Transcript Sleep Deprivation and its Effects on Health Care Providers Ansley Buckhalter Advisor: Dr Weaver.

Sleep Deprivation and its
Effects on Health Care
Providers
Ansley Buckhalter
Advisor: Dr Weaver
Definition
Webster’s New Millennium Dictionary of English
defines sleep deprivation as “the condition of being
robbed of sleep, in real life or in experiment, as
opposed to being unable to sleep”.
What does sleep do for us?
Not everything is understood about the influence
sleep has on the body but through numerous studies,
it has been determined that sleep plays a major role
in the proper function of both the endocrine and
immune systems.
What happens when you
don’t get enough sleep?
What happens when you
don’t get enough sleep
• Some serious illnesses such as obesity, hypertension,
depression, and diabetes are being linked to the
deprived of sleep.(sleepfoundation.org)
• It has been reported that “gastrointestinal and
cardiovascular complaints increase, immune
function, carbohydrate metabolism, and endocrine
function are impaired to some degree”.
• A study conducted by Kripke et al showed a rise in
mortality with “severe shortening of daily sleep” and
that “sleep of <4 hours increased likelihood of death
by a factor of 2.8 in a 6-year follow-up period”.
Sleep deprivation and the
health care provider
• A survey study, conducted from July 2002 to May
2003, found that doctors working 1-4 or 5 or greater
extended shifts (>24 h continuously) per month
increased adverse events related to fatigue by seven
to eight times compared to months in which no
extended-duration shifts were worked
• ABC new reported in 2006 that after 5 or more
marathon shifts medical providers were four times
more likely to make errors that result in patient
deaths.
What happens when you
don’t get enough sleep?
• To emphasize the effect sleep deprivation has
on the body and its potential harm that could
come; it has been show that after 24 hours of
consecutive wakefulness, psychomotor
function was equivalent to a blood alcohol
concentration of 0.1%.
Sleep deprivation and the
health care provider
• In 2004 Rosen published a paper stating that acute sleep
deprivation, or lack of sleep over a short period of time, has
been shown to be related to a decrease in “rote memory,
verbal comprehension, and mathematical calculations” as well
as errors in prescribing medications and recording medical
history.
Sleep deprivation and the
health care provider
• In 2001, a study interested in the sleep behaviors and attitudes
among internal medicine residents was conducted at the
University of Pennsylvania. Surveys were given to 52 incoming
interns and 79 “current housestaff”. There was a 100%
completion rate of the survey and their findings revealed that
among the current housestaff, 69% said it was possible that they
could fall asleep while doing charts, 61% while reading
medications, 51% while reviewing labs, and 46% while doing
orders. 48% reported to suffer from acute sleep deprivation
while doing ward rotations as well as 81% post-call. The study
also reported that about two-thirds of the housestaff on the
wards and in ICU admitted to chronic sleep deprivation.
Sleep deprivation and the
health care provider
• Physical on-the-job injury could occur to the health
care provider. A case-crossover study from five
teaching medical centers in both the US and Canada,
has shown that sleep deprivation in interns was
associated with a “3-fold increase” for being injured
with a sharp instrument.
Sleep deprivation and the
health care provider
Barger conducted a nationwide prospective study
using a web-based survey. 2,737 first year
postgraduate residents participated and completed
17,003 monthly reports that inquired about hours of
work, extended hour work shifts, “documented car
accidents”, almost accidents, and involuntary
sleeping. From the information that was obtained
from the interns, Barger determined that the monthly
chances of him/her being involved in an automobile
accident while commuting from work is raised 16.2
percent
Sleep deprivation and the
health care provider
• There have been efforts to address this problem. In
2003, the Accreditation Council for Graduate Medical
Education set work-hour limits for all residents in the
United States. These regulations limit residents to
work a maximum of 30 hours nonstop per shift and
no more than 80 hours a week.
