Why Nurses Need More Sleep

By Jennifer Larson, contributor
May 9, 2012 - It’s mid-afternoon, and your energy is waning. You’re sleepy and a little cranky, so you pour yourself another cup of coffee to propel you through the rest of your shift. How many cups have you already had? You’re trying not to think about that.
It’s a scene repeated daily in hospitals, clinics and offices all over the United States. Many of us function on less sleep than we really need, so we adopt survival mechanisms to help us.
In fact, a report in the April 27 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report noted that about one-third of the U.S. workforce gets six or fewer hours of sleep per night. That’s at least one hour less than the National Sleep Foundation’s recommended amount of nightly sleep, which is seven to nine hours.

“We have this idea that we can be a 24-hour society and function well,” said Arlene L. Johnson, Ph.D., RN, a nursing researcher at George Mason University, who has studied sleep and performance in nurses.
“But it’s not true.”
Common signs of inadequate sleep include mood swings and irritability, an increased inability to concentrate, memory problems, weight gain, and of course, feeling drowsy or tired during the day.
“Getting by” on less sleep than you really need isn’t the ideal way to function. For one thing, it could have serious consequences for your patients. You may not be alert enough to deliver the top-notch care that your patients expect from you--or that you expect from yourself. You might even make a mistake.
Chronic sleep restriction affects your critical thinking skills, noted sleep expert Michael Decker, Ph.D., RN, the Byrdine F. Lewis Chair in Nursing and associate professor in nursing, neuroscience and respiratory therapy at Georgia State University.
“As a person suffers reduced sleep, their reflexes become slower and their decision-making skills become reduced,” said Decker, one of only a handful of registered nurses certified by the American Board of Sleep Medicine.
Three studies that provide additional evidence:

• A 2006 study in the American Journal of Critical Care titled “Effects of Critical Care Nurses’ Work Hours on Vigilance and Patient Safety” examined logbooks completed by 502 critical care nurses. Those nurses routinely worked longer shifts than they were supposed to, and that tended to decrease their vigilance and increased the likelihood of making errors. According to the authors, these findings supported recommendations from the Institute of Medicine recommendations to limit nurses’ work hours to 12 consecutive hours during a 24-hour period and reduce or minimize the use of 12-hour shifts.
• A 2003 study in the journal Sleep found that sleep loss and drug use can have similar effects on people. The authors of “Ethanol and Sleep Loss” wrote that sleep loss “was more potent than ethanol in its sedative effects but comparable in effects of psychomotor performance.”
• A 2011 study by Penn State College of Medicine researchers found that a surgeon’s brain has to work harder to learn new tasks when she is sleep-deprived, which could have ramifications if unexpected events occur during surgery. The study was published in the American Journal of Surgery.

But it’s not just your patients who are affected by your lack of sleep. You suffer, too. According to the American Academy of Sleep Medicine, good sleepers have a better quality of life and suffer less depression than people who don’t get enough sleep.
Additionally, people who don’t get enough sleep have a greater tendency toward developing conditions like obesity, high blood pressure, diabetes and metabolic syndrome.
“Most nurses are carers or givers, and we tend to ignore our own body,” Johnson said. “Our body is telling us what we need, and we tend to ignore that, and we try to move forward.”
But, she cautioned, if we want to live longer, healthier lives, we have got to put a higher premium on sleep. “It’s imperative that you take care of yourself now, and one way to take care of yourself is to get a good night’s rest,” she said.
How can you improve both the amount of sleep you’re getting and the quality? For those not working the night shift, experts suggest developing a nightly routine. Try to get to bed a little earlier, and give yourself some time to “wind down” before going to bed, and disconnect yourself from all your electronic devices. And if you need to employ some accessories to help you shut out the world, definitely go that route.
“Whatever it takes,” Johnson said. “If it takes eye covers, if it takes ear plugs, if it takes getting darkening shades for your room.”
Those steps can also be helpful for nurses who work the night shift and need to block out the daylight and the daytime noises when they’re trying to sleep. It is definitely harder to get enough sleep when you’re a night-shift worker, Decker said.
“They need to protect their sleep in the daytime,” he said. “The rest of the world doesn’t know that you’re a night-shift nurse, so the phone still rings in the daytime, people still show up at the door.”
Plus, you are working against your body’s own circadian rhythms, particularly if your job requires you to work rotating shifts. “It’s very difficult to train your body to stay awake at night, and then two weeks later, expect your body to stay awake in the daytime,” Decker said. “So if nurses have rotating shifts, they’re in a state of chronic sleep restriction.”
Other strategies that can enhance your ability to get the sleep you need include dialing back on the caffeine in the later part of the day and getting some exercise. Exercise has been shown to enhance the slow-wave sleep that’s restorative for your body and brain, Decker said, and you need to get enough of that to be well-rested.

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Signs You Are Not Getting Enough Sleep
Many people don’t realize they are sleep-deprived, said psychologist James Maas, Ph.D., author of the books Sleep for Success and Power Sleep. “They get habituated to low levels of alertness,” he said.
If you are experiencing any of the following signs on a regular basis, you might be experiencing the effects of sleep restriction--which means you’re not getting an adequate amount of rest.

1. Irritability
2. Difficulty concentrating or remembering
3. Mood swings
4. Dependence on an alarm clock to wake up each day
5. Drowsiness in a warm room or during a meeting
6. A regular feeling of fatigue or tiredness
7. You fall asleep within five minutes of getting in bed