Why Do Hospitals Hate Sleep So Much? - <AUTHOR> https://www.motherjones.com/kevin-drum/2018/12/why-do-hospitals-hate-sleep-so-much/ <comment><USER2> I recently had a family member in the intensive care unit (ICU) for over a month in Austin, Texas. I quickly learned my main contribution would be protecting her sleep when I saw she hadn't slept in days because of the constant interruptions. She went from reasonable and compliant in taking her medication, to extremely irritated and noncompliant with the doctors. Of course I could see this was due to sleep deprivation, but when I kept bringing this up to the doctors and nurses, they gave me blank stares and didn't seem to believe or care. When they started suggesting another surgery due to her not improving, I nearly lost my sanity. Ultimately, I had to become a very vocal and unpleasant protector of her sleep - if a nurse came in, I quickly took him/her outside the room and asked what they were planning and whether it was absolutely necessary. This annoyed them quite a bit and they hinted that they could have me removed. It was one of the worst experiences of my life. Just being in the ICU for a month with a loved one is hard enough, but having to battle the staff to protect something so basic as SLEEP so she could recover, made it a true nightmare. Something is truly broken if trained medical staff see sleep as optional - the data and science behind sleep is so compelling, and they don't understand these basics? Desperately frustrating...

<comment><USER3> You were dealing with doctors and nurses, right?

One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted.

I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting for sleep- dep survival traits; only people who can work insane hours make it through hospital medical training, and only people who can take shift work in their stride make it as hospital nurses.

(Also, my observation of hospital doctors is that anyone you see on a ward outside core office hours is relatively junior, i.e. aged about 22-35. Senior consultants and professors work normal hours like everybody else. As for the nurses ... my understanding is that ICU nursing burns them up.)

(Source of observations: former hospital pharmacist here, who just got a refresher course c/o a relative who spent three months on an acute stroke ward this fall.)

<comment><USER4> To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?

<comment><USER5> Those people spent many years learning to understand, diagnose, and treat thousands of medical issues. During that entire time, they were continuously sleep deprived as a matter of culture. Those that could not handle this environment dropped out. They're probably still sleep deprived. They may have learned about sleep's medical effects, but the personal experience of those who survived the selection process who work 120-hour weeks and have been waking patients up once an hour for years has a blinding effect on this diagnosis.

It's a bit like bringing someone from south Florida to northern Michigan this winter for some ice fishing. I understand that it's cold here, I intellectually know about, have observed the effects of, and can treat frostbite and other problems resulting from this cold - but all that would make it hard for me to intuit the problems of a visitor who was unable to control their fingers when they removed their gloves and dipped their hands into a minnow bucket to bait a hook. My fingers work fine in that bucket, everyone else on the lake is doing it, you're just going to dry them off in a few seconds and put them back in warm gloves...what's the issue?

</comment></comment></comment></comment><comment><USER6> I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter?

\- Elementary school starting so early all the kids are half asleep in class.

\- College + Sleep? Not gonna happen.

\- 24 hour construction in certain part of NYC, check!

\- Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, and all your neighbors do the same!

\- Having attention deficit? Lets start with ADHD medecine, not with a sleep study, no sir.

\- Bazillion jobs requiring on call, waking people up at all manner of time, as a standard thing.

\- Neighbors woke you up? Toughen up bro!

\- Myth around how so many people apparently can do just fine on 5 hours of sleep.

The hospital thing is just a symptom of a society built around lack of respect for sleep. No one seems to consider it an important thing. If you're drowsy because you couldn't sleep, it's considered a minor inconvenience and little more.

<comment><USER7> My theory is that there is an eternal secret war between morning people and evening people and the morning people are winning. Resistance must be done in secret but fight back in every way you can.

<comment><USER8> The first rule of the resistance is that we don't talk about the resistance with people who find 5:30am tolerable.

;)

<comment><USER7> Cough. Timezones. Cough...

</comment></comment></comment></comment><comment><USER9> I spent a week in a German hospital a few years back. One thing that struck me is that they offered sleeping pills to ensure patients got a good night of sleep. Worked for me. Also didn't notice too many interruptions at night.

Another trend that I know of in the Netherlands (where I'm from) is that newly built hospitals have private rooms for all patients. These hospitals no longer have shared rooms by design. They also try to minimize hospital stays as being in a hospital exposes you to hospital infections, is expensive, and to be avoided unless explicitly needed.

That's a big difference with Germany, which is old fashioned on this front. The default attitude in Germany seems to be to keep people in a hospital much longer. In Germany you only get a private room if you need it medically or if you take private insurance.

I suspect a lot of this stuff is part cultural and part wrongly aligned incentives because hospitals just bill whatever to insurers and couldn't care less about patient comfort because their paying customer is the insurer, not the patient. The insurer cares about cost, the hospital cares about milking the insurer to the maximum of their ability. Between those two, patient comfort is not much of a concern.

The reason things have improved in the Netherlands is that they spent the last decade realigning incentives to cut cost between insurers and hospitals. People pick their own insurer (they are all private). However, all insurers are required to offer the same base packages (with extras if you want). So, people can easily switch insurance provider if they want and they do. So, insurers now compete on quality of service and cost. Which is why a lot of hospitals are actively concerning them selves with upgrading their facilities to improve customer happiness (still the insurers). Insurers are happy when their customers don't switch to another insurer and when hospitals don't waste their money.

<comment><USER10> How does that work: insurers trying to keep as many customers as possible is disjoint from the customer satisfaction a patient has when receiveing healthcare at a hospital.

As a patient I don't think about my insurer when I'm at a hospital. I just want to be treated.

It's more likely to be the opposite, where the hospitals with the better healthcare and care of the patients have to spend more money and thus get less contracts with the insurers, who have an incentive to reduce cost as much as possible. Out of the 4 hospitals I've visited for healthcare in my area, only 1 will currently be covered by insurers in their most basic plan next year, and that one is the most remote.

Basically, next year I cannot visit my regular hospitals to continue my current treatment plan without getting a more expensive basic healthcare plan (+15%, or roughly 220euro).

<comment><USER11> US is weird, you are usually stuck with whatever insurance your employer provides. If you try to buy your own we're talking $500 a month with a $3000 deductible. If your insurer doesn't cover a hospital there is no way you want to end up there. Down that path lies bankruptcy because the hospital will try to charge your insurer an arbitrary large amount who will then just hand it to you and go "Good Luck!"

One time my family was charged $1000 for an ibuprofen for a perforated eardrum at an emergency room. We never even saw a doctor because we waited 7 hours and left. It was faster to get an appointment at our personal doctor the next morning. I can't imagine what it would have cost for a severe problem like a car accident...

<comment><USER12> >> One time my family was charged $1000 for an ibuprofen for a perforated eardrum at an emergency room

This kind of maddening injustice is why I left the USA after living there for 3 years, and will likely never return even to visit.

</comment></comment></comment></comment><comment><USER13> I felt the question and answer to be a little flippant, which is fine, but hear this: Sometimes there are reasons, very genuine reasons. I've been recovering from a recent stay. I, too, was interrupted frequently - every 45 minutes in fact. After a few nods off and being woken up by a knock at the door repeatedly I asked 'why' and the staff gently explained that me sleeping for too long would be a bad idea for a few reasons:

1\. My surgery affected my nervous system and thyroid; maintaining blood flow (especially in my legs) was important.

2\. Knowing how I felt at the time kept the nurses informed about the dosage of medicine they should administer. Hormones and their effects can change rapidly.

3\. Having a patient awake for blood draws, or an emergency, is useful. I'm not a small person; turning me over for some blood is much easier if I am awake and cooperative.

I can imagine anyone with recent head trauma shouldn't be allowed to sleep either.

Ask your doctor (and nurses!) to keep you informed and educated about your situation. You're responsible for yourself. Medicine isn't always intuitive, especially if you're not yourself yet.

<comment><USER14> I don't think all hospital patients meet all (or even any) of the three points you listed. Hospitals should wake up folks that actually need it (e.g. folks like you in your past situation), and leave those who don't need it alone to sleep.

<comment><USER13> I mostly agree. The author of the piece didn't go into much detail about their medical needs at the time - perhaps they were a high-attention patient and didn't know it? Hence my call to educate oneself about their own situation. When you're in a foreign bed/room, in some amount of discomfort, on (likely) new medicine, you probably aren't the best judge of neediness and intent. The best you can do is ask and see what you can do to make the situation better.

<comment><USER15> The author makes it pretty clear, hospital staffs should wake up patients if absolutely necessary.

"If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don't do that check once every four hours." ..

"..I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don't need your counts on a daily basis. And they certainly don't need them at 4 am. That's merely for the convenience of doctors, who want the results back by 8 am." ...

</comment></comment></comment></comment><comment><USER16> For both of our children, the hospital caused us more stress and discomfort than anything else. Newborn baby's finally asleep, wife is comfortable re pain, finally start to get some sleep.

Then the nurse comes in at 2 am, writes her name on the board, asks us questions that they should have the answer to, then leaves.

Nurse change 3x a day, baby doctor checking in to ask if were ok, mom doctor doing the same, house keeping, meal people 3x a day. Plus any legitimate and needed medical attention e.g. baby shots/bath /moms wound dressing change

With our second, insurance would've covered another 2-3 days in the hospital, but my wife nearly had a mental breakdown between normal post partum depression, nursing difficulties, and people interrupting every quiet moment we have with our new family member, so we left asap.

<comment><USER17> We had our first child ~3 months ago. We had a room to ourselves and nurses/midwifes would only come in once or twice a day unless they were paged (which we did, they were a godsend). This made the stay as comfortable as could be, and we could get all the quiet time alone we wanted, although sleep was in short supply for other reasons.

This was in Copenhagen, Denmark, so the entire stay was free. Sadly, the central hospital is removing this practice and kicking out patients after 4 hours.

