Sleep… nature’s healer. So why is it the last thing you’ll find at a hospital?
During my one-month stint as a Children’s Hospital parent, I learned that hospitals and the entire approach of western medicine is in sleep denial. Here’s why that’s a problem and how we can reshape health and healing to abide by nature’s greatest doctor, sleep.
I’m a cognitive neuroscientist in the department of Cognitive Sciences at UC Irvine. I would like to tell you a personal story that illustrates both the central theme of my research, which is to understand the importance of sleep, and one of the critical health problems that we face in our culture today, namely that medical science is in “sleep denial”.
When my son was one year old he had emergency brain surgery to fix an arachnoid cyst at Children’s Hospital Los Angeles (CHLA). I am very grateful to the staff, nurses, and doctors who expertly discovered and then mended this major obstruction in my son’s development. They saved his life, and today he is a happy healthy kid. I remember the moment he emerged from the operating room and the brain surgeon gave us the thumbs up, I felt such a crashing wave of relief realizing we had somehow survived a horrible disaster.
My story really begins when he was admitted to the ICU and later to the regular wards due to a secondary meningitis infection. But this isn’t a story about his harrowing baby bravery, or my mama bear bedside vigilance, or the crippling medical costs that took one year of patient negotiation between my then-husband, Will, and the insurance company to pay. Despite the excellent treatment we experienced at CHLA in all other areas, I’m going to describe the hospital’s complete and total disregard for my child’s sleep and the institutionalized denial of this most vital, natural healing resource that is completely free of charge, more powerful than many remedies that come in a pill, but bafflingly ignored by medical science.
During my one month stint as a Children’s Hospital parent, I learned that hospital sleep blockers can be categorized into three groups: 1) noise polluters, encompassing all the beeping and hissing medical monitors in every hospital room; 2) light polluters, including the non-adjustable, unvarying light levels during the day and night; and 3) sleep ignorance, evinced by the casual indifference for my son’s nap and nighttime sleep schedule by doctors, nurses and hospital staff.
Let’s start with the noise polluters. During our four-night vigil in the ICU, my baby was wired to the hilt with medical recording devices strapped, taped, and plunged into every possible orifice or patch of naked skin. This made sense, since he and the other unfortunate kids on the ward were recovering from trauma and this all-hands-on-deck effort includes checking vitals every four hours at least. What doesn’t make sense, however, was that all these wires were connected to stand alone monitors that surrounded his crib with bright, flashing lights and constant boisterous beeping.
The beeps fell into two categories. The first was a systematic, high-pitched, moderately loud tone alerting the reluctant listener that everything was A-OK. Thanks, pal. The second alarm would occasionally pierce the atmosphere so robustly that anyone within a distant radius would feel the hairs stand up on the backs of their necks as their fight-or-flight autonomic nervous system was put on guard. This tone informed the listener that something was drastically wrong with one of the vitals or alternatively that the medicine pump was just empty. Same alarm, different meaning, no rest.
As I sat staring at this feisty little honey-badger-of-a-baby for four long days, I asked myself time and again the same questions: Why were either of these alarms designed to ring inside his room, instead of at the nurse’s station? What could my son possibly do with this information? How did it benefit him that every time he began to relax his seriously injured brain into sleep, he would be jolted awake by an auditory intrusion?
Of course, these alarms are not meant for the patient or caretaker, but for his nurse sitting at his station a considerable distance away with a closed door between himself and the demanding calls. Perhaps the nurse’s station was equipped with other flashing lights and annoying beeps that kept him abreast of my son’s condition, but it appeared to me that the nurse only responded when the alarm volume in our room was turned up to 11, Spinal Tap style. After much trial and error, Will and I figured out which secret code of buttons allowed us to hack the system in order to turn down the volume control and then physically go get the nurse when neededd. But, these devices have no mute, so we could never get rid of the sound completely, and hence nobody ever really got any sleep or rest.
The second sleep antagonist pervasive in the hospital setting is light pollution. Your body and mind follow biological rhythms that are regulated by light. The presence of light, blue light specifically, sends signals to your brain to rev up the sympathetic nervous system, increase the stress hormone cortisol to boost arousal, go out in the world and forage for food, learn something new, meet a possible friend or foe, defend yourself and your cave mates, and possibly, buy a new car. All these Upstate activities make life exciting and meaningful, but they also drain your batteries. To stay balanced, you need an equal and opposite force of rest and restoration that happens in periods called Downstates. While the dawn and high noon sunshine radiates alerting blue light, the evening sunset is a natural bath of fiery red and orange, similarly the warm glow of fire light by candle or campfire. Even old-fashioned tungsten light bulbs emit warm, long wavelength light that mirror fire light and don’t mess with your biological rhythm. These evening colors shift your mind and body to the low power mode of the Downstate when your autonomic nervous system amplifies rest-and-digest RESTORE functions that calm down your cardiovascular and metabolic systems, clean out the toxins that build up from a day of activity, initiate the consolidation and integration of your recent experiences into long-term memories, and promote dreams that help solve your most creative quandaries.
