How Sleep Deprivation Affects Surgeons
There’s a new drug in style and chances are you already know someone who’s fallen into its clutches. Side effects can cause hypertension, cardiovascular disease, neurological impairment, insulin resistance and a host of other serious disorders. In fact, it’s been linked with seven of the fifteen leading causes of death in the United States.
Okay, so sleep deprivation isn’t really a drug nor is it new, but the pressure to stay online in today’s hyper-connected world and the effect it has on the individual, on their work, and on the national economy, is analogous with mass drug use. From the rich and famous, like Martha Stewart and Jack Dorsey, the founder of Twitter, to the inimitable Donald Trump, who all reportedly sleep only 4 hours a night, people are pushing themselves to accomplish more and sleep less.
On a mass scale, studies show that insufficient sleep accounts for up to $411 billion in losses annually in the USA. The US Center for Disease Control and Prevention (CDC) even declared that sleep deprivation is linked to many chronic diseases and conditions, and the detrimental effects of sleeplessness have only recently begun to be studied in depth. Yet already topping the CDC’s list of people affected by sleep deprivation are medical professionals.
The problem of sleep deprivation in medicine
Back in 1984, a young patient, Libby Zion, died in New York Hospital because of a simple, sleep-deprived diagnostic slip made by hospital staff. In response, the state of New York created the Libby Zion law, which limited the working hours of attending physicians to 80 hours a week, or no more than 24 consecutive hours.
|Fast forward thirty-four years to 2018 and the Libby Zion law has been adopted all across the US, yet has hardly been updated. The Accreditation Council for Graduate Medical Education (ACGME) still stipulates that all US medical residents should be limited to an astonishing 80 hours of duty per week, and even that’s only averaged out over a four week period. As if that wasn’t enough, they included a clause that allows them to raise the cap further to 88 hours per week, subject to committee review. That is well beyond double the current average US workweek.|
Even more worrying, the laws also allow for a maximum of 24 hours of continuous duty, with an option for an additional four hours. That means that medical residents could be making life-and-death decisions after 27 hours of consecutive work with no sleep.
Compare that with the EU, where the entire working week is capped at 48 hours in total and anything beyond that is considered ‘unsafe.’ Imagine how safe you’d feel if you knew the medical physician assigned to your emergency may already be exhausted and on duty for 25 hours straight?
If you’re wondering how this translates to medical practice, new research shows that clinical mistakes double after just 12 consecutive hours of work and triple after 16 hours. In a standard 24 hour shift, interns have been found to make up to 36% more serious medical errors than when they are limited to 16 hours or less.
How sleeplessness affects our brains
Clinical research into sleep deprivation is not new, but 2017 saw a wave of fresh interest into this issue, focusing on the specific dynamics of how lack of sleep affects our ability to function.
In one Japanese study published in the Medical Education Online Journal, scientists discovered lack of sleep causes a decrease in the activity of the right dorsolateral prefrontal cortex.
|Even when tasks are performed adequately, the brain function is still limited, especially for routine procedures, such as drawing blood. In contrast, the same study posited the effects of sleep deprivation are significantly diminished when extreme attention and concentration are required. This may partially explain why surgeons don’t show the same signs of fatigue as other medical staff working long shifts.|
A study published last June in Scientific Reports found that people can function fairly well on sleep deprivation while circumstances remain stable and predictable. Once the situation changes, however, fatigued people have trouble making quick decisions and adapting to change. In essence, this study showed that sleep deprivation may impair ‘top-down attentional strategy’ functions rather than the working memory. In other words, you may feel fine and function adequately until you are put in an emergency situation that requires quick thinking and adaptability. In these situations, small clues can be missed and decisions are less dependable.
The practical implications
In day to day terms, these studies indicate that someone who is severely sleep deprived would probably be able to drive a car, but if a pedestrian was to run into the road, or if the car in front were to stop suddenly, the driver’s ability to respond quickly to avoid an accident would be impaired.
When applied to healthcare, this means the long shift hours medical professionals are encouraged to work, significantly increase the likelihood of errors and mistakes.
Far from being our best and brightest, the people we trust to deal with life and death situations are diminished by a simple lack of sleep.
The CDC’s declaration that sleep deprivation is an epidemic, the economic cost and the mountains of new research, all point to the same conclusion: that medical personnel cannot function effectively without sufficient sleep. For all you medical professionals seeing double and day-dreaming of pillows, that means a change is in the wind.