[HN Gopher] Deadly heart attacks are more common on a Monday
___________________________________________________________________
Deadly heart attacks are more common on a Monday
Author : giuliomagnifico
Score : 184 points
Date : 2023-06-06 13:19 UTC (9 hours ago)
(HTM) web link (www.bhf.org.uk)
(TXT) w3m dump (www.bhf.org.uk)
| hugozap wrote:
| I think total disconnection on weekends cause more stress on
| Mondays and that's why most people hate them, you need a lot more
| cognitive effort to resume work.
| zer0tonin wrote:
| [flagged]
| wly_cdgr wrote:
| Anything except another week with this lot
| robotburrito wrote:
| I'd be curious to know if these heart attacks happen equally in
| those that have to work from home vs those who have to commute to
| an office.
| [deleted]
| xdavidliu wrote:
| or equally in those that are retired
| lukko wrote:
| Side note: there is also a stress-induced heart problem called
| tako-tsubo cardiomyopathy (aka 'broken-heart syndrome'), which
| also seems to be more common on Mondays.
|
| It's caused by sudden stress (e.g. bereavement, illness) which
| leads to weakening of the heart muscle, causing the heart to
| bulge out at the apex. It's named 'tako-tsubo' because the heart
| starts to resemble a round vessel used in Japan to catch
| octopuses.
|
| https://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy
| elzbardico wrote:
| I'd bet that probably alcohol and the consequent dehydration are
| one of the big drivers here. People severely underestimate how
| much alcohol can dehydrate someone.
| mstudio wrote:
| Thank goodness it's Tuesday!
| jimnotgym wrote:
| This contradicts some data released by 'The Cure'. Tuesday and
| Wednesday look much more risky.
|
| However 'The Boomtown Rats' seem to agree with the study.
| fnordpiglet wrote:
| Looks like someone has a case of the Mondays!
|
| (I know I'll get downvoted for using humor on HN, the "this
| isn't Reddit no smiling" brigade will be here in a moment to
| express their scorn at any sign of pleasure)
| branon wrote:
| It's not humor in general that's disliked, it's seeing the
| same few dozen tired references that it's seen as normal to
| repeat ad nauseum on more social media type sites like
| reddit.
|
| That said, Office Space is my favorite movie so don't take it
| personally, mmkay? Yeahh, that'd be great.
| fnordpiglet wrote:
| Yeah I actually have never used Reddit so don't know. I'm
| more a Usenet guy.
| [deleted]
| robocat wrote:
| Low value comments get downvotes - and most "funny" comments
| are about a zero on the funny scale (regardless that office
| space is fantastic).
|
| The point of the guidelines is to help reduce low value
| comments and on that note - mentioning voting is against the
| guidelines https://news.ycombinator.com/newsguidelines.html
| for the same reason "Please don't comment about the voting on
| comments. It never does any good, and it makes boring
| reading."
| dang wrote:
| The issue isn't humor, it's that people overestimate how
| funny their comments are. The best explanation of this was
| from scott_s years ago:
| https://news.ycombinator.com/item?id=7609289.
| [deleted]
| thenerdhead wrote:
| In other words, work is literally killing us due to Sunday night
| syndrome and stress we are unaware of.
| mahathu wrote:
| Thank god its Tuesday!
| cm2012 wrote:
| Also, a surprising amounts of heart attacks are during sex. But I
| think the number one killer is shoveling snow! Basically any
| physical exertion for people who don't normally do physical
| exertion.
| vaishnavsm wrote:
| It would be really interesting to see whether this holds in
| Middle Eastern countries or other places where the work week
| starts on a Sunday.
| amelius wrote:
| Why, though? A name is just a name, and that also holds for
| weekdays.
| ralusek wrote:
| Could rule out certain things. If they have more heart
| attacks on Sunday, then it would make it more likely that the
| association is "first day of the work week," as opposed to
| something like "first day of trading on international
| markets" (only Monday).
| macinjosh wrote:
| Work is stressful
| barbegal wrote:
| The headline is misleading. The actual study proved that the
| recorded date of admission to hospital in Ireland with ST-segment
| elevation myocardial infarction was increased on a Sunday and
| Monday. Increased admissions on a Monday is not that unusual
| given that people often seek medical attention after the weekend
| but maybe more surprising is the increase on a Sunday.
| https://heart.bmj.com/content/109/Suppl_3/A78
| 3minus1 wrote:
| Thanks for linking this. I wish the article included actual
| stats like the scientists expected about 1500 admissions per
| day, but Sun/Mon had over 1600, while the other days were
| between 1400 and 1500.
| magicalhippo wrote:
| Staffing tends to be lower on weekends AFAIK, could it be
| triggered by extra stress from not getting proper care during
| the weekend?
|
| Another possible factor could be the fact that doctors tend to
| make more mistakes during operations on Fridays compared to
| start of week.
| haldujai wrote:
| Not for a STEMI specifically, it's one of two ECG patterns
| even a radiologist like me knows how to read. This is a
| stronger argument for other diseases. Door to balloon target
| in STEMI is 90 minutes.
|
| STEMI centers (this is picked up by EMS and these ambulances
| are redirected to appropriate centers) have 24/7 cath lab
| coverage and any major one will have an ER bypass even during
| afterhours to expedite care.
