Dr. Glen Greenough, Assistant Professor of Neurology and Psychiatry at Dartmouth-Hitchcock Medical Center, gave a talk last week on the effects of sleep deprivation. The address served as a response to a mandate for DHMC faculty and residents to be educated about fatigue in the workplace in light of the new sleep recommendations issued by the Institute of Medicine.

Recent studies have shown that sleep deprivation increases the frequency of attention lapses, impairs decision making skills, and induces irritability and apathy. By some estimates, behavioral impairment following 24 hours of sleep deprivation is equivalent to that of an individual with a blood alcohol content of .08. In some states, it is illegal to drive after 24 or more consecutive hours of sleep deprivation.

Despite these findings, doctors in the United States typically have 80 hour work weeks and can work for a maximum  of 30 consecutive hours. In Europe, these numbers are greatly reduced to a 56 hour work week with a maximum shift length of 13 consecutive hours.

In a recent study conducted by Landrigan, et al, researchers examined the likelihood of serious medical errors occurring as a result of sleep deprivation. They monitored brain waves of residents at the Brigham and Women’s Hospital in Boston with EEG and recorded over the course of their typical shifts. Meanwhile, physicians constantly supervised these residents . Half of the residents followed their normal shift routine, working up to 30 consecutive duty hours. They placed the remainder of the residents on a non-traditional sleep routine. They allowed the  experimental group towork for no more than 16 consecutive hours and to nap in between shifts.

The residents claimedto be aware of their fatigue and told the researchers that they could accurately gauge how tired they were. However, their brain wave reports indicated otherwise. In the traditional sleep group, 50% of the residents fell asleep for at least a few minutes during their shifts, but they were  not aware that they had. Moreover, these residents were 36% more likely to conduct serious medical errors with patients (as judged by their physician monitors) than their non-traditional sleep counterparts and 5.6 times more likely to misdiagnose their patients.

Another study conducted by Baldwin, et al  found that sleep deprived residents have attention lapse levels much greater than those of sleep apnea patients and only a little less than those of narcoleptics.

Greenough stressed to the residents in the room the importance of fulfilling their body’s sleep requirement, likening fatigue to alcohol in terms of impaired judgment. He urged residents to change many of the common misconceptions about sleep, exclaiming at one point “you can’t adapt to sleep deprivation, and you can’t stockpile sleep!”

Dartmouth students are often placed under similar time commitments as residents. When in risk of sleep deprivation, Greenough suggests free sleep to fulfill the deficit. Brain waves usually take two days to normalize following extreme sleep deprivation. However, when it is absolutely necessary to remain awake and attentive, Greenough recommends exposure to bright light and standing up more often.

Congress is currently reviewing legislation to decrease the allowed number of consecutive duty hours for physicians.