Hailey Tran
Sleep is essential for a patient's recovery, with poor sleep leading to slower wound healing, less vitality and strength, and increased vulnerability to pain and illness. However, hospitals are notoriously bad places to get a good night's rest, with patients frequently complaining about noise, bright lights, and nighttime interruptions for vital checks, medication, and blood draws. While some hospitals have implemented strategies to reduce unnecessary wake-ups, such as scheduling medications around patient sleep schedules and minimizing noise, many patients still struggle to sleep. Pharmacological interventions, such as hypnotics and sleeping pills, are often used to aid sleep, but non-pharmacological approaches, including sleep hygiene and relaxation techniques, are also important.
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What You'll Learn
- Pharmacological treatments: hypnotics, sleeping pills, and anaesthesia
- Non-pharmacological treatments: meditation, music, and eye masks
- Patient feedback: hospitals are listening to patient feedback to improve sleep
- Staff awareness: reducing noise, dimming lights, and soft-soled shoes
- Sleep history: physicians assess sleep patterns, environment, and hygiene
Pharmacological treatments: hypnotics, sleeping pills, and anaesthesia
Sleep is essential for a patient's recovery. Insomnia is a common complaint among hospitalised patients, especially the elderly. To treat insomnia, physicians should obtain a thorough sleep history, including sleep patterns, sleep environment, and sleep hygiene at home. Pharmacists can then recommend appropriate hypnotics and dosages based on patients' renal and hepatic function and age. Hypnotics should be taken approximately 15 to 30 minutes before bedtime, and patients should be advised to avoid alcohol with hypnotics. If alcohol is consumed, the hypnotic dose should be skipped.
A single-centre study of 100 hospitalised patients found that 60% were given hypnotics while in the hospital, and 79% of patients felt that sleeping pills improved their insomnia. However, 56% were unaware of the side effects, and 89% were not offered non-pharmacological treatments. It is important to note that patients should be educated about the side effects of hypnotics and sleeping pills and be offered alternative treatments if they prefer.
In some cases, insomnia may be due to other underlying conditions such as OSA or RLS. Patients with RLS symptoms should have their ferritin levels checked, as it may be a sign of iron deficiency anaemia. If levels are low, an iron supplement such as ferrous sulfate can be given. For intermittent RLS symptoms, carbidopa/levodopa (Sinemet) may be prescribed, while nightly symptoms may require a different treatment approach.
Anaesthesia is another form of pharmacological treatment used in hospitals to induce a deep sleep-like state during surgery. It involves the administration of certain medicines, often through the vein or by inhaling a special gas through a mask. An anaesthesiologist or a certified registered nurse anesthetist typically administers anaesthesia. Patients under anaesthesia are closely monitored, and they do not feel any pain or have any memory of the procedure.
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Non-pharmacological treatments: meditation, music, and eye masks
Sleep is essential for a patient's recovery, and hospitals are implementing various methods to help patients get the sleep they need. Hospitals are increasingly recognizing the importance of sleep in patient recovery and the side effects of sleep medications, and are therefore turning to non-pharmacological treatments.
Meditation is one such method. Apps like Calm offer guided meditations, soundscapes, and Sleep Stories to help patients relax and fall asleep. Meditation apps can be particularly useful for those who do not want to take medication.
Music therapy is another non-pharmacological treatment that has been shown to improve sleep. Music can induce a sleep response in a matter of minutes and can be used in place of pharmacologic sedation. EMT (improvised music therapy) incorporates ambient sounds into a purposeful soundscape, taking into account the patient's culture, age, and ethnicity.
Earplugs and eye masks are also simple, cost-effective interventions that can improve patients' sleep quality in intensive care units. These can help control noise and light exposure, which are common causes of sleep interruptions. While some patients found these interventions very comfortable, others found them uncomfortable. Further research is needed to determine their effectiveness.
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Patient feedback: hospitals are listening to patient feedback to improve sleep
Sleep is essential for the body to function properly and hospitals are increasingly recognising the importance of improving sleep quality for patients. Insomnia is a common complaint among hospital patients, with 47% of 222 patients reporting insomnia and/or excessive daytime sleepiness during their hospital stay. Poor sleep can have detrimental effects on a patient's recovery, including impaired memory recall, slower wound healing, reduced strength, and increased susceptibility to pain and infections.
To address this issue, hospitals are listening to patient feedback and implementing various strategies to enhance sleep quality. One approach is the development of patient-centred interventions such as I-SLEEP, which educates and empowers inpatients to advocate for fewer nighttime disruptions. This intervention includes educational materials like videos, brochures, and sleep kits, along with specific questions patients can ask their care teams to reduce disruptions. Patient feedback on these materials has been positive, indicating that they are user-friendly and effective in reducing overnight vital sign disruptions.
Another strategy is the creation of tools like SLEEPKit, which uses icons and sleep promotion tips to address common sleep disruptors. The development of SLEEPKit involved feedback from patients, family members, and clinicians to ensure the effectiveness and acceptability of the strategies. This tool aims to provide tailored behavioural interventions based on each patient's specific sleep disruptors, promoting collaborative care planning.
In addition to these initiatives, hospitals are also focusing on individualised patient care. This involves assessing various factors that may impact a patient's sleep, such as room location, the necessity of nightly check-ups, and emotional factors like anxiety and depression. By addressing these issues, hospitals can reduce sleep disturbances and improve overall sleep quality.
