A Nation Short on Sleep
Julie Swidwa, The Herald-Palladium, St. Joseph, Mich.
Posted Nov 20, 2012
When Dr. Steven Culley was in medical school he got little sleep and didn't have much of a social life.
"The first two years were horrible. Classes were in a dark room, from 7 in the morning to 5, and we had to study five or six hours after that and all day on weekends," Culley said. "It's pretty exhausting. Most days I managed to get about six hours of sleep, including naps. You give up a lot of social life and personal life."
In an interview at Lakeland Regional Medical Center, St. Joseph, Culley said he gets more sleep as a resident doctor than he did as a student in medical school.
"Now I usually get seven or eight hours. Our schedules are not like the horror stories you hear, at least not here," said Culley, who in his first year of residency at Lakeland has been working a rotation in the hospital's Emergency Department.
When it's time for a shift change, he said, "Unless your patient is in critical condition, when you're done, you're done. If you stay late they adjust your hours after that so you rest up."
Based on a federal Centers for Disease Control National Health Survey, Culley is in a profession that ranks high on the list of the most sleep-deprived. Doctors are fourth on the list, behind police (third), lawyers (second) and home health aides (first).
And they're not alone.
The CDC reports that more than a quarter of the U.S. population at least occasionally does not get enough sleep, and 10 percent of the population is chronically sleep-deprived.
And, the CDC says, sleep is not a luxury but a necessity. Experts say adults should get seven to nine hours of sleep a night. Insufficient sleep has been linked to a number of chronic diseases and conditions, including diabetes, heart disease, obesity and depression. Sleep deprivation is a serious threat to the nation's health, the CDC says.
Why are Americans so tired?
Dr. Robert Piasecki, a local sleep expert, says the nation's 24-hour-a-day society is partly to blame. In other cases, people have undiagnosed sleep problems that could be threatening their health.
A growing problem
Piasecki is the medical director at Michiana Sleep & Pulmonary Associates in Royalton Township and is a pulmonologist and sleep specialist. He said that in his 18 years as a sleep doctor he has seen an increasing number of people with sleep problems.
He attributes that to growing demands on people's time, the economy -- which has many people working two jobs and odd shifts -- and an ever-growing pressure on people to get more things done in less time.
"Our society says if you want to get ahead, you have to work long hours and go to school. Companies want to be more efficient. But are they?" Piasecki wonders. "And a lot of people are taking care of their own parents to reduce costs. There's people working, taking care of children and taking care of parents."
Working long shifts or working and sleeping at odd hours can wage war with the body's circadian rhythms.
According to the National Institutes of Health, circadian rhythms are physical, mental and behavioral changes that follow a roughly 24-hour cycle. Circadian rhythms are produced by natural factors within the body, but are also affected by signals from the environment like light and darkness.
Melatonin is a hormone that makes people sleepy. The body's "master clock," which controls the production of melatonin, receives information about incoming light and sends it to the brain. When there is less light, as for example at night, the brain responds by making more melatonin, resulting in drowsiness.
Doctoring the doctors
Lorraine Kelly, residency program director for Lakeland HealthCare, said Lakeland uses guidelines set by the American Osteopathic Association to help ensure that its doctors get enough rest. The health care system uses New Innovations, a residency management software program, to keep track of its residents' academics, schedules and lifestyles. Residents work 10-hour shifts of either 7 a.m. to 5 p.m. or 5 p.m. to 3 a.m., with an attending physician on duty at all times who is trained to recognize fatigue.
"They do rotate shifts, but because of the AOA guidelines, if they work a certain number of hours they must have a certain number of hours off," Kelley said. "There's a sleeping facility available, and the attending physician is trained to recognize sleep deprivation and send them for a nap."
Sleep deprivation among resident doctors has been a big topic since the 1980s, when a bereaved and furious New York father, Sidney Zion, set in motion a series of reforms to the medical education system that he believed had killed his daughter, Libby Zion.
Zion alleged that resident doctors in training, who at that time routinely worked 36-hour shifts with little or no sleep, with no attending physician at the hospital, had given his 18-year-old daughter a lethal combination of medications when she was in the hospital for a suspected viral syndrome.
Eventually, the Accreditation Council for Graduate Medical Education made mandatory a list of recommendations from a state commission that reviewed the Zion case. Last December the Institute of Medicine released a report recommending even stricter guidelines.
Culley said that in his residency at Lakeland, "I have more free time than I did in medical school."
Regarding rotating shifts, he said, "When I'm on, I'm on, and it's very easy for me to turn off when I'm home."
Culley, 49, said he has always been health conscious, works out and eats right and has a good sleep environment at home, whether he's working days or evenings.
Piasecki said shift workers face a particular challenge when it comes to sleep. They include people who work at night or change shifts often.
They're fighting against the body's internal clock.
During sleep, Piasecki said, blood pressure and heart rate go down. Shift workers have more medical problems and are more prone to high blood pressure, heart attacks and diabetes because of extra stress on the body, he said.
