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Protecting Sleep in the Hospital, for Both Patients and Doctors

183 points by rafaelc 7y ago

jcims 7y ago
My wife has been in the hospital regularly over the past 18 months probably 20 days total. This is a renowned research hospital with a gorgeous, vibrant facility and spacious rooms. They absolutely 100% ignore any semblance of a sleep cycle for their patients (as well as proper nutrition but that's for another day). Constant interruptions to check vitals, ask if we want to pick a meal, beeping infusion pumps, a whole squad going on rounds with banal questions...it seems to never end. I'd like to find a watch/fitbit for her and either find or write an app that just fills the screen with a color based on her current sleep phase...green she's awake, yellow light sleep and red means she's in REM or deep sleep and should not be disturbed unless necessary. Place that by the door so the nurses can see and hopefully adjust their timing accordingly.
- Simple_Guy 7y ago
  yeah, sleep monitoring should be a thing for inpatients
- bradknowles 7y ago
  Yup. Been there, done that. I had to get rather obstreperous with the nurses to make them leave me alone as much as possible, so that I could get sleep. I also had 32db NRR earplugs that I take with me everywhere (my hearing can be very sensitive), and I used those extensively. I got lucky and I wasn’t in the hospital for long. Once I got home, I could sleep as much as I needed.
- AlphaWeaver 7y ago
  > I'd like to find a watch/fitbit for her and either find or write an app that just fills the screen with a color based on her current sleep phase... Related to this: I looked into trying to get real time sleep data found it surprisingly hard. Fitbit, for example, only makes sleep data available after sleeping is over and the device is synced to the cloud. If anyone has a good solution to this I'm all ears.
  - phire 7y ago
    An accelerometer based approach (which the fitbit uses) can't actually tell the difference between someone who is just lying there still and someone who is in deep sleep. All it can do is measure movement (which might mean they are awake, or it might mean they are in REM) and no movement. Then it can post-process it later and use the length of stillness and the patterns/amount of movement to infer probable sleep cycles. I don't think it's possible to get real-time sleep phase data without proper EEG sensors to measure brainwaves.
    - aperrien 7y ago
      Maybe you could with some sort of mask that measures eye movement?
      - johnchristopher 7y ago
        Can eyes movement be measured through eyelids ?
        Firadeoclus 7y ago
        Yes, the eyelids visibly move and deform along with the eyes moving underneath.
    - diamondlovesyou 7y ago
      My Fitbit also has a heart monitor. It never confuses "just lying there" with actual sleep, for me at least. Note that your heart rate slows during sleep, which is useful for detecting sleep cycles etc. Which is why I mentioned the heart monitor.
    - johnchristopher 7y ago
      Could EEG sensors be commoditizated ? I have sleep apnea and I find my fitbit + the CPAP readings lacking.
      - 7y ago
- Scoundreller 7y ago
  > research hospital > a whole squad going on rounds with banal questions I’m sure there’s a better way, but that’s par for the course for a research/teaching hospital. The patient’s room is a real-life classroom and lab, with everything that goes along with that.
  - C1sc0cat 7y ago
    And also for handover between shifts - information going missing is a risk here
- busymom0 7y ago
  If you need help developing the app, let me know! I do iOS and Android development so maybe I can help a bit. I haven’t worked in the sleep cycle field but we can figure out things maybe.
  - jcims 7y ago
    Hey that's extremely generous of you...thank you! It will probably take some time as I'm looking at various bits of hardware to experiment with, but if I get stuck I very well may reach out to see if you have a few cycles to assist. Much appreciated!
    - Infinitesimus 7y ago
      Also throwing my name in the hat if you want an extra hand on the Android development part! It seems like such a great solution to a problem that occurs all too often
    - busymom0 7y ago
      Ok, you can go through my submissions and you will figure out a way to contact me through that.
- xattt 7y ago
  Have you had a conversation to address concerns about your spouse’s care? There is always some flexibility around the care that she’d be receiving, and one core component to that is your rational/measured input, either in person or by phone. Framing your concern as rational helps immensely in establishing a dialogue with care staff. It sounds like your core problem is that you want to be bothered less. Nurses are not there to make every patient's stay miserable. At least in my practice setting, we are extraordinarily receptive to suggestions around care and stepping in as informal advocates when families are not available.
  - lojack 7y ago
    We ran into this with my daughter who needed multiple surgeries. Two different experiences in two different hospitals. First hospital was world renowned, ranked #1 in the world for the category of care she needed. This hospital seemed to spend all their money on what I would call “celebrity surgeons”. World renowned, only the best. I suspect the side effect is that they spent much less money on nursing care. There was only one or two nurses to a single floor overnight, and they utilized nursing assistants for everything. I got lots of attitude from the nurses, I suspect it was part of the culture. Their schedules were also much more rigid since they had a lot more patients to cover with limited resources. They also seemed to focus a lot more on the raw numbers and not the individuals. We fought tooth and nail to get a schedule that worked, and got a small amount of wiggle room, but it took a lot of work. Second hospital was a completely different experience. They had a good surgeon, who had good outcomes, but didn’t have as many surgeries under his belt, so less data. I suspect this meant he took up less of the budget. This hospital had zero nursing assistants, and each nurse only had one or two patients at any given time. This resulted in the nurses advocating for us, and actually working their schedule around us.
    - eitally 7y ago
      Our daughter was in for surgery at a world renowned hospital #1 for what she needed ... and our experience was like your second example. After she moved to the step-down unit from the ICU, she had the same day nurse for the next three days and the same night nurse for four, as well as a consistent overnight NP throughout. We had a private room with a separate vestibule containing a washing station & laundry bin for scrubs/aprons. Also in the room was a whiteboard where the current nurse always wrote the intended schedule and reviewed it with us at the start of their shift. Our room had a single-bed sized sofa and a fold-out chair. It was quiet, and except when we had to wake our daughter for overnight oral meds, the nurses let her sleep. To be honest, while it was a hugely stressful situation, I'm convinced the hospital recovery environment and staff played an enormous role in our daughter being able to be discharged only 4 days after open heart surgery.
- brlewis 7y ago
  Unfortunately sleep phase detection is not real time, even assuming you could get staff to pay attention to it. If you can get the hospital to care about sleep though, maybe they could start coordinating enough to consolidate wakings.
- mitchtbaum 7y ago
