How are you sleeping lately? Does it matter?

The answers to these questions may surprise you, as they did me. Getting enough sleep does matter, but how you sleep seems to matter, too.

Alex Janin, writing in The Wall Street Journal, says there is hope for those of us who live (and sleep) in the real world: Getting less than 8 hours of shut-eye a night doesn’t mean you’re doomed to an early grave. A recent study looking at sleep and longevity found that sleep “regularity”—going to bed and waking up at consistent times with few mid-slumber interruptions—matters more than how long you sleep. Sleeping six hours every night on a consistent schedule was associated with a lower risk of early death than sleeping eight hours with very irregular habits.

The study adds to a growing understanding of the links between sleep and longevity. Research in recent years has shown not only how important sleep is for health and lifespan, but also that the duration of sleep isn’t the only thing that matters.

“We’ve been missing maybe half of the story,” says Matt Walker, a neuroscientist and director of the Center for Human Sleep Science at the University of California, Berkeley, who wasn’t involved with the recent study. “Not just how much you sleep but the regularity with which you sleep has now come onto the map and exploded as perhaps the more important thing.”

More than a third of Americans don’t get the seven to nine hours of sleep recommended by sleep and medical organizations on a regular basis, according to Centers for Disease Control and Prevention data. Roughly 20% report rarely or never waking up feeling well rested, according to a recent U.S. News & World Report survey.

But there is hope for those of us in that third. A new study emphasizes the importance of regular sleep habits. The study, published in the journal Sleep, found that sleep regularity reduced the risk of premature death from any cause by 20% to 48% compared with those with the most irregular sleep. Irregular sleep habits included inconsistent sleep and wake times, interrupted sleep and napping. Sleep duration was still important: People who got long, consistent sleep had the lowest mortality risk, says Angus Burns, a research fellow at Harvard Medical School who co-wrote the study. But shorter, regular sleep was generally associated with lower mortality than longer, inconsistent sleep.

In a separate study, researchers looked at metrics such as how often people had trouble falling asleep and whether they used sleep medication. They found the healthiest sleepers had life expectancies of 4.7 years and 2.4 years longer than those with the worst sleep habits, for men and women respectively, according to the 2023 study published in the medical journal QJM.

Participants didn’t have to be perfect sleepers to reap longevity benefits, says Dr. Frank Qian, a cardiovascular disease fellow at Boston Medical Center and a lead author of the study. The benefits were cumulative with each additional good habit. Starting these good habits earlier in life also helped. “The longer you are able to maintain an optimal sleep pattern, that will probably have the greatest impact on your health and longevity,” he says.

There is an increased interest in the science of sleep. Among members of Life Extension and Anti-Aging, a longevity-focused Facebook group, sleep is one of the most frequent topics of conversation, says Nils Osmar, the group’s administrator. Just 1% of respondents to a September poll in the group said sleep isn’t a priority in the context of their health and longevity. Studies showing what aspects of sleep matter most for our long-term health can help us identify the habits to focus on. Even the healthiest sleepers had some variability in their bed and wake times, says Burns, who co-wrote the Sleep study, but he recommends people try to keep their sleep and wake times within a one to two-hour window.

I hope that includes my Sunday afternoon nap. I’m convinced that’s the key to living a long life, no matter what the study says.

Most people choose their doctor first, not their hospital. But there are times when you want to be sure the hospital your doctor uses is highly ranked, especially for the type of care you’ll be receiving.

As most of you know, I’m an orthopedic surgeon. In the field of orthopedics, there are many specialty areas and many specialty hospitals. Finding the best hospital for the specialty you need is important. You want a hospital that does a lot of the procedures you’re facing; not a place that only does that procedure once in a while. And you want a hospital that has a proven track-record of success with a low complication rate. How do you find such a hospital?

If you want to find a good car, you’ll probably check Edmunds or Kelley Blue Book. When you want to take a trip, you’ll probably check the ratings of Trip Advisor. Until recently, if you wanted to find the best hospital, many people relied upon U.S. News & World Report. After more than 30 years, U.S. News & World Report has become the most publicly visible ranking source for health care institutions.

Anthony A. Romeo, M.D. and Nikhil N. Verma, M.D., writing for Healio/Orthopedics, say this is changing. In recent years, the U.S. News rankings have been criticized by numerous leading institutions. Some top academic centers in the United States have withdrawn participation in the process with strong suggestions that the results provide artificially skewed perceptions and distorted incentives.

