fn7 “The genius of American farm experts is very well demonstrated here: they can take a solution and divide it neatly into two problems.” From Wendell Berry, The Unsettling of America: Culture & Agriculture (1996), p. 62.
CHAPTER 14 HURTING AND HELPING YOUR SLEEP: PILLS VS. THERAPY
fn1 E. L. Arbon, M. Knurowska, and D. J. Dijk, “Randomised clinical trial of the effects of prolonged release melatonin, temazepam and zolpidem on slow-wave activity during sleep in healthy people,” Journal of Psychopharmacology 29, no. 7 (2015): 764–76.
fn2 T. B. Huedo-Medina, I. Kirsch, J. Middlemass, et al., “Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration,” BMJ 345 (2012): e8343.
fn3 A related concern is that of sleeping pill use in pregnant women. A recent scientific review of Ambien from a team of leading world experts stated: “[the] use of zolpidem [Ambien] should be avoided during pregnancy. It is believed that infants born to mothers taking sedative-hypnotic drugs such as zolpidem [Ambien] may be at risk for physical dependence and withdrawal symptoms during the postnatal period.” (J. MacFarlane, C. M. Morin, and J. Montplaisir, “Hypnotics in insomnia: the experience of zolpidem,” Clinical Therapeutics 36, no. 11 (2014): 1676–1701.)
fn4 D. F. Kripke, R. D. Langer, and L. E. Kline, “Hypnotics’ association with mortality or cancer: a matched cohort study,” BMJ Open 2, no. 1 (2012): e000850.
fn5 D. F. Kripke, R. D. Langer, and L. E. Kline, “Hypnotics’ association with mortality or cancer: a matched cohort study,” BMJ Open 2, no. 1 (2012): e000850.
fn6 Source: Dr. Daniel F. Kripke, “The Dark Side of Sleeping Pills: Mortality and Cancer Risks, Which Pills to Avoid & Better Alternatives,” March 2013, accessed at http://www.darksideofsleepingpills.com.
fn7 M. T. Smith, M. L. Perlis, A. Park, et al., “Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia,” American Journal of Psychiatry 159, no. 1 (2002): 5–11.
fn8 Such committees will also assign a weighted grade to their clinical recommendation, from mild to moderate to strong. This grade helps guide and inform GPs across the nation regarding how judiciously they should apply the ruling. The committee’s grading on CBT-I was: Strongly Recommend.
fn9 https://sleepfoundation.org.
fn10 “Tips for Getting a Good Night’s Sleep,” NIH Medline Plus. Accessed at https://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/summer12pg20.html (or just search the Internet for “12 tips for better sleep, NIH”).
fn11 M. P. St-Onge, A. Roberts, A. Shechter, and A. R. Choudhury, “Fiber and saturated fat are associated with sleep arousals and slow wave sleep,” Journal of Clinical Sleep Medicine 12 (2016): 19–24.
CHAPTER 15 SLEEP AND SOCIETY: WHAT MEDICINE AND EDUCATION ARE DOING WRONG; WHAT GOOGLE AND NASA ARE DOING RIGHT
fn1 National Sleep Foundation, 2013 International Bedroom Poll, accessed at https://sleepfoundation.org/sleep-polls-data/other-polls/2013-international-bedroom-poll.
fn2 “RAND Corporation, Lack of Sleep Costing UK Economy Up to £40 Billion a Year,” accessed at http://www.rand.org/news/press/2016/11/30/index1.html.
fn3 W. B. Webb and C. M. Levy, “Effects of spaced and repeated total sleep deprivation,” Ergonomics 27, no. 1 (1984): 45–58.
fn4 M. Engle-Friedman and S. Riela, “Self-imposed sleep loss, sleepiness, effort and performance,” Sleep and Hypnosis 6, no. 4 (2004): 155–62; and M. Engle-Friedman, S. Riela, R. Golan, et al., “The effect of sleep loss on next day effort,” Journal of Sleep Research 12, no. 2 (2003): 113–24.
fn5 Ibid.
fn6 C. Y. Hoeksema-van Orden, A. W. Gaillard, and B. P. Buunk, “Social loafing under fatigue,” Journal of Personality and Social Psychology 75, no. 5 (1998): 1179–90.
fn7 C. M. Barnesa, J. Schaubroeckb, M. Huthc, and S. Ghummand, “Lack of sleep and unethical conduct,” Organizational Behavior and Human Decision Processes 115, no. 3 (2011): 169–80.
fn8 Centers for Disease Control and Prevention, “Teen Drivers: Get the Facts,” Injury Prevention & Control: Motor Vehicle Safety, accessed at http://www.cdc.gov/motorvehiclesafety/teen_drivers/teendrivers_factsheet.html.
fn9 Based on this description, you could be forgiven for thinking that residents now have a delightful eight-hour sleep opportunity. Unfortunately, this is not true. During that eight-hour break, residents are supposed to return home, eat, spend time with significant others, perform any physical exercise they desire, sleep, shower, and commute back to the hospital. It’s hard to imagine getting much more than five hours of shut-eye amid all that must happen in between—which, indeed, they don’t. A maximum twelve-hour shift, with a twelve-hour break, is the very most we should be asking of a resident, or any attending doctor, for that matter.
APPENDIX: TWELVE TIPS FOR HEALTHY SLEEP
fn1 Reprinted from NIH Medline Plus (Internet). Bethesda, MD: National Library of Medicine (US); summer 2012. Tips for Getting a Good Night’s Sleep. Available from https://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/summer12pg20.html.
Why We Sleep Page 40