Sleep Deprivation as a Social, Organizational and Healthcare Issue (Book Review)

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Alan Derickson, Dangerously Sleepy: Overworked Americans and the Cult of Manly Wakefulness, Philadelphia, University of Pennsylvania Press, 2014

sleepThe topic of this scholarly (a footnote for almost every paragraph) but well-written (not at all soporific!)  book gives an historical view of Americans’ neglect of sleep.  Sleep deprivation may be on very few lists of our top ten problems, but in fact it is a serious social issue that shows much about how our society works.

How much sleep one needs is still a controversial question and probably differs from individual to individual, but seven to nine hours is the generally accepted answer.  In addition, the medical consequences of insufficient sleep are very well known.  Yet 40 per cent of Americans get less than seven hours sleep per night, and we are sleeping on average one hour less per night than in 1942.

Long work hours are the major cause of sleep deprivation.  Derickson shows how the industrial revolution led to increased work hours and how this led to a cult of “manly wakefulness” that denigrated sleep.  Thomas Edison, who claimed to sleep no more than four hours a day and imposed his standards on his associates, is a classic example.

Efforts to reduce work hours and to control work shifts that prevent people from having a normal sleepsleep pattern have of course been made over the years. But the United States remains the most overworked industrialized nation, being the only one without laws mandating vacation time or paid sick days.

The author notes, too, that when reform efforts concerning work hours have been made, the motivation was really not the workers’ health but the adverse effects on those affected by them.  Constant fatal train crashes led to restrictions on railway employees work hours, though exceptions and weak enforcement have limited the value of these. Likewise, fears about airline disasters due to the sleepiness of pilots have given rise to limitations on their work hours.

Yet, as Derickson observes, such gains for certain occupations have not been accompanies by better treatment for those in the same industry.  Railroad and airline attendants have long hours and difficult shifts; yet they were not considered in the movement on behalf of engineers and pilots.

The same pattern can be seen in the healthcare industry, which provides some notorious examples of sleep deprivation caused by overwork.  The case of Libby Zion in 1984, whose death was attributed to too tired interns and residents, resulted in new standards some years later for residents’ hours by the Accreditation Council for Graduate Medical Education. Still, these do not have the force of law, and can be evaded; nor is there effective enforcement.

Subsequently, attempts have been made to reduce overwork by nurses.  Here there is the added problem of people taking additional shifts or jobs to get enough income.  As with doctors, the issue was framed in terms of patient safety, not the health of the nurses themselves. (But one husband of a nurse has filed a suit claiming that she was “worked to death” and addressed in this blogpost.) As a result of lobbying by professional organizations and unions, some states have restricted nurses’ mandatory overtime.

Of course even less has been done for others in the healthcare industry, who are comparatively powerless.  One instance of progress is that home health care emplo6yees working for third parties will be covered by the Fair Labor Standards Act in 2015, but these workers still remain a very exploited class.

Ironically, concern over patients’ sleep is one focus of HCAHPS.  Hospitals that score low on how well patients sleep thus stand to lose money.  But there is no such motivating factor concerning their employees.

How often do doctors advise patients that they need proper sleep? And how much concern do healthcare organizations show over the sleep health of doctors, nurses and other staff?

Likewise, one could say, how many times do doctors tell patients that they should get enough exercise? Yet how many medical institutions provide an employee gym?

Why shouldn’t healthcare companies be a model for organizations on how to promote employees’ welfare?  “Practice what you preach” is good management advice.

jim murphy Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium.  His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices.  Having produced newsletters for several organizations  and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as well as consulting and coaching.


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One Response to Sleep Deprivation as a Social, Organizational and Healthcare Issue (Book Review)

  1. Beth_Boynton_RN_MS says:

    Thanks for your insightful review, Jim. I think you are raising important points about our priorities in healthcare! Once again, the ideas about supporting our workforce as a means to providing safe, quality care are well researched and clear. I also have to say your final question is a profound one! I believe that healthcare organizations have the potential to lead communities towards healthier living and socially responsible role-modeling that answers a very high calling!

What are your thoughts?