<comment><USER18> Similar situation in Finland; we had a baby over Christmas two years ago. We spent a few days in a private room with a checkup on the baby/mother around noon and 6pm.

We paid €250 or so for 3 or 4 days (genuinely can't remember I guess my sleeping wasn't so great. Oops!) for the three of us, so it wasn't free, but it was pretty cheap.

</comment></comment></comment><comment><USER19> People die or suffer serious harm in hospitals all the time. This often happens during sleep, and in many cases it could have been prevented if the patient had been checked on more frequently.

It is much easier to confirm that the patient is ok if they are awake. When the nurse softly asks "do you feel ok?" when drawing blood in the night, it is not just meant as soothing, but just as much to check if further treatment is required.

It's a bit like the soldier checking if there is a bullet in the chamber when picking up a gun. Even if you experience a gun that goes off by acciden only once, it becomes really easy to understand the thousands of times the soldier will do this when he knows there is no bullet there.

<comment><USER20> This is interesting and not something I'd considered. I wonder though if they've got the balance right. These protocols were developed no doubt before it was really understood how incredibly dangerous poor sleep is to our health most especially during recovery from illness.

<comment><USER19> Its a mix of protocols, procedures, habits and personal biases, as are most such things in most workplaces.

But most of all, I think it is an attention thing. For the staff, a patient being sleep depraved for a couple nights is very low on their list of concerns. They see people die almost every day.

For the patient, the emphasis is different, especially for the ones that are there for minor issues.

Medically, a few nights with reduced sleep quality is unlikely to make a big difference.

Now, if it goes on for weeks or months, that is another matter. Still, more people are probably seriously injured or die from bedsores sleep depravation. Not to mention those that die from fall injuries caused by trying to walk to the bathroom unassisted. (The latter is the most frequent case of preventable fatal injuries aquired in most hospitals, at least in my country)

From my point of view, most complaints about loss of sleep in hospital are in the same category as complaining about the food. 1st world problems.

<comment><USER21> Except sleep is important to recovery for colds let alone serious ailments. It isn't like complaining about only bland vegetables and starches.

It is like complaining about hospital food being literally only a handful of breadcrumbs a day and lamenting their blood counts are so low, muscle atrophy and they have scurvy. Clearly the whiners should have been exercising more

<comment><USER22> Hospital food actually is quite unhealthy and not conducive to healing. I'd imagine that the only people who woild dismiss such concerns are the people who put such a system in place where they serve white bread and Jell-O with high fructose corn syrup and artificial food coloring to people who are barely breathing. Hospital patients need all the nutrition they can get. Providing the equivalent of a frozen dinner or fast food isn't very responsible.

</comment></comment></comment></comment></comment><comment><USER23> When my wife was in the hospital after the birth of both our two kids (premature so they weren't in the room with her to care for, they were in the NICU).... I chose to go home to sleep as the nurses just came and went endlessly. Someone had to get sleep.

Then my oldest son was in the hospital for a while. He was sick so I wasn't too surprised he was napping all the time until spent a few nights sleeping at the hospital with him and realized he was probabbly napping constantly in the day because the nurses would wake him, and me.... constantly all night.

When we went home we both crashed and napped a bit and then slept all night... i swear he recovered faster after catching up on sleep at home.

<comment><USER24> There are preliminary results showing that when the NICU dims it's lights during the day and goes even darker at night babies recover faster. 5 weeks faster on average. (That's from "Why We Sleep")

<comment><USER25> Sleep is the best recovery. If everybody got enough sleep there'd be fewer sick days, too.

</comment></comment></comment><comment><USER26> My wife just finished up a 22 hour labor and is desperately trying to get some sleep but the nurses refuse to stop yelling and laughing directly outside of her door.

It's not even medical. Just rude.

<comment><USER27> Ask them to stop, perhaps?

<comment><USER28> Sure, just get out of bed and run them down and ask them to stop...

<comment><USER29> That's why you've got a partner there with you. The partner's job is to keep an eye on whatever the young mother needs and make it happen.

<comment><USER26> Which I'm doing. But we're unfortunately stuck here and I'm just 1 person against an entire fleet of nurses, who also happen to be the caregivers.

<comment><USER29> I never said it would be easy, but it's important. Although honestly, unless the nurses want to be intentionally awful at their job, they will listen to you. They may not always be able to obey the letter of your request, but they absolutely should figure out a solution to any problem that's interfering with recovery.

<comment><USER26> Right, and I never said I wasn't doing it. But since this post was about how hard it was to sleep in hospitals, and I was in a hospital and my wife was struggling to sleep, I figured I'd share my story.

</comment></comment></comment></comment></comment></comment></comment><comment><USER30> This is a problem that a startup I'm involved with (www.snap40.com) is tangentially aiming to solve. The prime goal isn't really to help patients sleep better, but to help healthcare professionals monitor them better and be proactively alerted when things are deteriorating. It's an iPhone sized (but lighter) device that's worn on the upper arm and once you're wearing it, you forget about it. Instead of reading vital signs the patient can sleep, and we've caught instances where patients were in trouble before the normal rounds would have. Also applicable for home use as patients can be sent home earlier or safely monitored. It is up for approval by the FDA so it is a regulated medical device, and in most cases it does better than the gold standard ICU machines. Better sleep, more safety, and a faster return to home are just some of the benefits, and I'm really optimistic they can make a huge difference for healthcare.

<comment><USER31> >The prime goal isn't really to help patients sleep better ...

so really, this is just a same-industry product plug.

<comment><USER32> I think you read the comment disingenuously. It is pretty clearly implying "...but it will have that effect because it neutralises the problem that the article is all about".

</comment></comment></comment><comment><USER33> > As Frakt says, solutions aren't hard to fathom. In fact, they're trivially > easy to figure out.

Lots of things are "easy to figure out", and also "really hard to implement correctly".

Managing the care of a lot of different people with different conditions over long periods of time is complex and error-prone. You can't stand around all day in a hospital trying to figure out if you missed an edge case in a patient's customized care plan. Not only are you tremendously busy, but making a mistake in that customized plan could mean life or death. Routine is much safer and more reliable.

It's not impossible to improve patient care, but it is tremendously more difficult than a layman can observe just by sitting in a hospital bed.

<comment><USER34> There are low-hanging fruit.

My own anecdote... A few years ago, I spent the night in a cardiac ICU due to an arrhythmia. I also have a VERY low resting heart rate (<35bpm when sleeping). The alarm on the EKG is set at 35bpm. The alarm can ring in the room, the nurses station, or both. For an overnight stay, why on earth would they leave the room alarm on? After a long night of being awakened seconds after dozing off, the morning shift nurse stopped by and asked "why on earth wouldn't they switch off this silly alarm?" and walked back to her station to do just that.

Edit - the nurses on the overnight shift asked about my resting HR once, then ignored the alarm the rest of the night.

</comment></comment><comment><USER35> The article quotes a doctor speaking about nursing care. This is as accurate as asking an automotive engineer about automobile repair. Same field, different skill sets.

Nurses are trained to identify trends across many (sometimes too many) patients. Sure its inconvenient if a nurse monitors your blood pressure or oxygen levels every 2 hours after surgery, especially when you are sleeping, and especially if you recover perfectly.

But if you have a post-op internal bleed that occurs during the night, when you are asleep and unable to let someone know you are feeling woozy (because you are asleep), that's when trouble occurs. Frequent observations mean nurses can identify when things are going south before you get to an emergency situation.

Blood pressure drops sharply over 2 hours, monitor every 15 minutes, see if it stabilises. If it doesn't raise the alarm quickly.

Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids - silence on a night ward is a sign something is wrong, and quickly precedes an emergency alarm.

<comment><USER36> Seems like it's backward to me. The machine should be silent if everything is ok and start beeping if things are going wrong.

<comment><USER37> That was my first thought too.

However, the downside of that solution is that the failure signal relies on correctness of the machine. In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.

<comment><USER38> Monitoring over the network exists, and should be the preferred way to detect failure.

> In the current system, the failure signal is guaranteed to occur during > failure with a zero false negative rate.

I can easily imagine software bugs that make the machine continue beeping even if the normal function doesn't work anymore.

Somehow, this sounds like an excuse for lazy design.

<comment><USER21> It sounds like an excuse for not networking at all really. Or upgrading equipment. Just a primitive cables to a data station on a cart outside the room would handle it better on every level than trying to figure out which thing isn't beeping when it should. Have it beep if it loses a signal. Better yet it can handle triaging far better when networked. Signal lost and "patient definetly not breathing" are two very different triage levels for one. You want to restore signal as soon as able but it isn't a mobilize a crash team to resuscitate situation. Nearly everything else has abandoned beeps as the sole indicator with good reason.

</comment></comment></comment></comment></comment><comment><USER39> Some of this stems from simple things. For example, most doctors are never trained in what nurses do, or what the implications of their orders may be. If a doctor waits til the end of a shift (when it is convenient) to write out a bunch of prescriptions and there is a frequency of dosage, then the start time is dictated by the time of the prescription, unless the doctor puts a specific time on it. This means that patients will be woken up at an inopportune time for the dose (end of a shift change), and usually a time when people would be asleep.

I learned about this by watching a video put out by a hospitalist who was showing the results of requiring new doctors to be paired up with nurses for a week or two to see how hospitals actually worked. The new doctors were very surprised that their mental model of things just wasn't grounded in reality.

This all stems from institution centric care rather than patient centric care.

</comment><comment><USER40> I spent a night in hospital this year - My first ever hospital visit in 52 years on this planet!

I do agree with the OP. The thing that mystified me was that I was told I had to rest while under observation (for a non _too_ serious condition), but my night there was anything but restful.

