Sleep

March 21, 2017

If patient safety matters, why are residents returning to long, sleepless shifts?

Must doctors be absolutely impervious to common sense improvements in the way they train their own? Their bullheadedness has reemerged with the revisited decision by a major academic credentialing group to allow medical residents yet again to work 24-hour shifts.

The Accreditation Council for Graduate Medical Education clearly was on the defensive when it issued its memo on residents’ learning and working hours, guidance that academic medical centers and hospitals nationwide will rely on in setting workplace standards for the young doctors in whose hands so many patients will put their lives. The council noted that it had established a high-level task force to reconsider criticisms of residents’ stress and overwork and how this might imperil patient care, responding to an early rollback of shift hours:

“… The Task Force has determined that the hypothesized benefits associated with the changes made to first-year resident scheduled hours in 2011 have not been realized, and the disruption of team-based care and supervisory systems has had a significant negative impact on the professional education of the first-year resident, and effectiveness of care delivery of the team as a whole. It is important to note that 24 hours is a ceiling, not a floor. Residents in many specialties may never experience a 24-hour clinical work period. Individual specialties have the flexibility to modify these requirements to make them more restrictive as appropriate, and in fact, some already do. As in the past, it is expected that emergency medicine and internal medicine will make individual requirements more restrictive.”

December 16, 2016

Merry, merry, and happy, happy? Some ideas to keep the holidays safe, healthy

by Patrick A. Malone

Because the holidays should be filled with abundant joy, here are a few ways to safeguard the health and well-being of you and yours in the days ahead:

Don’t ignore deadly fire dangers

The tragic Oakland, Calif., warehouse-concert hall blaze that claimed at least 36 lives has provided a timely reminder: Fires remain a huge concern, and, especially as cold weather sets in and families add seasonal lighting displays, caution needs to be a watchword. Yes, building codes have improved admirably over time, and fire fighters and many inspectors do a public service that deserves a salute. But affordable housing, especially in big cities like Washington, D.C., remains in crisis shortage. This has forced many, including young people, into overcrowded, substandard housing—some as little more than squatters in dangerous, vacant, or dubious buildings. Meantime, many homeowners resort to space heaters or other devices (including turning on kitchen stoves and ovens) as temperatures fall. Or they’re putting up flashy holiday light displays or even Christmas trees with risky electricals. These excesses can overwhelm safety systems, and not every property owner does due diligence to maintain now common household alarms. The National Fire Protection Association reports that firefighters across the country in 2015 responded to more than 1.3 million blazes, which killed more than 3,200 Americans and injured almost 16,000, and caused more than $14 billion in damages. U.S. fire departments, between 2010 and 2014, responded to an estimated average of 210 home fires per year that began with Christmas trees. These blazes caused an annual average of six civilian deaths, 16 civilian injuries, and $16.2 million in direct property damage. Common sense doesn’t change: Be careful while cooking holiday feasts. Think super safety when setting up holiday displays. Reconsider if portable heaters make sense in your home. Ensure your smoke and carbon monoxide alarms are working. Click here for some seasonal fire safety ideas.

November 11, 2016

Tired parents shouldn’t stress out about baby’s sleep, SIDS safety advisory

by Patrick A. Malone

If the nation’s pediatricians panicked already exhausted and stressed out parents with their recent advisory about keeping babies in the same room at night, there’s some sensible counsel from New York Times columnists. Moms and dads need to strike a thoughtful balance between their nighttime needs and those of their infants, Aaron E. Carroll, a pediatrician and Indiana University medical school professor has advised in an “Upshot” column with writer Carol Cain Miller.

They looked at the underlying research that led the American Academy of Pediatrics to issue new guidelines aimed at preventing Sudden Infant Death Syndrome (SIDS). The academy suggested, among other items, that parents keep their babies in their same bedroom for at least six months, and even better, for up to a year. That upset enough already sleep-deprived moms and dads to prompt the column on SIDS, which medical science has made major progress in reducing, and the research as to where infants should sleep and why.

The writers points out that SIDS kills 3,500 American babies annually. But experts have more than halved SIDS fatalities with public campaigns to get parents to take steps like placing babies on their backs to sleep in their own cribs (the motto is “Back to Sleep”), and eliminating loose bedding and extraneous items like plush toys there.