He said shift work is one of about 85 sleep disorders doctors have identified.
"You're fighting your internal clock that tells you you should be sleeping at night, and you are likely to have trouble sleeping during the day because you have kids or animals, it's light and you don't have a good sleep environment. Phones are ringing, and people are running lawn mowers."
Shut-eye for cops
Cory Peek, 38, is a Berrien County Sheriff's Department deputy. In his 14 years as a cop for three police departments he has spent about seven years total on a night shift. He works from 10 p.m. to 6 a.m. for the sheriff's department and tries to sleep during the day.
"I have a fan for white noise, but it's not dark enough and the phone rings all day," Peek said. "And training, court, everything but the actual shift work happens during the day, so sometimes I get three or four hours of sleep, have court or training, then sleep another two or three hours. I'm also on call as an evidence technician, so the phone rings constantly."
Peek's wife works days, so their time together with their two young children is usually between 5 and 9 p.m., he said. They use baby sitters during the day so Peek can try to sleep.
"We have my mother-in-law a couple days a week and another older lady. They come to the house because it's less hassle than packing the kids up every morning, but that means there's noise during the day."
Peek said his body has never adjusted to the night shifts.
"I don't think your body ever gets used to it. On your days off you go back to sleeping at night. Half the time I don't even know what day it is. I look at the calendar on my watch to see what day it is."
To stay awake and alert on the night shift he stays as busy as he can.
"You do business checks, traffic stops, good police activity. You touch base with citizens at places that are open and communicate with people. And I drink a cup of coffee or two. It's reality. No matter what, police have to be there 24/7. We get acclimated to it as much as we can and stay as focused as possible," he said.
"When you go into the hospital or into the jail, lights are on everywhere, so it's like daytime. But when you're driving around patrolling and it's dark, it reminds your brain that you should be sleeping. To drive around in a car all night long isn't easy. The busier you are, the easier it is. When a call comes in, when you hear those tones and beeps, you get an adrenaline pump."
Sleep expert Dr. Piasecki said if someone comes into his office with sleep problems, even if that person is a shift worker, the staff doesn't assume that's the only problem.
When a patient complains that he or she can't sleep, Piasecki's staff explores other possible contributing causes such as asthma, heart disease, sleep apnea, restless leg syndrome, diabetes or some other sleep disorder.
Piasecki said he discusses any medical problems or lifestyle issues the patient might have and what medications the person is taking. He said that while there are some good prescription sleep aids on the market, many have side effects, and some affect normal sleep patterns.
"The medication stays in the system for a while and can cause morning grogginess," he said. "We also address any sleep hygiene issues. In kids this can be text-messaging at night or using other technology like a computer or TV."
Referring to the 24-hour society, Piasecki said he has had patients in his office whose cell phones start ringing during a sleep study.
The doctor said some people who work a night shift can adjust to it, and the goal is to improve the sleep environment, resulting in better sleep. He suggests using a soothing white noise to reduce the effects of daytime noises, or in some cases wearing small ear plugs. He suggests sleeping in a cool, dark room that is used only for sleep and not for reading or watching TV.
According to the CDC's National Health Survey, workers in these 10 occupations sleep the least: home health aides, lawyers, police officers, doctors and paramedics, economists, social workers, computer programmers, financial analysts, plant operators and secretaries. People in some other professions get more sleep than those 10 but less than the general public.
Piasecki called attention to a recent National Sleep Foundation poll that showed that transportation workers suffer from sleep deprivation more than the general public.
"Usually there's inadequate sleep due to schedules and crossing time zones," he said. "This can apply to pilots, train engineers and truck drivers. In the study, 25 percent of transportation workers said lack of sleep has affected their ability to do their work."
Piasecki said the federal government recently put new rules in place, including that in every 24-hour period transportation workers must have at least 10 hours of straight rest.
Nuke plants, too
There are also government regulations regarding hours worked at nuclear power plants.
"People depend on electricity 24/7, and we have a responsibility to make that happen, so there's people here all the time. Shift work becomes a part of that," said Bill Downey, a spokesman for the Cook Nuclear Plant near Bridgman.
He said Nuclear Regulatory Commission rules govern the number of hours that can be worked in a particular time period by people in jobs that deal with plant operations and security-related functions.
The rules limit the hours and set standards for the number of days workers should have off. In addition, Downey said, the rules require that every nuclear plant train people to recognize fatigue, monitor work hours and document adherence to the rules.
Downey said workers are trained in things such as the circadian rhythms of the body, sleep disorders and ways to recognize and combat fatigue.
"Because working hours are demanding as part of this business, we go beyond regulations and look out for each other. We have people whose entire job it is to monitor and report who is coming and going when," he said. "We take it pretty seriously here. We do it because it's required, but also because it's the right thing to do."
©2012 The Herald-Palladium (Saint Joseph, Mich.)
Visit The Herald-Palladium (Saint Joseph, Mich.) at www.heraldpalladium.com