour shifts?

Four shifts a day of 8 hours schedule will solve that. 2 hours is a very long overlap to hand over.

I asked my doctor relative about this once and IIRC they basically said because hospitals are not hotels - if you're inpatient in America you're pretty sick and more than likely need periodic monitoring for your condition. As soon as you're well enough to be sleeping for long periods of time without observation you'll get bounced.

The article's premise was that you can maintain the current quality of monitoring while increasing sleep quality with simple changes, and that increasing sleep quality will improve the patient's recovery.

You can be a patient and be so sick of the noise that you decide you want to opt out of the monitoring - or you DIY anyway, as most hospital do not take requests kindly.

I was once in ICU. The cardiac monitor was beeping loudly whenever I was starting to sleep.

After the first few time woke me up in pain, I bent over and pushed the button to power off the cardiac monitor. Problem solved! I fully admitted all the risks - but there comes a time when too much is just too much.

I then had a great night of sleep :-)

Did you check to see if the cardiac monitor was set up to prevent you sleeping?

I didn't care. I wanted to sleep. And I did.

I did that with my IV machine the one time I was in the hospital. It would start incessantly beeping when the fluids needed changing, so I learned how to silence the alarm (by watching the nurses do it the first time). When the alarm went off, I'd call the nurse and then silence the machine.

When it went off at 3am I did that and by the time the nurse came by I was already asleep. She saw what I did and got angry at me. Re-awakened me responded badly to that and words were exchanged. She didn't bother me for the rest of the night at least (and we made up in the morning, when I was awake enough to be rational).

For the birth of my second child, I learned to manage hospital staff so that they would leave my wife and newborn alone unless there was an emergency. I proactively scheduled scans, vital checks for the next morning so that the patients could rest.

The experience was so much better than what my wife and first child had. I do not understand why hospitals cannot do this kind of considerate scheduling by default.

Can you elaborate on how you worked with the hospital staff to make this "considerate scheduling" possible?

My initial feeling would be that the staff will do their jobs when it convenient for them to do it, regardless of when you would prefer them to do it. How did you manage to convince them to modify their scheduling?

Probably by asking, or skipping tests/interventions. Ultimately everything is patient’s choice.

It may work okay (administering one patient’s daily meds last amongst the caseload of patients).

Other times, by deferring the 6AM blood draw to 10AM could mean your providers don’t have a fresh picture of the patient’s condition during morning rounds.

I just asked! The head nurse on the floor knew that unless there was an emergency, we would like to rest between 9PM and 7AM. We would have preferred 8AM, but it was a teaching hospital and they needed to get rounds underway early in the morning.

Talk to the nurses. They control everything on the floor, the doctors are just passing through.

Not OP, but the same way you get anything 'management' done - get to know people, make them like you, understand procedures and incentives of everything and everybody involved, trust but verify, always be proactive and ahead of everything and everybody.

If nothing else works, make it more convenient for them to work with the patient than against the patient: annoy the hell out of them if they don't.

Good job. I was surprised how much I as a husband had to take charge on because the hospital had no idea what was really going on. You need to ask stuff from the nurses if your wife needs anything.

If you'd write a blog post and talk about all the tests you managed to have done right, I would be ever so grateful.

Thank you for even mentioning this is possible.

OMG, so glad to hear somebody else saying this. The last time I was hospitalized, the recovery was a complete nightmare for exactly this reason. If there wasn't somebody coming by to poke or prod me, there was somebody coming by to do something to the other patient in the room, or if it wasn't that, the door was open and the click-clack of heels on the tile floor kept me awake, or there was too much light coming in from the hallway, not to mention how uncomfortable those beds are, etc., etc. Sleep was damn near impossible.

It was so bad that the first day I came home, I went to bed, fell asleep and had a dream that somebody came into my room and woke me up and said "I need to draw some blood". I've never been more relieved in my life to wake up and realize "fuck, that was just a dream".