  Waking anyone uncaringly, insensitively, etc (too hard, too early) was the absolute worst sin in my mother's book, and mine too. In a way, it shows how powerful someone is, that they could take something so valuable from another with almost no effort, and yet so lost if they would do so. This is vital tech. Getting started: https://www.sleepcycle.com/how-sleep-cycle-works/ https://www.sleepcycle.com/how-sleep-cycle-works/ https://www.instructables.com/id/Sleep-Cycle-Alarm-Clock-with-Motion-Sensor/ https://www.instructables.com/id/Sleep-Cycle-Alarm-Clock-wit... https://github.com/npes-95/sleeping-beauty/wiki/Hardware-&-Electronics https://github.com/npes-95/sleeping-beauty/wiki/Hardware-&-E... https://github.com/npes-95/sleeping-beauty/blob/2f32d4722d3d6b8666c0e2fa492b0167b09be8c5/data_analysis.cpp https://github.com/npes-95/sleeping-beauty/blob/2f32d4722d3d... https://www.psychologytoday.com/intl/blog/brain-babble/201310/sleep-cycle-app-precise-or-placebo https://www.psychologytoday.com/intl/blog/brain-babble/20131... https://play.google.com/store/apps/details?id=com.fullpower.applications.sleepz&hl=en https://play.google.com/store/apps/details?id=com.fullpower.... https://www.businessinsider.com/does-apple-watch-track-sleep-apps-review https://www.businessinsider.com/does-apple-watch-track-sleep... https://ouraring.com/ https://ouraring.com/
- uremog 7y ago
  Any time my wife tried to sleep in her last hospital stay, the attached vital checkers got jostled and started beeping. She is used to sleeping in a reclined position and sleeps easily. I have no idea how a less-easy sleeper would get by.
ngcc_hk 7y ago
It is universal practice to wake you up all the time. Just to ensure you are not dead or ensure you are dead of sleep deprivation.
duxup 7y ago
My 9 year old son had a hospital stay a while ago. I stayed with him in the hospital, I got less sleep than when he was an infant with the constant interruptions.... When we returned home in the afternoon ....we both took naps.
baxtr 7y ago
We were in the hospital for 2 nights recently. On the second day we counted how often people got in and out of the room: 29 times. We decided to return home a day earlier than planned.
darkerside 7y ago
I had an infuriating experience with a young child in the hospital, where routine checks were being performed at the worst possible times for his sleep cycles. Sleeping is so critical to healing. Could it be that hospitals are being counterproductive, sacrificing effectiveness for efficiency?
- hanniabu 7y ago
  All they care about is the bottom line, which is money
  - jazoom 7y ago
    All it takes is for one child to die overnight and the parents to sue and you can be sure all patients will get their vitals checked regularly. This is how healthcare works. Source: am a doctor and see this kind of thing on small and large scales
    - hanniabu 7y ago
      Isn't this why there's monitors? You can also do a visual checkup without waking up the patient.
      - jazoom 7y ago
        What monitor are you thinking of? Not everyone gets telemetry. BP cuffs get very tight and will probably wake you up. You may even wake up if a saturation probe is put on your finger. >You can also do a visual checkup without waking up the patient. You can get respiratory rate visually. What other vital sign can you get without touching the patient? Transdermal temp. maybe (inaccurate).
  - namdnay 7y ago
    Bullshit. If that were true, this behavior remains wouldn’t exist in public hospitals in countries with socialised health care. And yet it does
JauntyHatAngle 7y ago
I've recently had similar experiences with a loved one. Older (Geriatric) friend of mine, serious medical condition, which necessitated (I'm told) continuous tests, medication & checks to be run to make sure he was in a "serious but stable" condition instead of a "on the way to death" situation. But this was for a number of days (nearly a week) and essentially it meant the few times he was able to sleep past the pain/illness, he'd be woken up within a few hours for another round of tests, medication, etc. He managed to get through it somehow, and I don't have any solutions to how they could have done it better (I'm no doctor), but it can't help the condition that he was getting by on one to two hours of sleep a day on top of the medical problems.
souprock 7y ago
It's not just tests. It's also constant beeping and the light from the hallway.
DoingIsLearning 7y ago
... and nurses?
Theodores 7y ago
There are a lot of exemptions in healthcare, sleep is part of this exceptional world, I was told bluntly 'we are not operating a hotel here' last time I spent a sleepless night in a hospital. Food is another area of concern. You can starve during a hospital visit or end up broke buying supplemental calories in the shop. Then there is the sheer difficulty of navigating the typical hospital if you are somewhat disabled or in agonising pain. It is as if that every hospital operates at some subliminal level as a field hospital in some 19th century war. It is thoughtcrime to think of how the place is run is less than heroic. There is also triage so that people with serious problems get dealt with before those with minor ailments. Therefore it is fine to keep a lot of people waiting. Or is it? In places that have a customer service ethos you don't keep people waiting. Apart from anything else it is just plain inefficient. The sleep thing is what I would consider inefficient. It is a given that at a typical hospital none of the patients are sleeping too well, if it is not disruption then it can be flimsy blankets. Sure any ward is not going to be your own bed, but we are way off any customer first thinking when it comes to this. I have had discussions about this with plenty of people and the idea of customer service in healthcare is poo-pooed. Is there anywhere in the world where it has been given a try? Scandinavia? Or even Cuba? It is not rocket surgery giving the patients a good night's sleep and enjoyable food. In our private lives we recommend to others that have a big day ahead of them that they get a good night's sleep. Why does this go out the window in the world of healthcare, whether it be staff or patients?
- musicale 7y ago
  A room and service upgrade would be totally worth it, and probably in the noise for most hospital bills. It really is amazing that hospitals are not patient-focused. I think the problem is that their real customers are insurance companies, who don't generally care how patients are treated.
- lazyasciiart 7y ago
  > ave had discussions about this with plenty of people and the idea of customer service in healthcare is poo-pooed. Is there anywhere in the world where it has been given a try? I spent several days in hospital for surgery as a teenager in Australia and my parents (with private health insurance) paid for me to have a private room, which I remember as being pretty comfortable and not filled with interruption. On the other hand I was on serious painkillers and couldn't even stand up so I may not be a reliable witness.
gwright 7y ago
Don't forget all the interruptions that occur when the staff is visiting your room mate also.
Tharkun 7y ago
I know that sleep is critical to healing. And I know that a lot of what happens to you in a hospital is very unpleasant. And I know that some things might seem silly, banal or irrelevant. But please remember that this is all done from a desire to keep you and other patients alive and (relatively) well. Hospitals are always understaffed. Doctors and nurses don't have the time to keep the sleeping schedule of all their patients into account. If you want that to change, I guess more investments in healthcare would be the way to go. People die in hospitals every day. If you're woken up a bunch of times while recovering from something, count your blessings that you're well enough to be woken up in the first place.