I get that the nurses had to come around every 4 hours to change my antibiotic and saline IV drip, and to give me painkillers - but outside of that the constant beeping and general noise and chatter of the medical staff was incessant. IV drip controllers were left in 'alarm' state for 15 minutes at a time so I could hear constant loud beeps that are purely intended to get attention.

To top it off, the night staff forgot to turn off the main lights in the ward, and it wasn't until 4am that I heard someone say "Oops, we forgot to turn off the lights!" and they did so, making the ward finally dark enough to sleep.

Generally, the care I received was great, but I was mystified at how hard it was to actually get some basic sleep, which I consider vital for recovery, under those conditions.

<comment><USER41> Did you try earplugs and an earmask? They work wonders on (especially) daytime flights for me.

<comment><USER40> Being a hospital noob, I didn't even think of those (plus I was admitted via ER fairly suddenly and unexpectedly).

Next time I know I have to stay in hospital overnight I will (or get my wife to) pack those in my overnight kit.

<comment><USER42> My hospital has earplugs that you can just request. Not sure about sleeping masks - didn't ever see anyone with one, so I assume they don't have those to give out.

</comment></comment></comment></comment><comment><USER43> As someone on HN who is medical, not tech, this thread is as frustrating to read as it would be for many of you to read doctor's opinions on how best to run a software engineering firm.

"I'm not a software engineer, but here's my full breakdown on where you are all going wrong based on using a BBC Micro for a week back in 1993"

<comment><USER44> But in your experience is there a problem with hospitals not understanding that patients need proper sleep?

<comment><USER43> I'm very junior and UK based so I can only speak on my experience...

No, there is no lack of understanding about the importance of promoting sleep. To suggest that somehow medical professionals haven't got round to working out that there are benefits to having a good sleep is, to be frank, completely ridiculous and quite insulting.

A very specific example would be the importance of sleep in relation to delirium in elderly patients. This is taken very seriously.

In a wider sense, hospital staff will try to establish a reasonable environment for sleep. There is a need to be realistic though, and accept that (for many many reason not readily apparent to the lay person) it just isn't always possible to remove all the factors that disturb sleep.

Most patients on a ward are in multi patient bays. If a patient is unwell medical staff will probably have to; talk out loud, turn on a light, move some kit around, walk in/out of the bay... and so on. This would certainly wake me up. There's just very little can be done about it. Clinical need top trumps comfort.

There will of course be room for improvement, and some staff will be forgetful of the need to be mindful of quiet hours (it's very easy to forget it's 'night time' when your brain is in 'at work' mode).

So, a more balanced summary would be: "Medical professionals try to promote a good sleeping environment, but the very nature of a hospital makes this a challenge. However, there is always room for improvement and many local issues can be solved via improved patient-staff communication". Doesn't make for such a clickbaity whinge blog though when you phrase it this way.

<comment><USER45> >Clinical need top trumps comfort.

I think this is where the disconnect is. As a best faith interpretation, I don't believe you made the statement in a condescending manner -- I think it just flowed naturally.

The comment I quoted seems to imply waking a patient is akin to disrupting the comfort of the patient. I read the arguments being made in this thread and in the article as: waking the patient and/or disturbing sleep of a patient causes detrimental effects on the patient's health which lie outside the realm of just comfort.

Multi-patient bays seem to act as an architectural reinforcement that sleep is a comfort.

</comment></comment></comment></comment><comment><USER46> I can attest to this issue first hand. In 1995 I was diagnosed with cancer and had to undergo major surgery, recovery from that in ICU, then several rounds of chemotherapy over the next nine months. While I was in the hospital for a week of chemo, I got maybe two or three hours of sleep per night with a half hour nap off and on throughout the day, and this was on sedatives and painkillers. I can only imagine how much better my recovery would have gone if I'd been allowed to sleep all night during my stays and didn't need sedatives to balance the constant interruptions.

I'm certainly not a medical expert nor a sleep expert, but I'd wager if nurses and doctors would let their patients have a full night of rest without interruption, they would see much faster recovery times.

</comment><comment><USER47> I've been hospitalised 7 times. In New Zealand, Australia, Thailand, and Singapore.

Aside from the first day/night after surgery, I've never felt like Hospitals are against slept?!?

My Wife had a c-section in October. Again, other than first day/night after surgery, never felt like we were interrupted all the time.

Is this article about America or something?

<comment><USER48> It very much depends on what's wrong with you. I've been hospitalised multiple times. Most of the times were fine, but once was neurosurgery, and I'd be woken up at regular intervals throughout the night to answer "What's your name? Where are you? What year is it? How many fingers am I holding up?" At some point there must be a crossover between the risk of an undetected problem vs the risk inherent in lack of sleep.

Not to mention "PAGING RESPOND MET CALL CODE BLUE"[0] followed by a crash cart tearing off down the hallway at 4am, and of course once you've been in the hospital for a few days you know that "MET call" means someone is probably dying and "code blue" means it's from cardiopulmonary arrest, which doesn't really help soothe you back to sleep.

[0] the jargon is probably wrong

<comment><USER49> Or they wake you up to move your bed from the high risk side of the ward as they have an emergency admission - and overhear the nurses say "might die"

</comment></comment></comment><comment><USER50> I just showed this to my mother, a nurse. She laughed and said "it's pretty stupid, but they would rather fix it with a pill if that's an option".

<comment><USER51> Can you please elaborate on "it's stupid...?"

<comment><USER52> I think the parent refer to its own solution as stupid "it is stupid that they would use a pill if possible"

<comment><USER50> Yeah, that's what she meant

</comment></comment></comment></comment><comment><USER53> Not only are they "designed to allow patients as little sleep as possible", but also doctors too. Residents and doctors frequently have take on 30-36 hour shifts.. How they could effectively treat patients with this level sleep deprivation is beyond me.

Maybe hospitals just have a vendetta on sleep in general?

<comment><USER54> It's because doctor handovers are surprisingly dangerous.

<comment><USER55> That's an interesting angle, and I'm sure you're right. I'd like to read more. Do you have a source for that?

<comment><USER56> [0] says: > Handover is clearly a time when errors or omissions in key information can have critical consequences. Statistics from the National Confidential Enquiry into Patient Outcome and Death showed that in 13.5 per cent of cases where patients died within four days of admission, poor communication − between and within clinical teams − was an important issue contributing to the adverse outcomes.

Might be a starting point at least.

[0] [https://www.hsj.co.uk/technology-and-innovation/taking- the-r...](https://www.hsj.co.uk/technology-and-innovation/taking-the-risk-out- of-care-handovers/5057867.article)

</comment></comment></comment></comment><comment><USER57> I asked my doctor relative about this once and IIRC they basically said because hospitals are not hotels - if you're inpatient in America you're pretty sick and more than likely need periodic monitoring for your condition. As soon as you're well enough to be sleeping for long periods of time without observation you'll get bounced.

<comment><USER58> You can be a patient and be so sick of the noise that you decide you want to opt out of the monitoring - or you DIY anyway, as most hospital do not take requests kindly.

I was once in ICU. The cardiac monitor was beeping loudly whenever I was starting to sleep.

After the first few time woke me up in pain, I bent over and pushed the button to power off the cardiac monitor. Problem solved! I fully admitted all the risks - but there comes a time when too much is just too much.

I then had a great night of sleep :-)

<comment><USER59> Did you check to see if the cardiac monitor was set up to prevent you sleeping?

<comment><USER58> I didn't care. I wanted to sleep. And I did.

</comment></comment></comment></comment><comment><USER60> For the birth of my second child, I learned to manage hospital staff so that they would leave my wife and newborn alone unless there was an emergency. I proactively scheduled scans, vital checks for the next morning so that the patients could rest.

The experience was so much better than what my wife and first child had. I do not understand why hospitals cannot do this kind of considerate scheduling by default.

<comment><USER61> Can you elaborate on how you worked with the hospital staff to make this "considerate scheduling" possible?

My initial feeling would be that the staff will do their jobs when it convenient for them to do it, regardless of when you would prefer them to do it. How did you manage to convince them to modify their scheduling?

<comment><USER62> Not OP, but the same way you get anything 'management' done - get to know people, make them like you, understand procedures and incentives of everything and everybody involved, trust but verify, always be proactive and ahead of everything and everybody.

</comment></comment></comment><comment><USER63> OMG, so glad to hear somebody else saying this. The last time I was hospitalized, the recovery was a complete nightmare for exactly this reason. If there wasn't somebody coming by to poke or prod me, there was somebody coming by to do something to the other patient in the room, or if it wasn't that, the door was open and the click-clack of heels on the tile floor kept me awake, or there was too much light coming in from the hallway, not to mention how uncomfortable those beds are, etc., etc. Sleep was damn near impossible.

It was so bad that the first day I came home, I went to bed, fell asleep and had a dream that somebody came into my room and woke me up and said "I need to draw some blood". I've never been more relieved in my life to wake up and realize "fuck, that was just a dream".

<comment><USER64> "If there wasn't somebody coming by to poke or prod me, there was somebody coming by to do something to the other patient in the room, or if it wasn't that, the door was open and the click-clack of heels on the tile floor kept me awake, or there was too much light coming in from the hallway, not to mention how uncomfortable those beds are, etc., etc. Sleep was damn near impossible."

surely you realize there's more to hospital than just you?

<comment><USER63> _surely you realize there 's more to hospital than just you?_

Of course I do. What does that have to do with anything?

As the article says, there are simple changes they could make that would maintain the same quality of care, while still allowing patients to get more sleep. Considering how important sleep is to our health, not doing those things is borderline malpractice, IMO.

</comment></comment></comment><comment><USER65> I'm lucky enough never to have been in hospital myself, but FWIW:

I was recently on the jury in a coroner's inquest. A patient had died suddenly in his sleep in hospital. The solicitor whose agenda was to make the hospital look bad aimed to suggest that nurses should have been entering his room every 15 minutes to check his breathing, but all medical staff witnesses argued that sleep is too important to disrupt by entering the room during the night, unless absolutely necessary. They used a torch to shine on the patients chest through the window to check for breathing, and specified that they tried not to shine on them directly (watching a shadow on the wall is preferable).