• But the regulations still allow residents to work two
30-hour shifts a week and up to nine 30-hour shifts a
month
Sleep deprivation and the
health care provider
• ACGME also investigates the compliance of the
accredited programs and found that for the academic
year of 2006-2007, “8.8% received one or more
citations for duty hour violations. This represented a
slight increase over the 7.9% of programs reviewed in
academic year 2005-06 that received duty hour
citations.
• So it appears that most of the accredited programs
are following the 80 hour work week limit.
What can be done?
• It has been found beneficial for workers to take a 20
minute nap before their shift begins.
• Some studies have shown that allowing a nap during
an extended duty hour shift can help reduce fatigue;
however, this required coverage of patients while the
intern was napping.
• However, this brings up the issue of “patient
handoff”
What can be done?
• The health care provider should make every effort
possible to ensure that they are prepared for
whatever the shift or work hour duration will be. By
exercising good sleep hygiene (good sleep habits),
the quality of their sleep might be improved. A
good sleep hygiene consists of a regular sleep
schedule, getting at least 8 hours of sleep, avoid
caffeine 4-8 hours before bedtime, avoid nicotine
before bedtime, no alcohol or heavy meals late in the
evening, regular exercise, and reduce noise, light,
and extreme temperatures while trying to sleep
References
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Arnedt JT, Owens J, Crouch M, Stahl J, Carskadon MA. Neurobehavioral performance of residents after heavy night call vs after
alcohol ingestion. JAMA. 2005 Sep 7; 294(9): 1025-33.
Arora VM, Dunphy C, Chang VY, Ahmad F, Humphrey HJ, Meltzer D. The effects of on-duty napping on intern sleep time and
fatigue. Ann Intern Med. 2006 Jun 6; 144(11): 792-8.
Arora VM, Georgitis E, Woodruff JN, Humphrey HJ, Meltzer D. Improving sleep hygiene of medical interns: can the sleep,
alertness, and fatigue education in residency program help?. Arch Intern Med. 2007 Sep 10; 167(16): 1738-44.
Aubrey A. Health Care Night-Shift Workers Often Neglect Selves. NPR. 2005 Sept 20; Morning Edition.
http://www.npr.org/templates/story/story.php?storyId=4855626
Ayas N T, Barger LK, Cade BE, Hashimoto DM, Rosner B, Cronin JW et al. Extended Work Duration and the Risk of selfreported percutaneous injuries in interns. JAMA. 2006; 296: 1055-1062.
Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer FE, Czeisler CA. Impact of extended duration shifts on medical
errors, adverse events, and attentional failures. PLos Med. 2006 Dec; 3(12): e487.
Barger LK, Cade BE, Ayas NT, Cronin JW, Rosner B, Speizer FE et al. Extended work shifts and the risk of motor vehicle crashes
among interns. N Engl J Med. 2005 Jan 13; 352(2): 125-34.
Fisman DN, Harris AD, Rubin M, Sorock GS, Mittleman MA. Fatigue increases the risk of injury from sharp devices in medical
trainees: results from a case-crossover study. Infect Control Hosp Epidemiol. 2007 Jan; 28(1): 20-7.
References
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Howard, Steve MD. Fatigue and the Practice of Anesthesiology. APSF Newsletter 2005 Spring.
http://www.apsf.org/resource_center/newsletter/2005/spring/01fatigue.htm
Kiernan M, Civetta J, Bartus C, Walsh S. 24 Hours on-call and acute fatigue no longer worsen resident mood under the 80-hour
work week regulations. CurrSurg. 2006 May-Jun; 63 (3):237-41. Cited in PubMed; PMID: 16757379
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Rosen IM, Bellin LM, Shea JA. Sleep Behaviors and Attitudes among Internal Med Housestaff in a U.S. University-Based
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www.wordnet.com
Armstrong, A M.D. Sleepy Doctors a threat to Patients. ABC News Medical Unit. 12 Dec 2006
http://abcnews.go.com/Health/Story?id=2717303&page=1