The Insomnia Blog by Sleep Doctor Michael Breus, Ph.D.

The Sounds and Sleeplessness in the ICU—Part II

Earlier this week I covered a new study that points to the disturbing effects (literally) of noise pollution in intensive care units. The second half of the article discussed several methods to reduce noise and their effectiveness. 

Some of the methods examined in the study to reduce such noise included the following:

• Earplugs/earmuffs on patients (self-explanatory)
• Behavioral modifications: Enforcing stricter rules among hospital staff so they are more aware of how much noise they are making. This is the “tone it down!” strategy, which entails establishing set quiet times during which the ambient light is lowered, alarms are cut down in intensity, and phones, televisions, and radios are turned off 
• Sound masking: The use of white noise machines to neutralize certain noises.
• Acoustic absorption: The use of certain materials like foam to dampen noise levels.

Not surprisingly, all four strategies to lower the noise proved effective. But surprisingly, sound masking beat out the sound-absorbing treatment. That’s good news for people who want to take a study like this and apply it to their bedroom setting at home. Far from an ICU, yes, but the two places share much in common.

It helps to think of your own bedroom as sanctuary for recovery much like an ICU. Applying these techniques at home can be equally as effective, if not more so since you’re not simultaneously battling serious health challenges (hopefully!). While I don’t expect you to install sound absorbers in your walls, the top three ideas are quite practical:

• Earplugs: these are inexpensive and available at most drug stores. I like the foam ones that expand in your ear canal.
• Behavioral modifications: evict the gadgets and machines from you room; if a television is a must, set boundaries so you’re not letting it encroach on your bedtime turf. Have a “lights-off” time set (and don’t fall asleep with the TV still on!-there are TV timers on most TVs today.)
• Sound masking: white noise machines can be incredibly powerful in axing out any background noise. Many clock-radios have built-in white noise makers, or you can try an oscillating fan. Some find the rhythmic beat of a fan to be very calming and “white-noise”-like.

My hope is that hospitals heed the lessons from studies like this one, and learn how to minimize unnecessary noise to maximize the very purpose those facilities serve—to spur the healing process and foster recuperation. Which is exactly what your bedroom is supposed to do. The ICU is a special place. And so is your bedroom.

Sweet Dreams,
Michael J. Breus, PhD, FAASM
The Sleep Doctor

Click here to see Dr. Breus's list of recommended sleep products. Click here to order his book, Beauty Sleep, on Amazon or Kindle.

The Sounds and Sleeplessness in the ICU—Part I

Noise. Whether it’s the blare of traffic and the hustling sounds of a city, or just your neighbor’s barking dog and lawn mower cutting into your Sunday snooze, noise pollution is something we all have to deal with to some degree. But what about indoor disturbances—in a hospital when you’re lying in the Intensive Care Unit?

I know, it’s not something we think about much, which is partly why there hasn’t been extensive investigations into this arena. But a fresh study out of the U.K. sheds some fascinating light on this subject.

Not Fit to Fly

It’s hard to legislate sleep. As an employer you can certainly set rules and guidelines, hoping your employees show up refreshed and ready to perform, but you can’t really enforce or police it—even when lives depend on it.

Hearing about the fatigue factor involved in Continental’s February plane crash on a cold, icy night near Buffalo, New York has been horrifying. According to the latest reports from the NTSB, the main cause of the crash is being blamed on the crew’s lack of experience and lack of sleep (lack of proper conduct in the cockpit, too, which certainly stems from a lack of experience and sleep).

Have you ever wondered:

• When you step on to a plane, how alert are your pilots?
• Have they just gotten off a transcontinental flight and haven’t slept in a day—or two?
• Have they been working the graveyard shift and catching some Zs on a couch in the terminal before taking control of your plane?
• Are they feeling fuzzy and spacey as they continue to fight a nagging cold bug (which really prefers them to be sleeping more)?
• How much does sleep factor into performance…even when an emergency happens suddenly?

To quickly answer that last question, sleep plays a huge role in the ability to perform, even when it comes to basic skills we’ve done over and over again. And thinking about our pilots’ alertness is probably not something that enters our minds as we’re boarding planes and getting organized in our seats, but the thoughts are crossing millions of grounded minds this week as more news emerges about the fate of that February ride.

Are You Fooling Yourself?

There are plenty of stories about famous short sleepers to go around. Among those who claim (or claimed, as some are no longer with us) that they do perfectly well on four hours of sleep are Jay Leno, Madonna, Michelangelo, Napolean Bonaparte, Florence Nightingale, and Thomas Edison (whose invention—the light bulb—forever changed our sleep habits). Winston Churchill got by on six hours, and Leonardo Da Vinci kept one of the most outrageously crazy sleep schedules, sleeping 15 minutes every four hours day and night.

