Dead tired: A management guide to sleep hygiene

Jack, an anesthesiologist, never saw the light pole his BMW wrapped around while he was driving home after a long shift at the hospital. The police investigation and autopsy revealed he had fallen asleep at the wheel, a not uncommon occurrence among health care personnel. (Barger) Colleagues said Jack had resigned himself to a work and call schedule that made him feel chronically “dead tired.” This time being tired had left him dead, and his hospital bereft of a valuable staff member.

Today’s health care worker sleeps 6.8 hours on week nights, one hour less than recommended. The 24/7 workplace takes part of the blame. We sleep an hour less than 50 years ago. Staying awake for 24 hour shift is equivalent to being legally drunk — a 0.1 blood alcohol level (Czeisler/stick)

Brain fog:

Repeated long work shifts and disruption of circadian rhythms can be fatal to patients and physicians alike Physicians who are asked to respond to a medication order in the middle of the night might give the wrong dosage. Medical staff are at particular risk for adverse events when sleepy. Interns have twice the risk of a motor vehicle crash while driving home after an extended shift disc in a study of _____ (Barger).

Work hour guidelines from the Accreditation Council of Graduate Medical Education have been made minimal impact. Shifts are limited to 30 hours a day and work weeks to 80 hours a week Prior to the new rules, the average was 32 hours a shift and 72 hours a week.

• Sleep loss and effects on work performance
• Absenteeism
• Accidents
• Decreased productivity
• Poor performance
• Medical errors

Sleep loss and impaired health:

Twenty three million Americans are shift workers and 6-7 million are in the health care field (BLS). Over thirty percent of health care personnel are in jobs that require extended hours or shift work that compromise the normal circadian rhythm(Beers) The adverse effects are profound. Lack of sleep contributes to medical errors, auto accidents, impaired productivity, decreased work performance, and poor health.

There is strong evidence that shift work contributes to sleep disorders and that shift and night workers obtain less sleep than day workers ( Akerstedt) The sleep deprived are more likely to suffer from obesity (Van Cauter), diabetes, cardiovascular, psychiatric and gastrointestinal disease, and impaired immunity. (Boggild) Night work worsens seizure disorders, and management of diabetes and asthma and post myocardial infarction. (Pratt) Kawachi studied 79,000 nurses over a four year period and found a dose response relationship between coronary artery disease and shift work even after adjusting for risk factors such as smoking, BMI, hypertension, lipids, alcohol use and physical activity (Kawachi) Metabolism, insulin resistance and the absorption of medication are altered. (Pratt) Weight gain (the average was 15 pounds) was more common in night shift than day shift nurses tracked for five years. (Niedhammer)

There is strong evidence to support an association between shift work and poor pregancy outcomes of miscarriage, preterm birth and low birth weight. (MacDonald/ Axelsson) Gastric ulcer disease is higher (Segawa) as is an increased risk of breast cancer adjusted for age, age at first birth of first and last child and number of children (Hansen) Psychiatric conditions are more frequent in shift workers, including depression, substance abuse, divorce, family violence and sexual dysfunction (Luna/ Green)

• Cardiopulmonary:
• Gastrointestinal/Metabolic: Diabetes, Obesity, Peptic ulcer disease
• Neuropsychiatric: Depression, Substance abuse, Seizures
• Pregnancy: Low birth weight, Miscarriages, Preterm labor