Now think about your local Walmart’s brightly lit parking lot, gas station convenience store, or any hotel lobby. These 24-hour artificial light landscapes emit constant blue light signals into the environment that confuse the hell out of your circadian rhythm, making you lose track of exactly when your heart, guts, and endocrine system should be racing into the Upstate to keep you alert, awake and ready for action, versus when you need to be diving in the quiet of the Downstate to repair tissues and release restorative neurochemicals, including growth hormone, prolactin, and satiety hormones.
In my son’s room at the CHLA ICU and later in the hospital room where he and I camped out for four weeks, we had no control of the ambient light, which was LED-heavy on the blue light part of the spectrum. We could not reduce light for his daytime naps or for the recommended 14 hours of consolidated nighttime sleep for a one-year-old baby. Conversely, the room was designed such that he also never experienced bright light from the sun, or an equivalent light box, and therefore never got the appropriate waking signals to his brain either.
Under constant ambient lighting the mind gets disoriented about time and place and cannot maintain a consistent pattern for basic functions, such as when to eat, sleep, and poop. In fact, extended stays in the ICU can result in “ICU psychosis”, in which patients become paranoid, hear voices, feel mistrustful and afraid of the hospital staff, and even violent. Even caregivers are vulnerable to ICU psychosis because the same time warping, day/night melting, crazy-making, beep-filled hell sinks its claws into them too. Since every organ in your body follows a rhythm of Upstates and Downstates. This topsy turvy world can even affect recovery from medical interventions. Consider that during your biological Upstate, your organs have more efficient metabolism and therefore respond better to medication, whereas during your biological Downstate, your organs require more medication to get the same level of benefit. For example, a single daily five thirty p.m. dose of inhaled corticosteroids is as effective at treating asthma as four doses spread throughout the day. Cancer cells are more active during the day, meaning evening chemotherapy may have the advantage of sneak-attacking malignant cells when they least expect it, nearly doubling their tumor-shrinking capability. See this recent New York Time article on the topic of circadian medicine.
All this to say that light confusion in the hospital setting can actually increase pain and prolong suffering. This is not something you want working against you when you are recovering from brain surgery at any age. But this is exactly the mayhem that modern day hospitals wreak on patients every day.
The hospital also kills sleep because nobody seems to have heard about it — or understands its importance. There was no evidence that my son’s sleep was considered in scheduling visits with doctors, specialists, and nurses. I had to turn away a janitor at 9pm who wanted to clean his room, a 2am fleet of specialists who finally had time to discuss his blood panel, and ask that the 6am grand rounds to visit my son last on their morning parade. He had just had brain surgery, but there seemed to be absolutely no awareness of the damage that they were doing by not letting him have his regular naps and his uninterrupted nighttime sleep.
This sleep denial behavior felt especially shocking given that every time I have met a nurse or doctor in any context other than as a mother of a patient, they tell me that lousy sleep is their biggest personal problem. But of course, a system that doesn’t give its patients the gift of sleep, doesn’t do any favors for its staff either. In fact, the average medical student only receives a total of two to three hours of sleep medicine eduation in their entire five years of medical schooling, suggesting that doctors may not know what they and their patients are missing. Think about that for a moment: something that we do for a third of every day and our lifespan, is barely discussed when physicians-in-training are learning to heal people. That is, medical students may spend more time learning about rare infectious diseases (that they are likely to never see in a patient) than learning about something that each and every patient does every day. This needs to change.
Now I am a sleep scientist and a nap expert with two popular books on the topic of restorative rest and sleep and a career advocating for the vital importance of sleep for human health and cognitive function. This knowledge gave me significant confidence in requesting that the hospital staff organize their visits in groups, so all the work that needed to get done could get done with the least amount of disturbance to my son’s sleep. I posted signs on my son’s hospital door when he was napping and when he turned into a pumpkin for the night. And even though quite a few nurses told me that they were personally aligned with my emphasis on sleep, this approach was far from the standard hospital practice.
Notably, my son was being treated at a children’s hospital that was ranked the №1 in California, and we received the greatest care in many facets of our treatment. But as far as I could see, all these accolades did not translate to smart medical practice in terms of sleep. And if this is the state of one of the best U.S. hospitals, what might be happening in smaller institutions here and around the world? Perhaps it takes a sleep scientist and mother, who shared the misfortune with so many other parents of having her dearest treasure need hospital care, to recognize this absurd state of affairs that removes our most critical healing process from the hallowed halls of medicine.
To protect our children and all the weak and ailing, we need to do more than just recognize the problem; we need to change the culture of medicine and the culture at large. The good news is that these changes are relatively simple and require little in the way of money or new technology. They require replacing the noise and light polluters with better messaging systems and circadian light bulbs, organizing medical visits in such a way that patients’ sleep is a priority. They require more time spent on sleep science in medical school and more probing of sleep habits and potential disorders by family physicians. Sleep disturbance is one of the first signs that something isn’t right with your body and/or mind, and chronically poor sleep is strongly associated with anxiety and depression; attention and memory deficits; hypertension and cardiovascular disease; diabetes and obesity; dementia and Alzheimer’s disease; and all-cause mortality.
Change of this magnitude will take a village. We can build one together.
