Skip to content
  • About
  • Contact
  • Contribute
  • What Physicians Say
  • My Book
  • Careers
  • Podcast
  • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Aging and dementia: what physicians say, in their own words
  • Artificial intelligence: what physicians say, in their own words
  • Be heard on social media’s leading physician voice
  • Cancer: what physicians say, in their own words
  • Children’s health: what pediatricians say, in their own words
  • Contact Kevin
  • COVID-19: what physicians wrote as it happened
  • Custom enhanced author page pricing
  • Diabetes and obesity: what physicians say, in their own words
  • Direct primary care: what physicians say, in their own words
  • DMCA Policy
  • End of life: what physicians say, in their own words
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words
  • Heart disease: what physicians say, in their own words
  • Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words
  • KevinMD influencer opportunities
  • Medical errors: what physicians say, in their own words
  • Medical ethics: what physicians say, in their own words
  • Medical malpractice: what physicians say, in their own words
  • Medical school: what students and physicians say, in their own words
  • Mental health: what psychiatrists and physicians say, in their own words
  • Nursing: what nurses and physicians say, in their own words
  • Opinion and commentary by KevinMD
  • Opioids: what physicians and pain patients say, in their own words
  • Physician burnout speakers to keynote your conference
  • Physician burnout: what physicians say, in their own words
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician personal finance: what physicians say about their own money, in their own words
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Physician suicide: what physicians say, in their own words
  • Physicians and administrators: what physicians say about who runs medicine, in their own words
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Primary care: what physicians say, in their own words
  • Prior authorization: what physicians say, in their own words
  • Privacy Policy
  • Private equity and corporate medicine: what physicians say, in their own words
  • Race and medicine: what physicians say, in their own words
  • Recommended services by KevinMD
  • Residency: what residents and attendings say, in their own words
  • Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words
  • Subscribe to the KevinMD enhanced author page
  • Subscribe to the newsletter
  • Surgeons and surgery: what surgeons say, in their own words
  • Take-home messages: what physicians say when asked to leave one
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The electronic health record: what physicians say, in their own words
  • Vaccines: what physicians say, in their own words
  • Violence against health care workers: what physicians and nurses say, in their own words
  • What physicians say: the KevinMD records
  • Women in medicine: what women physicians say, in their own words
  • Women’s health: what physicians say, in their own words

Hospital care practically guarantees that we won’t get good sleep

Peter Ubel, MD
Conditions and Diseases
July 31, 2013
Share
Tweet
Share

The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won’t get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics.

Recently I was all-too-miserably reminded of the challenges of hospital sleep when I spent a fitful night recovering from surgery to remove a small kidney tumor. Unlike some patients in that situation, my sleep was not disturbed by pain or nausea; I was lucky to avoid both of those postoperative complications. Instead, my sleep was interrupted, hourly, by clinicians taking care of me. There were vital sign checks every four hours, a frequency that makes sense given that I had just had part of my left kidney removed. Sometimes sleep interruptions are necessary in order to monitor patient conditions. But those vital sign checks, at midnight and 4 a.m., were not the only interruptions I experienced that night. At 3 a.m., if my very foggy memory serves me correctly, someone came into my room to draw blood for follow-up laboratory tests. Several other times that evening, the machine hovering near my left ear beeped to tell me that one of my IV medications had run out; I would push the nursing button and tell the person at the desk about the beeping, and eventually someone would come in and either replace the empty IV bag or turn the alarm off.

Between 10 p.m. and 6 a.m., I did not go more than an hour without some kind of interruption.

As I have already suggested, some of these interruptions are necessary. But many are not. And the consequence of too many sleep interruptions is that patients do not heal as quickly as they would otherwise, thereby not only reducing their quality of life but also driving up medical costs. Indeed, as I have written elsewhere: sleep disturbance is a leading cause of hospital complications, such as falls and delirium. Poor sleep has also been linked to reduced immune function,worsening blood pressure control and mood disorders. All of these problems potentially impair the ability of patients to recover from the acute illnesses that caused them to be hospitalized.

How do we improve hospital sleep?

First, hospitals could make simple organizational changes. During my recent hospital stay, for example, a major contributor to my interrupted sleeping was the specialization of tasks across different hospital personnel. When the IV machine beeped, it was the nurse who helped out, her training being necessary to monitor the IV lines and medications. When it came to measuring my vital signs, though, a nurse’s aide was sent to accomplish the task. And a phlebotomist came to draw my blood. Specialization matters. The doling out of these duties to different people — with different skills and different pay grades — makes great economic sense, and in many ways improves hospital quality of care. But such specialization interferes with sleep, because the different people performing each of these duties enter patient rooms at different times of the night.

There is a better way to coordinate these various clinicians to reduce sleep interruptions. For example, phlebotomists could coordinate their work with nursing aides. Imagine that instead of coming into patient rooms one hour apart from each other, the two came in together: “We are here to check your blood pressure and draw some blood,” they would say (maybe even in unison!). That little change would eliminate one interruption. A second change could also improve patient sleep: more flexibility in the timing of vital sign measures. If, for example, a patient’s IV machine beeps at 11 p.m. and the next check of her vital signs is due at midnight, the nurse could bump up the vital sign measures by an hour, since the patient is already awake.

Indeed, it was an 11 p.m. vital signs wake-up call that led to research that proves the value of my second approach to improving patient sleep: increasing the use ofsleep protocols designed to minimize unnecessary interruptions. More on sleep protocols in a bit, but first let me tell you about that 11 p.m. wake-up call.