|
| In fact more and more hospitals (and all the major ones)
| announce a "Code STEMI" overhead either when the ambulance is
| dispatched or as soon as the ECG showing ST elevations is
| discovered in triage/ER to activate the team and reduce door-
| to-balloon time.
| clairity wrote:
| any recommendations for a crash course in cardiology for
| the motivated learner? (randomly searching the internet
| being really inefficient for this type of targeted
| learning. motivated, as in, diagnosed with a significant
| coronary artery blockage.)
| selimthegrim wrote:
| How common is it for a non-cardiologist know how to read
| ECGs? Is it something required in medical school? I heard a
| critique of Soviet medical training that nonspecialists
| didn't know how to read them.
| robbiep wrote:
| If you can't read a critical ECG you failed medical
| school
| importantbrian wrote:
| My wife is a nurse, and they definitely learned how to
| read ECGs in nursing school, and she later worked in a
| cardiac ICU where she got additional training. She
| couldn't read a 12 lead and notice all the things that a
| cardiologist would, but for STEMIs and a few others she
| was trained to recognize them and call a code.
| haldujai wrote:
| Your wife would be more skilled than the vast majority of
| surgeons and radiologists at this as she looks at rhythm
| strips them way more than we do, and none of these
| physicians would hesitate to admit this.
|
| Honestly, when I have an ICU nurse providing procedural
| sedation for me I essentially just defer to their
| expertise on the rhythms and if they're worried I
| activate the mobile response team.
| importantbrian wrote:
| > Honestly, when I have an ICU nurse providing procedural
| sedation for me I essentially just defer to their
| expertise on the rhythms and if they're worried I
| activate the mobile response team.
|
| That matches with my impression about a lot of things in
| her job. I'm always a little surprised when she talks
| about calling the doctor saying I need X, Y and Z and the
| doctor just being like cool I'll put in the order.
| Obviously, not all doctors are like that but it seems
| like the vast majority defer to the nurses in a lot of
| situations. This is completely different than the
| conception I had of healthcare before I met her.
| haldujai wrote:
| I love working with ICU nurses. Generally speaking they
| are are very competent and very much respect their scope
| (both physicians and nurses overstepping is a recipe for
| disaster) so it's an incredibly healthy and collaborative
| relationship.
|
| > I'm always a little surprised when she talks about
| calling the doctor saying I need X, Y and Z and the
| doctor just being like cool I'll put in the order.
|
| This is the best part. A lot of decisions like sleeping
| aids, antipsychotics, antiemetics don't have evidence to
| choose from the various options so it's a bit of trial
| and error. An ICU nurse typically covers 1-2 patients and
| knows them very well, so if the recommend/ask for
| something it's usually the right decision and reduces the
| cognitive burden on the physician. We obviously still do
| a safety/sanity check but ballpark estimate I'd say I
| disagree or order something else < 5% of the time.
|
| Similarly I'd say the proportion of bullshit overnight
| pages (e.g. I fondly remember a 4am call that a patient
| has leg cramps) I've received from ICU nurses are even
| less than that.
|
| General ward nurses on the other hand... A very
| heterogeneous bunch with high turnover (worse in
| academia, at my last hospital average career length was
| ~2 years before they leave for greener pastures) so the
| relationship is very different.
|
| Not that I don't appreciate them or their work, but far
| less trust in decision making and they need more
| oversight.
| OJFord wrote:
| The basics definitely taught & required of all junior
| docs (UK) - but it's nuanced, not just a binary 'read an
| ECG correct or incorrect' - a specialist might spot
| something someone else doesn't; two specialists might
| disagree on whether it shows something or not. (And an
| interested (inherently non-specialist) junior might
| notice something a bored & rushed specialist doesn't.)
| haldujai wrote:
| Agree in general, even if one knew this at one point or
| know the textbook appearances patients don't read
| textbooks and there's nuance to everything. Unless you're
| actively exposed to/interpreting ECGs in clinical
| practice you lose the skill.
|
| When I was an intern I was 100x better than I am at this
| point in my career.
|
| The basic atrial fibrillation and STEMI is something any
| doctor can interpret with confidence (I used myself as an
| example as I'm probably the least competent because I
| haven't looked at an ECG in 10 years). I doubt non-
| cardiac surgeons are much better on average as they don't
| really look at these themselves that often other than for
| basic things.
|
| An ER or general internal medicine physician is expected
| to be competent in more advanced but common stuff like
| bundle branch blocks, left ventricular hypertrophy, non
| ST elevated MI.
|
| Weird arrhythmias or conduction abnormalities is really
| only for cardiologists, and even then typically a
| subspecialist electrophysiologist.
| antonjs wrote:
| Seems like the perfect application for some kind of first
| pass (in the ambulance,even) automated ML diagnostic,
| given the data is 2D, well characterized, and mostly
| repeating.
|
| Edit: aha--
| https://www.nature.com/articles/s41467-020-15432-4
| haldujai wrote:
| We've had computer-reads/AI on ECGs since I was a medical
| student. Really good at detecting normal, bad at
| everything else.