<comment><USER66> I know a torch is a flashlight but it amuses me to think of a nurse wielding a flaming torch walking down the hallway, peering into rooms.

It's been awhile since I was in a hospital overnight but checking in on a (presumably) stable patient every 15 minutes is madness. You hear all sorts of crazy things during jury duty--I love it.

<comment><USER67> Of course not a normal patient, but I would imagine that it would not be unreasonable to be checking an ICU patient's vitals every 15 minutes. It's called "intensive care" for a reason.

</comment></comment></comment><comment><USER68> For having spent a long time in hospital (France), I can tell that the beeps of the machines are completely useless. It is maybe very ok for someone spending 2 or 3 days in the hospital, but for people spending 3 to 6 or even more months in hospital (this was the case here), it is completely terrible and the sleep deprivation goes against any good care practice. Situation is the following: \- First you have beeps every few seconds in a floor with 20 or 30 rooms. The beeps, after a few days working in the hospital, is just a common noise for nurses and doctors. The human brain is wired to ignore repetitive noise in your environment. Basically no one cares about the beeps after a few weeks in the hospital, and the beeps turn into routine noise. They should be exceptional to be an alarm. Constant alarm is not an alarm anymore. \- Then there is no way to tell if the beeps are serious (dysfunction or else) or irrelevant. For example infusion pumps beep 2/3 minutes before ending as pre-alarm, then beeps when ending the infusion, and keep beeping until a nurse stops it. If you are in a room with 5 infusion pumps delivering medicines and one heart rate monitor with high and low alarms, you are guaranteed to get beeps in the room almost constantly, which kills the whole point for the beeps in the first place. They become useless. It is even counter productive. Not mentioning beeps of low-battery for infusion pumps or other devices which are plug into A/C. Very often the beeps cannot be de-activated, so the medical device vendor is safe for a legal point of view. \- children spending 3 or 6 months in hospital are seriously impacted by the 6 to 9 wake-ups during the night. Every kid with a leukemia or other form of cancer spends 3 to 6 months in hospital at least. This is a lot of kids (about 15 000 per year in the US). Nothing is done to help those kids sleep better during those months in hospital. they have a double burden: cancer and sleep deprivation. It is obvious patients should be monitored, but today we must admit sleep is the least of worry for all caregivers and medical devices vendors. It is possible today to design sleep-friendly monitoring devices. Machines states can be displayed on a central deck, nurses and doctors can have a smartphone or smartwatch with alarms connected to the machines, machines could only beeps when a care giver is in the room thanks to NFC, blinking lights in the corridor could be used as well.Stupid questions that are in the patient file should be answered in front of the computer, not at 2 a.m. during the night. In any case too much noise is bad for the patients and kills the whole point of an alarm.

<comment><USER69> Reminds me of the 'too many road signs' problem:

[https://www.safetysign.com/blog/too-many-traffic- signs/](https://www.safetysign.com/blog/too-many-traffic-signs/)

It's hard to get staff working within a bureacracy to acknowledge this sort of thing, however. Only bureacratic procedures are real. Attempts to reform merely add to the bureacracy.

</comment></comment><comment><USER70> I basically lived in a hospital room for the past week, though I'm not sick. The machine that pumps and monitors your iv fluids constantly emits screaming alarm tones. An alarm can be triggered if you bend your arm the wrong way, obstructing the iv. But most often the alarm is triggered because of air in the line. You can silence the alarm. But if a patient is not accompanied by someone, they will probably have to sit there with the alarm going off for 10 to 20 minutes at a time before the nurse finally arrives and deactivates it. That happened to us once and I never left again after that.

And it's true — nurses barge into the room quite unceremoniously, wake you up, and perform tests on you in the middle of the night. It's very annoying and leaves everyone except the nurses very hagard in the morning.

<comment><USER67> _> It's very annoying and leaves everyone except the nurses very hagard in the morning._

Nurses work hard. Believe me, they are haggard in the morning.

<comment><USER70> The point is that they go home and get uninterrupted sleep.

</comment></comment></comment><comment><USER71> Since bootstrapping my own sleep aid startup ([https://trycosmo.com/](https://trycosmo.com/)), I've been surprised at the lack of priority society places on sleep in general. Better sleep would help patients recover better and shorten hospital stays. The inability to sleep, especially in the ICU, likely results in tens of thousands of unnecessary secondary infections and deaths per year.

I like the author's approach of simply refusing to give blood at night. My guess is that hospitals default to checking vitals so frequently to avoid liability-- could you imagine the headline if a patient died because his vitals had not been checked for eight hours?

A simple "Do not disturb" sign for patients would resolve all of these issues.

<comment><USER35> > These statements have not been evaluated by the Food and Drug > Administration. This product is not intended to diagnose, treat, cure, or > prevent any disease. > Your search - site:trycosmo.com peer review - did not > match any documents

Sounds promising. Untested sleep drugs, sign me up!

<comment><USER72> It's actually just melatonin, L-theanine and magnesium in one pill. So nothing sketchy but also not anything new or interesting. Just a combo pill like most other supplements on the market.

<comment><USER71> You're right, the formula isn't groundbreaking. We did this intentionally to focus on the tried and true. We've also found that many sleep aids contain these ingredients, but only in very small quantities (1mg or less).

Is there anything else you would potentially like to see included?

</comment></comment></comment></comment><comment><USER73> I highly recommend the 2017 book "Why We Sleep" [1]. Written by a doctor, starting at page 335 he calls exactly for ensuring hospital patients can sleep, why this is so critical for recovery, and how many things in hospitals currently work against this. (The book covers so much ground, including other reforms like school time starts, why society doesn't value sleep because sleep-deprived people don't perceive their substandard performance, and so on.)

[1] [https://www.amazon.com/Why-We-Sleep-Unlocking- Dreams/dp/1501...](https://www.amazon.com/Why-We-Sleep-Unlocking- Dreams/dp/1501144324)

</comment><comment><USER74> Consider what hospitals optimize for (at least in the US). Not what they say but what they do...

For example, putting lots of money into fancy buildings. Fancy buildings attract patients for non-emergency things. That money doesn't go into things like enough nurses and techs to care for the people, especially at night.

Or, consider someone with a lump finding out it's cancer and getting setup with everything to get it treated. It's numerous visits to numerous places (some in Hospitals). This is not optimized for patient care.

If hospitals prioritized and optimized for patient care they would look a lot different.

</comment><comment><USER75> Danish company AudioCura is offering an auditory logging device [0] designed specifically to identify disturbances preventing sleep and rest in hospitals.

[0] [http://www.audiocura.com/portfolio/sou/](http://www.audiocura.com/portfolio/sou/)

</comment><comment><USER76> My experience (caring for someone in a private room):

Nurse head: "Any complaints?"

Me: "We kept getting disturbed."

Nurse head: "yeah, we hear that a lot."

Repeated 3x over the course of 3 days!!!

</comment><comment><USER77> I once spent two weeks in hospital with a smashed vertebra waiting for operation. I'm sure many of the individuals involved are trying their best, but it definitely feels more like a place for dying than a place for healing.

</comment><comment><USER78> During my daughters first year of life we had multiple hospital stays at multiple hospitals for surgeries. What we found was that your experience can vary a lot depending on the hospital.

Our worst experience was at a hospital that was #1 in the nation for its specialty. The staffing leaned heavily on STNAs, and they had a lot of patients to look after. Their nurses were similarly rushed. Once in the step down unit we were placed in a pod with three other families. Of course not all of them were respectful of recovery, with one of them staying up late into the night having boisterous conversations. We ended up advocating for leaving the hospital sooner than they were originally planning. We also found ways to get them to line up vitals and medicine a little better. All of this took significant advocating and considerable effort.

Our best experience was a complete flip. This was at a top 5 hospital in the nation for pediatric care. Nursing staff seemed top of their class. They took their jobs seriously, seemed to be extremely knowledgeable, and were attentive to both my daughter as well as the family. Similarly the doctors seemed to respect the nurses a bit more as they were the ones in closer contact with the patients and more capable of identifying things. We were often assigned a night nurse that only had a couple families to attend to, sometimes we were the only one. I don't remember ever seeing an STNA. They probably existed, but our care was overwhelmingly done through nurses. The step down unit was like a mini hotel, we had our own private room with a cot and pull out bed, private bathroom with shower, etc. The nurses seemed to actually give thought to their schedule and when to do vitals and meds. They also leaned on technology a bit more and had remote o2 and heart rate sensors, so they didn't need to take as many vitals.

The facilities made a bit of a difference in our experiences, but above all the nursing staff had the biggest impact. Highly skilled nurses that aren't over staffed seemed to be key.

</comment><comment><USER79> Of course YMMV.

Having spent two spells recently in hospital after surgery, it didn't bother me in the slightest being woken for 30s every few hours. Usually it coincided with me being brought painkillers, water and snacks. All of which were welcome.

There was also no issue regarding beeps in the post operative care unit that I remember. I was also given my personal belongings, as soon as I was able to structure a coherent sentence, which included headphones.

Similarly to other commenters, I should point out you might not be so quick to use technology to solve this problem. Implementing technology into an area where lives are at risk (ICU) takes a long time - with good reason. I saw a comment talking about a centralised monitoring desk. Good luck finding a ward where you are always staffed enough to have someone watching that. There is a good reason sounds have remained as the primary monitoring cue for so many years.

