Do Not Disturb

Original artwork by  Kyle Hodgman

Original artwork by Kyle Hodgman

This episode was written and produced by Leila Battison.

Alarm sounds have been around almost as long as humans themselves. But as our world has transformed, so have they. Today’s alarms are having an unexpected effect on our minds and bodies, and can even be putting our lives at risk when we’re at our most vulnerable. Dr Judy Edworthy and Yoko Sen talk to us about our alarming sound environment, and how it can be improved.


The Fairest Things by Chad Lawson
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Seeing the Future by Dexter Britain
Glacier by Jacob Montague
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Sleep Walker by Dexter Britain
Rennaissance by AJ Hochhaltar

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View Transcript ▶︎

[SFX: Noisy alarm ambience]

You're listening to Twenty Thousand Hertz... I'm Dallas Taylor.

Do me a favour, and turn off your notifications for the next half hour [SFX: alarms cut out]. Put your phone on silent, place it out of arm’s reach, and whatever you do, don’t give into the temptation to check it for notifications.

[music in]

How does that make you feel? Stressed? Disconnected? In the past few decades, the world has become a noisier place, full of devices of every sort vying for your attention. Attention that many of us seem all too ready to give.

But have you ever really wondered what effects all those alerts and alarms are having on you? The sound of a text message arriving only lasts about a second, [SFX: IPhone ding alert] but has the ability to affect your brain, your body, and your whole approach to life.

And to find out why, we need to go way back in time, to the beginning of human society.

[music out]

Judy: I guess people have always used sound to attract attention, because that's what the auditory sense is for.

That’s Dr Judy Edworthy, a professor of applied psychology at the University of Plymouth in the UK. She’s trying to understand what’s going on in our brains when we hear alarm sounds.

Judy: Hearing and vision work together, and because your ears are all-round sense, really they're there for directing your ears to face the right way so that you then use your eyes.

Judy: When people wanted to attract attention, the obvious way to do that is to make a sound, and there's a whole history of things that make very loud sounds, across mountains and all sorts of things.

Those ancient alarms would sound in times of crisis, to forewarn and call for help, and they play a big part in fictional and historical accounts of war. [SFX: War ambience begin]

One such alarm is the Gjallarhorn, which translates literally as the “yelling horn”. It’s from Norse mythology. At Ragnarok - the coming apocalypse - the horn would be blown [SFX: Horn Blow] and would be heard in all the worlds, where it would awaken the Gods for their last stand.

Judy: When society became more industrialized, of course you needed to announce the end of a factory shift or things like that, and the only ways you could produce sound was either to hit something or to pass air through something. So, you had a range of bells [SFX: single large bell] or klaxons [SFX: Vintage Klaxon sound] and very little else, really. Anything that made a loud sound, really. Because you couldn't do it any other way.

So, historically, alarm sounds have been used when someone really really needed to get your attention. We heard relatively few of them, and as a result, many of them are burned into our collective consciousness.

Judy: A very good example would be the air raid siren from the Second World War [SFX: Air Raid Siren] . Everybody knew what that sound was. It had a particular characteristic, because you had to literally wind it up. Everybody knew what that meant. It was very, very loud, so it could spread across the whole town. And as soon as you heard it, you knew what you had to do.

[music in]

But in more than 70 years since the war, the technological revolution has totally transformed our world, and the sounds that fill it.

Judy: The technology's got a lot better, so we can now produce any sound, rather than having a very restricted range of sounds.

Electronic advances have miniaturized and totally mastered sound production. Now, the most incredible sounds can be made from the device in your pocket. [SFX: Complex alert tone].

But despite the capabilities, beautiful sounds are not always what we get in day to day life.

Judy: Everything that surrounds us just beeps now, because if it's easy and cheap to put a sound on a piece of equipment, then you can be sure that people will do that. And of course we're now completely overwhelmed with these sounds.

[music out]

[SFX: Alarm clock interrupts music]

Judy: From the time you get up, you have your clock on [SFX: clock sound]. You have a phone as well [SFX: phone alert sound]. And then you've got the microwave that beeps [SFX: beeping microwave]. And then you've got your car that will beep about all sorts of things [SFX: car beeps]. And then you get to work and you open your computer and that beeps at you as well [SFX: PC alert sounds]. And so it goes on.

The [alert] constant [alert] interruption is [alert] unlike anything preceding generations [alert] have [alert] had to cope with.

[music in]

Alarms have historically been about action, emergency, a call to arms.

With that ingrained into our basic psyche, today we’re finding ourselves pulled in all kinds of directions by the simple tones that come out of our devices. The alarms assault us throughout the day, and we’re struggling to keep up with the unconscious instinct to react.

