If you sleep you will die. Why?

I saw this again in a film last night and it’s bothering me.

Why do they say in films that if a certain person sleeps they’re going to die ?
Usually it’s after a head injury or a drug overdose. Any truth to this, or is it a hollywood invention?

Oh well, I’m here, so I’ll take a guess - with all corrections welcomed.

It’s important to keep the metabolism running well enough to pumb blood to extremities, get rid of the toxic agent and so on. If one sleeps, things start to shut down.

There, a highly technical answer :smiley:

There are medical reasons to keep an injured person conscious - they can clear their own airway, they can report on their condition and any potentially life-saving information such as drug allergies or existing conditions that might complicate things.

I think it’s also true that some of the glandular stuff that happens when a person is conscious and stressed, may help to maintain blood pressure and respiration.

I’ll give you my take as an ED physician with about 30 years under my belt: I have no idea why this notion is given any credibility, despite it being the belief of most lay people, many medics and at least some physicians.

The prinicipal danger of any obtunded condition that is not otherwise life-threatening is an obstruction in the airway. Certainly any ministrations should be directed toward that, and the less alert you are the more likely you are to be unable to protect your own airway. This is not, however, what is usually implied, and an airway is sometimes easier to protect in an unconscious person than one who is confused and/or struggling.

What I have seen is the notion that after a blunt head trauma or during an exposure to extreme cold, for instance, the patient should be kept conscious. The implication is that keeping the patient conscious will, of itself, promote their survival. There is no truth to this. There are cases where it is actually counterproductive.

I suspect the misconception arises because patients whose underlying condition is severe enough to cause them to lapse into unconsciousness have lower survival rates than those whose underlying injury was not severe enough to render them unresponsive. That consciousness is itself therapeutic is incorrect.

In the specific case of exposure to toxins for which there is a specific antidote, we will usually deliver the antidote because we can render the patient fully alert and that is typically safer to deal with than partial obtundation or intubation.

Like the OP, I’ve seen this in films. It seems to me that it was most often associated w/ drug overdose, as when someone attempts suicide by taking “sleeping pills” or something similar.

I had to look up “obtund,” and the various definitions (to dull, to blunt, to reduce violence" still leave me confused. What does it mean as you use it? Thanks.

Apologies. Mea culpa.

We use “obtunded” in medicine to mean significantly less than fully alert, but not completely unconscious.

Just a personal experience here, but when I was about 12, I had a pretty severe head injury. The doctor told my parents not to let me sleep more than a half hour at a time. So they would wake me every half hour, even though it was taking me around 20 to 25 minutes to get back to sleep each time due to the pain, so basically, I was getting about 5 minutes of sleep every half hour. To this day, I still believe that it did more harm to me than good. I was a complete wreck for about two weeks afterward.

Snipe1978’s story brings up another point about head injuries and sleep. Sometimes a head injury can cause the rupture of blood vessels inside the skull; the result is a steadily-growing pocket of blood which compresses the underlying brain tissue (sometimes fatally). If a person is awake, this growing pressure on their brain causes their mental status to decline (progressing eventually to complete unconsciousness); they may also have unevenly dilated pupils. These changes are easily missed if the person is asleep. So standard advice after a severe head injury is to wake the person from sleep at regular intervals. The waking’s not theraputic in itself (quite the opposite, in fact); what you’re doing is checking to see that the patient is still arousable. If the person can’t be aroused from sleep, that could be a sign of a serious problem, and they need urgent medical attention.

This is absolutely correct. There is a value to serial exams for a patient who is naturally asleep but may have an underlying progressive deterioration masked by the natural need for sleep. There is nothing wrong with allowing the patient the opportunity to sleep soundly between exams–in fact, if you do not, the arousability check is eventually complicated by sleep deprivation.

I think the OP is wondering whether sleep, per se, is more dangerous than having constant alertness artificially maintained.

So, does this apply to cases where a person has overdosed on (for example) alchohol and sleeping pills?

You’ve been treating limp penises for 30 years?

Maybe…or maybe he works in an emergency department.

Erectile Dysfunction wasn’t even invented by Bob Dole until just a few years ago…I should have been more clear though: Emergency Department.

Couldn’t the layman’s fear of having the injured person falling asleep also stem from the fact that if the person falls asleep, you “lose” him/her - but as long as the person is awake, well, then he/she clearly isn’t dead. Keeping awake would be keeping alive. - I don’t know, just thinking out loud. I would probably panic if somebody seriously hurt in this way or the other “fell asleep”.

We normally let these folks sleep it off quietly with an occasional arousal check to make sure nothing else is going on that is being masked by the likker and sleepers. They might also get a baseline head scan depending on their presentation.
If they are really really obtunded or unconscious we might stick a tube in their airway so they keep breathing and don’t choke on their own secretions or vomit.

Yeah, nothing worse than choking to death on vomit, especially if it isn’t your own.

Ah, good 'ol Spinal Tap.

I have finally found the answer to the question, “How are you?”

I’m so happy!

slaps the thread’s face

Stay with me! Damnit, open your eyes! You’re gonna make it son, just hang in there!

Just to add to what Chief Pedant and artemis have already said, it’s valuable to keep people awake or wake them at regular intervals when the first signs of their health going seriously south involve their level of consciousness. This is true for head injuries that may cause increasing intracranial pressure, as described by artemis earlier in the thread, or illnesses like acute mountain sickness, where the patient’s level of alertness and orientation, as well as symptoms like stumbling (ataxia,) are your best clue to how bad the situation is. Let your patient go to sleep, and you lose that information.

In a wilderness context, that can become extremely important since any high-tech medical monitoring is hours to days away. Your best source of information is always the patient.
In an urban setting, I have also used sternal rubs, shouting, etc. to keep patients who lost lots of blood or overdosed on drugs awake until we can get them to the ER (Emergency Room, not Electable Republican :wink: ) because it’s far better for the information about what happened to come directly from the patient to ER doctors and nurses, rather than through a game of telephone with first responders, EMTs, and paramedics in the middle. As much as we strive for accuracy and complete recording of relevant information about the patient and his/her condition, the patient will always know more and be able to describe more about themselves when conscious than we will.

  • Wevets, Wilderness Emergency Medical Technician