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> 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"?

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." ...

> 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.

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.