More than a year and a half after the start of the COVID-19 pandemic, it’s no secret that responding to the disease has caused crushing stress among health care providers. To cite one of many examples, a survey of more than 1,100 industry workers reported that more than 90% experienced stress and three-quarters suffered from exhaustion and burnout as a result of the pandemic.

Given that, it’s not surprising that badly needed restorative sleep has been another casualty of the pandemic for health care workers. Another survey of nearly 1,000 frontline workers revealed that nearly all suffered from poor sleep and many experienced insomnia and burnout. The study concluded that “sleep interventions for frontline health care workers are urgently needed.”

Researchers on the University of Colorado Anschutz Medical Campus have taken up that challenge with a trial that tests the effectiveness of noise-masking Sleepbuds™ from Bose Corporation in improving sleep for health care providers. The study, now underway with funding from the Department of Psychiatry and CU Innovations, uses technology to track objective measures of participants’ sleep – time needed to fall asleep, sleep duration and awakenings – as well as their perception of the quality of sleep.

Providers are awake to the need for sleep

The study generated immediate interest from providers with direct patient contact on the Anschutz Medical Campus, including UCHealth University of Colorado Hospital, said principal investigator Dr. Andrew Novick, assistant professor of psychiatry with the CU School of Medicine.

“What we were seeing during the pandemic was that a lot of health care providers were struggling with sleep,” Novick said. “Sleep means everything as it relates to burnout prevention, ability to perform and mental health in general. We were therefore really interested in improving the sleep of (health care) providers and their overall quality of life.”

Novick noted that CU Innovations, which supports researchers in developing biomedical technology, procured Sleepbuds from funds from CU Anschutz donors and provided additional study support and resources. CU Innovations works in partnership with the UCHealth Care Innovation Center and The Children’s Hospital Care Innovation Center.

“The study is a great example of collaboration between CU Innovations and the Department of Psychiatry, and the dedication we both have towards attempting to utilize technology to improve well-being,” Novick said.

Pandemic further exposes a long-term issue with sleep

That effort began early on in the pandemic, as the Department of Psychiatry recognized the psychological burden COVID-19 imposed on health care workers, Novick said. The Department worked to make mental health resources available, specifically for providers affiliated with CU. The work included forming support groups, creating tips for improving sleep, offering psychotherapy strategies and more, all with the goal of reducing pandemic-related stress. Additional comments from providers across campus about COVID-related sleep disruptions helped to spur interest in the new study, he noted.

“Before the study, we heard from providers who had never had sleep issues, but said they were now waking up at 3 a.m. and not going back to sleep,” Novick said. Others reported having “disturbing dreams” and “feeling hyper-aroused and unrested,” he said.

With the additional support of two philanthropists, trial investigators began recruiting participants both on- and off-campus in April, with an enrollment target of 80, Novick said. In addition to the Sleepbuds, participants receive a device called a Dreem Band with electrodes to measure brain activity, breathing, heart rate and body movements. An app transmits the data to study researchers for collection and analysis. The trial period lasts 10 nights: three with the Dreem Band only, four with the Sleepbuds only, and three with both. The participants also subjectively assess the quality of their sleep.

Real-life sleep loss challenges for health care providers

Jessica Pettigrew had plenty of obstacles to satisfying sleep before COVID-19 took center stage in her life. A certified nurse midwife who practices at the UCHealth Women’s Care Clinic – Anschutz Medical Campus, describes herself as “a pretty light sleeper,” which makes it easy to awaken from sounds made by her husband, an 8-year-old son and dog.

“Why wouldn’t I be up several times a night?” Pettigrew asked jokingly. She said she’s tried earplugs to block noise but found them too uncomfortable.

Pettigrew said the pandemic intensified her sleep difficulties. “The biggest problem has been the chronic uncertainty,” she said, noting COVID connected worries about whether her son would be in or out of school, changes in her work schedule and the disappearance of “self-care” options like meeting friends, going to the gym and traveling. Because of all these factors, Pettigrew was eager to participate in the sleep study.

Difficult COVID conversations

The pandemic also created job pressures that contributed to sleepless periods, Pettigrew said. Conversations with patients about the need for vaccinating against COVID-19 sometimes were challenging and frustrating, she said.

“As we’ve seen in many other industries, some consumers of our services have become restless and angry about COVID restrictions,” Pettigrew said. “That has obviously impacted the clinical environment. Having to discuss the vaccine with patients multiple times a day has added a totally different dynamic to the work that we do and it’s stressful.”

She admitted that it’s easy to carry those frustrations home, where they can disrupt her sleep. Poor sleep, in turn, made her job more difficult.

“I think anyone who has been on call all night and then been back in clinic the next day can empathize,” Pettigrew said.

Previous study spurs further investigation

It remains to be seen what the final study data will show. But a 2020 study with Sleepbuds, sponsored by Bose in partnership with the UCHealth CARE Innovation Center and CU Innovations, produced promising results and spurred interest in the current trial, said its principal investigator, Dr. Susan L. Moore, research program director for innovation in the Office of the Vice Chancellor for Research at CU Anschutz and research assistant professor in the Colorado School of Public Health.

Rather than focusing solely on health care providers, the 2020 study recruited “community members with self-reported sleep problems due to environmental noise,” said Moore, who is a co-investigator with the current study. The participants did not have clinically diagnosed sleep issues, such as insomnia or sleep apnea, she added. They followed the same general regimen as those in the health care provider study, but instead of a Dreem Band, they used a device called a Sleep Profiler to collect brain activity data.

Fifty people completed the study, which produced findings of both objective and subjective interest, Moore said.

“We found a small but statistically significant effect on how quickly people fell asleep, both as measured by the Sleep Profiler and as reported by participants,” she noted. Independently of the data, participants also felt that their overall sleep quality improved, Moore added.

“The effect measured by the EEGs was not as large as what people felt,” Moore said. “We thought that was a really interesting take-away because we know the subjective experience of sleep is very important.”

Hunger for a solution

Following announcements of the results of the first trial, Moore said, members of her research team started hearing plenty of interest from campus colleagues about using the devices to help them improve their sleep. That was “part and parcel of how the current study came to be,” she said.

Health care providers are “a population that is having really significant issues and challenges with sleep,” Moore said. “Perhaps a solution like [Sleepbuds] can improve that. Health and wellness occurs outside of the clinic as well as inside of it. The promise of digital health technology to improve sleep quality is very interesting.”

Novick said that the “huge response” to the new trial confirmed that health care providers are hungry for new ideas about how to improve their sleep.

“This is actually a problem, as we suspected, and one that people are interested in remedying,” he said.

For more information on the sleep quality trial, contact Heinrich Haller at [email protected], or 303-324-0011.