Good Friday morning and happy Labor Day weekend,

How did you sleep last night?


Sleep deprivation raises the risk of death in men and can trigger serious mental illnesses in children that persist into adulthood, according to recent two studies.

Men with chronic insomnia, who typically got less than six hours of sleep a night, were four times more likely to die in one 14-year study than those who regularly got more rest. Young adults who habitually slept fewer than five hours a night were three times more likely to develop psychiatric disorders than with eight to nine hours of zzzz, a second study reported.

Both studies were published yesterday in the journal Sleep.

Pennsylvania researchers tracked 1,741 middle-aged volunteers who completed a questionnaire on their sleep history, underwent a physical exam and were monitored overnight in a sleep laboratory. The death rate exceeded 50 percent for men with chronic insomnia, compared with 9.1 percent of those who slept well, after researchers adjusted for differences such as weight and smoking habits.

The researchers didn’t find any variation in death rates among women who got fractured sleep. The American Academy of Sleep Medicine recommends adults get an average of seven to eight hours of sleep each night.

A second study, done in Australia, was the first to look at the link between sleep and mental illnesses in young people. Findings build on earlier studies that show sleep deprivation can lead to health conditions including heart diseases, high blood pressure and weight gain.

The study by the University of Sydney and the George Institute for Global Health in Sydney surveyed about 20,000 people between the ages of 17 years and 24 years in Australia’s eastern state of New South Wales over 18 months.

Teens need at least 8 1/2 hours of sleep a night to function best, according to the U.S. National Sleep Foundation. Only 15 percent reported sleeping that amount on school nights, the foundation said on its website.


The feds already regulate work hours and sets rest-period requirements in a variety of industries, including the highway, aviation, railroad and maritime transportation industries, because fatigue plays a major role in transportation safety. In none of these industries are workers allowed to work hours even remotely as long as these physicians, according to the groups asking for OSHA action.

Resident physicians work shifts as long as 30 hours as often as three times a week, which can lead to physician fatigue and medical errors. Exhausted resident physicians are at increased risk of being in a car crash and suffering from depression, pregnancy complications and needle sticks, research shows.

Because OSHA, which is part of the Department of Labor, is supposed to ensure the safety and health of workers, it has jurisdiction over resident physicians and should protect them, the groups said. Those petitioning OSHA include: Public Citizen; the Committee of Interns and Residents/SEIU Healthcare; the American Medical Student Association; Dr. Charles Czeisler, Baldino professor of sleep medicine and director of the division of sleep medicine at Harvard Medical School; Dr. Christopher Landrigan, assistant professor of pediatrics and medicine at Harvard Medical School; and Dr. Bertrand Bell, professor of medicine at Albert Einstein College of Medicine.

“Besides endangering patients in teaching hospitals, exposing more than 80,000 resident physicians to such hazardous working conditions for years during their employment increases their risk of harming themselves,” said Czeisler, one of the petition signers. “Given the failure of the medical profession to protect the health and safety of these young doctors, we are urging OSHA to set appropriate work-hour limits that eliminate the marathon shifts that endanger resident physicians and their patients.”

Currently, the Accreditation Council for Graduate Medical Education (ACGME), the nonprofit organization that oversees training programs for resident physicians, is responsible for regulating and enforcing resident physician work hours. In July, it proposed new guidelines for work hours for resident doctors, but they still leave the majority of those doctors in danger, the groups said.

Additional research shows that:

Because of acute sleep deprivation, female resident physicians who become pregnant while working as resident physicians may face an increased risk of premature labor requiring bed rest; high blood pressure and seizures during pregnancy; pre-term delivery and low birth weights for infants born during residency. Nearly half of married female resident physicians will become pregnant during their residency.

Resident physicians face an increased risk of serious needle stick injuries during day shifts after working for more than 20 consecutive hours compared to day shifts when they were working shifts that average fewer than 12 hours in duration. Needle stick injuries potentially expose resident physicians to HIV, hepatitis C or other infectious diseases.

The groups are urging OSHA to implement and enforce the following regulations:

A limit of 80 hours of work per week, without averaging (current rules allow for averaging, meaning that resident physicians may work 100 hours one week and 60 hours the next);

A limit of 16 hours worked in one shift for all resident physicians (the ACGME’s proposed guidelines limit the length of shifts to 16 hours only for first-year residents, also known as interns);

At least one 24-hour period of off-duty time per week and one 48-hour period per month, for a total of five days off per month;

In-hospital on-call frequency no more than once every three nights, without averaging;

At least 10 hours free between duty periods; and

No more than four consecutive night shifts and 48 hours off after working three or four of these.

Petition signers ask OSHA to strictly enforce the requested policies by requiring resident physician and fellow schedules to be recorded and kept as public records by the hospitals, implementing an official and confidential procedure for whistleblowers to report violations to OSHA, inspecting hospitals frequently and unannounced, and creating sufficient fines for violating the policies.


Here’s assistant secretary of labor for occupational safety and health, Dr. David Michaels, responding to the petition:

“We are very concerned about medical residents working extremely long hours, and we know of evidence linking sleep deprivation with an increased risk of needle sticks, puncture wounds, lacerations, medical errors and motor vehicle accidents. We will review and consider the petition on this subject submitted by Public Citizen and others.

“The relationship of long hours, worker fatigue and safety is a concern beyond medical residents, since there is extensive evidence linking fatigue with operator error. In its investigation of the root causes of the BP Texas City oil refinery explosion in 2005, in which 15 workers were killed and approximately 170 injured, the U.S. Chemical Safety Board identified worker fatigue and long work hours as a likely contributing factor to the explosion.

“It is clear that long work hours can lead to tragic mistakes, endangering workers, patients and the public. All employers must recognize and prevent workplace hazards. That is the law. Hospitals and medical training programs are not exempt from ensuring that their employees’ health and safety are protected.

“OSHA is working every day to ensure that employers provide not just jobs, but good, safe jobs. No worker, whether low-skilled and low-wage, or highly trained, should be injured, or lose his or her life for a paycheck.”

Appropriate remarks for the Labor Day holiday, which, after all, honors the dignity and contributions of worers.