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.
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.
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.
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.
That sounds almost exactly like the hospital we were at (Rainbow Babies, for the record). Hope your daughter is doing good, my daughter is also a heart baby -- coarctation and bicuspid valve.
The nurses have been stellar and I’m sure would try to accomodate, but they would actually have to guard the room against all the other ramblers to gain a net benefit.
> 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.
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.
Hi. I work at Fitbit. I don't speak for Fitbit, but the page below does. You are probably right that real time sleep phase data would require EEG, but wrong about Fitbit using motion data to infer sleep phases. Without heart rate Fitbit only measures awake/restless/asleep. REM/deep/light is estimated only when heart rate data is available.
A proper EEG for use in sleep studies is available on ebay (last time I looked, maybe six months to a year ago) for $1000 for a USB model or $1500 for one with a battery (might require a prescription). There are also ongoing costs, since the standard usage is to stick the electrodes to a particular location and I'm not sure how accurate it would be if you didn't do that (it is possible that some of the long term EEG monitoring caps used for epilepsy might work with less setup time, but I don't know if it would be directly comparable to the usual method). IIRC, it takes about a half hour to get set up for a sleep study. Additionally, scoring the sleep study is not a fully automated process and without the same training that sleep doctors receive the results would not be comparable. Getting a reliable and useful result might be quite difficult and you would need to compare with regular sleep studies to see how accurate a particular method is.
There seem to be an endless stream of companies trying to make easier to use EEGs, either for clinical or home use, and it seems like almost all of them go bankrupt in a few years. I suspect most of them are also not very accurate. A couple of years ago I saw an interesting one that tried to automate most of the scoring but would send the more difficult cases for human scoring. I'd guess that one at least has a better chance of reasonable accuracy than most. I think it was dreem (dreem.com), although they only mention automated scoring at this point. Possibly they managed to train their automated system sufficiently or maybe it was a different company. In any case, I would be suspicious of claims that they are as accurate as a sleep study, although it is certainly possible that someone has come up with an actually accurate method. You would still be spending hundreds of dollars for a device that sends all the data it collects into the cloud and in most cases will be useless if the company goes out of business or decides to stop supporting older products. They usually aren't clear about what, if anything, will still work if the company goes out of business.
Of course, less than ideal results can still be interesting. Once a few years ago I managed to set up my laptop's microphone to record might sleep at just the right level and it was very interesting. Unfortunately, I didn't write down how I changed the settings to get the right volume and could reproduce it when I tried a couple of times, although I imaging there are online guides for this type of thing and I didn't go looking for them. For anyone who sleeps alone and does not use CPAP I'd recommend giving it a try. With builtin laptop speakers you can only hear when sleeping on one side (I never sleep on my back, so not sure if that would be covered), but I bet it wouldn't be too hard to set up two or three microphones to get a good recording in any position. It isn't trivial to review, but looking at the recording in audacity it is possible to see the regular parts and just listen to the less regular parts. You can't even fully tell asleep or not from that, but you can notice when your breathing changes and in my case it was very interesting to see how that often happened due to quiet noises (e.g. a dog barking in the distance, car going by quietly). You can also tell how often you move at night (about every 45 minutes in my case, at least that night).
I've also used a basic pulse oximiter (Contec CMS-50I, was about $90 new on ebay) with the Sleepyhead software. It has pulse, SpO2, and perfusion index. At quick count it looks like I've used it 24 nights over the past couple years and I'm not sure the device will necessarily last much longer, hopefully it will (the display has an always on line and there are sometimes issues with the sensor that might be due to an issue in the cord, although it is sometimes due to not being cleaned sufficiently or to my hand moving in the sensor; the sensor can be replaced for something like $20 and it came with a second "one time use" sensor that I haven't tried but I suspect might be possible to use more than once). The pulse reading seems to accurately show when I first get to sleep, but doesn't help determine when I am sleeping for the rest of the night. SpO2 is the main thing I use it for, but doesn't help determine anything about sleep. Perfusion index mostly seems to indicate how warm my hand is and so can sometimes indicate when I change position.
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.
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.
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.
> 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.
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.
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!
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
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.
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.
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)?
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.
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.
It was a typo to deaf, but you do actually have to confirm death by checking a lack of response to loud verbal stimulus.
Never had it when I thought someone was dead not respond to voice, but I have had it where they only responded once we started chest compressions.
