The Ethics of Healthy Sleep in Hospitals
The Hippocratic philosophy of medicine regards the good treatment of the whole patient—body, mind, and soul—as a paramount goal. The foundational guideline for Western medicine, the Hippocratic Oath, proclaims a physician’s duty to avoid harming patients. This is indeed wisdom from the ancients that modern health care would do well to ponder.
I recently spent four nights in a hospital following a V-tach cardiac episode. Except for the first night, when I was heavily drugged, I hardly slept more than a few interrupted hours. This experience is not unusual. Almost everyone I know who has spent time hospitalized has commented to me on the sleep deprivation they suffered during their stay. One ironic story happened to the father of a friend. His dad was in a Veterans Administration hospital with several patients to a room. The noise and disturbances prevented him from sleeping well. One night, after he had finally fallen into a deep sleep, a nurse roused him—just to give him a sleeping pill.
Several years ago, when my own father was in the hospital during his final illness, family members took turns spending the night with him in his hospital room. It brought great comfort to my dad to have loved ones at hand, especially since he was suffering from dementia but still recognized my mother and his children. A vivid memory from that time was the total inability of my papa, or others in the room with him, to get a good night’s sleep. Hospital staff came by for various reasons all through the night. Noises, lights, and even overhead announcements came at random, disruptive intervals. I was completely healthy but felt shattered from lack of rest each morning after only managing to snatch a few moments of sleep whenever I stayed overnight with dad. My father was critically ill. This lack of sleep certainly made his recovery even more difficult.
Sleep deprivation is a serious and well-documented health issue. The US Centers for Disease Control and Prevention estimates that more than a third of adult Americans between the ages of 18 and 60 do not get the minimum of seven hours sleep needed each night to prevent multiple adverse health effects. Anyone who goes completely without sleep for 24 hours will typically start to experience a whole range of symptoms such as impaired judgment, lack of ability to concentrate, coordination problems, short-term memory loss, irritability, and higher levels of stress hormones and blood sugar. These symptoms and others only worsen as an individual falls deeper into “sleep debt,” a medical term for all the hours someone with poor sleep patterns accumulates, over time, below the minimum required for healthy living. Chronic lack of sleep can contribute to serious mental health problems like paranoia, depression, obesity, diabetes, and deadly cardiovascular diseases. Evidence already suggests that the COVID-19 pandemic has aggravated the insomnia many Americans face.
Modern medicine seems to theoretically understand the importance of sleep for our health. But frequently hospital settings do not prioritize this vital need of patients. Studies estimate, for instance, that 75% of intensive care unit (ICU) patients only manage to get “poor” or “very poor” sleep. A major barrier to improving the situation comes from routine assessments and actions that occur at regular intervals in a hospital setting, whether the patient is asleep or awake. When I was in the cardiac ICU, a blood pressure cuff on my arm went off automatically every 30 minutes, day and night, squeezing my arm so tightly that it was very hard to sleep through it. Once I was awakened at 3 a.m. by a lab technician to draw blood. I simply could not believe this was a routine practice.
It is stressful enough to be in the hospital. It is uncomfortable to have catheters and intravenous (IV) lines in your body while monitors beep or flash around your bed. On top of all that, as a patient you can expect to be regularly awakened in the middle of the night or very early in the morning. This adds insult to injury and actively harms patients by depriving them of needed sleep. The health consequences of this problem raise it from the level of a nuisance—one that everyone complains about but puts up with—to a significant medical bioethics issue that must be addressed.
The ethics of Hippocratic medicine puts the doctor and other health professionals at the service of the patient. Clearly some medical policies ignore patients’ need for proper sleep and prioritize instead the convenience and schedules of hospital workers. Much of the technology of modern medicine does not facilitate sleep either. One of the doctors who came to my bedside agreed that this is a common problem in hospitals and mentioned that some institutions have changed their policies to minimize disruptions between midnight and five in the morning. A few of my nurses were more attentive than others in doing assessments with the bare minimum of disruption, often by “clustering” some interventions and postponing others to promote more sleep. Sadly, however, this kind of compassionate attentiveness to what is best for the patients seems to be more of an exception than the rule.
Major reform is needed in this area. When I came home, I slept almost 12 hours straight the first night. Through successive nights I made up much of the sleep debt I had accumulated in the hospital and felt noticeably better. Catholic health care ministries, in particular, should develop a special interest in this area of hospital reform. When St. Padre Pio founded a hospital, as part of the facility’s inaugural tour he insisted to the medical staff that this hospital is for the good of the patients, not the doctors. The Catholic health care ethos is to follow the example of Jesus, the Divine Physician, and that clearly means putting the needs of patients ahead of what is most convenient or practical for hospital workers.
Trying to facilitate healthy sleep for patients should rank far higher in the medical priorities than it currently does in too many hospitals. I experienced the problem firsthand, and the NCBC will be taking this issue seriously.
Copyright © 2020, The National Catholic Bioethics Center, Philadelphia, PA. All rights reserved.