Not only are they making us more distracted, but the acoustic intrusion is doing things to your mind and body that you might not expect.

[music out]

Judy: You make a response to a sound on the basis of its acoustic structure in the first instance. So, a shrill, loud sound will stimulate more nerve cells than a quieter, lower-pitched one. So, it will increase your attention levels or your stress levels or your arousal level more than a sound that's not like that. So, you can't really avoid that.

But, even the most innocuous sounds can mess with your mind - if they mean something to you. In psychology it’s called stimulus-response behaviour.

Judy: You hear a sound, and you learn a response. It doesn't require any real thought. You just learn an association between the two.

Judy: So, if you've learnt that, let's say, Twinkle Twinkle Little Star [SFX: Twinkle Twinkle Little Star on music box] is the alarm that your submarine uses [SFX: submarine explosion with Twinkle Twinkle little Star alarm tone] if it's just about to be flooded. Now, that will be an urgent sound to you, because you've learnt its meaning. It's not an urgent sound psychoacoustically or acoustically, but because you've learnt its meaning, then it will produce a similar response to the shrill, loud sound, in you, because you know what it means

Now, submarines flooding might not be a problem for most people, but chances are you’re familiar with this kind of learned response. Take email or text for example. Have you ever had a toxic exchange with a colleague, or a loved one, and you’re nervously waiting, dreading their response? For a while after, every time your phone or computer pings [SFX: alert], you’d feel a knot in your stomach, your heart would beat harder in your chest. Basically, you’d be getting an instant, unconscious stress response, before you even knew who sent the message.

[music in]

Science is starting to catch up with some of the effects that alerts from our devices are having on us. Studies have shown that we’re not just experiencing short term distraction, but our habits are leading to more serious symptoms of ADHD.

Plus there’s a phenomenon that scientists have had to come up with a name for, since it never really existed before. Ringxiety is where we are convinced we hear our phone ringing [SFX: Phone ring], when really, it was just some other, broadly similar sound.

On the other hand, there is another response to this busy world of alerts and alarms...

[music out]

Judy: I think we just ignore them. When I'm with people and I hear an alarm, I say, "What's that?" And they're looking at me as if to say, "What? What are you talking about?" It's because I guess I listen to them more than most people. But people just don't hear them.

It’s known as inattentional deafness.

Judy: There's no reason why you didn't hear it, but you paid no attention to it. Or it registered with your ear but not with your brain, really.

Judy: There's so much stimulation of so many sorts, that we can cut ourselves off from all of it.

It might seem like the obvious solution is to switch off our notifications, silence the alarms, and get back to a simpler life, but it might be too late for that. Our relationships with our devices are showing the signs of compulsive addiction. This is the same type of addiction you’d experience from nicotine or hardcore drugs. The alerts give us a sense of social connectedness, and in the modern world many of us feel stress simply by feeling unconnected.

We’re caught in a Catch 22. What’s important is to be mindful of the alerts we are inviting into our lives.

Judy: Pay attention and learn what's important and what's not. Because it probably won't be intuitive.

[music in]

The alarm sounds we hear in our daily lives are creating so much physical and psychological stress, but there’s a place where they’re causing more serious harm, and even be putting lives at risk.

We’ll find out where, after the break.

[music out]


[music in]

We are so surrounded by electronic devices today that we can’t get away from the sounds they produce. The assault of alarms and alerts in our everyday lives is affecting our minds and bodies, even though we might not realise it.

But what’s it like for people who are already unwell?

Yoko: My name is Yoko K. Sen and I suppose I am a sound designer. I am a musician.

Yoko: I produce music. I mix, write, record, perform music, I think I'm a very sound person per se.

Yoko: I had to spend some time in hospitals as a patient, and being a musician, sensitive to sound, I was very disturbed by the noise in hospitals

[music out]

If you’ve ever had to visit a hospital, you know that they’re far from restful places. As soon as you walk through the door, and a tide of sound washes over you.

[SFX: Hospital soundscape begins]

Yoko: You hear machine sounds and it's all the beeps of medical devices, but it's not limited to medical devices. You also hear phones, pagers, overhead speakers. Often times in hospitals, the staff members carry this card key and you have to scan the card key, so every time that scan takes place, there's "beep," a tiny sound. And lots of people go through the door, so that accumulates and that's also part of the soundscape. Elevators make the "ding" sound. Parking payment machine makes a sound. So everything makes a sound.

Yoko: Then we have talking of people, that are generally a sort of ambience of conversations and carts rolling, people's footsteps, doors getting slammed, distant muffling sound of people screaming. [SFX: Baby crying] Then there are like white noise from the fan. There's a ice machine. There are all sorts of different sounds, so it's the combination of all, but I think the most characteristics of hospital is those beeps, the medical alarms.

