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Sleep Deprivation and its Effects on Health Care Providers

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

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Sleep Deprivation and its Effects on Health Care Providers

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

  2. 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”.

  3. 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.

  4. What happens when you don’t get enough sleep?

  5. 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”.

  6. 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.

  7. 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%.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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”

  15. 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

  16. References • 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 self-reported 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.

  17. References • 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 • Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004 Oct 28; 351(18): 1838-48. • Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP et al. Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med. 2004 Oct 28; 351(18): 1829-37. • Orton D.I., Gruzelier J.H. Adverse changes in mood and cognitive performance of house officers after night duty. BMJ. 1989 Jan 7; 298(6665): 21-3. Cited in PubMed; PMID: 2492842 • Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being, and sleepiness in college students. J Psychosom Res. 1997 Jun; 42(6): 513-4. • Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep. 1996 May; 19(4):318-26

  18. Rosen IM, Bellin LM, Shea JA. Sleep Behaviors and Attitudes among Internal Med Housestaff in a U.S. University-Based Residency Program. Acad Med. 2004 May; 79(5): 407-16. • Rosen IM, Gimmoty PA, Shea JA, Bellin LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006 Jan;81(1): 82-5 • Sleep Education. www.sleepeducation.com/SleepScale.aspx • Sleep Foundation. www.sleepfoundation.org • Van Dongen HP, Maislin G, Mullington JM, Dinges DF, et all. The cumulative cost of additional wakefulness, dose response effects on neurobehavioral function and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003 May 15; 26(2): 117-26. • 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

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