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Sleep deprivation contributes to medical errors, affects health care workers' health
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Sleep deprivation contributes to medical errors, affects health care workers' health

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Sleep Deprivation

Ricky Osorio, a registered nurse who works the night shift in UnityPoint Health-St. Luke's emergency department, tried numerous strategies to help him fall asleep.

SIOUX CITY -- Even on his days off, Ricky Osorio, a registered nurse who works in UnityPoint Health -- St. Luke's emergency department, struggled to fall asleep.

He'd drink hot decaffeinated tea, read a book, meditate and picture a beach in Mexico.

"I would lay there for hours," said the 28-year-old Sioux City man, who is a member of the Army National Guard and a student finishing up his master's degree. "It's just really hard to adjust from working night shift to day shift. We work night shift, but the rest of the world operates on day shift."

A growing number of health care workers are suffering from sleep deprivation and fatigue, according to a survey published in the journal Sleep in 2010. Thirty-two percent of health care workers reported getting six or fewer hours of sleep per day in 2007, up from 28 percent in 1985. Seven to nine hours of sleep is recommended daily for adults.

Heather Davis said sleep deprivation is ingrained into the culture of medicine. Davis, director of UCLA's paramedic education program, will give a presentation about how a lack of sleep is making emergency medical services personnel "stupid, slow and dangerous" at the 2017 Emergency Conference, Feb. 24-25 at the Sioux City Convention Center.

After working a 24- or 48-hour shift, Davis said health care workers wear their tiredness and fatigue like a "badge of honor," even though it contributes to medication errors that kill more than 100,000 Americans every year.

A 2006 National Academy of Sciences study found interns who worked just three hours more per shift committed 22 percent more critical errors, which result in increased morbidity and mortality, than their counterparts.

Davis said shift work and long hours combined with the desire to do more in less time is leaving nurses fatigued. Instead of going home and sleeping for seven or eight hours after their shift, she said they're studying for classes, taking care of their kids and running errands. They're also likely picking up more hours at work, as there's a national shortage of nurses.

She said EMS workers make minimum wage, so they may have a second job to make ends meet. Rural areas are served by volunteer EMTs, who are on call at night and work another job during the day.

When his 4-year-old son was younger, Osorio didn't have a day care provider. He would sleep just two hours before returning to work for another 12-hour shift. Approaching 3 a.m., Osorio said he could either be his normal happy self or a bit crabby.

"I'm usually pretty happy all the time now because I sleep a lot more," he said. "We've got day care now, thank god. But still it's hard managing."

Davis said losing two hours of sleep a night over the course of two weeks is equivalent to being awake for two days. She said a person could recover from such a sleep deficit if they started getting adequate amounts of sleep again.

"If it was just the holidays where you were so busy, you would recover from that," she said. "The problem is, for folks who work in health care, it's not just the holidays. It's all the time, so they're chronically sleep deprived."

People who are sleep deprived feel drained and sluggish. They suffer from muscles aches, exhibit crankiness and become easily frustrated. Their decision-making and impulse control are also affected. Researchers at the University of Warwick linked sleeping for less than six hours a night to an increased risk of dying from a heart attack or stroke.

Davis said norepinephrine -- the neurotransmitter most involved in "fight or flight" -- is chronically being released in the bodies of the sleep deprived, raising their blood pressure and heart rate.

She said sleep deprivation also takes a toll on the endocrine system, increasing inflammation in the body and the stress hormone cortisol, which ramps up appetite and leads to weight gain.

"Not only are people packing on the pounds and all the health risks that come with that, but it's really hard to lose (weight) when you're sleep deprived," she said. "If you look around at both the EMS and the health care community, you see a lot of folks who are bigger. Much of it has to do with lack of sleep."

Health care employers are taking notice of the detrimental effects a lack of sleep has on their workers.

When tired employees started running red lights, causing car crashes and driving their vehicles into ditches, Travis County Texas EMS developed sleep safe rooms to help employees get to deep sleep and stay there. The rooms, which are equipped with a bed, clock and fan, are soundproof and feature blackout curtains.

Some hospitals require nurses to wear vests with the message "do not disturb" when dispensing medications. Davis said this safeguard helps tired nurses concentrate by preventing interruptions.

Suzie Fischer, a spokeswoman for St. Luke's, said the hospital works with employees to meet their individual needs including offering sleep rooms to team members who require those accommodations due to extended commutes, weather and other factors.

Davis said getting an adequate amount of sleep has to be a priority for both health care employers and employees.

"Work shouldn't be the only place that you're getting decent sleep," she said. "It is an important strategy for employers in terms of the health of their workforce, but employees also have a responsibility to take care of themselves at home."

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