Archive for the ‘circadian rhythm’ category

Reducing Night Nurse Fatigue

March 30, 2014

Lately it’s been a pleasure to provide an intervention program for night-shift nurses to help them sleep well during the day, and thereby improve their alertness at night. For many nurses working nights a typical shift is 12 hours, often from 7pm to 7:30am. This requires them to function well during the hours that human beings are designed for sleep. Many of these employees like to sleep during the night on a similar schedule to their loved ones when not working, which keeps them in a perpetual state of circadian misalignment, making it even more difficult to function well at night.

In December 2011 the Joint Commission issued Sentinel Event Alert #48 on the effect of extended work hours and cumulative work hours on patient safety and nurse health. They summarize the extensive research on the performance effects of working at night. Some of the results of fatigue include:
– impaired information processing and judgement
– inability to focus attention
– reduced motivation
– loss of empathy
Fatigue among healthcare workers increases the risk of adverse events, decreases patient safety, and negatively impacts the health of the night shift workers.

The Commission report goes on to suggest steps organizations take to improve employee alertness and thereby improve patient safety. Fatigue management typically includes steps for both individual employees and the administration. Sleep training for employees so they can sleep well during the day, and entrain their circadian rhythm to the schedule, is one step. Another is fatigue reducing strategies such as precisely-timed caffeine and light to increase alertness on the job. Administrations can optimize their scheduling practices, and provide an alerting work environment. You can see the full Sentinel Event Report of the Joint Commission here: http://www.jointcommission.org/sea_issue_48/

Over the next 6 months I hope to continue this work for Seattle-area hospitals, and expand to help other public safety organizations that are providing 24/7 service, including the police and fire departments. Around the clock service is a must for public safety, and helping these night-shift staff to sleep well during the day, so they can be alert and healthy during the night is extremely rewarding!

Does a Hot Bath Help Sleep?

May 24, 2012

Many people ask me “Does a warm bath help sleep, or is that just a myth?” The research shows . . .

Yes, it seems to help somewhat. Medical research has investigated the impact of both baths and foot baths on sleep. One study in older people with sleep disturbance found that a 40 minute footbath at 41C decreased wakefulness in the second nonREM sleep period. Women undergoing chemotherapy for cancer have also found increased sleep quality with a warm footbath. Another study done in elderly insomniacs found that a full-body bath (immersed to the mid-chest) for 30 minutes at 40-41C did increase deep sleep, and caused people to experience a good night sleep. .

How does a warm bath improve sleep? Human body temperature is not constant, but varies with a consistent circadian rhythm.  There is a slight dip in body temperature at approximately 1pm, and then a more significant drop in the evening hours.  We get that sleepy feeling as our body temperature drops. The bath effectively raises our body temperature, and the subsequent drop helps sleep. The bath should be about 60-90 minutes before bedtime.

Of all the means you can use to improve your sleep, this one seems one of the most simple, with the least possible negative side effects. This is a good therapy to try first before using other, more invasive medicine.

Sleepy Transportation Workers – Scary!

March 15, 2012

Last week was National Sleep Awareness Week, and the time each year that the annual Sleep in America Poll is unveiled. This year it is all about sleep health in the transportation industry. This data raises concerns about public safety, and the health of the transportation workers. Here’s what pilots, train operators, and professional drivers of all types reported about their sleep.

Sleepiness and Safety
When asked about sleepiness, 1 in 4 pilots and train operators said that sleepiness has impacted their job performance once a week. Even more concerning is the number of professionals who say that sleepiness caused safety issues: 20% of pilots, 18% of train operators, and 14% of truck drivers.

These safety issues persist during transportation employees personal time: 6% were in an auto accident due to sleepiness compared to 1% of those who work in other industries.

The Sleep Schedule
Almost half of transportation workers are dis-satisfied with their sleep. Many say their work schedule does not allow enough time for sleep (44% train operators, 37% pilots). This compares to 27% of non-transportation workers.

Transportation professionals tend to work longer shifts, with less time off between shifts. They also tend to have longer commute times, and irregular shiftwork type schedules.

Adequate Sleep for Transportation Professionals
It’s been a pleasure in my office to help transportation professionals get healthy, natural sleep. This is primarily about strategically using our body’s sleep systems to promote alertness during work hours and sleep during sleep times.

First, create a window of time for sleep that can be as consistent as possible. Also put into place a routine of meal times, exercise, activity – all those things that signal time to the body. Second, reduce the commute as much as possible. Third, use precisely timed melatonin and light therapy to promote sleep at sleep times and increase alertness during the work day. This is a very individualized approach which takes into account the irregular work schedule, commute time, sleep environment, and lifestyle.