|
| US/Can healthcare systems still pay a cardiologist a
| couple of bucks to "finalize" the interpretation whenever
| they get around to it. It's a bit ironic, someone could
| have an MI on Friday, get treated and discharged and
| we're still paying someone on the Monday to read 40 ECGs
| (note these would have been acutely interpreted by the
| cardiologist treating the patient, most places have rules
| against self-referrals so you can't formally interpret
| anything you order yourself).
| pixl97 wrote:
| >more surprising is the increase on a Sunday.
|
| This doesn't seem that surprising to me, or at least I expect
| we should also see an increase on Saturday. People like to do
| harder work, like lawn projects on the weekend, and things like
| drinking that can affect the heart.
| coffeeshopgoth wrote:
| So the "Sunday Scaries" are real - where you dread going into
| your toxic job on Monday. Diet and genetics are big
| contributors to the blockages forming, and the stress sets it
| off. I had mine (which lead to a double bypass) on a Sunday
| morning. My job, at the time, was very high stress and I
| started dreaded going in every Sunday. I could feel panic
| attacks welling up on Sundays quite often. This is absolutely
| just opinion, but talking to some other people that were in
| the hospital with me, it sounded like I definitely wasn't
| alone in this life experience.
| prepend wrote:
| Victor Frankl said in Man's Search for Meaning: > Sunday
| neurosis, that kind of depression which afflicts people who
| become aware of the lack of content in their lives when the
| rush of the busy week is over and the void within
| themselves becomes manifest.
|
| So it wasn't so much about dreading the coming week but
| being still from the previous week and being sad about what
| they actually accomplished (or didn't).
| CobaltFire wrote:
| Damn, I need to reread that book. I'm struggling with
| that now; I just retired at 40 and am looking for meaning
| in my life with that exact issue popping up.
| prepend wrote:
| It was the first time I remembered someone describing the
| small depression one experiences after accomplishing a
| goal and it was funny because wasn't something I remember
| hearing about from others. Mentally, I called if "post-
| summit malaise."
|
| I suppose it's a nice problem to have but still
| uncomfortable. Congratulations on your retirement and
| hope you get to figure it out and find a new mountain to
| climb.
| coffeeshopgoth wrote:
| I have read it, and yes, this is true...but I actually
| had a boss that would just demean you in front of anyone
| and every so often threw a chair, so my stress was coming
| from multiple fronts.
| dspillett wrote:
| _> maybe more surprising is the increase on a Sunday_
|
| I don't think that seems surprising. People working office jobs
| through the week go out and drink more on a Friday and Saturday
| night, and those of a more sporty bent will often push their
| bodies more at the weekend because that is when they can find
| the time for longer or multiple training sessions, and it is
| where you find organised events (the highest proportion of runs
| are on a Sunday, with the second highest being Saturday).
| renewiltord wrote:
| There has to be an Internet Law that nothing is surprising -
| whether it is true or false. Every statement, true or false,
| has an explanation for why it is true.
| CDRdude wrote:
| Yes, but that law isn't surprising. The internet brings
| such a wide variety of life experience and education into
| the same discussion that there is always someone for whom
| the statement is obvious given their life experience.
| interlinked wrote:
| Aren't sports good for heart?
| slashdev wrote:
| Not if you're on the verge of a heart attack. Also slightly
| more controversially, I think very vigorous/taxing sport
| (like marathons) could do more harm than good. Like a u
| shaped distribution where moderate exercise is the sweet
| spot.
| dspillett wrote:
| Depends on what state the heart is in to start with.
| elzbardico wrote:
| In the long run, if you increase your intensity slowly,
| giving time for your body to build up increased fitness it
| tends to be mostly positive. But the short-term stress can
| be fatal if you are already on the verge of a myocardial
| event.
| falcor84 wrote:
| Sports are apparently good for the heart in the medium-long
| term, but can be very taxing (read: dangerous) for the
| heart while you're actually doing it.
| hansvm wrote:
| They're probably a net positive on average given the
| reductions in weight and blood pressure and whatnot, but
| there's a lot of variability, both in short-term trauma and
| long-term accumulated damage.
| outworlder wrote:
| > but maybe more surprising is the increase on a Sunday.
|
| Anxiety due the the looming work week?
| treeman79 wrote:
| When you've had a number of issues over the years at some
| point, you just have to kind of keep working and go to the ER
| on your off hours.
| haldujai wrote:
| From the methods section of the abstract: "We excluded post-
| fibrinolysis patients, patients with old stents, and those who
| presented more than 24 hours after the onset of pain."[edit: I
| misread the PDF version which included multiple abstracts, the
| methods I'm referring to was from a separate study with the
| title cutoff, this specific abstract didn't specify. But from
| below and table 1 in:
| https://jamanetwork.com/journals/jama/article-abstract/20140...
| which looked at 68,000 STEMIs, 3.1% presented > 12 hours and
| 8.4% had an unknown time of symptom onset. Wouldn't explain the
| magnitude of effect seen in this study. Circadian effects on
| STEMI and increased incidence on Monday are not new
| observations.]
|
| Don't think late presentation STEMIs are that common to begin
| with for your argument to have logical sense, this is the worst
| form of a "heart attack".