"If there wasn't somebody coming by to poke or prod me, there was somebody coming by to do something to the other patient in the room, or if it wasn't that, the door was open and the click-clack of heels on the tile floor kept me awake, or there was too much light coming in from the hallway, not to mention how uncomfortable those beds are, etc., etc. Sleep was damn near impossible."

surely you realize there's more to hospital than just you?

surely you realize there's more to hospital than just you?

Of course I do. What does that have to do with anything?

As the article says, there are simple changes they could make that would maintain the same quality of care, while still allowing patients to get more sleep. Considering how important sleep is to our health, not doing those things is borderline malpractice, IMO.

I'm lucky enough never to have been in hospital myself, but FWIW:

I was recently on the jury in a coroner's inquest. A patient had died suddenly in his sleep in hospital. The solicitor whose agenda was to make the hospital look bad aimed to suggest that nurses should have been entering his room every 15 minutes to check his breathing, but all medical staff witnesses argued that sleep is too important to disrupt by entering the room during the night, unless absolutely necessary. They used a torch to shine on the patients chest through the window to check for breathing, and specified that they tried not to shine on them directly (watching a shadow on the wall is preferable).

I know a torch is a flashlight but it amuses me to think of a nurse wielding a flaming torch walking down the hallway, peering into rooms.

It's been awhile since I was in a hospital overnight but checking in on a (presumably) stable patient every 15 minutes is madness. You hear all sorts of crazy things during jury duty--I love it.

Of course not a normal patient, but I would imagine that it would not be unreasonable to be checking an ICU patient's vitals every 15 minutes. It's called "intensive care" for a reason.

For having spent a long time in hospital (France), I can tell that the beeps of the machines are completely useless. It is maybe very ok for someone spending 2 or 3 days in the hospital, but for people spending 3 to 6 or even more months in hospital (this was the case here), it is completely terrible and the sleep deprivation goes against any good care practice. Situation is the following: - First you have beeps every few seconds in a floor with 20 or 30 rooms. The beeps, after a few days working in the hospital, is just a common noise for nurses and doctors. The human brain is wired to ignore repetitive noise in your environment. Basically no one cares about the beeps after a few weeks in the hospital, and the beeps turn into routine noise. They should be exceptional to be an alarm. Constant alarm is not an alarm anymore. - Then there is no way to tell if the beeps are serious (dysfunction or else) or irrelevant. For example infusion pumps beep 2/3 minutes before ending as pre-alarm, then beeps when ending the infusion, and keep beeping until a nurse stops it. If you are in a room with 5 infusion pumps delivering medicines and one heart rate monitor with high and low alarms, you are guaranteed to get beeps in the room almost constantly, which kills the whole point for the beeps in the first place. They become useless. It is even counter productive. Not mentioning beeps of low-battery for infusion pumps or other devices which are plug into A/C. Very often the beeps cannot be de-activated, so the medical device vendor is safe for a legal point of view. - children spending 3 or 6 months in hospital are seriously impacted by the 6 to 9 wake-ups during the night. Every kid with a leukemia or other form of cancer spends 3 to 6 months in hospital at least. This is a lot of kids (about 15 000 per year in the US). Nothing is done to help those kids sleep better during those months in hospital. they have a double burden: cancer and sleep deprivation. It is obvious patients should be monitored, but today we must admit sleep is the least of worry for all caregivers and medical devices vendors. It is possible today to design sleep-friendly monitoring devices. Machines states can be displayed on a central deck, nurses and doctors can have a smartphone or smartwatch with alarms connected to the machines, machines could only beeps when a care giver is in the room thanks to NFC, blinking lights in the corridor could be used as well.Stupid questions that are in the patient file should be answered in front of the computer, not at 2 a.m. during the night. In any case too much noise is bad for the patients and kills the whole point of an alarm.

Reminds me of the 'too many road signs' problem:

https://www.safetysign.com/blog/too-many-traffic-signs/

It's hard to get staff working within a bureacracy to acknowledge this sort of thing, however. Only bureacratic procedures are real. Attempts to reform merely add to the bureacracy.