- munmaek 7y ago
  Particularly with the human shortage, it would seem that some sort of a computer management system would be prudent here, no?
- Aromasin 7y ago
  It's basic cost-benefit analysis. I completely appreciate where you're coming from, but despite all your points many of the checks are still silly, banal and irrelevant - the benefit of waking someone up mid sleep cycle to ask them what they want to eat, or to get them to fill out a questionnaire, or to take a blood sample when they've only had one an hour or two before, is not worth the cost. You're giving a passionate response about how lucky we are to have that care anyway, but frankly you are vastly underestimating the devastating effects broken sleep has on the body. Most of the patients are on opiates anyway, so sleep is already at a premium (sedation =/= sleep). Hospitals are understaffed, but that does not mean they have an excuse to endanger patient safety by ruining their best method of recovery; sleep. Many of my friends work in sleep science. Ask any of them what they think about the current ways we treat patient sleep, and they'll go on an hour long tirade about how absolutely ridiculous it is - how there are 100s of things that we could be doing differently, but don't because of antiquated science and work dogma, and there is almost no reason for close to 50% of times we wake patients up. I highly recommend "Why We Sleep" by Matthew Walker. He puts a massive spotlight on the health implications that are cause by lack of sleep, especially for the elderly who make up the most hospital patients.
bdcravens 7y ago
About once a year I have to spend 3-7 days in the hospital (I have cystic fibrosis and a round of antibiotics are often needed to bring my lung function back to baseline). The sleep situation is one of the things that's the most unpleasant.
dzink 7y ago
In the US Hospital reimbursements from insurers and medicare are per procedure, not duration of stay. Hospitals have a strong vested interest in both keeping patients alive and reducing length of stay. Food quality and sleep interruptions for non-critical patients both help the latter metric, even if that is likely not their sole reason.
- Ayesh 7y ago
  From what I see in Asia and Europe, hospitals charge per night stayed in the hospital, plus the cost for any procedures.
- sourceless 7y ago
  > not duration of stay for which they charge facility fees
HeraldEmbar 7y ago
The arrogance of nurses and physicians in constantly waking patients up, completely unaware and uncaring of the health detriment that comes with loss of sleep, is inexcusable. While some people can go back to sleep after being awakened, there are many of us who have real difficulty getting back to sleep, and sometimes it doesn't happen at all.
- C1sc0cat 7y ago
  You know there may be other patients needs here, I recall being woken up on the higher risk renal ward, the nurses apologized but they needed to move my bed to the other side of the bay as they needed my bay (which had all the kit for monitoring) for an emergency admission. When you overhear the nurses commenting " its xxxxx he might die in the night - you might think getting woken up is not that important.
- joshgel 7y ago
  That’s a bit to far in my opinion. I’m a physician. Now days, if you are admitted to a hospital overnight it implies you are probably pretty ill. We push hard to ensure that only patients that need to be in the hospital are (wasn’t always that way). Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. So ‘well-meaning’ institutions like mine, mandate hourly rounding by nursing staff. Now is this absurd in some patients, yes! In very elderly patients this may do more harm than good by causing delirium, which can be deadly... Personally, I go out of my way to not wake anyone up, but that’s often not an option in some situations. But to say it is doctor or nursing arrogance is to not really understand healthcare.
  - u801e 7y ago
    > Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Could this be accomplished by using devices that monitor patients vital signs and report the data back to the nurses station? Then spot checks would not really be needed. > Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. Could you list some of the studies you're referencing?
tomohawk 7y ago
When you are given medicines and examinations has more to do with shift changes than anything else. For example, many doctors write prescriptions at the end of shift and neglect to put a specific time to administer on it. The nurses are then required to use the time the prescription was created as when the medicine must be provided, which is often a very inconvenient time for the patient. If doctors received adequate training in how hospitals actually worked, in what nursing staff does, and in how they can best interact for optimum care, many of these problems could be resolved. In the hospital you rarely get patient centric care. Instead, you get institution centric care. This guy's channel brings up a lot of interesting points: https://www.youtube.com/user/ZDoggMD https://www.youtube.com/user/ZDoggMD
Engineering-MD 7y ago
I’m a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in time for morning, or chase scan results/reassess patient/repeat bloods). This is necessary as for these patients (and patients who have become more unwell in hospital) there are too many unknowns to be able to safely leave it until morning, or need to be ready for theatre the next day. The main problem I have is that I often wake up everyone else in the same bay due to lack of private rooms and the need to turn on lights and often shout at dead patients so they can hear me. Beeping machines is a big problem, and the sooner they are made to wirelessly notify the better.
- kdelok 7y ago
  I must confess that the main reason I'm replying is to correct the darkly amusing dead->deaf typo that I'm hoping you made. However, I wonder if you could comment on whether you think a) that you and your colleagues' approach is reflective of the broader medical community, b) you think earplugs could be feasibly issued in shared wards (from a financial/hygiene/other perspective)?
  - joshgel 7y ago
    Sounds right. I’ll add (as in another comment) that nursing hourly rounds is mandated by my institution. Personally i go out of my way to avoid waking you up, but it’s not a hotel and if I’m even a little bit worried about your trajectory, I won’t hesitate to wake you up. My hospital gives out ear plugs. Luckily never had to test it but the beeping is so loud and annoying that I doubt they’d work for me.
  - Engineering-MD 7y ago
    In the UK generally similar experience I think. No one does unnecessary work at night. I am a huge advocate of sleeping plugs, and try to get them introduced at any ward I work at. Usually they are not enough though, but it’s the only feasible solution currently.
smartbit 7y ago
Even without awakening by medical staff or sounds (ear plugs do wonders), with some illnesses patients can only sleep on their back which can be a unpleasant experience if you're used to sleeping on your side. It takes time to get accustomed to and in the mean time patients get little sleep with all mentioned effects. Pillows designed for sleeping on your back [0][1] with special curvatures for your head and neck to relax on ease falling and staying asleep. If a 10% of the patients sleep better and are released earlier from hospital or get to work faster, these pillows are a very small costs compared to costs savings, both personal & society. Anyone seen hospitals with Orthopedic pillows? Or doctors recommending pillows for sleeping on your back? [0] https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleeping https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleepin... [1] eg "Emolli Contour Memory Foam Pillow" on https://www.forbes.com/sites/forbes-finds/2019/02/21/pillows-neck-pain/ https://www.forbes.com/sites/forbes-finds/2019/02/21/pillows... (advertising article)
