This year, in 2019, two of my favorite passions, sleep and patient safety are being honored in the same week. How did these come to be my passions? Well, 20 years ago, when I was finishing my residency before any restrictions on work hours of young doctors was the same year that a prestigious scientific organization released a landmark report stating that nearly 100,000 patients die in hospitals each year due to medical error. Two years later, as I was creating the resident schedules, the group that regulates residency training set limits for how long resident physicians should work. While both the numbers of patients dying from medical error and how many hours physicians should work continue to be debated scientific circles today, clearly this is an area where we should be truly doing no harm.
Fast forward to 20 years later, I am now a doctor who works to improve sleep and safety for the patients those tired residents care for in hospitals. We just completed a major study called SIESTA that reduced sleep disruptions for hospitalized patients by 44% and improved patient experience scores. While there are several things that are unique to the hospital environment, there are also some commonsense things you can do to help you and your loved ones are safe when it comes to both sleep and safety.
Friends don’t let friends drive drowsy. Drowsy driving is no laughing matter. According to the CDC, 1 in 25 adult drivers say they fell asleep while driving in the past month! In 2013 alone, drowsy driving is listed as the cause of 72,000 crashes, 44,000 injuries, and 800 deaths. Drowsy driving is not just a statistic, it hits close to home. One of my high school friends, Jennifer Pearce, lost her sister, Nicole Lee, to drowsy driving and has become a major public advocate and face to this epidemic. Because drowsy driving is underestimated, the numbers are likely much worse. When I was a resident, several drowsy driving accidents led to the establishment of a taxi cab (now ride-share) fund so tired resident doctors would not have to drive home after a marathon shift. Protecting long-shift workers is important given that some states are now passing laws to make drowsy driving the equivalent of vehicular homicide. Because we are very bad at estimating our own level of drowsiness, I always say friends don’t let friends drive drowsy.
Turn in your technology at bedtime. We are all connected at our hip to our technology, whether it be a smartphone, tablet, computer or something else. The blue light that phones emit is a problem and can mess with your inner clock, or circadian rhythm, making it harder to sleep! Thus, you enter a vicious cycle of insomnia, waking up in the middle of the night, looking at your phone, and staying awake longer! This is especially true in children (take it from me firsthand) because it alters melatonin, the miracle hormone responsible for regulating our sleep cycles. Give the tech a rest so you can rest. It works wonders.
If you need to stay awake, try a “caffeine nap.” Many of us overuse caffeine as a miracle to stay more alert and awake longer. When I was a resident, I drank so much coffee that I developed a tolerance and no amount of coffee affected my ability to sleep. That is why “strategic consumption” of caffeine is recommended for those that need to stay awake or work against their circadian rhythm. One example is a caffeine nap. Caffeine fights sleep inertia, or the grogginess and immediate desire to return to sleep upon waking (alarm clock snooze anyone?)). Naps actually can be restorative but one problem is people fear the sleep inertia that goes along with naps. The solution- combine them together for a power packed nap. Since caffeine takes 15-30 minutes to work, you can have your espresso shot, take a snooze for 30 minutes, and then wake up feeling refreshed. I actually won a radio show by telling Rhymefest something he did not know- the caffeine nap! Check it out here.
Ask your doctor or nurse about better sleep. Given that many people that are suffering from insufficient sleep, the CDC has described sleep deprivation a public health epidemic. Sleep loss has been linked to increased mortality, obesity, diabetes, and a host of other health problems. Up to 1 in 3 people report symptoms of insomnia, which is estimated to cost $63.2 billion annually. To make matters worse, many people suffer from a sleep disorder, like obstructive sleep apnea, but don’t even know it. Sadly, medical schools only only 3 hours dedicated to learning about sleep, with some having no training in it. So this is an area that everyone should know more about. Whether you are in the clinic or in the hospital, ask your doctor or nurse about ways they can help you or your loved ones sleep better if you are having trouble. While you may be a good sleeper at home, if you ever find yourself hospitalized, trust us, you will likely have some difficulty. The good news is that there are many interruptions that can be rescheduled or batched to provide better care. So don’t be afraid to ask your doctor or nurse if you can forgo some of these interruptions or have them grouped so you’re only waking up once.