I basically lived in a hospital room for the past week, though I’m not sick. The machine that pumps and monitors your iv fluids constantly emits screaming alarm tones. An alarm can be triggered if you bend your arm the wrong way, obstructing the iv. But most often the alarm is triggered because of air in the line. You can silence the alarm. But if a patient is not accompanied by someone, they will probably have to sit there with the alarm going off for 10 to 20 minutes at a time before the nurse finally arrives and deactivates it. That happened to us once and I never left again after that.

And it’s true — nurses barge into the room quite unceremoniously, wake you up, and perform tests on you in the middle of the night. It’s very annoying and leaves everyone except the nurses very hagard in the morning.

>It’s very annoying and leaves everyone except the nurses very hagard in the morning.

Nurses work hard. Believe me, they are haggard in the morning.

The point is that they go home and get uninterrupted sleep.

Since bootstrapping my own sleep aid startup (https://trycosmo.com/), I've been surprised at the lack of priority society places on sleep in general. Better sleep would help patients recover better and shorten hospital stays. The inability to sleep, especially in the ICU, likely results in tens of thousands of unnecessary secondary infections and deaths per year.

I like the author's approach of simply refusing to give blood at night. My guess is that hospitals default to checking vitals so frequently to avoid liability-- could you imagine the headline if a patient died because his vitals had not been checked for eight hours?

A simple "Do not disturb" sign for patients would resolve all of these issues.

> 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?

I highly recommend the 2017 book "Why We Sleep" [1]. Written by a doctor, starting at page 335 he calls exactly for ensuring hospital patients can sleep, why this is so critical for recovery, and how many things in hospitals currently work against this. (The book covers so much ground, including other reforms like school time starts, why society doesn't value sleep because sleep-deprived people don't perceive their substandard performance, and so on.)

[1] https://www.amazon.com/Why-We-Sleep-Unlocking-Dreams/dp/1501...

Consider what hospitals optimize for (at least in the US). Not what they say but what they do...

For example, putting lots of money into fancy buildings. Fancy buildings attract patients for non-emergency things. That money doesn't go into things like enough nurses and techs to care for the people, especially at night.

Or, consider someone with a lump finding out it's cancer and getting setup with everything to get it treated. It's numerous visits to numerous places (some in Hospitals). This is not optimized for patient care.

If hospitals prioritized and optimized for patient care they would look a lot different.

Danish company AudioCura is offering an auditory logging device [0] designed specifically to identify disturbances preventing sleep and rest in hospitals.

[0] http://www.audiocura.com/portfolio/sou/

My experience (caring for someone in a private room):

Nurse head: "Any complaints?"

Me: "We kept getting disturbed."

Nurse head: "yeah, we hear that a lot."

Repeated 3x over the course of 3 days!!!

I once spent two weeks in hospital with a smashed vertebra waiting for operation. I'm sure many of the individuals involved are trying their best, but it definitely feels more like a place for dying than a place for healing.

During my daughters first year of life we had multiple hospital stays at multiple hospitals for surgeries. What we found was that your experience can vary a lot depending on the hospital.

Our worst experience was at a hospital that was #1 in the nation for its specialty. The staffing leaned heavily on STNAs, and they had a lot of patients to look after. Their nurses were similarly rushed. Once in the step down unit we were placed in a pod with three other families. Of course not all of them were respectful of recovery, with one of them staying up late into the night having boisterous conversations. We ended up advocating for leaving the hospital sooner than they were originally planning. We also found ways to get them to line up vitals and medicine a little better. All of this took significant advocating and considerable effort.