During our recent stay, while the monitors did indeed beep, it was possible to put them on silent mode, which the nursing staff was happy to do because the rooms all had nice big LED screens outside the door with vitals alerts and the nursing station had a much larger multi-monitor display showing each patient's status. It turned our problem into their problem, but we never had an issue with noise. A large part of this is also because we had a private room, and the rooms all had vestibules for further sound isolution (and containing the scrub-in sink & laundry bin).
That said, besides the specific reason our daughter was in-patient to address, she was otherwise vigorous and healthy, and that absolutely was not the case for the majority of the other kids no the ward, most of whom had congenital heart defects and other developmental conditions, and I can completely understand why it becomes more important to interrupt less stable patients.
I don't know why hospitals don't invest in the very same technology I use every night as a downtown urban area dweller to stay asleep -- a sleep mask, and headphones with a continuous stream of pink noise. I can sleep through pretty much anything in that cocoon, and I'm a fairly light sleeper.
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?
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.
> 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.
But what if you were born into a family that were not able to look out for you?
From the sibling comments I get the feeling that people in countries where private health insurance is needed that the concept of healthcare for all is not imaginable. I was writing in the context of the NHS, as introduced by the Labour government in the post WW2 UK when Britain was broke and broken.
It goes against the NHS ideal to have some patients be able to pay for an upgrade, you get what you are given. There are no up-sells.
In recent years the neo-liberal politicians have chipped away at the NHS, slashing budgets and outsourcing services. Now that I consider what people in the USA get for healthcare I wish to take back all of my grumblings about the UK's beloved NHS! Sure it can be improved on but the values that go with it - universal and for all - are important to me. I would not feel happy paying for a better bed than the next guy or being the person that can't pay for that better bed. I have a sense of fairness that this goes against. I imagine I would not have that 'survivors guilt' feeling if private healthcare was all I knew.
That's not completely true - when our son was born we paid for a private room in an NHS hospital. Mind you that was ~20 years ago don't know if they still do it.
They still do, or did in 2015 and 2018. We were lucky enough to not need the doctor-led hospital unit - using the midwife-led maternity unit instead (where private rooms are standard). However, we were moments away from foreceps being used - a doctor-administered intervention - for the first birth, which would have necessitated a move downstairs to the hospital wing, and thus a ward or payment for a private room.
I thought that forceps had been replaced by sink plungers. Obviously not the sort you buy in the DiY store but the expensive medical grade. The same principle applies though, suction cup goes on baby's head and with one pull the baby is born!
I thought the suction cup approach was standard now with the benefit to the technique being no birth marks.
I was wrong about the forceps. But there is now a new rabbit hole I need to go down - birth marks and what causes them. Plus this 'ventouse' gadget and the merits of it compared to ye olde forceps.
Haven't got time for this rabbit hole now, I might save it for when I meet someone with skin in the game!
Australia has publicly funded healthcare for all. If my parents hadn't been able to pay for extra, I would have had the same operation in the same hospital in a room shared with someone else.
People in for a suspected heart attack should get bacon, right? I was at a place that did it. That is either an assumption about what heart attack patients like to eat, or it is an effort to get repeat customers.
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.
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.
If they're waking you up to take blood samples when you're sleeping, it's probably for good reason. Maybe the patient is at risk for some kind of kidney complications and maybe not dying from renal failure is more important than getting a good night's sleep. There could be any number of reasons for this. Maybe another patient had some kind of emergency that had to be dealt with first, and your sleep schedule is less important than someone else's life.
Generally speaking, doctors and nurses care about patients (some more than others, sure). They're also aware of the importance of sleep. If you're a nurse on a night shift, and you have to take care of a ward of 20 patients, you'll quickly find yourself too busy to be terribly considerate. Especially when something unexpected happens.
The blood checks I brought up because this was a thing specifically criticised by my friends in the medical trade. For the vast majority of cases where they need to take blood, it just so happens to be the preferred method used for diagnosing the patient, not the only method. There are other things that can be done beyond waking the patient and sticking a needle in their arm. Often they just end up disposing it, as they don't even have the resources to test the blood of every patient every hour; but they will continue to take blood every hour. If the nurses are told to take blood, they will do it to protocol - regardless of what common sense might suggest.
The main criticism they had was that of treatment for patients with infection. It's nice for a doctor to know whether the body is fighting it off effectively or not. Many doctors will ask for blood tests every hour because it's so nice to know, and you'll get a pretty graph to tell you what's going on by the hour. You know what's better than a graph? Letting the patient fight off said infection. Best way to do that? Decent sleep. Apparently the education on sleep is abysmal in most institutions currently, purely because it's been a branch of medicine that has bloomed late, and it has resulted in doctors who often don't give sleep the respect it deserves.