</comment><comment><USER80> A million times this. Fortunately my only adult experiences overnight in a hospital were for the births of my children, but I was amazed in exactly the same way as the author here at how the place seemed designed to not let you sleep for more than 90 consecutive minutes. Even for non-medical stuff, there was laundry, meal prep, delivery, and cleanup, and cleaning, and then add regular checkins and tests and such to that, and it was just constant. (And of course with a newborn it's not like you're getting uninterrupted sleep at night even when they do leave you alone, so you're trying to catch up in the daytime, which is even more impossible.)

</comment><comment><USER81> I really like posts/articles like this that point out problems that need to be addressed, but they always seem to miss a reasonable call to action. In this case it mentions what the author did (refuse to let her sleep be interrupted and make a verbal agreement with those tending.)

But if that doesn't work? For instance, what do I do about the new nurse that doesn't want to upset the dr and insists on doing the 4am blood draw?

With hard facts about WHY the nurse doesn't need that 4am draw I could formulate an argument to convince the nurse to let me sleep instead. But outright refusing to let the nurse do their duties just feels... obnoxious.

</comment><comment><USER82> When I was at the Stanford cardiac unit last, they let me sleep. That wasn't the problem but they had a problem giving me privacy: door wide open, curtain wide open.

<comment><USER83> Patients with privacy are patients who end up dying. Hospital floor plans are designed to ensure that nurses can see if patients take a turn for the worse.

</comment></comment><comment><USER84> I understand if clinical staff are actually coming to check on you. In many cases you may need to be checked on every few hours to prevent some decline in condition from going unnoticed. What I don't get is why some hospitals (seems American hospitals don't do it this badly) won't let you sleep when they aren't even coming to check on you.

Last Halloween in Toronto I got a (spooky) appendectomy, and although they were not coming to check on me, I could not sleep because I was in a loud room (the patient beside me had his whole immediate family watching over him, and my mind was awake, trying to decide whether they were speaking Brazillian or Portuguese) with bright overhead lights. I normally sleep with earplugs, but in the sort of rush I was, getting in the ambulance, I neglected to bring a pair. I managed to flag down a nurse to get me a pair of earplugs after five hours of trying to get to sleep.

If they have to come check on you, they could at least make it possible to rest when they're _not_ checking on you.

</comment><comment><USER85> Doubly true in a neurorehabilitation facility given sleep is critical to brain repair. Stayed in with someone in that situation before and was blown away by the frequent interruptions of sleep of the patients by staff checking stuff that could have been done without waking the patent.

</comment><comment><USER86> I've always slept very well in hospitals.

Source: home, Brussels Belgium

<comment><USER87> Me too. Source: Berlin, Germany.

If you don't have any super critical stuff or you call the nurses because of pain, they'll leave you alone from 9/10pm to 6/7am

</comment></comment><comment><USER88> This article calls to mind the Voltaire quote "The art of medicine consists in amusing the patient while nature cures the disease." If you ascribe to this idea then the argument of the article takes on even greater force.

</comment><comment><USER89> This article brought back memories. When I was 9 something went through my eye. One night after surgery, the nurse came to check on my IV. She broke it. Her next mistake was getting a resident to put a new one in. Five tries in one hand and four in the other, they finally decided I could live without it for the night.

My wife and I still recoil at the memory of trying to rest the night after my daughter's birth. We were woken up every two hours for different tests. Keep in mind that it was a no complications birth. The fourth time they came in to run a test I begged them to leave us alone.

</comment><comment><USER90> I think the reason is simple. It has to do with money. If a medical worker doesn't come in and perform their job, he/she is not entitled to be paid.

When you step into a hospital, there's a process in place to make money out of you. If anyone misses their part, they'll have revenue shortfall. The pressure is on medical workers. Hospitals have admin staff to pay (CEO, managers.) They have bonds that come to due.

Hospitals are not there just to care for the sick. They're there primarily to make money. I think most of them are designed that way.

</comment><comment><USER91> I've been unfortunate enough to have my 2 year old daugther hospitalised 4 times already and every time, in every ward, she slept very little.

Constant sources of lights, machines that beep. I get they're serving a purpose but an oxygen monitor going off at full volume every 20 minutes, really? You're telling me that cannot be replaced with a smarter machine that just sends a signal directly to the nurses instead of beeping up the place?

After every hospital stay she fell asleep immediately when we got home and slept for over 12 hours just to recover.

</comment><comment><USER92> We have 7 kids and I saw this with every one of them. After the baby was born the nurses would come in a minimum of every 2 hours and wake my wife up to ask how she was doing. She would do a lot better if they weren't waking her up! For that very reason my wife wanted to leave the hospital ASAP so she could go home and sleep. I sort of wonder if that is the intention of the hospital, to get patients out sooner, but they make more money the longer you are there... so it doesn't really make any sense any way I look at it.

</comment><comment><USER93> Anecdote time. I spent ~3 weeks in the hospital with pneumonia in 6th grade (age 11 or so). For some reason the time they decided on to give me a daily dose of antibiotics was 3am. They were pills, so I had to be woken up enough to swallow them. Fortunately my mom wouldn't stand for that shit and put up a fuss and it only lasted a week. I was in bad shape, I was in the hospital after all, but not such bad shape that antibiotics were so urgent that they were worth ruining the sleep of a sick child on a nightly basis.

</comment><comment><USER94> Former air traffic controller, my schedule for the last 5 years at a 24 hour facility.

Monday and Tuesday - 7am : 3pm Wednesday and Thursday - 3pm : 11pm Friday and Saturday - 11pm : 7am

48 hours off to start that again on Tuesday.

<comment><USER95> Why though? Certainly it's possible for everyone to work the same shift each day they work.

Though that kind of schedule would probably work pretty well for me considering my tendency to try to live on days longer than 24 hours. I want to sleep for 8 hours, but then be up for 18 hours. So between Christmas and New Years, when my work shuts down and I have a week off that I usually spend at home, I find myself staying up until 2 AM the first night, 4 AM the second night, and wanting to stay up until 6 AM the next but have to force myself in bed at 4 because otherwise I'd end up coming back to work with my sleep schedule almost completely opposite of the usual pattern needed to work.

<comment><USER94> I couldn't tell you why. We were given BS excuses at each facility I worked. Its terrible as I worked radar so you're in a dark room in zombie mode.

My educated guess is the artificially low manning thus needing to shuffle people according to traffic.

</comment></comment></comment><comment><USER96> I had a cycling accident 4 years ago, and so I remember this problem VERY well.

The second time the bright-eyed resident working for my surgeon came by to talk with me WITHOUT HAVING ANY NEW INFORMATION before 6 in the morning, I read him the fucking riot act. It didn't happen again.

But I was a fit (if broken) 44-year-old white dude with good insurance, very sure my privilege and very willing to exploit it. I'm sure they run roughshod over meeker folks.

</comment><comment><USER97> This is contradictory to any experience I had in my hospital. I've broken my leg a few times and have spent some time in the hospital. It was always the same one so this is very anecdotal.

They always had strict sleeping schedules for all patients, from 23:00 until 7.30 or 8 everything would be quiet and as little as possible would happen. Besides the pain I always slept like a baby and the hospital encourages that as much as possible.

</comment><comment> trey-jones I've been so down on Healthcare in the US for the past 10 years that this kind of thing doesn't even phase me anymore. I see things like this and I now think:

"Of course it doesn't make any sense, the whole system is busted and any competence and intelligence that might exist in the industry is buried beneath red tape and scummy insurance practices."

</comment><comment><USER98> Anecdotally this seems like it's probably a real problem, but doesn't he only have a sample size of one hospital stay?

<comment><USER99> In a word, no. Until they start getting lawsuits over contempt for sleep, nothing will improve.

</comment></comment><comment><USER100> Is this a problem in UK because I slept like a baby in hospital but this was over 20 years ago. P.s. I wasn't a baby!

</comment><comment><USER101> It's up to us to set boundaries. If a corporation says sleep is dead unproductive time, it's the individual that must disagree and disconnect around their sleep. Same with exercise. There are so many benefits to the brain and the body from sleeping 7h+!

DISCLAIMER: I slept only 5h last night :(

</comment><comment><USER102> Nothing has illuminated my poor sleeping habits like reading 'Why We Sleep' by Matthew Walker. The book scared me into working on improving those habits with some degree of success. Many of the topics that Matthew Walker covered have been brought up in this thread.

</comment><comment><USER103> more than sleep I've found bigger issue with excessive paperwork, while giving birth in China there was no need to measure your baby prior and after each feeding, this was not the case in EU hospital

you would say it helps to decrease newborn mortality but loss of weight it's completely natural and i don't see reason why bother mother and baby measuring weight every two hours, that's just insane harassment

can't really compare sleep since in China we landed in private room (public hospital, not that busy in smaller town) while in EU room for three which was extremely overheated that in winter you had to open window, in China you had to pay astronomic fee around 1.5€ per day for AC remote control and AC to be switched...

</comment><comment><USER104> Hospitals being a place where sleep is hard to get is the premise of one of German animation's cult classics: [https://www.youtube.com/watch?v=SYc6r7JRh9s](https://www.youtube.com/watch?v=SYc6r7JRh9s)

</comment><comment><USER105> Hospitals worldwide should be optimized for _increased patient comfort_ even at the cast of marginally lowering survival (let's say 1%) and increasing cost (again 1%)! Almost all patients would prefer it.

But it's hard to convince people that often in life _paying slightly more_ for _a statistically slightly worse outcome_ increases you comfort ~10x and is 1000% worth it! After all, _we live to feel good, and living is only worth it as long as we feel good doing it!_

...but no, we just have to insist that we want _the absolutely best things_ (as customers) and that we need to be _as efficient as possible_ (as service providers). This combination of constraints makes life a living hell that I'm not sure why we can still stand. Also there's those maniacs that absolutely _hate_ being or making others _COMFORTABLE,_ but making life worse for them would be sooo enjoyable.