Our best experience was a complete flip. This was at a top 5 hospital in the nation for pediatric care. Nursing staff seemed top of their class. They took their jobs seriously, seemed to be extremely knowledgeable, and were attentive to both my daughter as well as the family. Similarly the doctors seemed to respect the nurses a bit more as they were the ones in closer contact with the patients and more capable of identifying things. We were often assigned a night nurse that only had a couple families to attend to, sometimes we were the only one. I don’t remember ever seeing an STNA. They probably existed, but our care was overwhelmingly done through nurses. The step down unit was like a mini hotel, we had our own private room with a cot and pull out bed, private bathroom with shower, etc. The nurses seemed to actually give thought to their schedule and when to do vitals and meds. They also leaned on technology a bit more and had remote o2 and heart rate sensors, so they didn’t need to take as many vitals.

The facilities made a bit of a difference in our experiences, but above all the nursing staff had the biggest impact. Highly skilled nurses that aren’t over staffed seemed to be key.

Of course YMMV.

Having spent two spells recently in hospital after surgery, it didn’t bother me in the slightest being woken for 30s every few hours. Usually it coincided with me being brought painkillers, water and snacks. All of which were welcome.

There was also no issue regarding beeps in the post operative care unit that I remember. I was also given my personal belongings, as soon as I was able to structure a coherent sentence, which included headphones.

Similarly to other commenters, I should point out you might not be so quick to use technology to solve this problem. Implementing technology into an area where lives are at risk (ICU) takes a long time - with good reason. I saw a comment talking about a centralised monitoring desk. Good luck finding a ward where you are always staffed enough to have someone watching that. There is a good reason sounds have remained as the primary monitoring cue for so many years.

A million times this. Fortunately my only adult experiences overnight in a hospital were for the births of my children, but I was amazed in exactly the same way as the author here at how the place seemed designed to not let you sleep for more than 90 consecutive minutes. Even for non-medical stuff, there was laundry, meal prep, delivery, and cleanup, and cleaning, and then add regular checkins and tests and such to that, and it was just constant. (And of course with a newborn it's not like you're getting uninterrupted sleep at night even when they do leave you alone, so you're trying to catch up in the daytime, which is even more impossible.)

I really like posts/articles like this that point out problems that need to be addressed, but they always seem to miss a reasonable call to action. In this case it mentions what the author did (refuse to let her sleep be interrupted and make a verbal agreement with those tending.)

But if that doesn't work? For instance, what do I do about the new nurse that doesn't want to upset the dr and insists on doing the 4am blood draw?

With hard facts about WHY the nurse doesn't need that 4am draw I could formulate an argument to convince the nurse to let me sleep instead. But outright refusing to let the nurse do their duties just feels... obnoxious.

When I was at the Stanford cardiac unit last, they let me sleep. That wasn't the problem but they had a problem giving me privacy: door wide open, curtain wide open.

I was also at Stanford hospital earlier this year, for a few weeks over two different stays. I don't know which is the cardiac unit, but I remember being in units D1, D3, F3, and G2. Some times I was closer to the door; some times closer to the window. In both cases, I had times when I would need to specifically ask a nurse (or nurse assistant) to close the door (or the curtain), but I don't ever remember having pushback on my request.

Patients with privacy are patients who end up dying. Hospital floor plans are designed to ensure that nurses can see if patients take a turn for the worse.

Doubly true in a neurorehabilitation facility given sleep is critical to brain repair. Stayed in with someone in that situation before and was blown away by the frequent interruptions of sleep of the patients by staff checking stuff that could have been done without waking the patent.

I've always slept very well in hospitals.

Source: home, Brussels Belgium

Me too. Source: Berlin, Germany.

If you don't have any super critical stuff or you call the nurses because of pain, they'll leave you alone from 9/10pm to 6/7am

But is that because there are just nog enough nurses to do the checking that would be medically beneficial, or because of deliberate choices/scheduling? (am Belgian, not always impressed with quality of healthcare)

This article calls to mind the Voltaire quote "The art of medicine consists in amusing the patient while nature cures the disease." If you ascribe to this idea then the argument of the article takes on even greater force.

This article brought back memories. When I was 9 something went through my eye. One night after surgery, the nurse came to check on my IV. She broke it. Her next mistake was getting a resident to put a new one in. Five tries in one hand and four in the other, they finally decided I could live without it for the night.