|
| From this single center study presentations > 12 hours only
| comprised 10%.
|
| https://www.ingentaconnect.com/content/wk/jcarm/2017/0000001...
| barbegal wrote:
| Thanks for links to those extra studies. The 3.1% and 10%
| presented > 12 hours are averaged across all days of the week
| not just the Sunday to Monday gap which is likely to be
| greater given the reduction in public services in Ireland on
| a Sunday. Do you know of previous studies which report Monday
| as being particularly risky? I can only find references to
| time of day (circadian cycle) which obviously make sense
| given how many bodily processes are linked to a circadian
| cycle but I'm skeptical about a weekly cycle (which I find
| confusing to be referred to as circadian also)
| haldujai wrote:
| They include an off-hours subgroup which comprises of
| weekday after hours as well as weekends and represents
| 2/3rds of cases. They don't provide a further breakdown but
| in this after-hours group delayed presentation was even
| lower (2.9%) and they report statistical significance
| (although it looks like a multivariate P value at a quick
| glance). Unknown (10%) is hard to interpret what that
| actually means.
|
| Just knowing the pathology of STEMI it's hard to buy that
| an effect of this size (in the Ireland study) is largely
| due patient's not seeking care on weekends unless you're
| somewhere extremely rural as this isn't your average heart
| attack.
|
| If this was about ACS (acute coronary syndrome) in general
| I'd be more suspicious that patient delays are a relevant
| confounder, but we have other literature to support the
| trend (granted with some conflicting studies).
|
| from [1]: > _Many studies have shown an excess of
| cardiovascular events on Mondays (1,3,10,16,18,19). A
| relative trough has been seen on Saturdays and Sundays I
| compared with the expected number of cases. A similar
| pattern was seen in most subgroups irrespective of age,
| gender, cardiac medication, and in-fart characteristics
| (first or recurrent, Q or non-Q, site). The frequency of
| morning infarction is greater during the working week than
| on weekends, suggesting a superimposition of work-related
| stress on endogenous circadian rhythms._
|
| > _Circadian variation is found on all days of the week
| including weekends ' when the morning peak is less
| obvious._
|
| I haven't looked at the methodology of the cited studies
| but they include 6 references for your perusal.
|
| [0]https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.22 [
| 1]https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960
| 261... [2]https://europepmc.org/article/med/12061302
| tgv wrote:
| What is the effect in this study? The linked article has no
| info, not even the doi.
| OJFord wrote:
| I linked it in another comment, but that's now a flag-
| hidden thread, so:
| https://heart.bmj.com/content/109/Suppl_3/A78.abstract
| tgv wrote:
| Thanks for the link. I'm not impressed by the effect at
| first sight. I certainly wouldn't want to exclude
| anything based on it. I mean, it's 13% more on Monday,
| which makes it "significant", but if you subtract the
| 3.1% you mention, you get close to the Sunday fraction,
| which isn't significant (p>0.05, which is a lousy
| statistic anyway). While it looks there's something going
| on, it's not enough to ignore the effects of data
| manipulation.
| haldujai wrote:
| You're assuming that the 3.1% for > 12 hours is different
| between weekdays and weekends. While the study you're
| quoting grouped after-hours with weekends there were
| _less_ delayed presentations in this subgroup compared to
| the M-F business hours group.
|
| Other weekday numbers will also have delayed
| presentations included so you can't just "subtract 3.1"
| from one day and declare statistical insignificance.
|
| What you can do is subtract it from every day as we know
| that 97% of STEMIs present within 12 hours.
|
| As this is just an abstract we don't know what the
| authors did in this particular example but it's not the
| first study to suggest Mondays have the highest ACS
| rates.
| hinkley wrote:
| I wonder how much that diminishes if you control for DST
| weekend.
|
| We already had evidence that the time shift increases heart
| attacks.
|
| I'm planning to just ignore DST this year. I'll show up a
| little early for work half the year, and a little late for the
| rest.
| PreInternet01 wrote:
| Alternate theory: most deadly heart attacks are _reported_ on a
| Monday, because that 's when the admin assistant tasked with
| doing the paperwork gets around to clearing out the backlog. And
| since most reports don't include the actual time of death, Monday
| 08:02 it will be...
| prepend wrote:
| It would be unusual that they use reporting date vs date of
| death. The date of death is pretty normally distributed [0]. So
| while the reporting date probably piles up on Mondays, that's
| not very useful for studying.
|
| [0] https://www.cdc.gov/nchs/data/dvs/table14_99.pdf (in the US
| at least)
| malfist wrote:
| Do you have any evidence for any of the claims here?
| pc86 wrote:
| Do you honestly think people on dying on a Saturday and it's
| being logged as a Monday morning death because of the admin
| assistant? That's insane, and has no basis in reality.
| HL33tibCe7 wrote:
| [flagged]
| PreInternet01 wrote:
| Well, I certainly changed my mind now! Sorry, that was
| sarcasm, I _know_ this isn 't Reddit... Anyway: so I tried to
| track down the actual paper being presented (since the linked
| article, of course, does not cite that). No luck. Lots of
| clickbait re-peats and re-re-peats. But I guess you have the
| link and will gladly provide it?
