GPSJ - SPRING 2025 - Flipbook - Page 27
NHS & HEALTHCARE
GPSJ
The NHS at Night: Disturbance
on the wards
By Tom Magner, GPSJ Special Investigator
I am certain that everyone reading this will have woken up knowing what it feels like not to have had a good
night’s sleep - and not just because of late night partying! According to a recent study (Aviva Wellbeing), a third
of UK adults report insomnia, and two-thirds experience disrupted sleep, costing the economy annually an
estimated £34 billion (RAND Europe).
CEO of The Sleep Charity, Lisa
Artis, believes that: “Nowhere is
this more critical than in healthcare
settings, where patients require
uninterrupted rest to support
healing and recovery.”
I recently had to spend 7 nights
in a hospital being treated for
a serious injury to my foot that
had become infected. I have no
criticism of the medical care but I
was discharged feeling exhausted.
My sleep was randomly and
avoidably disturbed at night by, for
example:
(i) the rubbish bin lid at the end
of my bed being slammed shut
(Ii) sta昀昀 suddenly laughing loudly
chatting about their forthcoming
holidays
(iii) being abruptly awoken by
a nurse trying to take a blood
sample unannounced
Echoing my experience, Lisa
Artis says that: “Fragmented sleep
is often associated with: slower
physical healing; heightened
pain sensitivity; increased
risk of delirium, particularly in
older adults; impaired immune
response; emotional instability and
increased anxiety.”
None of this surprises Dr Vikki
Revell, Associate Professor of
Translational Sleep & Circadian
Physiology at the Surrey Sleep
Research Centre.
She says that there are two key
processes that control when we
feel sleepy or awake.
The 昀椀rst is an internal timer.
The longer we’re awake, the more
“sleep debt” we build up, making
us feel tired. Sleeping then pays
o昀昀 this debt and should make us
feel refreshed.
“Think of it like an hourglass”
says Dr Revell: “When you are
awake, sand 昀氀ows out of the
upper bulb, representing the
accumulation of sleep debt - the
longer you are awake, the more
this builds up. Sleeping: This is
like 昀氀ipping the hourglass, and
conceptually, it’s the process that
reduces the accumulated sleep
debt, leading to a feeling of being
refreshed (a full or fuller lower bulb
in a subsequent cycle).”
The second is our body’s
internal clock, which runs on a
roughly 24-hour cycle. It makes
us feel more awake as the day
goes on, peaking in the early
evening. Then, it suddenly makes
us feel sleepy at the beginning of
the night, which is also when our
body starts releasing the sleep
hormone melatonin. Later in the
night, this internal clock helps us
stay asleep, particularly stimulating
REM sleep (the dreaming stage
characterised by Rapid Eye
Movement).
During the day, our need
for sleep (from being awake)
is balanced by our body clock
making us feel more awake. At
night, the sleepiness we built up
during the day is balanced by our
body clock actively promoting
sleep.
Normally, these two systems
work together to give long periods
of being awake during the day
and long periods of sleep at night.
But, continues Dr Revell, “if one
or both of these systems get
out of sync, our sleep and wake
times can become confused and
disrupted.”
For Lisa Artis, CEO of The
Sleep Charity, it’s clear that
“Poor-quality sleep leads to longer
recovery times, increased risk
of complications, and greater
emotional distress. For patients
already in a vulnerable state, this
can signi昀椀cantly impact outcomes
and overall satisfaction with their
care.”
She added that the NHS
should foster a sleep-positive
night culture including: performing
only essential observations and
procedures during sleep hours;
reducing noise and light, alongside
focused sta昀昀 training.
The Sleep Charity says that
it is committed to supporting
healthcare providers to make
sleep fundamental to every care
plan, by prioritising sleep as
a pillar of recovery to improve
clinical outcomes, enhance patient
dignity and comfort during what is
often a challenging time.
NHS England were approached
for comment. Nothing has been
forthcoming. Using the restorative
power of sleep appears not to be
on their radar, never mind their
agenda.
Until the NHS wakes up to the
importance of sleep to the delivery
of faster and better recovery
for patients, disturbance on the
wards at night can only get worse.
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