If you’re a short sleeper, which is technically defined as someone who gets fewer than 6 hours a night, are you living well off that brief sleep? Are you catching more Zs during the day in the form of a nap? (Which, by the way, is how some of the aforementioned geniuses got by. Churchill took a complete 1.5- to 2-hour nap in the afternoon—and he undressed and got into bed.)

Well, if you think you could use more sleep time, you’re probably right. And science continues to reveal what sleep deprivation can do to us (other than make us tired and cranky). The National Sleep Foundation recently released an alert pointing to new evidence: people who average fewer than six hours a night could develop prediabetes. And you know what that leads to: full-fledged diabetes.

Oh Canada, Get Some Sleep!

A recent study I read showed some interesting aspects about the sleep of our friends to the north, and they seem to be as bad as ours here in the US! The study recently published in the journal Sleep explained the economic cost associated with sleep disorders in Canada. Here are the bullets (all in Canadian $):

• total annual cost of insomnia (direct and indirect) in the province of Quebec was estimated at $6.6 billion
• prescription medications ($16.5 million)
• over the-counter products ($1.8 million)
• alcohol used as a sleep aid ($339.8 million)
• The total estimated annual cost of alcohol used for promoting sleep was $51.1 million spent by people with insomnia syndrome, $211.2 million by those with symptoms of insomnia and $77.5 million by good sleepers.

What everyone seems to be making a big deal about is the alcohol consumption number.  My question is WHY?

Has Your Doctor Had a Nap?

It’s long been known that doctors in training don’t get much sleep. They endure long hours in teaching hospitals and double shifts. Which is why I was happy to hear about a new report that urges rest breaks during 30-hour shifts.

You heard that right: 30-hour shifts. The most recent recommendation is to allow for a 5-hour break for sleep after the first 16 hours.

It’s hard to believe that the first caps on extended working hours in medicine came just five years ago when regulations limited docs to about 80 hours a week. In reality, that still meant logging upwards of 100 hours of work but reporting only 80.

Now, a panel from the Institute of Medicine is encouraging a step further, which may or not may fly (I’m guessing the latter, unfortunately).

I remember my own dog days of graduate school. I got pretty good about taking naps when I needed them. The sleep deprivation not only affects a doctor’s ability to treat patients and be adept to handling emergencies—not to mention learning how to be a doctor!—but it also has other consequences. Think about doctors driving home as bleary-eyed as a someone with a few too many drinks in them.

This news comes the same week another report (The American College of Emergency Physicians’ 2009 National Report) points to how bad our emergency care system is on a national scale. In a word: FAILING! It mentions a widespread shortage of doctors and nurses. Hello! That’s not going to help doctors get more sleep. Maybe schools should be educating more health care practitioners and encouraging more people to enter this profession.

Just don’t tell them they’ll never sleep again. Maybe we will see reform in all areas of the medical industry soon. Doctors seem to work miracles on a daily basis. But they are still human, and there’s no miracle that can make up for lost sleep. 

Don’t Take the Election TOO Seriously

Highly emotional moments can be stressful… and deadly. I think we all know someone who has been taking the election so seriously that thoughts of their party losing has them contemplating a move to another country.

But too much can be, well, too much. Take Terence Tolbert as an example. Working tirelessly for Obama as his campaign director in Nevada, he died of a massive heart attack Sunday night while driving alone near the offices in North Las Vegas. He was a young 42.

While I cannot speculate that the campaign had anything to do with his death—for all we know he could have had a congenital defect in his heart or some such and would have died even under the least stressful situations—I think it’s fair to point out that when someone young dies suddenly under a very stressful job situation or environment, you have to wonder.

Within days before E-Day (the actual election), McCain and Obama crisscrossed the country with very little sleep to capture last-minute votes. McCain even held a rally in his home state long after midnight. What does that do to a septuagenarian? Obama was caught yesterday giving a talk in Florida thinking he was in Ohio. The sleep deprivation is definitely taking its toll and spotting his memory.

We were all blessed (except for the candidates, no doubt) with an extra hour of sleep the other night, and it could have meant more than you think it did. The end of daylight savings could not have come at a better time this year, as a new study shows the impact that one extra hour can actually have on you.

And you can thank the Swedes for finding this: the extra hour of sleep we gain from turning back the clock may protect us from a heart attack. We’ve long known that Mondays tend to be “heart attack days.” Because they are usually considered the worst day of the week for many, there’s a pattern of higher heart attacks on Monday morning as people dread the new work week, stressful thoughts rush in, and there’s an uptick in activity following the restful weekend.

After poring over 20 years of records, Swedish researchers discovered something else is actually going on. Time shifts negatively affect our biological rhythms, but when those shifts offer more sleep, there’s a 5 percent drop in Monday Blues heart attacks. Pretty amazing, don’t you think? Yet another example of how sleep really has an impact on our stress level and ability to cope. In the spring, when we “spring forward,” there’s an increase in heart attacks after that one-hour loss of sleep.