<comment><USER106> I don't want to create a false dichotomy, but it looks like you're saying you can have either one of two things: increased comfort with a higher chance of death and cost or a maintain to the low level of comfort with a higher chance of successful recovery. You go on to say:

> _After all, we live to feel good, and living is only worth it as long as we > feel good doing it!_

I think I get what you're going for, but I'd rather be uncomfortable in the hospital for a week in my 40s if that means I get to live another 40 or 50 years. I think a lot of other people would also feel the same.

<comment><USER105> The dichotomy _is real,_ I know a thing or two of how hospitals work and what prioritizing comfort would actually mean. But I'd still choose it.

> but I'd rather be uncomfortable in the hospital for a week in my 40s if that > means I get to live another 40 or 50 years

Yeah, if you're the 1% that could've actually died if not continuously and repeatedly checked upon and pestered with tens of mostly unnecessary tests, or if you need that expensive life saving drug whose costs would've been covered if less money were spent on better air-conditioning, lighting and soundproofing... bad luck for you. The other 99 would prefer the additional comfort. Heck, there's _many_ people who avoid going to hospitals when they know they should because they know how uncomfortable they are, and some end up dying because of that...

</comment></comment></comment><comment><USER107> We experienced the same thing after the birth of our first 2 children, and after our 3rd 2 months ago we were actually left alone all night. I commented to a nurse how nice it was and apparently protocol had recently changed for this reason.

</comment><comment><USER44> Other places terrible for sleep: Airplanes and long distance buses. That is one area where trains have an advantage; one can sleep surprisingly well in overnight sleeper trains.

</comment><comment><USER108> Most of the time it's vitals checks and lab tests. I've always asked them to coordinate them. Usually they will but you need an advocate with you.

</comment><comment><USER109> As for me, the worst factor is urine catheter. I couldn't sleep with it at all. I advise everyone to buy non-invasive one before it happens with you.

</comment><comment><USER110> Hospitals are designed to collect money first and foremost.

Anything having to do with your healing is a secondary concern. The only occasional exceptions are in profit centers like OB.

Usually the night nursing staff are better as there are fewer doctors and managers around. When my wife and I were hospitalized for a few days at various points we quickly grew to hate the morning, as that's when various parties would show up to say hello and log an encounter.

</comment><comment><USER111> Fewer staff means you need to start rounds earlier. Phlebotomists, RTs and Nurses manage insane workloads.

</comment><comment><USER112> From the article: "I can't wait for the letters to pour in offering BS excuses for why none of these solutions is really possible."

This fellow evidently already decided that any possible criticism of his solutions is BS. He is also a political writer. Is it reasonable to draw a connection between this attitude and journalistic political discourse in the US today? I think they are part and parcel.

</comment><comment><USER113> This article makes the problem of doctor/test scheduling sound way easier than it actually is. Optimally scheduling these tests when you have a few doctors and a few patients isn't that difficult, but it gets very tricky as you increase the numbers of both as well as the number of constraints on both patients and doctors.

</comment><comment><USER114> Could it be that hospitals make a hefty profit for every hour you spend on one of their beds? Less sleep means slower recovery, means more .

</comment><comment><USER115> Probably rich people in high end hospitals don't have this problem. I don't know this for a fact, I'm just comparing here the shitty experience that I had with the experience that a friend seemed to be having in a luxury hospital.

<comment><USER116> Well, at least the wealthy end up in private rooms, which is a big help. If you are unfortunate enough to share a room with another patient, then either he will be sick enough that the staff keeps you awake half the night as they attend to him, or he will be feeling fairly well, and will insist on watching Family Feud all night on the TV mounted on the wall.

<comment><USER21> From what I heard most new hospitals have gone private room only for triage reasons alone - sure a broken leg isn't contagious but hospital bugs are downright nasty.

</comment></comment></comment><comment><USER117> > There's much more that could be done about this, but I'll spare you.

No! Don't spare me the details! I read _for_ the details!

What a strange way to end an article...

</comment><comment><USER118> Hate is a strong word but I found myself hating my hospital stay because I felt trapped, I was unable to do anything for five days but be in my room, watching shark week over and over again. All that time just for tests. Tests take up time and money and at one point I scared my family badly with a few results. I think it's a combination of worry, stress, being awoken up every few hours and just being unable to do normal things- like taking a dump without the need for other people to know!

</comment><comment><USER119> Isn't it obvious? Sleep is when the body does most of its own healing and restorative functions. Hospitals make money when people are ill. Why would they want you getting better on your own when they have a host of treatments and medications they can sell you on?

</comment><comment><USER120> I fear the days I might have to spend in a hospital. My hope is that I will have saved enough money to afford home-care and die in my own bed, with a cat or a dog nearby.

</comment><comment><USER121> I would imagine patients in the hospital have much bigger problems than how much sleep they're getting. They'll probably be awake all night anyways worrying about their over-billed hospital bill and how their insurance company is going to get out of paying for it.

<comment><USER122> Only in the private hospitals.

 _self-induced sleep deprivation intensifies_

</comment></comment><comment><USER123> Hospitals aren't persons, so they can't hate anything. Nurses checking your vitals signs when necessary != hating you sleep.

Why do I hate inflammatory clickbait garbage so much?</comment>


IRC chat log of PSN hackers - <AUTHOR> http://pastebin.com/m0ZxsjAb <comment><USER2> This is old. Here is the same pastie, but posted on February 16, 2011 <http://pastie.org/private/97oth9v5tspkiztwwdmnga>

They aren't talking about the PSN Hack that brought down the network this time, they are going back and forth about how PSN stores the user's CC information in plain text on the console and that a shady/grey custom firmware has the potential to skim that information off the hardware and onto a bad guy's server.

The only slightly frightening thing about this is how they allude to the idea that this plain text CC information and security codes are transmitted over plain text, but that information is false. All transactions done between your PS3 console and the PSN network were done over SSL.

<comment><USER3> I don't think "user2" is claiming that the credit card information was sent in plaintext:

 _normally you ATLEAST enccrypt the securtity code, even if its ssl_

That seems to refer to encrypting the CC security code before sending it over SSL using public key encryption, which is good practice if you subscribe to defence in depth. But it's nothing I'd get upset about.

<comment><USER4> Right, it's just how HTML forms work.

</comment></comment></comment><comment><USER5> They seemed to be concerned about the lack of security they were witnessing, and they also alluded to "this could be bad in the hands of a spammer".

If this log is real, is it truly the conversation of those that took the data?

<comment><USER6> I'm with you on all points; however, what I find interesting is that these guys talk explicitly about the credit card data being available via the path they took. If these are the same people--or if perhaps it was someone lurking in the channel--the suggestion is that the technique used would have exposed the credit card data of these users--despite Sony claiming that they felt it was unlikely.

I'm not sure there's a lot of "news" to this post; my feeling is that if Sony, "isn't ruling out the possibility" that my credit card information was stolen, I'm working under the assumption that it was. I'd encourage everyone else who was subscribed to PSN to do the same.

<comment><USER2> They only talk about the unencrypted credit card data available to the console, not to PSN. This chat happened weeks before whoever gained access into PSN's network. Basically the same thing as pointing out the flaws in someone storing their passwords in a plain text file on their desktop. It isn't secure, but you'd have to get access to the single machine before you could get anywhere else.

I agree. This isn't much for "news".

I am, however, curious on the repercussions of the current hack of other services tied to the PSN network, like Netflix, that aren't directly gaming related. Do you think it will make companies give pause to developing dedicated clients for 3rd party services on game consoles that rely on the manufacturer of the console to maintain a network outside of the 3rd parties control?

</comment></comment></comment><comment><USER7> This is fascinating. As a developer, I enjoy reading such logs and stories. I like the thought that if you make something good, popular or interesting, there will be someone that will admire your work, play with it and try to break it.

</comment><comment><USER8> Could someone please provide a précis?

<comment><USER9> Please there is no reason to use words that most people here don't know. Plenty of people who frequent HN are non native speakers of English.

To save others the trouble, calpaterson asked for a _resume_.

<comment><USER10> Jesus, now that we're done with all the pointless bickering about language, could someone provide a Zusammenfassung? I skimmed it, and saw nichts interessantes.

<comment><USER11> Here are the important claims made in the logs:

* They have "decrypted all PSN functions."

* Sony spies on basically everything PS-related (hardware plugged in, games played, etc.) and uploads it. There are "independent checks" and history wipers, etc. don't work. This may only happen when the device is networked. They can detect backups, piracy, etc.

* It sends CC data, etc. via SSL, but leaves unencrypted logs on the HD that contain that data in the URLs visited. It may not have used SSL at all at launch.

* You can modify a few things when you download something from the PSN store to tell it that you should be getting the game for free.

* Sony monitors all messages sent over PSN, may be searching that for keywords.

* Has a big list of censor words that lives on your HD. Checks this list on receipt of a message, not sending. Easy to bypass now.

* Various worries about people creating spam apps with this data.

* Comments indicating that Sony is running old Apache servers with known vulnerabilities internally.

Watching this, I'm glad I don't have a PS3.

<comment><USER12> Most of stuff that they are talking requires use to have CFW in order to still. Hardware information are probably for statistical information and show me at least one service that they don't log messages, specially once that are hosted in the cloud. and they didnt talk anything about apatch, as long as they got this in EULA that you accepted it's fine. Best of all this log have nothing to do with the current situation, it's normal CFW development talk

</comment></comment></comment></comment></comment><comment><USER13> <http://pastebin.com/8YNDuFCw>

line 177 fixed for new lines

</comment><comment><USER14> "#define rand() 4"

Pure genius -- fool the hackers by making your "random" number static, they'll never guess! Now that PSN users are actually seeing money ciphered from their debit accounts, it's only a matter of minutes until the class action lawyers are all over this.

<comment><USER15> From the context, this appears to be a joke (see <http://xkcd.com/221/>), not a serious accusation.