| OJFord wrote:
| Here you go:
| https://heart.bmj.com/content/109/Suppl_3/A78.abstract
|
| (I searched 'Laffan cardio monday' on Google Scholar,
| Laffan was quoted as lead author in OP.)
|
| Your argument at least in its current form seems not to
| hold - there's higher incidence over the weekend too.
| PreInternet01 wrote:
| Thanks! This still seems to be just an abstract, though,
| and I was unable to find any details about the actual
| method of data collection. Been downvoted enough for
| today, though, so...
| OJFord wrote:
| I think that and the figures might be 'it' since it was
| presented at the mentioned conference, i.e. either a
| poster (which wouldn't necessarily ever be published in
| that form) or an oral presentation (which I guess might
| just be discussion & slides around the abstract, without
| anything more than that being written up? Or perhaps to
| follow - it is dated as 5-7th, i.e. ongoing at time of
| writing.)
| iancmceachern wrote:
| Work stress man, it'll kill you
| HL33tibCe7 wrote:
| Deadly heart attacks are also more common on days when the clocks
| go forward. It's to do with lack of sleep, apparently.
| SketchySeaBeast wrote:
| > when the clocks go forward
|
| I had a moment trying to figure out when the clocks moved
| backwards before I remembered DST is a thing.
| shagie wrote:
| I once worked in a computer lab for a graveyard shift on the
| weekend (midnight to 10am).
|
| One early Sunday morning the clock started making noise.
| Chunk. Chunk. Chunk. Chunk. Moving the minute hand rapidly.
| It kept going and going and going.
|
| The clock can only go forward. In order to set the time back
| 1 hour it had to advance the clock 23 hours, one minute at a
| time.
|
| This also confused payroll when I handed in my time sheet.
| 12:00 AM - 3:00 AM (3h) 2:00 AM - 10:00 AM (8h)
|
| They also had trouble when I did 12:00 AM -
| 10:00 AM (9h)
|
| But they figured that it was going to be easier to just pay
| me an extra hour ($7.50 then) than it would have been to try
| to correct it.
| itronitron wrote:
| A better solution would be to have the clock turn itself
| off, wait an hour, and then turn itself back on again.
| shagie wrote:
| This was a centrally controlled clock. When the master
| clock sent a pulse, all the clocks would advance 1
| minute.
|
| These were synchronized wired clocks (
| https://www.natsco.net/industries-served/industries-
| served-o... /// https://blog.american-time.com/wireless-
| master-time-clock-vs... ).
|
| > Schools traditionally used wired clock systems for two
| basic reasons: rock solid reliability and the ability to
| synchronize school bells to the rest of the system. The
| wired synchronized system ensured that clocks would all
| read the same time and bells would ring at the same time
| every day, no matter what classroom you were in, and that
| students would arrive to class on time -- something
| teachers could only dream of before installing a
| synchronized system.
| ZFleck wrote:
| I've read a bit into this subject before; Matthew Walker's book
| 'Why We Sleep'[0] discusses it at length.
|
| A lot of it boils down to blood pressure. High blood pressure is
| a serious contributing factor to cardiovascular incidents (as
| well as a slew of other negative health risks), and getting a
| good night's sleep will help keep blood pressure down. This is
| also why the amount of heart attacks are up around 24% after
| daylight savings[1]; an hour less sleep means higher blood
| pressure means higher risk of heart attack (relative to any other
| 'normal' day).
|
| I can definitely see how the same logic could apply to Mondays.
| Less sleep, more stress = higher blood pressure = higher risk of
| heart attacks.
|
| [0] https://www.goodreads.com/book/show/34466963-why-we-sleep
|
| [1] https://pubmed.ncbi.nlm.nih.gov/18971502/
| aaron695 wrote:
| [dead]
| m463 wrote:
| I feel really good with a sleep rhythm going to bed later each
| day and getting up later the next day.
|
| I think many people do the same sort of thing, and then monday
| -- they have to cut their sleep short to get up early and sync
| with the rest of the world.
|
| I can see how this would be the stressor you allude to.
| asdfman123 wrote:
| It's so much better going to sleep and waking up the same
| time every day.
|
| The only problem is it's often incompatible with a social
| life when you're in your 20s, but thankfully I'm not in my
| 20s anymore.
| samtho wrote:
| This is because our circadian rhythms are naturally found to
| be about 25 hours absent external stimuli or timekeeping
| devices.
| pushcx wrote:
| This book has serious issues. https://guzey.com/books/why-we-
| sleep/ The only mention of daylight savings time in Why We
| Sleep is:
|
| > In the Northern Hemisphere, the switch to daylight savings
| time in March results in most people losing an hour of sleep
| opportunity. Should you tabulate millions of daily hospital
| records, as researchers have done, you discover that this
| seemingly trivial sleep reduction comes with a frightening
| spike in heart attacks the following day. Impressively, it
| works both ways. In the autumn within the Northern Hemisphere,
| when the clocks move forward and we gain an hour of sleep
| opportunity time, rates of heart attacks plummet the day after.
|
| I don't see a specific study cited, but my ebook copy doesn't
| seem to have all the footnotes.