So what’s my point here? Well, today is a very stressful, exciting, and activity-filled day for millions of Americans. If there is no clear winner by suppertime, how many will stay up late watching the coverage on television? How many hearts will sink—or race like a rabbit—when their candidate loses or wins?

Take heart: this is an historic election. Experience it in stride. Whatever the outcome, great reform and change is likely on the way. Just don’t take is so seriously that it ruins your health. Or you may not be around to watch this next president in action. (And if you’ve been emotionally involved in this election for the past 18 months, then think about all that accumulated stress. You, more than anyone, need a good night’s sleep.)

Vote early. And get to bed early!

Get Sleep, Get Smart, Get Sane

It’s hard not to comment on the financial doom surrounding us this week like a darkening tunnel, but I want to point something out that’s very positive and that can potentially help you to navigate these uncertain times. It’s the value sleep can have on your smarts. Yes, you read that right: sleep can make you smarter. And saner.

Unlike a stock that you buy and declines in value (with your sanity), if you buy yourself more sleep you could add value to just about everything that makes you, well, you. And perhaps one of the best payoffs to more sleep is getting smarter. Simple as that. A sharper, wittier mind can make better decisions, manage stress more easily, put things into perspective, and generally make sense of a world that oftentimes seems so crazy and out of balance.

An article I read online yesterday reminds us just how critical sleep is in our ability to maintain our wits. It’s no joke that sleep increases our judgment, creativity, and memory. Our bodies may be resting up and repairing before the next day at battle, but our minds are hard at work in the night—performing all the actions that need to get done behind the scenes for us to be able to learn new things, complete difficult tasks, solve challenging problems, and capture profound memories the next day so they don’t just dissipate. In fact, memories can have emotions attached to them, which help us keep track of what’s safe or not, what brings us joy or pain. Those memories could be critical to our survival, and sleep is what allows us to keep them.

I say all this knowing, though, that sleep is so hard to come by, especially given our current economic climate. You may be watching the news like a hawk and having nightmares about your retirement fund. You could be worried about your job and ability to pay the bills next month. None of this bodes well for a good night’s sleep.

This week, I have a 3-piece recipe for you to try; get our your daily agenda or calendar out and mark these down as reminders:

1. Within EIGHT HOURS of bed (between 2:00 and 3:00 PM for most people): quiet the caffeine and sugar. Stop consuming highly-caffeinated and sugared beverages. What I’m really getting at here is halting coffees and sodas. We tend to drink them mindlessly, then wonder why we’re wired and tired, and having a hard time sleeping later on. All that sugar and caffeine will feed your worries and distort your perspective. 
2. Within THREE HOURS of bed:  quiet your mind by eliminating all sources of stress and anxiety. This means avoiding certain conversations, work, media (including the Internet), and anything that will bring stressful topics to your eyes and conscious.
3. Within ONE HOUR of bed:  quiet your body by engaging in an activity that is soothing, relaxing, and pleasurable. It could be a warm bath, light reading, light stretching, or even sex. Have a cup of herbal tea if you like.

Keeping the mind nourished and nurtured is much easier that you think. The mind is a terrible thing to waste in sleep deprivation. Remember, get sleep to get smart! It also helps to remember this: stocks are NOT necessary for survival, but sleep is. The more refreshing sleep you get, the saner life seems to become.

Tired Teachers

I’ve written a lot about sleep-deprived parents, kids, and students, but I don’t think I’ve given teachers the nod lately, if ever. 

According to a new Ball State University study that I just read about online, teachers in the US are among the sleep-deprived and admit to being “impaired” in the classroom. The total cost of this deprivation across the US (not just among teachers) is estimated to be $100 billion annually from workplace accidents, decreased productivity, and absenteeism. Yes, that’s billion with a B. Where’s the bailout plan for that?

Sleep Got Your Tongue?

Have you been drinking? Or are you just sleep deprived?

Check it out: Discovery news is reporting a new study that indicates a lack of sleep changes the brain to such a degree that without enough, you might sound drunk.

The study that supports this finding got downright technical and nit-picky, to say the least, over words. But the results were not surprising: sleep-deprived speakers gradually lost their ability to articulate, producing fewer detectable landmarks.

“Landmarks” are the crisp articulations of clear speech, such as that the puff of air we release when producing “t” or “k” sounds (didn’t I say it got technical?). The computers used in the study could actually detect these subtleties. Oddly enough, however, when such sleep-deprived people hear themselves, they think they sound fine. Like a drunk who thinks they haven’t had enough yet and can walk and talk like normal.

Research like this isn’t just for kicks. It can be used to train 911 employees, communication professionals, and therapists who work with the hearing impaired.

It’s also a reminder, though, for all of us who’ve ever tried to get through the day “drunk on sleeplessness.” You might want to avoid important conversations, like job interviews, speeches, and deal-making. And don’t get pulled over by the cops.