GaurVimen 7y ago
Good luck trying to change the hospital mindset. Doctors actually have a term for patients who suffer sleep deprivation: hospital-induced-psychosis. It should be called a crime and the head nurse and doctor in charge of the patient ought to be arrested.
- mhalle 7y ago
  Hospital delirium is the current accepted name for this condition. It covers much more than sleep. It includes the stress of complex and potentially life threatening medical and social conditions, confusion related to time of day and time unconscious, the effects of medication, and possible underlying mental health issues. All compound each other. Your charge against doctors and nurses is extreme and unwarranted. Health professionals don't exacerbate these problems willingly or intentionally. ICU delirium puts doctors and nurses at risk of injury or even assault by patients with vivid hallucinations.
bigtex 7y ago
Man is this so true. Years ago I had a daughter spend some time in a hospital and they wanted to change her diaper every 2 hours...during...the...night! Sure the child who is recovering from brain surgery should have their sleep interrupted 5 times to change a diaper. I am fairly certain no sane parent wakes up a perfectly sleeping baby to change a diaper. My wife kindly told them we didn't need that and they obliged.
- eitally 7y ago
  Our diapered daughter was recently in the hospital and the only thing they asked us was to weigh a dry diaper as a reference, and then place any soiled diapers on a scale in the room so they could be weighed at the nurse's convenience so they could track I/O, which is otherwise challenging for babies/toddlers.
bpyne 7y ago
When my wife gave birth to our daughter we had a room to stay in. Every 1.5-2 hours the nurses came in to ask questions and run tests. It was maddening. My wife had to finally cry and beg them to stop. Afterward, we managed about a few hours of uninterrupted sleep.
- apohn 7y ago
  Our experience as well. I was in the room as well the whole time and it was ridiculous how often somebody came in to do something. With exception of one nurse, every single person pushed back against us asking for fewer interruptions and said it was for the baby and mom. One nurse basically acted like my spouse was acting entitled for wanting to sleep. I wanted to swear at that nurse and throw her out of the room. One of the night nurses realized my spouse was about to collapse and found a way to let her sleep for 3 hours.
OldFatCactus 7y ago
Is there a website or service that scores hospitals? Customer service, outcomes, incidents, and whatever other relevant data
hannob 7y ago
I wondered this a lot before. I'm lucky enough that I haven't spent much time in a hospital in my life, but visiting people there I often heard how hard it was to sleep for them due to constant interruption, noise from neighboring beds or indensive care units where it's constantly busy. Yet on the other hand it's so often emphasized how important good sleep is for health. It seems such a nobrainer to do everything possible to make sure people can sleep well in a hospital.
irrational 7y ago
My main experience with this is every time my wife gave birth. She goes through this long ordeal and is exhausted, but as long as we were there they were in every 2 hours, day and night, waking her up and talking to her. They don't seem to have any concept of people needing to sleep more than 2 hours continuously. The only thing I could come up with is that they really wanted us to get out of there ASAP and were making things a living hell to encourage us towards that end. Except, one of my rules is to follow the money and they make more money the longer we stay, so... it really doesn't make any sense.
- twothamendment 7y ago
  My wife's experience was much the same. So much that when I had an emergency appendectomy I answered every question with the goal of being discharged and not spending the night. I was even more motivated when I overheard a phone call from a patient down the hall. It was so loud that my nurse rolled her eyes and informed me he be awake until 3am. I was sure between him and the nurses there wouldn't be any sleep in that place. I got out about 20 minute before the cutoff time for being stuck in hell.
- ksdale 7y ago
  We’ve had 4 babies in 3 different hospitals and it seems like it is really dependent on the hospital and the nursing staff. We’ve had nurses that are younger and just following the playbook all the way to nurses that are much older with several of their own children who are much more willing to use their intuition. While the nurses have all been surprisingly excellent (maybe it’s a maternity thing? That hasn’t been our experience in other parts of the hospitals) some of them are happy to let you sleep if it seems like there’s no bleeding and baby is doing well, and some of them insist on taking all the readings, though they were all apologetic while they did it. Since we went through different hospitals, it’s hard to compare, but at the last one, it seemed like the fact that we had 3 healthy children at home already made the nurses surprisingly willing to defer to our preferences, and we got as close to a full night of sleep in the hospital with a newborn that you can get. As an added data point, we also told the nurses at every hospital that we wanted to leave as soon as possible, so trying to kick us out wasn’t a consideration.
rjohnk 7y ago
Stayed in the hospital in April for about a week for a colon resection - without a doubt worst sleep is in a hospital. It was an amazing environment too and I only had 11:00pm and 4:00am checks. I think it's the nature of the environment.
vonnik 7y ago
This is a huge issue. A family member spent two weeks in the hospital last year, and one of the hardest parts of that experience was how difficult it was to sleep there. The light, the noise, the demented patient shouting in the next room, the constant interruptions and questionnaires from nurses and doctors: you just couldn't sleep more than 90 minutes if you were lucky. We called them "the bleeping machines", in the double sense. I would turn them off sometimes, because the stats they were monitoring were not life or death for us. Hospitals are a place where there is no night. The nurses working on the graveyard shift under the bright fluorescents cover a third of the day, and for them, it's just another workday, but it runs from 11pm to 7am. And they treat patients as though it is daytime. Don't get me wrong, the nurses were great, but the structure and incentives don't favor sleep. There is so much that could be done to help patients get better faster, by giving them a more restful environment. But the incentive is to monitor them until you can get them out of the bed, to save everybody money.
abarringer 7y ago
At my recent overnight stay at a large hospital the Nursing staff were very aware of the necessity of good sleep. They worked hard and went out of their way to create an environment where I was interrupted as little as possible. Their first exit interview question was "How well did you sleep? And how can we improve that?"
deleted 7y ago
[deleted]

