Why Do Hospitals Hate Sleep So Much?

Renee C. Byer/Sacramento Bee/ZUMAPRESS

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I’ve been hospitalized once in my life, four years ago, and ever since then a very specific question has rattled around my brain, fruitlessly seeking an answer: Why are hospitals designed to allow patients as little sleep as possible?

Is my phrasing a little too aggressive? Designed to prevent sleep? Maybe that’s going a tiny bit too far. Instead let’s say: Why do the people who design hospitals not give a rat’s ass about patients getting any sleep?

There. That’s better. And it’s nuts. The whole point of hospitals is to care for sick people, and getting adequate sleep is a critical part of recovery. So why would every part of every hospital be designed without the slightest consideration of sleep? I’ll hand the mic over to Austin Frakt for a bit:

Peter Ubel understands the problem as both a physician and patient. When he spent a night in the hospital recovering from surgery in 2013, he was interrupted multiple times by blood draws, vital sign checks, other lab tests, as well as by the beeping of machines. “Not an hour went by without some kind of disruption,” said Dr. Ubel, a physician with Duke University. “It’s a terrible way to start recovery.”

….Solutions aren’t hard to fathom. Dr. Ubel listed some in 2013. Hospital workers could coordinate so that one disruption serves multiple needs: a blood draw and a vitals check at the same time instead of two hours apart. Or they could allow patients’ needs to guide schedules. If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours.

Small changes in hospital routines like these can go a long way. A clinical trial to test them found that they significantly reduced the proportion of patients reporting hospital-related sleep disruptions, and they cut sedative use in half. These small changes can even increase patients’ ratings of hospitals, which are now part of Medicare quality measures. The key insight seems to be to prioritize patients over tests and other interruptions that can be deferred.

As Frakt says, solutions aren’t hard to fathom. In fact, they’re trivially easy to figure out. This is why hospital routines strike me as deliberate negligence: they could only be put in place by administrators who literally don’t care about anything except the convenience of doctors.

Is there anything we poor patients can do? It’s hard to say. One time I asked a nurse to turn off the sound on the IV drip, and he actually did try to do it. But apparently he didn’t know how, because it kept beeping all night regardless of whether there was a problem. This does not give me great confidence in the possibility of further noise-reduction measures.

FWIW, though, it is sometimes possible to get better treatment. After a couple of days during my stay, I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don’t need your counts on a daily basis. And they certainly don’t need them at 4 am. That’s merely for the convenience of doctors, who want the results back by 8 am.

There’s much more that could be done about this, but I’ll spare you. This is my rant for the day—now backed up by an official column in the New York Times. I can’t wait for the letters to pour in offering BS excuses for why none of these solutions is really possible.

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WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

If you can, please support the reporting you get from Mother Jones—that exists to make a difference, not a profit—with a donation of any amount today. We need more donations than normal to come in from this specific blurb to help close our funding gap before it gets any bigger.

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