All of this added together isn’t just background noise. It can be really, really loud.

Yoko: When it's quiet, it's about 40 to 50 decibels, but when it's pretty loud, it goes up to easily 60, 70 decibels. Sometimes it hit 80 to 90 decibels as well.

For some context, 60 decibels is about the volume of a normal conversation at home, but in a hospital that’s the minimum you’re likely to experience. Ninety decibels is the volume you get when you’re using a lawnmower. [SFX: lawnmower sound]

Unsurprisingly, these kinds of sound environments aren’t all that healthy for recovering patients.

Yoko: Florence Nightingale said, "Unnecessary noise is the cruelest absence of care." She wrote that more than 100 years ago.

[music in]

Yoko: When things are loud, people complain that it's difficult to sleep at night. It disturbs their sleep. It disturbs their rest. Noisy environment could cause more anxiety, sense of fear, and stress for patients. Especially for pediatric patients and the young patients' parents. I often hear from those parents that when alarms go off for they're babies, the first thing that young parents would think is, "Oh, no. Is my baby going to die?" It's very scary, and it happens so often, so it kind of creates this [SFX: shocked inhale] feeling in not just your sort of mental state, but like physically. It's sort of a physical sensation.

That physical reaction is just like the stomach-dropping, heart thumping stimulus response you get when a dreaded email alert comes in, only much worse. And it stays with you...

Yoko: I interviewed one person. He had his daughter more than 10 years ago in NICU, and there was this particular alarm sound that kept going off, so even after 10 years, if he hears the sound that's similar to that alarm on television or other places, he still gets this, sort of a traumatized reaction.

[music out]

Yoko: When it comes to staff members, like clinicians, nurses, and doctors, they are often conditioned to only think about the welfare of patients. But I think that there is a enormous impact of noise on clinicians' wellbeing, and often times they are not aware of such impact. I think it affects their fatigue, stress, burnout...

That burnout is a pretty well-recognised thing - it’s called alarm fatigue.

Yoko: Alarm fatigue is a desensitization that clinicians have when all the alarms keep going off all the time. [SFX: Medical alarms building] Then they start to get desensitized by all the alarms. There is a study that indicates that 85 to 99% of alarms are either clinically insignificant or false positives, but there's 1% of alarm that you're not supposed to miss, so that creates a extremely tiring environment.

Hold up. Up to 99 out of every hundred of those constant hospital alarms are insignificant. But that 1 percent, could be a sign of someone’s life in danger. That’s - just - TERRIFYING.

Judy: There are some things that the nurses, the doctors, and so on, can do to reduce the false alarm rates. Things like making sure the leads are always fresh and new, and if you got sensors on a patient they're clean, and when you move the patient, you turn the alarms off.

Judy: But of course you're also operating in a culture where the manufacturer doesn't want to be sued. So, the easiest way to do that is to have an alarm, and to have those alarms going off all the time. 'Cause they quite reasonably say, "Well, an alarm went off. You didn't hear it."

It’s a scary environment to be in, let alone work in. But it’s not all bad news.

Judy is part of a group working on improving the global standards for medical alarms.

Judy: It's I-E-C, which stands for International Electrotechnical Commission, which is the International Standards Organization. The alarms currently in the standard are tonal, so they're like little melodies. You'll have heard these, because they're used on medical equipment, and to some extent that explains why when you go into just a general hospital ward you'll hear all these little melodies, 'cause that's really the way people are thinking about designing alarms for medical equipment.

[SFX: generic hospital beeps]

They’re all pretty generic, the same kind of electronic beep. And because they’re so similar, they’re hard to distinguish from each other. But Judy and her team are thinking laterally to design an entirely new kind of alarm.

Judy: When we hear a natural sound, it's because two or more objects or things have interacted. And the sound that you hear is a function of those objects.

Judy: If you think of a bowling ball going down an alley and then hitting the skittles, there's a very characteristic sound. You can imagine it now. But you know that the ball is rolling along the alley [SFX: ball rolling], you know when the skittles have gone down [SFX: skittle drop], because of the structure of the alley and the structure of the skittles and the structure of the ball, and the acoustics of that environment. So you know what's happening.

The plan is to incorporate these kinds of environmental sounds into medical alarms, so that they give information about what they’re alerting for.

Judy: Because environmental sounds can act as a metaphor for the event that's happening, and it's much, much easier for people to understand what the sound is for.

Judy: So, for example, there's only one obvious one for cardiac, which is a heartbeat [SFX: Heartbeat icon].