My wife and I still recoil at the memory of trying to rest the night after my daughter's birth. We were woken up every two hours for different tests. Keep in mind that it was a no complications birth. The fourth time they came in to run a test I begged them to leave us alone.

I think the reason is simple. It has to do with money. If a medical worker doesn't come in and perform their job, he/she is not entitled to be paid.

When you step into a hospital, there's a process in place to make money out of you. If anyone misses their part, they'll have revenue shortfall. The pressure is on medical workers. Hospitals have admin staff to pay (CEO, managers.) They have bonds that come to due.

Hospitals are not there just to care for the sick. They're there primarily to make money. I think most of them are designed that way.

I've been unfortunate enough to have my 2 year old daugther hospitalised 4 times already and every time, in every ward, she slept very little.

Constant sources of lights, machines that beep. I get they're serving a purpose but an oxygen monitor going off at full volume every 20 minutes, really? You're telling me that cannot be replaced with a smarter machine that just sends a signal directly to the nurses instead of beeping up the place?

After every hospital stay she fell asleep immediately when we got home and slept for over 12 hours just to recover.

We have 7 kids and I saw this with every one of them. After the baby was born the nurses would come in a minimum of every 2 hours and wake my wife up to ask how she was doing. She would do a lot better if they weren't waking her up! For that very reason my wife wanted to leave the hospital ASAP so she could go home and sleep. I sort of wonder if that is the intention of the hospital, to get patients out sooner, but they make more money the longer you are there... so it doesn't really make any sense any way I look at it.

Anecdote time. I spent ~3 weeks in the hospital with pneumonia in 6th grade (age 11 or so). For some reason the time they decided on to give me a daily dose of antibiotics was 3am. They were pills, so I had to be woken up enough to swallow them. Fortunately my mom wouldn't stand for that shit and put up a fuss and it only lasted a week. I was in bad shape, I was in the hospital after all, but not such bad shape that antibiotics were so urgent that they were worth ruining the sleep of a sick child on a nightly basis.

Former air traffic controller, my schedule for the last 5 years at a 24 hour facility.

Monday and Tuesday - 7am : 3pm Wednesday and Thursday - 3pm : 11pm Friday and Saturday - 11pm : 7am

48 hours off to start that again on Tuesday.

Why though? Certainly it's possible for everyone to work the same shift each day they work.

Though that kind of schedule would probably work pretty well for me considering my tendency to try to live on days longer than 24 hours. I want to sleep for 8 hours, but then be up for 18 hours. So between Christmas and New Years, when my work shuts down and I have a week off that I usually spend at home, I find myself staying up until 2 AM the first night, 4 AM the second night, and wanting to stay up until 6 AM the next but have to force myself in bed at 4 because otherwise I'd end up coming back to work with my sleep schedule almost completely opposite of the usual pattern needed to work.

I couldn't tell you why. We were given BS excuses at each facility I worked. Its terrible as I worked radar so you're in a dark room in zombie mode.

My educated guess is the artificially low manning thus needing to shuffle people according to traffic.

I had a cycling accident 4 years ago, and so I remember this problem VERY well.

The second time the bright-eyed resident working for my surgeon came by to talk with me WITHOUT HAVING ANY NEW INFORMATION before 6 in the morning, I read him the fucking riot act. It didn't happen again.

But I was a fit (if broken) 44-year-old white dude with good insurance, very sure my privilege and very willing to exploit it. I'm sure they run roughshod over meeker folks.

This is contradictory to any experience I had in my hospital. I've broken my leg a few times and have spent some time in the hospital. It was always the same one so this is very anecdotal.

They always had strict sleeping schedules for all patients, from 23:00 until 7.30 or 8 everything would be quiet and as little as possible would happen. Besides the pain I always slept like a baby and the hospital encourages that as much as possible.

