The stuff of nightmares: Sleep deprivation’s devastating consequences
Key Takeaways
Sleep deprivation not only contributes to physician burnout but also poses life-threatening risks to both patients and doctors.
Chronic sleep deprivation can lead to involuntary, brief periods of sleep known as micro-sleeps, putting doctors at risk of making fatal medical errors.
Tragic incidents, such as doctors falling asleep at traffic lights, hallucinating on the motorway, and even losing their lives in car accidents after consecutive night shifts underscore the dire consequences of sleep deprivation.
The healthcare system heavily relies on dedicated physicians who often work long hours under immense pressure to provide the best care possible.
However, around 30% of physicians suffer from at least one sleep disorder, including insomnia, obstructive sleep apnea, restless leg syndrome, and shift-work sleep disorder.[]
These issues can stem from a lack of restorative sleep following night shifts, extended or rotating shifts, on-call duties at night, and taking on extra work to settle debts.[]
Real-life consequences
According to CDC surveillance data, sleep disruptions in healthcare workers have resulted in the following issues:[]
A 36% increase in serious medical errors.
A five-fold rise in significant diagnostic errors.
Twice as many attention lapses during night shifts.
A 61% increase in needlestick and sharp injuries after working more than 20 consecutive hours.
Double the risk of a driving accidents when commuting home after extended work hours.
Additionally, reports indicate a 300% increase in medical errors, leading to patient fatalities.
Medication errors
The risk of procedural complications increases by 1.7 times when physicians get less than 6 hours of sleep.[]
In an interview with The Guardian, a general physician trainee shared a disturbing account of a serious mistake during an exhausting 9-hour shift in the emergency department.[]
Deprived of sleep and basic necessities, such as bathroom breaks and food, the doctor inadvertently administered IV amoxicillin to a penicillin allergy patient, leading to the patient's collapse.
The doctor immediately realized the error, and the patient was saved with prompt treatment.
Another medical professional, a consultant, confessed that they were oblivious to the debilitating effects of sleep deprivation. “My sleep deprivation affected my daily work, and I didn’t realize it until a near miss happened. I’m now off the on-call rota on health grounds.”
The worst of it
To highlight the tangible consequences of sleep-deprived doctors, we turn to a poignant case that has left an indelible mark on the medical community.
In March 1984, 18-year-old Libby Zion tragically lost her life at New York Hospital due to a medication-prescribing error while under residents' care in a grueling 36-hour shift.[]
This devastating incident served as a wake-up call, bringing attention to the potential reduction in patient safety from physician fatigue.
While it is challenging to definitively pinpoint lack of sleep as the sole cause of adverse patient outcomes in every case, the evidence overwhelmingly suggests its strong influence.
Impaired empathy and pain management
A recent international study conducted by American and Israeli researchers discovered that resident doctors were less inclined to prescribe pain medication during night shifts compared with daytime shifts. This trend persisted after accounting for other confounding factors, suggesting decreased empathy among physicians for patients’ pain during night shifts.[]
“When fatigue sets in, we in the medical and nursing team are less empathetic with patients and colleagues, vigilance becomes more variable, and logical reasoning is affected, making it hard for us to calculate, for example, the correct dose of drugs a patient might need,” a consultant anesthetist told The Guardian.[]
A danger to themselves
Dr. Ronak Patel, a 33-year-old trainee anesthetist, tragically lost his life in a car accident after three consecutive night shifts at Norfolk and Norwich Hospital.[] Other doctors have admitted to falling asleep at traffic lights and hallucinating on motorways.
In a 2022 study on physicians, those with less than 4 hours of uninterrupted sleep while on call had a significant 3.11-fold increase in the risk of motor accidents.[]
While current strategies primarily focus on reducing work hours, this may only mean less time to do the same amount of work. Future research should prioritize finding other approaches, like night float schedules, to ease workload pressure.
What this means for you
Prioritizing adequate sleep, advocating for better scheduling, and promoting mental health support are essential steps to prevent accidents and errors related to sleep deprivation. Workplace safety measures can also help prevent these accidents. Being well-rested is the best way to ensure you are providing your patients safe and compassionate care.