<comment><USER14> It's also a reference to when the PS3 was first cracked, which was possible because they weren't really using random numbers to generate keys.

So yes, it is a serious accusation that points out their consistently lax programming techniques when it comes to security.

<comment><USER16> No.

The problem was that one of the parameters they used in their ECDSA signatures, k, was the same at least once. This allowed the key to be computed with simple math, but the generation of the key itself was not the issue.</comment></comment></comment></comment>


Injured motorcyclist accuses robot-driven vehicle of 'negligent driving' - <AUTHOR> https://www.washingtonpost.com/news/innovations/wp/2018/01/25/after-crash-injured-motorcyclist-accuses-robot-driven-vehicle-of-negligent-driving/ <comment><USER2> One of the reasons I don't use the autopilot that much in my Model S is that it is trying to be "too perfect", in the sense that it seems to want to stay right in the middle of the lane.

You may be thinking: why would that be bad? It seems like a reasonable approach.

It is reasonable, but not good enough.

In the Bay Area, potholes abound, and the car - if left to its own driving style - will happily go over every single one of them. Same if there is any hazard on the road (tires, debris, etc): no avoidance at all.

The second thing is that it will not adapt to lane sharing traffic: the car will happily go back to center, even though a motorcycle may be passing it to the side. Even if the sensors detect it, it's still a bad scare for the motorcyclist who will believe that I tried to run him/her over.

At the end of the day, I end up having to take over too frequently to be very useful. The cognitive load of maintaining a lane is so small that it doesn't feel like offloading it is a big benefit.

Once we reach full autonomy (with an algorithm that minimizes damage to the car from potholes and other elements), it'll be different I think.

</comment><comment><USER3> Lane-splitting should be illegal. It puts vehicles in places where they are not expected to be, and "I didn't see him" is one of the most common explanations for collisions.</comment>


European Court limits right to be forgotten to E.U. - <AUTHOR> http://curia.europa.eu/juris/document/document.jsf?text=&docid=218105&pageIndex=0&doclang=EN&mode=req&dir=&occ=first&part=1&cid=903295 <comment><USER2> The ruling is fair, it would open an international can of worms if EU bodies would start to dictate other countries users what to see on the net.

However, it means the real effect of the RtBF law is that it impedes less technically proficient internet users to search other person's data, but absolutely doesn't achieve stated goals (as nothing is forgotten, and entities which do personal data checks will for sure be able to use non-EU IPs to get unrestricted results). What it essentially does is limitation of low-skilled users search results. And that's all.

Which proves the whole thing was a combination of PR stunt, and incompetence on behalf of wide array of EU politicians, and NGO activists.

<comment><USER3> I don't understand why it's search engine's burden to bear for right to be forgotten. Shouldn't the takedown notices go to the source materials, eg newspapers, who actually contains the knowledge? Google is simply the references to knowledge that "needs" to be forgotten, and not the knowledge itself?

<comment><USER4> It's easy to understand- Google is an American company, but individual websites could be anywhere, even France.

</comment></comment></comment><comment><AUTHOR> The crux of the ruling

> [...] that operator is not required to carry out that de-referencing on all > versions of its search engine, but on the versions of that search engine > corresponding to all the Member States, using, where necessary, measures > which, while meeting the legal requirements, effectively prevent or, at the > very least, seriously discourage an internet user conducting a search from > one of the Member States on the basis of a data subject's name from gaining > access, via the list of results displayed following that search, to the > links which are the subject of that request.

<comment><USER5> I'm curious what "seriously discourage" would mean in this context, just bury the search result and that's fine?

<comment><USER6> I think practically speaking it means a VPN will be able to bypass it and that's ok.

</comment></comment></comment><comment><USER7> So now you could defeat the purpose of the "right to be forgotten" by making a site that remembers and lists all items that have been purged from EU only search results?

righttoberemembered.eu hasn't be registered yet.

<comment><USER8> Except that for a .eu domain you need to be EU citizen or a organisation based in the EU, making you liable under EU law. But other than that, yes.

</comment></comment><comment><USER9> A few comments/explanations on that ruling:

1\. It is not the end of the case -- this ruling is from the European Union law's top court (the CJEU) to give the ultimate interpretation of European Union law on the topic.

2\. The case now goes back to France, where the French judge will decide, taking into account both EU law and French law, whether the Data Protection Authority's (CNIL) ruling against Google was correct or not. The most crucial point that most media reports miss is that the CJEU ruling states clearly that French courts are not prohibited from ordering a global de-listing of all versions of Google, if the protection of privacy requires so (Point 72 of the ruling).

3\. The CJEU ruling restates many points from its 2014 ruling against Google Inc (US) and Google Spain - i.e. this is about an individual's right to remove certain results from the list of results based on the individual's name. It is not a right to remove content per se, nor is it a right to remove results entirely (i.e. the de-listed results should be searchable through any other search query)

4\. As in 2014, the Court rules that as a general rule/principle, the individual's right to opt-out prevails over the public's freedom to access search results -- but this is not absolute, and the other way around may be true depending on the circumstances (e.g. if the result is particularly relevant for the public's interest). [This "general rule" is the part of the ruling which I find most open to criticism, as in my opinion this is not what the law provides]

5\. This ruling is based on law before the GDPR. While the GDPR will continue to apply this _mutatis mutandis_ as we say, this ruling has nothing to do directly with GDPR.

</comment><comment><USER10> So basically, if you cannot find what you are looking for, use a few proxies to try the same on non-EU countries versions of the same search engine?

<comment><USER11> The goal of the law is not to make information impossible to find. That's why this targets search engines primarily.

The goal is that it becomes harder to resurface irrelevant information from someone's past.

<comment><USER10> The issue of course is not about the Law, and not even with the actual right to be forgotten (right or wrong is another question), it is IMHO more about the fact that this (or that) search engine will have different results depending on from where you make the same search.

Now these differences may well be only for the searches related to someone who invoked his/her right to be forgotten, but the moment the results of a same search from different places can be different, it opens all possible avenues to remove (or add) other kind of information selectively.

<comment><USER11> Even without that law search engines already return different results in different countries.

</comment></comment></comment></comment><comment><USER12> People in the US have never had a right to control over what people in other countries write or think about them. Vice versa.

</comment><comment><USER13> I really like what they are trying to do in the European Union

Just surprised this court hasn't had its Marbury v Madison moment when it rules for itself to take over the government

</comment><comment><USER14> Did this limit the law to search engine's again?

We've seen it used against newspapers. I worry about that.

</comment><comment><USER15> Too bad. I was hoping the EU would use its economic might to apply pressure against surveillance capitalism. Sometimes when our host nations fail us our best option is to hope for global pressure.

<comment><USER16> My issue with "right to be forgotten" is with the principle, not the implementation. It violates not only freedom of speech, but freedom of private communication. Let's look at what it's really involved with: I send an encrypted request asking a company for some information. That company wants to reply (also encrypted) with that information. This law forbids them from doing so. The company might be a megacorp like Google, but (depending on what I'm searching for) it might be a smaller service run by an enthusiast.

This law should really be called, "The right to stop other people saying true things about me to people who request that information."

</comment></comment><comment><USER17> All this does is to move business out of EU.

We are now worst that when we started: Still no right to privacy and now, loosing our companies.

<comment><USER18> makes room for companies that respect privacy

<comment><USER19> People care far more about companies that provide the best price.

</comment></comment></comment><comment><USER20> That's a good news. It was the worst part of GDPR.

<comment><USER21> it has nothing to do with GDPR

thanks for trying

<comment><USER22> Are you sure about that?

The implications of what's been said here will on some level impact how EU law will apply to countries outside of the EU. Considering the right to be forgotten is closely married to the right to erasure, GDPR is in the crosshairs. Remember, GDPR was supposed to apply globally. It's clear from today's ruling, there's some doubt in the courts whether or not that is even responsible, let alone possible.

<comment><USER23> > Considering the right to be forgotten is closely married to the right to > erasure

How? The right to be forgotten is just basically asking google/yahoo/bing/qwant not to put articles that can hurt one's reputation if asked. Imagine the only thing you're known for is a pedophilia case were you were first condamned, then release because it appears the children (and some of the really guilty) have lied: [https://en.wikipedia.org/wiki/Outreau_trial](https://en.wikipedia.org/wiki/Outreau_trial) You might want your name removed from google. Maybe.

The right to erasure is just your furnishing your own personnal data to a service provider and then asking them to remove all the data they have on you they can delete.

In the last case, you have a direct, business relation to the service provider. In the first one you don't.

<comment><USER22> Erasure cannot stand on its own. It needs the Right to be Forgotten upheld, globally.

"The correspondingly-named rule primarily regulates erasure obligations" [https://gdpr-info.eu/issues/right-to-be-forgotten/](https://gdpr- info.eu/issues/right-to-be-forgotten/)

GDPR even labels the right to erasure as "the right to be forgotten" [http://www.privacy-regulation.eu/en/article-17-right-to- eras...](http://www.privacy-regulation.eu/en/article-17-right-to- erasure-'right-to-be-forgotten'-GDPR.htm)

</comment></comment></comment></comment></comment><comment> m-p-3 One more reason to push the jurisdiction we each live in to move towards similar rights.

</comment><comment><USER24> I wonder how it came to be that only people in certain countries have a particular right, and how a court can determine that. I'd like to know their definition of a right. I'm pretty sure it differs from mine.

<comment><USER19> Some countries define rights on paper and then fight wars to preserve them.

Where there are differences between political bodies, the options are:

      * Negotiate to resolve them via treaties, etc.
      * Coerce via other means - usually loops back to the first bullet once sufficient force has been applied

</comment></comment><comment><USER25> Apparently the "right to be forgotten" is from laws in Spain which exist to allow people to erase their fascist past. Avoiding awkward conversations about what oke did during the war.