|
| I pulled up the article you linked on sci-hub: https://sci-
| hub.se/https://pubmed.ncbi.nlm.nih.gov/18971502/ The only use
| of the number "24" refers to hours in the day, and its summary
| doesn't seem to match your claim:
|
| > The incidence of acute myocardial infarction was
| significantly increased for the first 3 week-days after the
| transition to daylight saving time in the spring (Fig. 1A). The
| incidence ratio for the first week after the spring shift,
| calculated as the incidence for all 7 days divided by the mean
| of the weekly incidences 2 weeks before and 2 weeks after, was
| 1.051 (95% confidence interval [CI], 1.032 to 1.071). In
| contrast, after the transition out of daylight saving time in
| the autumn, only the first weekday was affected significantly
| (Fig. 1B); the incidence ratio for the whole week was 0.985
| (95% CI, 0.969 to 1.002
| quenix wrote:
| Personal anecdote--I fucking _hate_ this book.
|
| For many reasons, I slept just fine until I read it.
| NilsIRL wrote:
| Would love to hear more
| quenix wrote:
| Sure. I'll start by prefacing that I'm not necessarily
| wholly attributing these as faults of Walker's book. I
| don't doubt I have a higher propensity for certain
| anxious responses, or perhaps my personality made me more
| susceptible to the sort of thinking I'll discuss.
|
| Walker's book--and his accompanying Ted talks and
| podcasts--instilled a deep sense of sleep anxiety in me,
| which led to episodes of chronic insomnia (still occurs
| today). I had never experienced these issues before
| reading the book. Unfortunately, his message ensures that
| the insomnia is self-exacerbating, causing a vicious
| cycle.
|
| Essentially, I find it very wrong for Walker to focus on
| and overhype the negative aspects of sleep loss as much
| as he does. Guzey's article [0], also linked above, goes
| through much of this. Why We Sleep turns into a horror
| book if you aren't able to sleep for whatever reason. It
| implies that, from just _one_ bad night 's sleep,
| 1. your immune system will deteriorate significantly
| 2. the chance that you develop a cancer will increase
| 3. your mental health will suffer 4. you
| are more likely to develop anxiety or depression
| 5. the probability you hurt yourself will increase
| 6. your mental faculties will be destroyed, you will be
| unable to reason well 7. you are at higher
| risk of mortality (!) 8. you are literally
| closer to death, which the book supports by mentioning
| fatal familial insomnia (FFI)... a flawed analogy
|
| ... and much more.
|
| I was initially ok after reading the book, but the
| problems really started after I had a bad nights' sleep.
| I was absolutely _terrified_ the following night,
| remembering all the awful things that will happen to my
| body and mind if I do not recuperate the next night. And
| we all know how easy it is to lose sleep when you are
| worried. I stayed up until 6 AM that night. Every passing
| hour made it harder to sleep.
|
| Naturally, this started a cycle. Grumpy and even more
| anxious the next day ("two days? wow, am I now DOUBLE the
| chance of cancer and depression?"), sleep began evading
| me more and more often. The bed became a place of
| anxiety. Every minute I spent awake, I remembered
| Walker's book and the terrible things he told me was
| happening to my body due to the insomnia. This caused an
| infernal, unending loop of insomnia. Morning birdsong
| became hell to my ears.
|
| I still sometimes suffer from it to this day, but Guzey's
| essay really helped. I think some quotes can do my point
| more justice:
|
| > Your essay on Why we sleep - I can't thank you enough.
| I'm a sleep doctor in Oregon and have seen many many
| patients who have developed severe sleep anxiety and
| insomnia. Two friends in the sleep field and myself
| weekly have talked about people that slept well until
| reading this book.
|
| > I wanted to drop you a line to thank you for all the
| time and effort involved in debunking Matthew Walker's
| book. As someone who works with individuals with insomnia
| on a daily basis, I know from firsthand experience the
| harm that Walker's book is causing. I have many stories
| of people who slept well on less than eight hours of
| sleep, read Walker's book, tried to get more sleep and
| this led to more time awake, frustration, worry, sleep-
| related anxiety, and insomnia.
|
| > My patients are coming to me after reading this
| alarmist book, with insomnia that they did not have
| before, and worse, harder to treat because although the
| book has caused these anxieties - they can't shake their
| newly built alarmist beliefs they learnt from the very
| same book.
|
| > Scott slept well his entire life until he listened to a
| podcast that led him to worry about how much sleep he was
| getting and the health consequences of insufficient
| sleep. That night, Scott had a terrible night of sleep
| and this triggered a vicious cycle of ever-increasing
| worry about sleep and increasingly worse sleep that
| lasted for ten months.
|
| [0]: https://guzey.com/books/why-we-sleep
| moneywoes wrote:
| If it helps I have heard that his book is poorly
| researched
| NilsIRL wrote:
| Thanks for the write-up
| chearon wrote:
| I had the same experience. Very often, I couldn't fall
| asleep until 6-7am. I felt like I was losing my mind. I
| got professional help from sleep psychologists but it
| didn't do much. They told me all the same stuff that
| comes up when you google it, and it terrified me even
| more that even professionals didn't know why I couldn't
| sleep. I never had this much of a problem sleeping before
| I read the book.