Again, this is not from the horses mouth. I am only passing on the information my friends gave me as effectively and accurately as I can. I'm not trying to shit on those in the medical profession, as it's a career I envy, but it is something that is a chronic issue in most wards and many sleep specialists across the globe are trying their hardest to rectify it with significant push back.
I do agree with what you've said, but I don't agree with the conclusion, so I want to provide a counterpoint and I hope I don't come across as unconstructive in doing so.
Just because doctors and nurses have a desire to help, doesn't mean that anything they do is therefore the right thing to do. Like you said, we know that sleep is critical to healing so doesn't that go against nurses and doctors having a desire to prevent harm? I would think that something preventing healing or causing emotional stress is de-facto harm.
Yes, hospitals can be understaffed and underfunded, but that's hardly an excuse when we know some of their practises can cause harm. You wouldn't let a nurse do something harmful and let them say "Sorry we don't have the budget". We can sit here and say that yes, here's the reason but that doesn't actually mean that's what they ought to be doing.
There seems to be quite a lot of bias for doctors and nurses because they do work that is seen as very important and good. While that is true, it can often cloud judgement when deciding what we ought to do in a prescriptive medical sense. There's been many occassions where doctors or nurses were holding back advancement of their own field because they're just people and like all people they have their own faults and their own bias. I don't say this to say that doctors are bad, or cause harm, but rather that some are bad and some do cause harm, even if they're trying their best to stop you dying.
Sure, but there still is a huge difference in the way staff deals with it.
When my daughter of three weeks old was in the hospital she needed to get some checks at night. Some doctors would walk in with a little flashlight, do the checks and leave the room without waking her up.
Others would switch on the ultra bright hospital lighting waking up the little one, only to do checks which take 10 seconds but kept my daughter up for hours.
'Doctors and nurses don't have the time to keep the sleeping schedule of all their patients into account.'
Speaking from the UK, where this problem has been well publicised, the biggest complaint being disturbance during the night when it ought to be obvious that most people will be asleep?
Accepted there will be exceptions where patients are sleeping during the day and this does present obvious problems. However, where medical staff are carrying on their normal work routines or idly gossiping at night time without regard for their patients is inexcusable.
The understaffing is because decades ago the AMA decided to limit the number of doctors. The AMA is run by doctors. Good for them for having power to run protectionism but I'm not going to thank them for it.
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.
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.
> 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?
I'm really excited about [0], but as far as I know there is no way to take blood pressure without touching the patient. If someone here could invent it, I could probably provide a test environment for large scale investigations.
Re: studies. I can't say I know the evidence that well, so I wouldn't want to mislead, this isn't my area. A google search for Hourly Rounding reveals lots of articles, but I haven't poked into the underlying data that proves it is a successful strategy (if that exists). I guess I overstated my confidence above.
For blood pressure, our experience was that the staff were perfectly happy to leave a cuff on our daughter's leg, which automatically took a reading every hour (or on demand).
I find that anecdotally, I really REALLY hate being connected to shit during a hospital stay. A nurse waking me up is infinitely less disruptive than having another dozen sensors on me permanently.
Doubly so when, now nurses have to track uptime of all those sensors.
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.
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:
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?
FWIW my experience was totally different less than 9 months ago when I visited the hospital with my youngest and had to stay a few days for what ended up as a minor surgery (but still with anesthesia):
I woke up once in the night and saw a shadow with a tiny led light, carefully taking a look at the sleeping child before disappearing just as quitely.
(FWIW the nurse was there every night, but this was the only time I observed it.)
My daughter slept very well during those days, as did I.
IIRC they'd also plan with me in advance to know when the best time would be for checks and blood works, at least it came across as very thoughtful.
This was Norway, not one of the major hospitals, so not so relevant for many others except as proof that it isn't like that everywhere in the world.
I couldn't make sense of what you wrote until the last line. From personal experience, and reading several of the accounts here, I believe that hospitals in the US do not respect sleep, almost willfully so.
This isn't universally true. I'm happy to report that the Cardiac Surgery step-down unit at Boston Children's does a fantastic job working with families to determine the least intrusive modes of nursing care based on their needs & condition.
Thanks, that's good to know! The topic was discussed here a few months ago [0]. It's probably difficult to get the data required for a systematic discussion...
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
Maybe so, but please don't post unsubstantive comments here. And please note this guideline: "Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something."
Good comment except for the first bit, which you should shorten out, as the guidelines ask:
"When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3.""
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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?"
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.
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.