Romeo and Verma say the rankings are flawed and they give reasons. The first step of performing a ranking analysis is to obtain consistent data among various institutions that will comprise the source of the analysis and conclusions. The U.S. News data are largely obtained from the American Hospital Association, including patient satisfaction scores and CMS data. CMS data are limited to Medicare patients, with 86% of the patients being aged 65 years or older. Perhaps you’re looking for an ACL reconstruction or rotator cuff repair. These procedures are usually done in a younger population.

Even the Medicare age data are flawed. The most common orthopedic procedures within the Medicare population are hip and knee replacement. But strangely, these procedures are excluded from the U.S. News ranking algorithm. The outcomes and complications of these procedures are similar across the entire Medicare population, especially at the top health care institutions evaluated with U.S. News rankings.

The authors say, “Due to the limited variability, the results of the most common elective orthopedic procedures in the Medicare population are not reflected in the overall rankings. If 50% or more of the Medicare procedures being performed are removed from the analysis, along with the absence of procedures in the non-Medicare population, the analysis and subsequent ranking represent less than 10% of the overall orthopedic procedural volume, providing minimal evidence for conclusions related to overall orthopedic program quality and outcomes.”

Another flaw they point out is the use of risk-adjusted mortality as a proxy for quality. Mortality is a “worst-case” approximation of outcome. In contrast, understanding outcomes in orthopedic literature is largely determined by patient-reported outcome measures (PROM). These measure pain, function, satisfaction and quality of life – what patients really need to know about the procedures they’re having. But PROMs are not reported to CMS or any accrediting body and thus, are not available for use.

These are just a few of the flaws mentioned by the authors in this disturbing report. If you’re looking for the best hospital for orthopedics, try looking somewhere else than the U.S. News & World Report rankings.

In a recent blog post called Texans at the School Choice Showdown, I discussed the battle being waged by Texas Governor Greg Abbott to bring more school choice to Texas. In this reliable red state with Republican control of the Governor’s mansion and the legislature, you wouldn’t expect this to be a difficult hill to climb.

But Texas is so large that it has many rural counties where there are few other options for public school students. Republicans that represent these counties seem to believe that school choice doesn’t offer them anything better than the current public schools and may threaten their future.

To move the ball forward, Governor Abbott called a 30-day special session of the legislature to debate the issue. There is only one day left in the session and unless they come to an agreement, Abbott has threatened to call another 30-day session.

A breakthrough came last week when Mr. Abbott said he’d reached a deal with House Speaker Dade Phelan on a bill to establish education savings accounts, or ESAs, for families who want options outside of public schools. The universal program would be open to any K-12 student, and it would provide about $10,500 to each. That’s more generous than the $8,000 ESA package passed by the state Senate earlier in the session.

The agreement also includes billions of dollars for public education, including raises for teachers, which Mr. Abbott pledged to add to the agenda only when lawmakers reached a deal on school choice. The shrewdness of the Governor’s approach is that the political calculation ought to be simple: Voting yes means helping families who want out of public schools, while also helping public schools.

You’d think this would be a slam-dunk since it seems to benefit both charter and private schools, as well as public schools. But some of the rural Republicans have joined the Democrats in resisting ESAs. Their claim is that because their districts have few private schools, education choice doesn’t help their constituents. But ESAs could help change that, since they’d be a financial incentive for alternatives that might serve some families better than the local government school monopoly.

The Texas Tribune recently reported that the state has almost 1,200 private schools, but only 55 are in the 165 counties with 50,000 or fewer people. This sounds like an argument in favor of school choice, not against it. “If vouchers are approved to allow state money to be spent on private education,” the article says, private schools could act on their dreams of “expanding the reach of programs into relatively underserved areas, particularly in rural parts of Texas.”

The framework announced by Messrs. Abbott and Phelan is a good one, and it could be the starting point for negotiations in a renewed special session. If lawmakers still can’t come to agreement, the Governor might need to make good on plan B. Mr. Abbott has suggested he might support primary challengers to lawmakers who oppose ESAs, as Iowa Gov. Kim Reynolds successfully did in 2022. At least eight school-choice advocates have already lined up to run against GOP incumbents.

School choice benefits all children since it gives everyone the freedom to choose the best school for their needs. It frees parents to make decisions in the interest of their children, instead of the interests of the teachers unions. In Florida, where I live, school choice is growing in popularity and private schools are rapidly making plans for expansion. School choice has been called the “civil rights issue of our times” by former Secretary of State Condoleeza Rice. It’s about time that everyone got on board.