Judy: If you present people with these sounds, and say, "This is cardiovascular, a rattling pill bottle is infusion pumps [SFX: Pill bottle icon]," ... 'cause it's drugs, right? It only takes them one or two trials to learn that.

Those last 2 examples are some of the alarms Judy has been developing. They’re a huge leap from the kinds of alarms we’re used to hearing, alarms that are based on those ancient bells and horns.

Judy: People might say, "Well, if you use a heartbeat, how will I hear that? I would need a really shrill alarm in order to hear it." And actually, you don't. Because it's harmonically rich, you can detect it in lower signal-to-noise ratios, which means it needs to be less loud for the same noise background, as a traditional tonal alarm. So, you can detect it.

[music in]

When the new standard is finalised in the next few years, it looks set to transform the alarm soundscape in hospitals. It’ll help doctors and nurses to do their jobs, and potentially make hospitals a calmer, and quieter place. But, is it doing enough?

Judy: Alarms are often seen as a bad thing, because they sound so bad. But if they were better, I think people would appreciate their value more. But ultimately, you don't want any alarms at all.

Yoko: Often times people ask me what's the ideal alarm, what's the ideal sound environment, and I say, "No, nothing." And I'd love to design toward the obliteration of my work.

[music out]

Getting rid of alarms altogether is probably a step too far for now, but alarms aren’t the only part of the busy and stressful sound environment in hospitals. Yoko has been thinking about the effect of so much noise on medical staff. After all, they’re the people who spend the most time there.

Yoko: Noise is causing stress, but stress might be causing more noisy behaviors. Like, when I'm stressed out, I become less careful and I might be talking louder, I slam the door [SFX: door slam]. I'm just louder in general. So, we thought about ways to help reduce the stress level of staff members in the hospital in order to reduce their behavior-based noise.

Yoko: So we prototyped and implemented a relaxation space for hospitals' doctors and nurses. [SFX: Tranquility room audio] It's a space with soothing music, dim light, aromatherapy, and amenities. It's like a spa inside hospitals, but for staff members to come and take a moment of peace outside the cacophony of noisy environment.

It’s called the Tranquility Room, and right now you’re hearing some of the soothing music that fills the space. So far, it’s only been installed in one hospital in Washington DC. It’s too soon to say if it’s reduced stress based noise, but it is already having tangible effects on stress levels themselves.

Yoko: On the first day that we opened the space there was a young graduate nurse who had his first patient death, and he was able to use that space to have a moment and collect his thoughts, and he said that made such a difference in his shift.

So if these creative ways to reduce noise just happen to improve people’s mental health in other ways, that can’t be a bad thing, right?

[Tranquility room audio out]

[music in]

The end of life isn’t something many of us like to think about, but it’s a pretty sobering fact that the majority of people over 65 actually come to the end of their lives in a hospital.

Yoko: Some people say hearing is the last sense to go when we die, and I used to wonder what is the last sound I get to hear at the end of my life? And I wondered if it's the combination of beeps, and I just thought that's really sad, you know? If that's the last note the closing note of my life, that's just sad, right?

[music out]

[music in]

Yoko’s approach is a creative, emotive one, while Judy is working hard to improve those necessary medical alarms. Together, they’re pushing towards a better understanding of the sound in hospitals. And with a better understanding will hopefully come a better experience for those that work in them, and visit them.

Judy: You know, we've moved on a long way, and it can affect people's lives. It can in fact even save their lives.

Yoko: I'm fascinated by complexity, and this sound environment is seemingly really simple, but it's very complex and it has very nuanced ways of affecting us, and as a musician I believe that life happens in nuances that words cannot explain, and I like to improve those nuances of life.


Twenty Thousand Hertz is produced out of the studios of Defacto Sound, a sound design team dedicated to making the world of television, film, and games sound better. Find out more at defactosound dot com.

This episode was written and produced by Leila Battison, and me Dallas Taylor, with help from Sam Schneble. It was edited, sound designed and mixed by Nick Spradlin.

Thanks to our guests, Dr Judy Edworthy and Yoko Sen. You can listen to Yoko’s tranquility room and other sound projects, as well as her other research and outreach at sensound.space.

Dr. Judy Edworthy is the Director of the Cognition institute and Professor of Applied Psychology at the University of Plymouth in the UK. As well as designing and understanding alarms in everyday and specific situations, she’s also researching the aesthetics of popular songs.

The music in this episode was from our friends at Musicbed. Check them out at Musicbed dot com.

Finally, I LOVE to hear from our listeners, and I’m curious to know what kinds of sounds YOU think you might have an unconscious reaction to. Tell us on Facebook, Twitter, or by writing hi@20k.org.

Thanks for listening.

[music out]

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