Melissa Bartick is a hospitalist in the Harvard medical system, a physician who focuses mainly on inpatient rather than outpatient care, treating patients who have been hospitalized with acute or chronic illnesses. Spending as much time in hospitals as she does, Bartick has long recognized the problems created when patients have difficulty sleeping. But it took her own hospitalization to convince her how fixable this problem is.

Bartick had spent an exhausting evening being evaluated for an acute illness in her hospital’s emergency department. She finally made it up to a hospital bed around 10 p.m., where the nurse checked her vital signs and made sure she was receiving appropriate treatments. Finally allowed to rest, Bartick quickly fell asleep only to be awoken at 11 p.m. for … another vital sign check! She was not awoken because her illness was so acute that she needed hourly assessments. Instead, she was awoken because hospital protocol required nurses to check vital signs each shift, and the night shift began at 11 p.m.

“By the time I left the next morning, I had half of my research design worked out,” Bartick told me. When Bartick was healthy again, she conducted the clinical trial she had begun designing that night. In the trial, some patients, at random, were cared for under a sleep protocol, an order that alerts nursing staff to eliminate all unnecessary middle of the night intrusions — eight hours of quiet time for patients, with darkening of the room and avoidance of waking patients for nonurgent matters. The protocol reduced sleep disturbances by 38 percent.

How do we make sleep protocols the norm among stable hospitalized patients? We change hospital practice so that minimization of sleep disturbances becomes the default condition for how to care for non-critically ill patients, with more frequent sleep interruptions only occurring when physicians actively indicate that such interruptions are clinically necessary. Research in behavioral economics has demonstrated that people are strongly influenced by default options when making decisions. Employees are more likely to contribute to retirement funds when such contributions are automatic. People are more likely to donate their loved ones’ organs in countries where such donations are default policy.

Currently, the default setting in most hospitals is to prioritize testing over patient sleep. While patients in intensive care usually do need to have their vital signs monitored closely, and often need multiple blood draws each day to monitor rapidly changing clinical circumstances, many hospitalized patients do not change enough in their clinical course to require routine middle-of-the-night interruptions. Patient sleep would be improved overnight, literally, if hospitals established new default procedures — for instance: “all patients in non-ICU settings will be cared for under sleep protocols after 36 hours in the hospital, unless the physician indicates otherwise.”

ADVERTISEMENT

There is one problem with making sleep protocols into default procedures — such protocols cut against tradition. “Hospital cultures are very difficult to change,” Bartick told me, “especially when there is so little incentive for hospitals to make those changes.” She explained that the problem is aggravated by low patient expectations: “We are trying to make hospital care more patient-centric, even looking closely at things like patient satisfaction measures. But sleep interruptions do not reduce patient satisfaction, because patients assume that all of those interruptions are medically necessary.” When Bartick and I were each hospitalized, it was not sleep interruptions per se that disturbed us. It was the fact that as physicians, we knew that those morning labs and middle of the night vital signs were not medically urgent.

The irony is that because of increased emphasis on “patient centric care,” hospitals sometimes act more concerned about patient satisfaction than patient health. Perhaps hospitals will change their practices when patients realize that hospitalization and sleep are not always mutually exclusive.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in The Atlantic.

Prev

Your doctor's a jerk: Professionalism extends to the community

July 31, 2013 Kevin 76
…
Next

The medical school interview: Strategies from an admissions officer

July 31, 2013 Kevin 2
…

Tagged as: Hospital Medicine

< Previous Post
Your doctor's a jerk: Professionalism extends to the community
Next Post >
The medical school interview: Strategies from an admissions officer

 

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

Related Posts

  • Social media: Striking a balance for physicians and parents

    Dawn Baker, MD
  • Health care’s hidden problem: hospital primary care losses

    Christopher Habig, MBA
  • Too many older adults are taking risky sedative medications

    Wendy Levinson, MD and Christine Soong, MD
  • How deprescribing in psychiatry offers a path to safer care

    Muhamad Aly Rifai, MD
  • Are hospital CEOs responding to the realities of health care?

    Ammura Hernandez, MD
  • Chronic health issues and homelessness

    Michele Luckenbaugh

More in Conditions and Diseases

  • Shift work and circadian rhythms shape the 24/7 workplace

    Deepak Gupta, MD
  • Telehealth and postpartum psychosis defy simple blame

    Rabia Cheema, MD
  • Underage online gambling needs more than a checkbox

    Kayvan Haddadan, MD
  • Why must fourth trimester care begin after delivery?

    Allison P. Boyle, DPA, PA-C
  • Nutrition during cancer treatment is more than calories

    Dr. Manjari Chandra
  • Why witnessing death outside the hospital felt different

    Denise Moulton, RN
  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • Surgical judgment: the skill no one sees from the gallery

      Mustafa Kemal Çalık, MD | Physician
    • Why haven’t ambient AI scribes boosted productivity?

      Karan Kanwar | Health Technology
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician well-being is not an individual problem

      Heather Buckley | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • Surgical judgment: the skill no one sees from the gallery

      Mustafa Kemal Çalık, MD | Physician
    • Why haven’t ambient AI scribes boosted productivity?

      Karan Kanwar | Health Technology
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician well-being is not an individual problem

      Heather Buckley | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use Agreement
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Hospital care practically guarantees that we won’t get good sleep
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...