Some people seem able to function after pulling all-nighters, but a new study shows that they're probably not 100-percent "there." Researcher David Dinges of the University of Pennsylvania School of Medicine followed 24 adults after normal rest, and then again after they missed a night of sleep. He found that the brain literally shuts down for a few seconds as a result of sleep deprivation. Okay one minute -- shut down the next. Using magnetic resonance imaging (MRI), Dinges identified several areas of the brain that "frequently faltered" in the sleepy subjects, but not in those who had enough rest.
"Imagine you are sitting in a room watching a movie with the lights on," he said. "In a stable brain, the lights stay on all the time. In a sleepy brain, the lights suddenly go off." Dinges noted that the sleepy person switches back and forth between complete wakefulness and sudden brain shutdown.
You've probably experienced this phenomenon if you've ever been in a conversation with someone who seemed perfectly coherent until he nodded off mid-sentence, only to fade back in a few seconds later and pick up where he left off. Or, perhaps you've found yourself nodding off at the wheel of your car when just seconds earlier you felt alert. And that's the issue that has the researchers concerned -- the fact that brain fade-outs can compromise safety. In fact, the report, published in The Journal of Neuroscience, specifically expressed concern about people who drive when exhausted, noting that a four-second brain lapse could spell disaster.
Certainly, it is scary to consider that those commuters zooming past you on the highway might be sleep-deprived. But it's equally scary to realize that some of the professionals whom you entrust with your well-being -- doctors and nurses, for example -- routinely pull all-nighters.
It's hardly news that medical residents work long hours. A 2005 study by Brown University and the University of Michigan found that doctors on "heavy duty," with an average of only 3.5 hours of sleep, functioned at the same level as if they had consumed three to four vodka cocktails. Earlier concerns about impaired functioning in sleepy residents led the Accreditation Council for Graduate Medical Education to set a new policy limiting residents to an 80-hour work week -- which, as we just learned from the latest study, won't help much.
It's incredible to think that an 80-hour cap on hours worked per week represents a big cutback. And even with the new regulations, the fine print leaves plenty of room for trouble. The 80-hour limit can be averaged out over four weeks, so residents might have a 100-hour shift one week, and a mere 60-hours the next. Plus, the new standards prohibit working more than 30 hours non-stop in one shift -- but a 30 hour shift, by definition, requires an all-nighter, and that means your doctor might be performing medical procedures while in a drunken-like stupor, fading in and out of consciousness. Not comforting, is it?
And the long hours put in by doctors are just the tip of the iceberg in the medical community. According to the International Council of Nurses, "In a large number of hospitals nurses report the existence of a documented policy that imposes mandatory overtime." A study by the University of Pennsylvania Medical School found that 81 percent of nurses aren't able to leave work at the scheduled time. Because of the nursing shortage, twelve-hour shifts are becoming the norm, and many nurses routinely work double shifts.
This spells trouble for both nurse and patient safety. A study last year published in Medical News Today found that about 67 percent of the nurses reported at least one episode of drowsy driving after working overtime. This same study found a strong link between working long hours and making medical errors such as delivering the wrong medication or writing wrong information in a patient chart.
At least in some places, nurses are getting fed up. A few weeks ago, the nursing staff at a Veteran's Administration facility in Illinois staged a protest in response to a contractual requirement that they work overtime. Certainly, the long hours put patients at risk. As the executive director of the Illinois area nurse's union, Henry Bayer, said, "An exhausted worker is a safety hazard waiting to happen. A lot of the accidents that happen are when they are on overtime."
No wonder so many patients go into the hospital only mildly ill and never come out. No wonder the statistics are off the charts for prescribing errors. The upshot is that you'd be well advised to get plenty of sleep yourself in order to keep yourself healthy and out of the hospital, where dozy nurses and drowsy doctors abound, with their brains flickering on and off...like the lights in a prison during an execution by electric chair.