<comment><USER9> This comes from a [EU Court 2014 Ruling][1] based on Spain's implementation of European Union Directive 95/46 from 1995 which has nothing to do with what you're talking about.

[1]: [http://curia.europa.eu/juris/document/document.jsf?text=&doc...](http://curia.europa.eu/juris/document/document.jsf?text=&docid=152065&pageIndex=0&doclang=EN&mode=lst&dir=&occ=first&part=1&cid=969114)

And the 2014 ruling, as this ruling, are clear that there is no absolute right to "erase" the result on a name.

It is not a wildcard to erase every bit of relevant data about anyone, and Google regularly denies requests to de-list result on this basis.

As the 2014 ruling provides:

"Whilst it is true that the data subject's rights protected by those articles also override, as a general rule, that interest of internet users, that balance may however depend, in specific cases, on the nature of the information in question and its sensitivity for the data subject's private life and on the interest of the public in having that information, an interest which may vary, in particular, according to the role played by the data subject in public life. (§81 of 2014, Case C-131/12)"

And for example the court provides that "for particular reasons" the right does not apply. Such reasons include "the role played by the data subject in public life" that would be "justified by the preponderant interest of the general public in having, on account of inclusion in the list of results, access to the information in question. (§97)"

As always, the actual ruling is much more nuanced and balanced than many media reports or corporations would have you believe.</comment></comment>


Suzy Orman gives her book away free online through Oprah.com - <AUTHOR> http://www.oprah.com/article/oprahshow/20081119_tows_bookdownload

<comment><AUTHOR> Interesting piece of promotion from Suzy here. I'd be interested to know Cory Doctorow's thoughts. Suzy has not gone Creative Commons on the copyright and is forbidding forwarding and copying and is stopping the free distribution on Jan 15th (hilarious less than a week after Apple remove DRM and the file is a standard PDF). But given her wide exposure I suppose that she wouldn't need an IdeaVirus (Seth Godin) type effect to get it into wide distribution. I've downloaded it myself. So maybe I can forward the link to someone else. I would love to know what her publishers think of this - either (a) they can't stand it but Suzy is so powerful that they had to go with it or (b) it was their idea, in which case it is significant news.</comment>


Netflix Recommendations: Beyond the 5 stars – Part 1 (2012) - <AUTHOR> http://techblog.netflix.com/2012/04/netflix-recommendations-beyond-5-stars.html

<comment><USER2> netflix likes to talk a big game, but they still show me movies and shows i've already seen -- multiple times -- in multiple categories.

How am i supposed to discover new things to watch if you keep showing me the same things?

<comment><USER3> I had a similar thought. I was intrigued by the title of "beyond 5 stars" but as soon as I realized it was about the recommendation system and dated from 2012, I hit cmd-w.

The recommendation system is more of a loose suggestions based on criteria we cannot really explain system. It's rare that I'll look at recommended titles and think "hey, cool".

Ironically enough, first level recommendations that are "hmm intriguing" lead to far more "hey, cool": I click on a recommendation, think "meh", but notice something in the "more like this".

It's as if they are circling the target but cannot quite close the loop.

Before someone declares this to be working as designed, consider that I the user have to go through quite a few recommendations before getting to "hmmm" and not all "hmmm"s lead to "cool".

Not sure it's better than Monte Carlo, really.

(What I'd really like is a filter, either "movies only", "shows only", or "both". If I want to watch a movie, I do NOT want to be intrigued by a show. I want a 90-120 minute commitment and that's it. CAVEAT: my primary Netflix client is AppleTV, I rarely use the web to pre-search or pre-filter, so perhaps this is a limitation of that app.)</comment></comment>


Ask HN: Will my Bitcoin open source contributions count against me? - <AUTHOR> I'm a hobbyist developer who is looking to change careers and start working as a full-time software developer.  I learned to program about 2-3 years ago and  have been increasingly active in open source contributions, and even maintaining my own (somewhat) popular open source project.  I've been learning all the important stuff I missed in college by not majoring in CS: algorithms, data structures, etc.  I've got a pretty nice Github for someone who's only been into this a few years.  I love programming and want to do it full-time.
The (potential) problem is, I went through a stage when I was pretty amazed by Bitcoin technology (and I'm still pretty amazed by it).  And I even got some modest code contributions into the core Bitcoin client.
Now, I'm not a Bitcoin fanatic or invester.  In fact, I've been pretty disappointed by the number of scammers and stock-pumper types the project has attracted. And none of my other open source projects are Bitcoin related, nor are my blog posts, which cover a variety of other technical topics.  And I've got Github contributions to some other big, popular open source projects.
But seeing the negative reaction that some popular HNers have to Bitcoin, I'm really worried that my Bitcoin contributions will be seen as a negative by potential employers and even potentially rule me out as a job candidate, particularly in my small city, which is very far from being SV.
Problem is, I can't just delete the Bitcoin contributions from my Github account without deleting the account, and then I lose all my other (positive, and hopefully impressive) code to show employers.
This shouldn't be such a negative, since it's not easy to get code into the Bitcoin core project (there is, after all, a large economy that depends upon it).  But so many people on both sides are totally irrational about the matter, so I'm very worried about this.
Is this a problem? <comment><USER2> It probably won't be a problem. Don't be an evangelist, and be even-keeled about how you talk about your projects. Discuss what made them interesting and the technical challenges you had with them. There's not a lot of hate for Bitcoin the technology, just the die-hard advocates that it attracts (i.e. the kind that throws penny shavings at people via changetip and talks about how the blockchain will bring about a utopian anarcho-capitalist society, end-the- fed-ron-paul-2016)

As long as you keep it technical and keep the non-technical stuff to yourself, it will be beneficial (and you should really do that for _any_ topic in a technical interview). As an ancedote, I certainly wouldn't have any problems hiring someone with Bitcoin work, and my post history shows that I'm pretty skeptical of Bitcoin.

</comment><comment><USER3> It will when you go around making self-conscious posts about it.

Be proud of the code you write. Be even prouder it has users and if someone decides they don't like you based on their own short-sighted judgements, remember the world of technology is exploding and you will find gainful employment elsewhere. Also, you can use this mindset to maximize your income in negotiations and be quick to leave for better opportunities if you find your current job lacking.

In an interview situation, your tech skills and intelligence will shine through, even if making small talk, even if you express strong ideology surrounding your interests (passion sells so that would be a plus in my book even if I didn't agree with your views, your technical capability will demand respect). I guarantee you there are shadier people than yourself out there fishing for higher profile jobs. You control the means of production in a new economic era and as such you get to make a choice for the people you work for or with so why not take advantage of that. In addition, there's a good chance that this field will expand and your early involvement will become an additional credential.

</comment><comment><USER4> I bet if you don't list it on your resume most interviewers won't even notice it.

<comment><AUTHOR> I'm not sure about that. It's toward the top of my "Github Contributions", and by necessity I have to show them my Github. I've never worked as a developer before beyond a few small contract jobs, so I have to show them code somewhere.

In any case, this is falling off the new page, so I probably won't be able to hear from a meaningful sample of the hiring population. So I'll just have to risk it, and revisit it if I don't get any calls.

</comment></comment><comment><USER5> I think a majority of places will see your contribution as a positive thing. A few will not, but you probably don't want to work for those places anyway. I think the more conservative the company is, the more likely they will be to look down on your bitcoin contribution. I'm thinking small mom-n-pop shops outside of the valley, maybe also big financial institutions. Pretty much any startup in the valley would see the contribution as positive.

</comment><comment><USER6> I wouldn't worry about it - if someone you interviewed with was staunchly anti-bitcoin, you could certainly claim you did it as you found it an interesting technical problem rather than being a "true believer".

But I suspect most people who are skeptical of bitcoin as a viable currency still think it's kind of neat technically, and would be impressed at you writing some (presumably good) code for it.

</comment><comment><USER7> I wouldn't worry too much about it. I think basically anything that demonstrates open source contribution is a positive in the hiring process, besides maybe contributing to one of those dubious movie downloader apps or similar.

There may be some rare exceptions but as others have said, you probably don't want to work at a place that will criticise your extracurricular activities.

</comment><comment><USER8> Create a separate account or an organization under your account, transfer ownership to it.

Anyway, a technically savvy interviewer would still be able to find your commits but your personal profile will be cleaner.

Edit: I don't think your contributions will be negative but it is your GitHub, your rules.

<comment><AUTHOR> Thanks for your comment. I can't transfer ownership to the repo, because it's the Bitcoin core project and I don't own it (and I'm not even a core committer, so I basically can't do anything). But it shows up on my profile as "Projects contributed to". And since it's such a popular project, it's high in the list of projects contributed to.

I have considered a similar plan, really just an alternate take on your suggestion, which is creating a new profile and transferring ownership of my own (semi) popular projects to it. The problem is, I then give up my 2+ year old Github account for a brand new one. And then I also give up proof of other external projects I've contributed to, including some big name open source projects.

Github really should let users have control over what repos are shown in their profile. I mean, fine if employers want to use Github as a resume, but at least we should have control over which ones of our projects Github displays, then.

But the most important is that you don't think those contributions will be seen as a negative, good (anecdotal) data point. I'm beginning to think that I may be worried for no good reason.

Thanks for taking the time to comment.

</comment></comment><comment><USER9> No. It will be a huge positive.

<comment><AUTHOR> Thanks for your comment. I hope you're right. It's so hard for me to tell based on the people who comment on Bitcoin matters in online communities like HN and Reddit, who tend to be either very pro- or very anti-Bitcoin.

</comment></comment><comment><USER10> I don't see how contributing to Bitcoin could be a bad thing whatsoever...

This is just all in your head

</comment><comment><USER11> Or apply for a job with Bitcoin startup - it won't count against you then!

</comment><comment><USER12> I wonder if contributing to a BitTorrent client counts as better or worse.</comment>