|
| After a year of this, a therapist pointed out that you
| can have bad days on good sleep and good days on bad
| sleep. That finally made it click that it wasn't logical
| to worry about bad sleep so much. I just stopped caring
| and that mostly got me over it, but I still have more bad
| nights than I ever used to.
|
| If I see people reading the book, I warn them about it
| even though it feels a bit rude to tell someone not to
| read something.
| kulahan wrote:
| The important consideration here is that these people are on
| the cusp of death already, and this is typically just the straw
| that broke the camel's back. You don't get a heart attack from
| one bad night of sleep, of course, unless there are significant
| underlying conditions.
| gtop3 wrote:
| High blood pressure is often refereed to as the "silent
| killer". It's not like these individuals present sick/ill in
| their daily lives. Basically the only symptoms of high blood
| pressure are sudden traumatic events like Heart Attack and
| Stroke. If you meet one of these people hours before their
| heart attack you often wouldn't describe them as 'on the cusp
| of death'.
| kulahan wrote:
| Yep! You're correct. I didn't mean to imply that they look
| sickly or anything, just that their body is literally on
| the verge of failing, even if it looks perfectly fine.
| sublinear wrote:
| > If you meet one of these people hours before their heart
| attack you often wouldn't describe them as 'on the cusp of
| death'.
|
| I disagree. It's not that the symptoms aren't there, but
| that they have become normalized due to obesity, smoking,
| etc. being commonplace. Shortness of breath, sleep apnea,
| feeling weak, upper body tension/pain, etc. are usually
| present for _quite a while_ in most people before it
| finally happens. People don 't check their blood pressure
| often enough despite it being so cheap and easy to do.
| 2devnull wrote:
| You're wrong. A young person with borderline hypertension
| (130/80) can present in perfect health. Blacks for
| instance have a genetic predisposition to hypertension,
| obesity and diet don't have to be involved. Besides
| genetics, other health conditions like insomnia or other
| medications can cause hypertension. Some people are just
| salt sensitive.
| moneywoes wrote:
| What makers can I check?
| avgcorrection wrote:
| Here's a spectrum:
|
| - "on the cusp of death already"
|
| - Normalized ill-health
|
| There are some things in between those two.
| outworlder wrote:
| I see your point, although some of the symptoms are quite
| subtle. Most people with sleep apnea don't know they have
| it until they get tested. Same for other symptoms.
|
| What's really normalized is metabolic syndrome. 88% of
| adult americans have some degree of metabolic
| dysfunction. High blood pressure, obesity and other
| ailments are very often a direct result of that. So much
| so, that the 'normal' range of indicators such as uric
| acid has been revised and adjusted over the years,
| because "normal" people had higher levels and still
| appeared to be fine. Thankfully, we are starting to
| question that (eg.
| https://pubmed.ncbi.nlm.nih.gov/24867507/)
|
| First order of business for anyone watching their blood
| pressure creeping up over the years (even more so if A1C,
| triglycerides, liver enzymes and uric acid are rising
| too): cut sugar in all forms. Not just the sugar you
| personally add to food, not only what's specified as
| 'added sugar', but all food containing sugar - which is
| basically all ultra processed foods. It does include
| sliced bread which is easily broken down into sugar( and
| is often laced with additional sugar, check ingredients).
| Leave your sugar 'allowance' to be used by a reasonable
| amount of fruits.
|
| That may not reverse the problem (although, in my case,
| it did) but should help tremendously.
| jahewson wrote:
| No this is completely wrong. Over the age of 40, a
| perfectly healthy, functioning and complaint-free
| individual can have alarmingly high blood pressure. Often
| it's hereditary. They can even have an obese sibling
| who's just fine.
| samstave wrote:
| I have high BP due to my insomnia coupled with sleep
| apnea.
|
| I have insomnia ~5 nights a week. and for some reason I
| can no longer take naps in my older age. I used to be
| able to Nap-on-command when I was younger. It SUCKS
| Retric wrote:
| While presumably true in the general case, there are many
| drugs etc that drastically lower peoples risks of dying from
| a heart attack.
|
| So many people must get quite close to a heart attack only to
| live a long life and die of something else.
| sramam wrote:
| On the flip side, isn't it also likely that repeating the
| same stressful behavior pattern over years (decades?) results
| in this outcome?
|
| However, parsing signal from noise does seem a very difficult
| proposition.
| asdfman123 wrote:
| It's actually not very hard to know at all, at least if
| your question is "what kind of lifestyle will generally
| lead to the best longterm health outcomes?" Sure, there's
| minor distinctions to be made and important medical
| questions, but generally it's pretty clear.
|
| Everyone knows it, I don't need to list it: eating clean,
| getting good sleep, plenty of exercise, etc.
|
| And furthermore, though our healthcare system seems only
| configured to deal with things once they become
| emergencies, metabolic disorder takes your whole life to
| take root. The time to start making positive changes is
| now.
| marcosdumay wrote:
| This is where an intervention-based study shines. It's just
| basically impossible to design an intervention for this
| one.
|
| (But then, this also means that knowing it for sure would
| be useless.)
