October 12, 2007

Good night’s sleep crucial to health, productivity

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Good night’s sleep crucial to health, productivity

Restful sleep, like a healthy diet and exercise, is an important part of good health.

Unfortunately, many people don't get enough of it. Sleep deprivation is a common condition that affects about 47 million Americans, nearly 25 percent of the population. Long-term trends indicate people are sleeping less than they used to, from an average of nine hours per night in 1910 to 6.9 hours in 2002.

Accidents related to sleep deprivation have been estimated to have an annual economic impact of $43 billion to $56 billion, said Beth Malow, M.D., associate professor of Neurology and director of the Vanderbilt Sleep Center.

Malow and Vanderbilt University School of Medicine Dean Steven Gabbe, M.D., recently gave a presentation on sleep to Vanderbilt employees.

Medical students seem particularly prone to sleep deprivation, and Gabbe reminds them that sleep is an important part of their wellness during school and the years beyond.

“I know that medical students have thought about the challenges they will face in meeting the demands of medical school and whether they will be able to get many good nights’ sleep,” Gabbe said. “Over the years I've tried to help our students with this — some of them have told me that during my lectures they get the best sleep they've ever had.”

Joking aside, inadequate sleep, especially when prolonged and marked by a significant sleep debt, has been associated with a greater risk for diabetes, heart disease and obesity. Motor vehicle accidents related to fatigue, drowsy driving, and falling asleep at the wheel are common and underestimated.

“When students haven't slept enough, they become irritable, fall asleep in class and have difficulty concentrating,” Gabbe said.

For decades, physicians have equated the number of hours they spend caring for patients and the hours they spend without sleep as representative of their dedication to patient care. Many senior physicians trained in residency programs that required working every other night, every other weekend, and more than 100 hours each week, often going 60 hours with little sleep.

“If we are honest with ourselves, those of us who worked those hours can remember mistakes we made because of sleep deprivation,” Gabbe said.

Interns were found to make 36 percent more serious medical errors when working 24 hours or more than when they worked shorter shifts. In another study, one-third of residents were found to be suffering from acute sleep deprivation while two-thirds were chronically sleep deprived.

“It is not only residents who work long hours, it is our third- and fourth-year medical students and often our faculty who work side by side with the residents,” Gabbe said.

In response to these concerns, VUSM adopted a policy calling for its faculty and house staff to be sensitive to student fatigue and the total number of hours spent by their students on clinical and educational activities and requiring that all third- and fourth-year students have at least one full day off each week.

The Liaison Committee on Medical Education, the body that accredits all U.S. medical schools, which Gabbe co-chairs, recently adopted a similar policy. In 2003 the Accreditation Council on Graduate Medical Education imposed limits on resident work hours including no more than 80 hours of work each week.

Sleep deprivation in the general public can be related to lifestyle as well as due to sleep disorders and other medical disorders and their treatments.

These causes can include insomnia, obstructive sleep apnea, leg movements, frequent awakenings due to a medical disorder (such as arthritis), narcolepsy, medications and depression. All are causes of daytime sleepiness.

Nearly 10 percent to 20 percent of adults report chronic insomnia, Malow said. The first step is to identify and treat the underlying cause. Several drugs can interfere with sleep, including caffeine, some antidepressants, bronchodilators, stimulants and corticosteroids. While sleeping aids can be effective, they are not without side effects, so an important first step in treatment is to work on improving sleep hygiene (sleep habits).

Malow recommends making sleep a priority. "Even though we believe we can be more productive by getting less sleep, we actually tend to be more efficient and less irritable when we allow ourselves to get the sleep we deserve."