183 points by rafaelc 7y ago

My wife has been in the hospital regularly over the past 18 months probably 20 days total. This is a renowned research hospital with a gorgeous, vibrant facility and spacious rooms. They absolutely 100% ignore any semblance of a sleep cycle for their patients (as well as proper nutrition but that's for another day). Constant interruptions to check vitals, ask if we want to pick a meal, beeping infusion pumps, a whole squad going on rounds with banal questions...it seems to never end. I'd like to find a watch/fitbit for her and either find or write an app that just fills the screen with a color based on her current sleep phase...green she's awake, yellow light sleep and red means she's in REM or deep sleep and should not be disturbed unless necessary. Place that by the door so the nurses can see and hopefully adjust their timing accordingly.

Simple_Guy 7y ago
yeah, sleep monitoring should be a thing for inpatients
bradknowles 7y ago
Yup. Been there, done that. I had to get rather obstreperous with the nurses to make them leave me alone as much as possible, so that I could get sleep. I also had 32db NRR earplugs that I take with me everywhere (my hearing can be very sensitive), and I used those extensively. I got lucky and I wasn’t in the hospital for long. Once I got home, I could sleep as much as I needed.
AlphaWeaver 7y ago
> I'd like to find a watch/fitbit for her and either find or write an app that just fills the screen with a color based on her current sleep phase... Related to this: I looked into trying to get real time sleep data found it surprisingly hard. Fitbit, for example, only makes sleep data available after sleeping is over and the device is synced to the cloud. If anyone has a good solution to this I'm all ears.
- phire 7y ago
  An accelerometer based approach (which the fitbit uses) can't actually tell the difference between someone who is just lying there still and someone who is in deep sleep. All it can do is measure movement (which might mean they are awake, or it might mean they are in REM) and no movement. Then it can post-process it later and use the length of stillness and the patterns/amount of movement to infer probable sleep cycles. I don't think it's possible to get real-time sleep phase data without proper EEG sensors to measure brainwaves.
  - aperrien 7y ago
    Maybe you could with some sort of mask that measures eye movement?
    - johnchristopher 7y ago
      Can eyes movement be measured through eyelids ?
      - Firadeoclus 7y ago
        Yes, the eyelids visibly move and deform along with the eyes moving underneath.
  - diamondlovesyou 7y ago
    My Fitbit also has a heart monitor. It never confuses "just lying there" with actual sleep, for me at least. Note that your heart rate slows during sleep, which is useful for detecting sleep cycles etc. Which is why I mentioned the heart monitor.
  - johnchristopher 7y ago
    Could EEG sensors be commoditizated ? I have sleep apnea and I find my fitbit + the CPAP readings lacking.
    - 7y ago
Scoundreller 7y ago
> research hospital > a whole squad going on rounds with banal questions I’m sure there’s a better way, but that’s par for the course for a research/teaching hospital. The patient’s room is a real-life classroom and lab, with everything that goes along with that.
- C1sc0cat 7y ago
  And also for handover between shifts - information going missing is a risk here
busymom0 7y ago
If you need help developing the app, let me know! I do iOS and Android development so maybe I can help a bit. I haven’t worked in the sleep cycle field but we can figure out things maybe.
- jcims 7y ago
  Hey that's extremely generous of you...thank you! It will probably take some time as I'm looking at various bits of hardware to experiment with, but if I get stuck I very well may reach out to see if you have a few cycles to assist. Much appreciated!
  - Infinitesimus 7y ago
    Also throwing my name in the hat if you want an extra hand on the Android development part! It seems like such a great solution to a problem that occurs all too often
  - busymom0 7y ago
    Ok, you can go through my submissions and you will figure out a way to contact me through that.
xattt 7y ago
Have you had a conversation to address concerns about your spouse’s care? There is always some flexibility around the care that she’d be receiving, and one core component to that is your rational/measured input, either in person or by phone. Framing your concern as rational helps immensely in establishing a dialogue with care staff. It sounds like your core problem is that you want to be bothered less. Nurses are not there to make every patient's stay miserable. At least in my practice setting, we are extraordinarily receptive to suggestions around care and stepping in as informal advocates when families are not available.
- lojack 7y ago
  We ran into this with my daughter who needed multiple surgeries. Two different experiences in two different hospitals. First hospital was world renowned, ranked #1 in the world for the category of care she needed. This hospital seemed to spend all their money on what I would call “celebrity surgeons”. World renowned, only the best. I suspect the side effect is that they spent much less money on nursing care. There was only one or two nurses to a single floor overnight, and they utilized nursing assistants for everything. I got lots of attitude from the nurses, I suspect it was part of the culture. Their schedules were also much more rigid since they had a lot more patients to cover with limited resources. They also seemed to focus a lot more on the raw numbers and not the individuals. We fought tooth and nail to get a schedule that worked, and got a small amount of wiggle room, but it took a lot of work. Second hospital was a completely different experience. They had a good surgeon, who had good outcomes, but didn’t have as many surgeries under his belt, so less data. I suspect this meant he took up less of the budget. This hospital had zero nursing assistants, and each nurse only had one or two patients at any given time. This resulted in the nurses advocating for us, and actually working their schedule around us.
  - eitally 7y ago
    Our daughter was in for surgery at a world renowned hospital #1 for what she needed ... and our experience was like your second example. After she moved to the step-down unit from the ICU, she had the same day nurse for the next three days and the same night nurse for four, as well as a consistent overnight NP throughout. We had a private room with a separate vestibule containing a washing station & laundry bin for scrubs/aprons. Also in the room was a whiteboard where the current nurse always wrote the intended schedule and reviewed it with us at the start of their shift. Our room had a single-bed sized sofa and a fold-out chair. It was quiet, and except when we had to wake our daughter for overnight oral meds, the nurses let her sleep. To be honest, while it was a hugely stressful situation, I'm convinced the hospital recovery environment and staff played an enormous role in our daughter being able to be discharged only 4 days after open heart surgery.
brlewis 7y ago
Unfortunately sleep phase detection is not real time, even assuming you could get staff to pay attention to it. If you can get the hospital to care about sleep though, maybe they could start coordinating enough to consolidate wakings.
mitchtbaum 7y ago
Waking anyone uncaringly, insensitively, etc (too hard, too early) was the absolute worst sin in my mother's book, and mine too. In a way, it shows how powerful someone is, that they could take something so valuable from another with almost no effort, and yet so lost if they would do so. This is vital tech. Getting started: https://www.sleepcycle.com/how-sleep-cycle-works/ https://www.sleepcycle.com/how-sleep-cycle-works/ https://www.instructables.com/id/Sleep-Cycle-Alarm-Clock-with-Motion-Sensor/ https://www.instructables.com/id/Sleep-Cycle-Alarm-Clock-wit... https://github.com/npes-95/sleeping-beauty/wiki/Hardware-&-Electronics https://github.com/npes-95/sleeping-beauty/wiki/Hardware-&-E... https://github.com/npes-95/sleeping-beauty/blob/2f32d4722d3d6b8666c0e2fa492b0167b09be8c5/data_analysis.cpp https://github.com/npes-95/sleeping-beauty/blob/2f32d4722d3d... https://www.psychologytoday.com/intl/blog/brain-babble/201310/sleep-cycle-app-precise-or-placebo https://www.psychologytoday.com/intl/blog/brain-babble/20131... https://play.google.com/store/apps/details?id=com.fullpower.applications.sleepz&hl=en https://play.google.com/store/apps/details?id=com.fullpower.... https://www.businessinsider.com/does-apple-watch-track-sleep-apps-review https://www.businessinsider.com/does-apple-watch-track-sleep... https://ouraring.com/ https://ouraring.com/
uremog 7y ago
Any time my wife tried to sleep in her last hospital stay, the attached vital checkers got jostled and started beeping. She is used to sleeping in a reclined position and sleeps easily. I have no idea how a less-easy sleeper would get by.