| [deleted]
| seizethecheese wrote:
| A lot of speculation here. Here's a link to the actual study:
| https://heart.bmj.com/content/heartjnl/109/Suppl_3/A78.full....
|
| They don't break it down by age which might help show if it's
| work related.
|
| Heart attacks are also clearly elevated on Sundays, and not
| depressed on Saturdays, which might suggest this is related to
| alcohol.
| lukko wrote:
| I definitely felt Mondays on-call were much busier in the
| hospital. I always thought this could be due to patients spending
| weekends with family, not wanting to cause a fuss and maybe
| ignoring symptoms of cardiac chest pain until it evolves into a
| serious heart attack (STEMI). Also, they may be waiting to see
| their GP on Monday morning and then get referred to hospital
| (although less likely with STEMIs).
|
| I also remember the time between Christmas and New Year being
| very busy - I thought for a similar reason - people
| understandably just don't want to be in hospital for Christmas.
| Ekaros wrote:
| I wonder if there is expectation of not getting help on weekend
| and thus time and energy would be wasted on traveling to
| hospital?
| dqv wrote:
| Maybe for some of them, but I think _a lot_ of people eat worse
| and drink more on holidays /weekends. A lot of people with
| dangerously high blood sugar around holidays and a lot of older
| folks get/report UTIs.
| seizethecheese wrote:
| An anecdote that supports this: I was just in the emergency
| department and asked them why it was so quiet on the weekend.
| They said many people wait until Monday to seek treatment for
| whatever reason.
| switch007 wrote:
| Probably varies by hospital and area but things like
| imagining departments being closed might factor in to that.
| England here.
|
| More than once a relative has been admitted on a Saturday and
| is just observed until Monday when the full diagnostics are
| available (eg MRI).
| CoastalCoder wrote:
| I wonder if modern smartphones lay the groundwork for people
| knowing they're on the cusp of a heart attack.
|
| E.g., using sensors that are cheap, and are less invasive than
| EKG electrodes. Kinda like the way Apple watches can now
| continuously monitor stuff
| dividedbyzero wrote:
| Does an Apple Watch actually tell you if you are?
| Aeolun wrote:
| It monitors for atrial fibrilation using a single leak EKG
| I think.
|
| It is _very_ clear about the fact it cannot detect a heart
| attack though.
|
| Then there's these slightly more sophisticated things:
| https://store.kardia.com/products/kardiamobile6l
| rootusrootus wrote:
| I don't believe it uses the EKG functionality to detect
| afib. I think it's just using some sort of machine
| learning on the data coming from the photoplethysmograph
| sensor (now that's a word I had to look up to remember
| the correct spelling for). Basically the sensor that
| takes your pulse.
|
| The EKG, as far as I know, doesn't really tell you much
| other than whether it thinks you have a normal sinus
| rhythm, or something it doesn't recognize. Too fast, too
| slow, or whatever. It's also on demand, not continuous.
| You have to touch a finger from your opposite hand to the
| crown, while the EKG app is running.
|
| Also, that Kardia advertising is borderline scam. It's a
| 1 lead EKG just like the Apple Watch. Six lead my ass,
| they make that claim because you can contort your body in
| enough ways to take readings from each standard EKG
| location. You can sorta do the same thing with an apple
| watch, though it's not physically as large so it wouldn't
| be as easy. What rubs me the wrong way about calling the
| Kardia a 6-lead EKG is that it cannot do 6-leads
| _simultaneously_ , and I think that is a critical detail.
|
| I had a Kardia myself before the first Apple Watch with
| EKG came out.
| WWLink wrote:
| The "very clear about the fact it cannot detect a heart
| attack" thing is so obnoxious that it actually kinda
| breaks that app. If you got a messy/noisy EKG reading and
| want to do it again, you have to carefully scrooll to the
| bottom of the page and click done. Or you accidentally
| tap the large grey box at the top that takes you to a
| multi-page legal explanation of how it's not meant to
| detect a heart attack - and that page has a teeny tiny
| button at the top left to take you back to the last page.
| lukko wrote:
| Yep, it will be interesting to see - Apple Watch can already
| monitor for atrial fibrillation:
| https://support.apple.com/en-gb/HT212214. Though, it looks
| like the patient must already have a diagnosis from a doctor.
| So rather than diagnosing, it's sort of an AF tracker - which
| is useful as AF can come and go.
|
| The problem obviously with heart attacks is the implications
| of false negatives and positives are huge, and the tracing
| from a watch would be less reliable than the gold-standard
| ECG / EKG.
| JoeAltmaier wrote:
| I would cynically suspect: existential dread
| JoeAltmaier wrote:
| Used to wonder why more hospital patients had critical episodes
| at night. My brother-in-law who's worked hospitals all his life,
| said simply "the night shift is on"
| xdavidliu wrote:
| not entirely sure what this comment is saying. Night shift
| workers not as effective? Can someone spell it out for me?
| floxy wrote:
| I'm going to presume the OP was hinting at people working
| night shifts are more sleep deprived, and thus more accident
| prone, causing the increase in emergency room visits.
| Yondle wrote:
| This feels like something i'm going to log into the 'why do i
| know this' section of memory.
| dokem wrote:
| A case of the Mondays?
| [deleted]
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