Nap A Day Makes Doctors OK, Stanford Study Finds

The findings, to be published in the November issue of Annals of Emergency Medicine, showed improved mood, a higher alertness level and the ability to complete a simulated I.V. insertion more quickly among doctors and nurses who were allowed a short nap while working the night shift in an emergency room.

"Napping is a very powerful, very inexpensive way of improving our work," said one of the study's authors, Steven Howard, MD, associate professor of anesthesia and expert on sleep deprivation and fatigue.

Howard has taken the results of the study one step further and begun implementing an official napping program at the hospital at the Veterans Affairs Palo Alto Health Care System. "This is the first time a napping program has been instituted to try to get at the problem of fatigue in the workplace for health-care workers," he said.

According to statistics on America's need for sleep, plenty of people could use a nap. More than 50 percent of Americans are sleep-deprived.

Scientific research has documented the need for naps to mitigate drowsiness and improve performance and alertness in pilots and truckers, but no previous study has looked specifically at the possible benefits for health-care workers, said the first author of the study, Rebecca Smith-Coggins, MD, associate professor of surgery (emergency medicine).

"I've been really worried about physicians," said Smith-Coggins, whose research has focused on sleep deprivation and its effects on health-care workers for the past two decades. "Everyone was complaining around me, 'I'm so tired.'"

The study's authors hope that by providing scientific data that supports the benefits of napping, more hospitals and other employers will consider policy changes that include nap breaks to help improve safety and performance levels.

"Being up for 24 hours has the same effects as being legally drunk," said Howard. "Caffeine and nicotine mask the effects of sleepiness, but naps actually replace lost sleep. It's totally different mechanistically."

To determine just how much a nap would help alleviate sleep deprivation, researchers recruited 49 subjects - 24 nurses and 25 doctors - who worked through the night from 7:30 p.m. to 7:30 a.m. in the emergency room at Stanford Hospital. They divided the subjects into two groups. One group worked straight through the night as usual, while the other subjects were allotted a 40-minute nap break at 3 a.m. in the middle of their shift.

"They fell asleep really fast," said Smith-Coggins. "Half fell asleep in less than 10 minutes. They were tired!"

At the end of their shift at 7:30 a.m., both groups underwent a series of tests including a 40-minute simulated car drive, a 10-minute written memory recall test, a computer-based I.V. insertion simulation and a questionnaire developed by NASA that measured different mood states including anger, confusion, depression, fatigue, tension and vigor.

The nap group scored fewer performance lapses, reported more vigor, less fatigue and less sleepiness. The doctors and nurses who napped also tended to complete more quickly the simulated intravenous insertion, and they were safer drivers in the tests.

By contrast, many of those without naps would "crash over and over again" in the driving simulations, Smith-Coggins said. Their cars would often leave the road or collide with oncoming vehicles. "I felt so badly after seeing how tired they were."

Another test measured facial alertness to assess drowsy driving. Researchers scored videotapes of the subjects' faces while performing the driving simulation. If their heads bobbed or they closed their eyes for longer than five seconds, they were labeled dangerous drivers. Again, those with naps scored better than those without.

Despite an accumulation of scientific evidence showing the benefits of napping for workers, little has been done in the United States to implement any institutionalized napping programs, primarily due to a cultural bias, Howard said. Battling this bias and finding a comfortable napping spot as close as possible to the work station have been the primary challenges he's faced while implementing the new napping program at the VA-Palo Alto.

"The social connotation of someone who naps is lazy, slothful," Howard said. "Attitudes toward people who nap are hard to break."