September 13, 2016

3 hospitals strive for a caregiving rarity: allowing patients a good night’s sleep

by Patrick A. Malone

It long has been a nightmare for patients. It also likely affects patients’ health, and how happy the public is with hospital care. So why do hospitals make it so difficult for the already sick to get a good night’s rest? Some hospitals in Connecticut, however, are blazing a trail for quiet, lights out, coordinated night care, and other measures to boost the prospect that their charges get healing sleep.

The reasons to act are many, as Karen Weintraub writes for the nonprofit Connecticut Health-I-Team:

There’s no question that sleep matters for recovery and health. Patients who don’t get enough sleep heal more slowly, have decreased immunity and pain tolerance, higher rates of anxiety, and are more likely to suffer from confusion and delirium. Hospitals nationally are also waking up to the need to prioritize patient sleep as part of the broader shift toward patient-centered care, and also because of a federal program that penalizes hospitals for substandard performance scores in patient surveys.

April 20, 2016

Live long and prosper? It’s untrue for rural poor, especially white women

by Patrick A. Malone

While the rich tend to live longer and generally prosper in their better health, the poor─and especially now less affluent whites and white women─ don’t fare nearly so well, new research says. And geography may be helpful to some of the poor in surprising ways.

Major newspapers have been full of reports on death rates, especially since a Nobel Laureate and his distinguished researcher wife analyzed data and recently reported that for the first time in recent years the rates were increasing for poorer, less educated white men.

As I’ve written, this sudden mortality shift shocked public health experts, who knew that longevity for blacks in the U.S., while trailing that for whites, has been steadily improving.

October 12, 2015

The Connection Between Sleep and Heart Health

by Patrick A. Malone

We’ve said it before and we’ll say it again: Sleep is not an indulgence; the right amount is critical for your health. Yet another study confirms this truth by showing a link between insufficient sleep and a higher risk of heart disease.

NPR analyzed research published in the journal Arteriosclerosis, Thrombosis and Vascular Biology indicating that the right amount of good-quality sleep is key to good heart health and that poor sleep habits can raise your risk for heart disease at a relatively young age.

According to the data, adults who slept fewer than five hours a night had 50% more calcium in their coronary arteries than those who slept seven hours. But too much sleep also might not be a good idea: Adults who slept nine hours or more a night had 70% more coronary calcium compared with those who slept seven hours.

June 19, 2015

Sleep Less, Eat More

by Patrick A. Malone

Being tired and grumpy the next day seems punishment enough for a lousy night’s sleep, but recent research indicates that chronic sleep disruption might have another unpleasant effect: It makes you overeat.

The paper, published in the Journal of Health Psychology, analyzed how a crummy night’s sleep affected eating habits and other behaviors among both children and adults.

“It is well recognized that food intake is implicated in many chronic health issues including obesity, diabetes and heart disease, and diet is often a target of treatment to prevent the onset of these conditions”, the researchers said in a news release. “[U]nderstanding the mechanisms linking disrupted sleep patterns to increased food intake is important for informing both prevention and treatment interventions for chronic health conditions.”

May 29, 2014

FDA Cuts Lunesta Dose in Half

by Patrick A. Malone

According to its manufacturer, 31 million prescriptions have been written for the sleep drug Lunesta, but its standard dose is dangerous, and the FDA is recommending that it be cut in half.

Known generically as eszopiclone, the drug’s levels in some people may remain high enough the morning after they use it to impair alertness. For many people, even if they feel fully awake, driving, using machinery and other activities can be dangerous.

Last year, we wrote about the dangers of another sleep aid, Ambien and similar drugs, whose dose the FDA required to be reduced. At the time, the feds did not include Lunesta in those revisions because its active ingredient is different from zolpidem, the one in Ambien, but the agency was looking at its safety all along.

February 10, 2014

Why You Should Avoid Sleeping Pills, and What to Do Instead

by Patrick A. Malone

Everyone knows popping a pill to make you sleep is probably not a good idea for the long term, and for most people isn’t good even for an occasional bout of insomnia. Sleep-inducing medicine is powerful, dangerous and can be habit forming.

And, according to The Conversation, a website devoted to the popular discussion of science and current events, a growing body of evidence suggests that these drugs might increase the risk of premature death.

Medicines to help people suffering from insomnia are called hypnotics. They can be prescribed both for people who have difficulty falling to sleep and those who struggle to stay asleep. These drugs fall into several classes, the most commonly prescribed of which are benzodiazepines and their close relatives. They’re also prescribed for anxiety, seizures and muscle spasms. You might recognize some of the brand names as Valium and Xanax.