I've been so down on Healthcare in the US for the past 10 years that this kind of thing doesn't even phase me anymore. I see things like this and I now think:

"Of course it doesn't make any sense, the whole system is busted and any competence and intelligence that might exist in the industry is buried beneath red tape and scummy insurance practices."

Anecdotally this seems like it's probably a real problem, but doesn't he only have a sample size of one hospital stay?

In a word, no. Until they start getting lawsuits over contempt for sleep, nothing will improve.

Is this a problem in UK because I slept like a baby in hospital but this was over 20 years ago. P.s. I wasn't a baby!

It's up to us to set boundaries. If a corporation says sleep is dead unproductive time, it's the individual that must disagree and disconnect around their sleep. Same with exercise. There are so many benefits to the brain and the body from sleeping 7h+!

DISCLAIMER: I slept only 5h last night :(

Nothing has illuminated my poor sleeping habits like reading 'Why We Sleep' by Matthew Walker. The book scared me into working on improving those habits with some degree of success. Many of the topics that Matthew Walker covered have been brought up in this thread.

more than sleep I've found bigger issue with excessive paperwork, while giving birth in China there was no need to measure your baby prior and after each feeding, this was not the case in EU hospital

you would say it helps to decrease newborn mortality but loss of weight it's completely natural and i don't see reason why bother mother and baby measuring weight every two hours, that's just insane harassment

can't really compare sleep since in China we landed in private room (public hospital, not that busy in smaller town) while in EU room for three which was extremely overheated that in winter you had to open window, in China you had to pay astronomic fee around 1.5€ per day for AC remote control and AC to be switched...

Hospitals being a place where sleep is hard to get is the premise of one of German animation's cult classics: https://www.youtube.com/watch?v=SYc6r7JRh9s

Hospitals worldwide should be optimized for increased patient comfort even at the cast of marginally lowering survival (let's say 1%) and increasing cost (again 1%)! Almost all patients would prefer it.

But it's hard to convince people that often in life paying slightly more for a statistically slightly worse outcome increases you comfort ~10x and is 1000% worth it! After all, we live to feel good, and living is only worth it as long as we feel good doing it!

...but no, we just have to insist that we want the absolutely best things (as customers) and that we need to be as efficient as possible (as service providers). This combination of constraints makes life a living hell that I'm not sure why we can still stand. Also there's those maniacs that absolutely hate being or making others COMFORTABLE, but making life worse for them would be sooo enjoyable.

I don't want to create a false dichotomy, but it looks like you're saying you can have either one of two things: increased comfort with a higher chance of death and cost or a maintain to the low level of comfort with a higher chance of successful recovery. You go on to say:

> After all, we live to feel good, and living is only worth it as long as we feel good doing it!

I think I get what you're going for, but I'd rather be uncomfortable in the hospital for a week in my 40s if that means I get to live another 40 or 50 years. I think a lot of other people would also feel the same.

He's talking about losing 1% of your future life not 100%.

The dichotomy is real, I know a thing or two of how hospitals work and what prioritizing comfort would actually mean. But I'd still choose it.

> but I'd rather be uncomfortable in the hospital for a week in my 40s if that means I get to live another 40 or 50 years

Yeah, if you're the 1% that could've actually died if not continuously and repeatedly checked upon and pestered with tens of mostly unnecessary tests, or if you need that expensive life saving drug whose costs would've been covered if less money were spent on better air-conditioning, lighting and soundproofing... bad luck for you. The other 99 would prefer the additional comfort. Heck, there's many people who avoid going to hospitals when they know they should because they know how uncomfortable they are, and some end up dying because of that...

We experienced the same thing after the birth of our first 2 children, and after our 3rd 2 months ago we were actually left alone all night. I commented to a nurse how nice it was and apparently protocol had recently changed for this reason.

Other places terrible for sleep: Airplanes and long distance buses. That is one area where trains have an advantage; one can sleep surprisingly well in overnight sleeper trains.

Most of the time it's vitals checks and lab tests. I've always asked them to coordinate them. Usually they will but you need an advocate with you.