ngcc_hk 7y ago

It is universal practice to wake you up all the time. Just to ensure you are not dead or ensure you are dead of sleep deprivation.

duxup 7y ago

My 9 year old son had a hospital stay a while ago. I stayed with him in the hospital, I got less sleep than when he was an infant with the constant interruptions.... When we returned home in the afternoon ....we both took naps.

baxtr 7y ago

We were in the hospital for 2 nights recently. On the second day we counted how often people got in and out of the room: 29 times. We decided to return home a day earlier than planned.

darkerside 7y ago

I had an infuriating experience with a young child in the hospital, where routine checks were being performed at the worst possible times for his sleep cycles. Sleeping is so critical to healing. Could it be that hospitals are being counterproductive, sacrificing effectiveness for efficiency?

hanniabu 7y ago
All they care about is the bottom line, which is money
- jazoom 7y ago
  All it takes is for one child to die overnight and the parents to sue and you can be sure all patients will get their vitals checked regularly. This is how healthcare works. Source: am a doctor and see this kind of thing on small and large scales
  - hanniabu 7y ago
    Isn't this why there's monitors? You can also do a visual checkup without waking up the patient.
    - jazoom 7y ago
      What monitor are you thinking of? Not everyone gets telemetry. BP cuffs get very tight and will probably wake you up. You may even wake up if a saturation probe is put on your finger. >You can also do a visual checkup without waking up the patient. You can get respiratory rate visually. What other vital sign can you get without touching the patient? Transdermal temp. maybe (inaccurate).
- namdnay 7y ago
  Bullshit. If that were true, this behavior remains wouldn’t exist in public hospitals in countries with socialised health care. And yet it does

JauntyHatAngle 7y ago

I've recently had similar experiences with a loved one. Older (Geriatric) friend of mine, serious medical condition, which necessitated (I'm told) continuous tests, medication & checks to be run to make sure he was in a "serious but stable" condition instead of a "on the way to death" situation. But this was for a number of days (nearly a week) and essentially it meant the few times he was able to sleep past the pain/illness, he'd be woken up within a few hours for another round of tests, medication, etc. He managed to get through it somehow, and I don't have any solutions to how they could have done it better (I'm no doctor), but it can't help the condition that he was getting by on one to two hours of sleep a day on top of the medical problems.

souprock 7y ago

It's not just tests. It's also constant beeping and the light from the hallway.

DoingIsLearning 7y ago

... and nurses?

Theodores 7y ago

There are a lot of exemptions in healthcare, sleep is part of this exceptional world, I was told bluntly 'we are not operating a hotel here' last time I spent a sleepless night in a hospital. Food is another area of concern. You can starve during a hospital visit or end up broke buying supplemental calories in the shop. Then there is the sheer difficulty of navigating the typical hospital if you are somewhat disabled or in agonising pain. It is as if that every hospital operates at some subliminal level as a field hospital in some 19th century war. It is thoughtcrime to think of how the place is run is less than heroic. There is also triage so that people with serious problems get dealt with before those with minor ailments. Therefore it is fine to keep a lot of people waiting. Or is it? In places that have a customer service ethos you don't keep people waiting. Apart from anything else it is just plain inefficient. The sleep thing is what I would consider inefficient. It is a given that at a typical hospital none of the patients are sleeping too well, if it is not disruption then it can be flimsy blankets. Sure any ward is not going to be your own bed, but we are way off any customer first thinking when it comes to this. I have had discussions about this with plenty of people and the idea of customer service in healthcare is poo-pooed. Is there anywhere in the world where it has been given a try? Scandinavia? Or even Cuba? It is not rocket surgery giving the patients a good night's sleep and enjoyable food. In our private lives we recommend to others that have a big day ahead of them that they get a good night's sleep. Why does this go out the window in the world of healthcare, whether it be staff or patients?

musicale 7y ago
A room and service upgrade would be totally worth it, and probably in the noise for most hospital bills. It really is amazing that hospitals are not patient-focused. I think the problem is that their real customers are insurance companies, who don't generally care how patients are treated.
lazyasciiart 7y ago
> ave had discussions about this with plenty of people and the idea of customer service in healthcare is poo-pooed. Is there anywhere in the world where it has been given a try? I spent several days in hospital for surgery as a teenager in Australia and my parents (with private health insurance) paid for me to have a private room, which I remember as being pretty comfortable and not filled with interruption. On the other hand I was on serious painkillers and couldn't even stand up so I may not be a reliable witness.

gwright 7y ago

Don't forget all the interruptions that occur when the staff is visiting your room mate also.