Summary

“The margin of error in these professions is extremely small. Transportation professionals need to manage sleep to perform at their best,” said David Cloud, leader of the National Sleep Foundation.  His comment really sums this up, that sleep health is so important for transportation professionals and the safety of the public they serve.

 You can read the report here: http://www.sleepfoundation.org//article/press-release/sleepy-pilots-train-operators-and-drivers

Meet Us at the Bus Stop

January 24, 2012

So . . . how many of you are driving to work at 6:30ish? Ever see a kid suddenly caught in your headlights as they are waiting for the bus?

Over the last months the Start School Later movement has been gathering steam as almost 3,000 people across the nation have signed the petition, and the media has discussed the research showing that students do better when school starts later.

This week, on Thursday January 26th, the Meet us at the Bus Stop event is happening across the country to highlight how early children have to get up for school, so early that they are often waiting in the dark, on cold winter mornings, to catch the bus. Please join in by posting photos or video interviews of your children as they are waiting for the bus on Thursday morming. You can post them on Facebook at https://www.facebook.com/events/279393105455960/

See video from the previous Winter Solstice 2011 event at http://www.youtube.com/watch?v=rl0zvs43wjQ&feature=youtu.be

Sign the Start School Later petition at http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

Better School Start Times

December 31, 2011

Over the last several months national efforts to start school later have been growing, and it’s about time! For over 2 decades it’s been well established by medical research that there is a shift of the internal body clock during puberty. This causes teens to become sleepy later than younger children, and wake up later. This is a physiologic change, and not simply a preference for later socializing or “laziness” in the morning as was sometimes described.

Terra Snider, PhD, has created a national petition calling for legislation to prevent high schools from starting before 8am. When students go to school at times when they are most alert their performance improves, including improved test scores, decreased absenteeism, and increased graduation rates.

This issue is very close to my heart, and of utmost importance. Right out of college, in the early 1990’s, I worked in the research lab of Dr. Mary Carskadon, the leading researcher on children’s sleep/alertness patterns. After a couple years my impression was that a lot was known about this among researchers, but wasn’t being used to make children’s lives better. So although I’m interested in research, I decided to become a physician and help people with sleep problems. Now in my private practice it is striking how many adults say their sleep problems started as teens. For this reason I love to help children with sleep problems in hopes of improving their sleep before they’ve had problems for 20+ years.

Please sign this important petition, then ask your circle of friends to sign it too. http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139.   As of this writing there are 1466 signators across the nation, and growing each day.

There is a wonderful website by Dennis Nolan, JD, summarizing the impact of school start time on student’s well-being at http://schoolstarttime.org/.

If you are inspired to lend your talents to improving student’s lives in this way please let me know, or contact organizers directly.

Sleep Health in the News

March 30, 2011

It’s been fun the last week to talk with several folks in the media, both here in Seattle and on the web.  Here’s the links:

Interview about sleep & social skills with Linda Thomas of KIRO news
radio will air Weds, 5-8am, 97.3 fm
http://www.mynorthwest.com/category/news_chick_blog/20110328/Lack-of-sleep-impairs-teen-social-life/#comments

Interview on sleep needs & performance with Michael Harthorne of KOMO
community news
http://ballard.komonews.com/news/health/specialist-ballard-students-suffering-sleep-they-arent-getting/630340

Interview about insomnia with Myrna Sandbrand, RN on BlogTalkRadio

http://www.blogtalkradio.com/ezsleep/2011/03/25/interview-with-dr-darley

I love to talk to people about sleep health, the may ways it impacts their well-being, and what to do to improve sleep.  If you’d like a speaker for your group let me know, drdarley@naturalsleepmedicine.net.

Understanding Circadian Rhythms at the Molecular Level

March 16, 2011

We’ve talked in the past about circadian rhythms, how there is a daily rhythm of hormone fluctuations that make us more alert during the day, and more sleepy during the night. There are also changes in organ function by time of day. Shiftworkers’ health suffers for being up and active at a time their body is programmed to sleep.

What we haven’t discussed is how these rhythms are established in the first place. Just this week, there was an article published in Science by Lazar and Feng about the circadian rhythm of fat metabolism in the liver.

During the day, molecules modify the liver DNA to reduce fat production. Those molecules leave during the night (so there are 100 at 5am, as opposed to 15000 at 5pm). With those molecules absent, more fat is produced and stored in the liver. The authors conclude “This leads to a circadian rhythm of metabolism that is important, because disruption of this rhythm leads to fatty liver. This may explain in part why altered circadian rhythms in people who do shift work is associated with metabolic disorders.”

There are molecular changes like this happening in many organ systems, multiplying the effect of being out of sync with the natural light-dark cycle.  As our understanding of circadian physiology develops, we’ll be better able to improve the health of shiftworkers.


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