As for me, the worst factor is urine catheter. I couldn't sleep with it at all. I advise everyone to buy non-invasive one before it happens with you.

Hospitals are designed to collect money first and foremost.

Anything having to do with your healing is a secondary concern. The only occasional exceptions are in profit centers like OB.

Usually the night nursing staff are better as there are fewer doctors and managers around. When my wife and I were hospitalized for a few days at various points we quickly grew to hate the morning, as that’s when various parties would show up to say hello and log an encounter.

Fewer staff means you need to start rounds earlier. Phlebotomists, RTs and Nurses manage insane workloads.

From the article: "I can’t wait for the letters to pour in offering BS excuses for why none of these solutions is really possible."

This fellow evidently already decided that any possible criticism of his solutions is BS. He is also a political writer. Is it reasonable to draw a connection between this attitude and journalistic political discourse in the US today? I think they are part and parcel.

This article makes the problem of doctor/test scheduling sound way easier than it actually is. Optimally scheduling these tests when you have a few doctors and a few patients isn't that difficult, but it gets very tricky as you increase the numbers of both as well as the number of constraints on both patients and doctors.

Could it be that hospitals make a hefty profit for every hour you spend on one of their beds? Less sleep means slower recovery, means more .

Probably rich people in high end hospitals don't have this problem. I don't know this for a fact, I'm just comparing here the shitty experience that I had with the experience that a friend seemed to be having in a luxury hospital.

Well, at least the wealthy end up in private rooms, which is a big help. If you are unfortunate enough to share a room with another patient, then either he will be sick enough that the staff keeps you awake half the night as they attend to him, or he will be feeling fairly well, and will insist on watching Family Feud all night on the TV mounted on the wall.

From what I heard most new hospitals have gone private room only for triage reasons alone - sure a broken leg isn't contagious but hospital bugs are downright nasty.

> There’s much more that could be done about this, but I’ll spare you.

No! Don't spare me the details! I read for the details!

What a strange way to end an article...

I understand if clinical staff are actually coming to check on you. In many cases you may need to be checked on every few hours to prevent some decline in condition from going unnoticed. What I don't get is why some hospitals (seems American hospitals don't do it this badly) won't let you sleep when they aren't even coming to check on you.

Last Halloween in Toronto I got a (spooky) appendectomy, and although they were not coming to check on me, I could not sleep because I was in a loud room (the patient beside me had his whole immediate family watching over him, and my mind was awake, trying to decide whether they were speaking Brazillian or Portuguese) with bright overhead lights. I normally sleep with earplugs, but in the sort of rush I was, getting in the ambulance, I neglected to bring a pair. I managed to flag down a nurse to get me a pair of earplugs after five hours of trying to get to sleep.

If they have to come check on you, they could at least make it possible to rest when they're not checking on you.

Hate is a strong word but I found myself hating my hospital stay because I felt trapped, I was unable to do anything for five days but be in my room, watching shark week over and over again. All that time just for tests. Tests take up time and money and at one point I scared my family badly with a few results. I think it's a combination of worry, stress, being awoken up every few hours and just being unable to do normal things- like taking a dump without the need for other people to know!

Isn't it obvious? Sleep is when the body does most of its own healing and restorative functions. Hospitals make money when people are ill. Why would they want you getting better on your own when they have a host of treatments and medications they can sell you on?

I fear the days I might have to spend in a hospital. My hope is that I will have saved enough money to afford home-care and die in my own bed, with a cat or a dog nearby.

I would imagine patients in the hospital have much bigger problems than how much sleep they're getting. They'll probably be awake all night anyways worrying about their over-billed hospital bill and how their insurance company is going to get out of paying for it.

Only in the private hospitals.

self-induced sleep deprivation intensifies

Hospitals aren't persons, so they can't hate anything. Nurses checking your vitals signs when necessary != hating you sleep.

Why do I hate inflammatory clickbait garbage so much?

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