Tharkun 7y ago

I know that sleep is critical to healing. And I know that a lot of what happens to you in a hospital is very unpleasant. And I know that some things might seem silly, banal or irrelevant. But please remember that this is all done from a desire to keep you and other patients alive and (relatively) well. Hospitals are always understaffed. Doctors and nurses don't have the time to keep the sleeping schedule of all their patients into account. If you want that to change, I guess more investments in healthcare would be the way to go. People die in hospitals every day. If you're woken up a bunch of times while recovering from something, count your blessings that you're well enough to be woken up in the first place.

munmaek 7y ago
Particularly with the human shortage, it would seem that some sort of a computer management system would be prudent here, no?
Aromasin 7y ago
It's basic cost-benefit analysis. I completely appreciate where you're coming from, but despite all your points many of the checks are still silly, banal and irrelevant - the benefit of waking someone up mid sleep cycle to ask them what they want to eat, or to get them to fill out a questionnaire, or to take a blood sample when they've only had one an hour or two before, is not worth the cost. You're giving a passionate response about how lucky we are to have that care anyway, but frankly you are vastly underestimating the devastating effects broken sleep has on the body. Most of the patients are on opiates anyway, so sleep is already at a premium (sedation =/= sleep). Hospitals are understaffed, but that does not mean they have an excuse to endanger patient safety by ruining their best method of recovery; sleep. Many of my friends work in sleep science. Ask any of them what they think about the current ways we treat patient sleep, and they'll go on an hour long tirade about how absolutely ridiculous it is - how there are 100s of things that we could be doing differently, but don't because of antiquated science and work dogma, and there is almost no reason for close to 50% of times we wake patients up. I highly recommend "Why We Sleep" by Matthew Walker. He puts a massive spotlight on the health implications that are cause by lack of sleep, especially for the elderly who make up the most hospital patients.

bdcravens 7y ago

About once a year I have to spend 3-7 days in the hospital (I have cystic fibrosis and a round of antibiotics are often needed to bring my lung function back to baseline). The sleep situation is one of the things that's the most unpleasant.

dzink 7y ago

In the US Hospital reimbursements from insurers and medicare are per procedure, not duration of stay. Hospitals have a strong vested interest in both keeping patients alive and reducing length of stay. Food quality and sleep interruptions for non-critical patients both help the latter metric, even if that is likely not their sole reason.

Ayesh 7y ago
From what I see in Asia and Europe, hospitals charge per night stayed in the hospital, plus the cost for any procedures.
sourceless 7y ago
> not duration of stay for which they charge facility fees

HeraldEmbar 7y ago

The arrogance of nurses and physicians in constantly waking patients up, completely unaware and uncaring of the health detriment that comes with loss of sleep, is inexcusable. While some people can go back to sleep after being awakened, there are many of us who have real difficulty getting back to sleep, and sometimes it doesn't happen at all.

C1sc0cat 7y ago
You know there may be other patients needs here, I recall being woken up on the higher risk renal ward, the nurses apologized but they needed to move my bed to the other side of the bay as they needed my bay (which had all the kit for monitoring) for an emergency admission. When you overhear the nurses commenting " its xxxxx he might die in the night - you might think getting woken up is not that important.
joshgel 7y ago
That’s a bit to far in my opinion. I’m a physician. Now days, if you are admitted to a hospital overnight it implies you are probably pretty ill. We push hard to ensure that only patients that need to be in the hospital are (wasn’t always that way). Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. So ‘well-meaning’ institutions like mine, mandate hourly rounding by nursing staff. Now is this absurd in some patients, yes! In very elderly patients this may do more harm than good by causing delirium, which can be deadly... Personally, I go out of my way to not wake anyone up, but that’s often not an option in some situations. But to say it is doctor or nursing arrogance is to not really understand healthcare.
- u801e 7y ago
  > Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Could this be accomplished by using devices that monitor patients vital signs and report the data back to the nurses station? Then spot checks would not really be needed. > Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. Could you list some of the studies you're referencing?

tomohawk 7y ago

When you are given medicines and examinations has more to do with shift changes than anything else. For example, many doctors write prescriptions at the end of shift and neglect to put a specific time to administer on it. The nurses are then required to use the time the prescription was created as when the medicine must be provided, which is often a very inconvenient time for the patient. If doctors received adequate training in how hospitals actually worked, in what nursing staff does, and in how they can best interact for optimum care, many of these problems could be resolved. In the hospital you rarely get patient centric care. Instead, you get institution centric care. This guy's channel brings up a lot of interesting points: https://www.youtube.com/user/ZDoggMD https://www.youtube.com/user/ZDoggMD

Engineering-MD 7y ago

I’m a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in time for morning, or chase scan results/reassess patient/repeat bloods). This is necessary as for these patients (and patients who have become more unwell in hospital) there are too many unknowns to be able to safely leave it until morning, or need to be ready for theatre the next day. The main problem I have is that I often wake up everyone else in the same bay due to lack of private rooms and the need to turn on lights and often shout at dead patients so they can hear me. Beeping machines is a big problem, and the sooner they are made to wirelessly notify the better.

kdelok 7y ago
I must confess that the main reason I'm replying is to correct the darkly amusing dead->deaf typo that I'm hoping you made. However, I wonder if you could comment on whether you think a) that you and your colleagues' approach is reflective of the broader medical community, b) you think earplugs could be feasibly issued in shared wards (from a financial/hygiene/other perspective)?
- joshgel 7y ago
  Sounds right. I’ll add (as in another comment) that nursing hourly rounds is mandated by my institution. Personally i go out of my way to avoid waking you up, but it’s not a hotel and if I’m even a little bit worried about your trajectory, I won’t hesitate to wake you up. My hospital gives out ear plugs. Luckily never had to test it but the beeping is so loud and annoying that I doubt they’d work for me.
- Engineering-MD 7y ago
  In the UK generally similar experience I think. No one does unnecessary work at night. I am a huge advocate of sleeping plugs, and try to get them introduced at any ward I work at. Usually they are not enough though, but it’s the only feasible solution currently.

