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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 he

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...

flippyhead 8y ago
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)!
mattjaynes 8y ago
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://www.youtube.com/watch?v=pwaWilO_Pig https://podtail.com/en/podcast/the-joe-rogan-experience/-1109-matthew-walker/ https://podtail.com/en/podcast/the-joe-rogan-experience/-110...
- mrhappyunhappy 8y ago
  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.
arkades 8y ago
> 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.”
- culot 8y ago
  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.
  - Retric 8y ago
    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.
  - jyounker 8y ago
    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.
    - pc86 8y ago
      > 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.
cstross 8y ago
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.)
- technofiend 8y ago
  >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.
  - mfe5003 8y ago
    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.
    - mattkrause 8y ago
      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.

flippyhead 8y ago

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)!

mattjaynes 8y ago

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://www.youtube.com/watch?v=pwaWilO_Pig https://podtail.com/en/podcast/the-joe-rogan-experience/-1109-matthew-walker/ https://podtail.com/en/podcast/the-joe-rogan-experience/-110...

mrhappyunhappy 8y ago
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.

arkades 8y ago

> 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.”

culot 8y ago
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.
- Retric 8y ago
  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.
- jyounker 8y ago
  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.
  - pc86 8y ago
    > 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.

cstross 8y ago

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.)

technofiend 8y ago
>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.
- mfe5003 8y ago
  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.
  - mattkrause 8y ago
    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.