smartbit 7y ago

Even without awakening by medical staff or sounds (ear plugs do wonders), with some illnesses patients can only sleep on their back which can be a unpleasant experience if you're used to sleeping on your side. It takes time to get accustomed to and in the mean time patients get little sleep with all mentioned effects. Pillows designed for sleeping on your back [0][1] with special curvatures for your head and neck to relax on ease falling and staying asleep. If a 10% of the patients sleep better and are released earlier from hospital or get to work faster, these pillows are a very small costs compared to costs savings, both personal & society. Anyone seen hospitals with Orthopedic pillows? Or doctors recommending pillows for sleeping on your back? [0] https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleeping https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleepin... [1] eg "Emolli Contour Memory Foam Pillow" on https://www.forbes.com/sites/forbes-finds/2019/02/21/pillows-neck-pain/ https://www.forbes.com/sites/forbes-finds/2019/02/21/pillows... (advertising article)

GaurVimen 7y ago

Good luck trying to change the hospital mindset. Doctors actually have a term for patients who suffer sleep deprivation: hospital-induced-psychosis. It should be called a crime and the head nurse and doctor in charge of the patient ought to be arrested.

mhalle 7y ago
Hospital delirium is the current accepted name for this condition. It covers much more than sleep. It includes the stress of complex and potentially life threatening medical and social conditions, confusion related to time of day and time unconscious, the effects of medication, and possible underlying mental health issues. All compound each other. Your charge against doctors and nurses is extreme and unwarranted. Health professionals don't exacerbate these problems willingly or intentionally. ICU delirium puts doctors and nurses at risk of injury or even assault by patients with vivid hallucinations.

bigtex 7y ago

Man is this so true. Years ago I had a daughter spend some time in a hospital and they wanted to change her diaper every 2 hours...during...the...night! Sure the child who is recovering from brain surgery should have their sleep interrupted 5 times to change a diaper. I am fairly certain no sane parent wakes up a perfectly sleeping baby to change a diaper. My wife kindly told them we didn't need that and they obliged.

eitally 7y ago
Our diapered daughter was recently in the hospital and the only thing they asked us was to weigh a dry diaper as a reference, and then place any soiled diapers on a scale in the room so they could be weighed at the nurse's convenience so they could track I/O, which is otherwise challenging for babies/toddlers.

bpyne 7y ago

When my wife gave birth to our daughter we had a room to stay in. Every 1.5-2 hours the nurses came in to ask questions and run tests. It was maddening. My wife had to finally cry and beg them to stop. Afterward, we managed about a few hours of uninterrupted sleep.

apohn 7y ago
Our experience as well. I was in the room as well the whole time and it was ridiculous how often somebody came in to do something. With exception of one nurse, every single person pushed back against us asking for fewer interruptions and said it was for the baby and mom. One nurse basically acted like my spouse was acting entitled for wanting to sleep. I wanted to swear at that nurse and throw her out of the room. One of the night nurses realized my spouse was about to collapse and found a way to let her sleep for 3 hours.

OldFatCactus 7y ago

Is there a website or service that scores hospitals? Customer service, outcomes, incidents, and whatever other relevant data

hannob 7y ago

I wondered this a lot before. I'm lucky enough that I haven't spent much time in a hospital in my life, but visiting people there I often heard how hard it was to sleep for them due to constant interruption, noise from neighboring beds or indensive care units where it's constantly busy. Yet on the other hand it's so often emphasized how important good sleep is for health. It seems such a nobrainer to do everything possible to make sure people can sleep well in a hospital.

irrational 7y ago

My main experience with this is every time my wife gave birth. She goes through this long ordeal and is exhausted, but as long as we were there they were in every 2 hours, day and night, waking her up and talking to her. They don't seem to have any concept of people needing to sleep more than 2 hours continuously. The only thing I could come up with is that they really wanted us to get out of there ASAP and were making things a living hell to encourage us towards that end. Except, one of my rules is to follow the money and they make more money the longer we stay, so... it really doesn't make any sense.

twothamendment 7y ago
My wife's experience was much the same. So much that when I had an emergency appendectomy I answered every question with the goal of being discharged and not spending the night. I was even more motivated when I overheard a phone call from a patient down the hall. It was so loud that my nurse rolled her eyes and informed me he be awake until 3am. I was sure between him and the nurses there wouldn't be any sleep in that place. I got out about 20 minute before the cutoff time for being stuck in hell.
ksdale 7y ago
We’ve had 4 babies in 3 different hospitals and it seems like it is really dependent on the hospital and the nursing staff. We’ve had nurses that are younger and just following the playbook all the way to nurses that are much older with several of their own children who are much more willing to use their intuition. While the nurses have all been surprisingly excellent (maybe it’s a maternity thing? That hasn’t been our experience in other parts of the hospitals) some of them are happy to let you sleep if it seems like there’s no bleeding and baby is doing well, and some of them insist on taking all the readings, though they were all apologetic while they did it. Since we went through different hospitals, it’s hard to compare, but at the last one, it seemed like the fact that we had 3 healthy children at home already made the nurses surprisingly willing to defer to our preferences, and we got as close to a full night of sleep in the hospital with a newborn that you can get. As an added data point, we also told the nurses at every hospital that we wanted to leave as soon as possible, so trying to kick us out wasn’t a consideration.

rjohnk 7y ago

Stayed in the hospital in April for about a week for a colon resection - without a doubt worst sleep is in a hospital. It was an amazing environment too and I only had 11:00pm and 4:00am checks. I think it's the nature of the environment.

vonnik 7y ago

This is a huge issue. A family member spent two weeks in the hospital last year, and one of the hardest parts of that experience was how difficult it was to sleep there. The light, the noise, the demented patient shouting in the next room, the constant interruptions and questionnaires from nurses and doctors: you just couldn't sleep more than 90 minutes if you were lucky. We called them "the bleeping machines", in the double sense. I would turn them off sometimes, because the stats they were monitoring were not life or death for us. Hospitals are a place where there is no night. The nurses working on the graveyard shift under the bright fluorescents cover a third of the day, and for them, it's just another workday, but it runs from 11pm to 7am. And they treat patients as though it is daytime. Don't get me wrong, the nurses were great, but the structure and incentives don't favor sleep. There is so much that could be done to help patients get better faster, by giving them a more restful environment. But the incentive is to monitor them until you can get them out of the bed, to save everybody money.

abarringer 7y ago

At my recent overnight stay at a large hospital the Nursing staff were very aware of the necessity of good sleep. They worked hard and went out of their way to create an environment where I was interrupted as little as possible. Their first exit interview question was "How well did you sleep? And how can we improve that?"

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