Furthermore, hospitals are encouraging non-pharmacological treatments, such as good sleep hygiene, relaxation techniques, and physical exercises. Patients are advised to regulate lighting and exposure to natural daylight, minimise noise, and engage in activities like deep breathing exercises, meditation, and light walking to enhance sleep quality. Pharmacological interventions, such as hypnotics and melatonin, are considered only when non-pharmacological strategies have not shown improvement.
By listening to patient feedback and implementing a range of strategies, hospitals are striving to improve sleep quality for patients and ultimately enhance their recovery and overall well-being.
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Staff awareness: reducing noise, dimming lights, and soft-soled shoes
Sleep is essential for a patient's recovery. Poor sleep can have harmful effects on a patient's recovery, including poor memory recall, slower wound healing, less vitality and strength, and increased susceptibility to colds.
Hospitals can be noisy, bright, and busy places, which can make it difficult for patients to get a good night's rest. Hospitals are rethinking how they function at night to allow patients to sleep relatively uninterrupted.
One way to improve patient sleep is through a staff awareness campaign. This can include simple measures such as:
- Reducing noise by lowering the ring volume on phones, using break rooms for night-time conversations, fixing squeaky doors and carts, and avoiding the use of the public address system.
- Dimming lights by using flashlights instead of overhead lights, turning off TV and computer screens, and using blackout window shades or curtains.
- Wearing soft-soled shoes to reduce noise when walking around.
Additionally, hospitals can improve patient sleep by reducing unnecessary wake-ups. For example, by letting nurses re-time when they give medicines to better match patient sleep schedules, changing when floors are washed, and giving nurses checklists of tasks to complete before 11 pm.
Pharmacists can also play a role in improving patient sleep by recommending appropriate hypnotics and dosages, as well as discussing non-pharmacologic treatments such as good sleep hygiene.
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Sleep history: physicians assess sleep patterns, environment, and hygiene
Sleep is essential for a person's health and recovery. However, it is a common complaint that it is challenging to get a good night's sleep in a hospital due to various factors, including noise, bright lighting, and frequent interruptions. To address this issue, hospitals are increasingly focusing on improving patient sleep as part of their patient-centered care initiatives.
When a hospitalized patient complains of insomnia, physicians should conduct a thorough sleep history assessment to identify the underlying causes and determine if it is a new or pre-existing condition. This involves questioning the patient about their sleep patterns, environment, and hygiene practices at home. For instance, patients may be asked about the timing and duration of their sleep, any difficulties falling or staying asleep, and their bedtime routines and surroundings. Additionally, direct observation, patient questionnaires, and formal sleep studies, such as polysomnography, may be utilized to gather comprehensive information.
By evaluating sleep patterns, physicians can identify any deviations from healthy sleep habits, such as irregular sleep schedules, excessive napping during the day, or reliance on electronic devices before bed, all of which can contribute to insomnia. Assessing the patient's sleep environment helps determine if there are any external factors disrupting their sleep. For example, noise from roommates, staff, or equipment, uncomfortable bedding or lighting conditions, or interruptions for vital sign checks and medication administration can impact sleep quality.
Sleep hygiene refers to the practices and habits that promote healthy sleep. Physicians will assess if patients are adhering to good sleep hygiene, including maintaining a consistent sleep schedule, engaging in relaxing activities before bed, and avoiding stimulants like caffeine and alcohol. Poor sleep hygiene can exacerbate insomnia and disrupt the patient's overall sleep quality. By addressing these factors, physicians can provide tailored recommendations to improve sleep hygiene and facilitate better sleep during hospitalization.
In addition to sleep history assessments, hospitals are implementing various initiatives to enhance patient sleep. This includes staff education on noise reduction, adjusting medication schedules to minimize nighttime interruptions, and offering non-pharmacological treatments such as relaxation techniques and improved sleep hygiene practices. These efforts are driven by a growing recognition of the importance of sleep in patient recovery and overall satisfaction with hospital stays.
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Frequently asked questions
Hospitals don't usually give patients medication to sleep unless they are suffering from insomnia. In such cases, hypnotics or sleeping pills may be prescribed.
Insomnia is characterised by an increase in sleep latency (difficulty falling asleep), a decrease in sleep maintenance (difficulty staying asleep), or a decline in sleep quality (less time sleeping compared with time spent in bed).
There are many factors that can affect your sleep in the hospital, such as noise, lighting, treatments, roommates, medication side effects, and more. Here are some tips to help you sleep better:
- Ask the staff to lower the volume of phones, dim the lights, use flashlights instead of overhead lights, and fix squeaky doors.
- Use earplugs or listen to soothing music or white noise with headphones.
- Make sure blood draws, medication administration, and other interruptions are scheduled during the day if possible.
- Avoid caffeine after noon and finish dinner at least 3 hours before bedtime.
- Take naps earlier in the day and set an alarm to avoid napping too close to bedtime.
- Try relaxation techniques such as deep breathing exercises, meditation, or reading.
Hospitals can implement strategies such as:
- Reducing unnecessary wake-ups by re-timing medication administration and treatments to better match patient sleep schedules.
- Changing the timing of certain procedures, such as blood draws and vital sign checks, to avoid interrupting patients' sleep.
- Lowering noise levels by using break rooms for nighttime conversations and wearing soft-soled shoes.
- Improving lighting by using blackout window shades or lowering blinds to block out bright hallway lights.
Poor sleep can have negative impacts on a patient's recovery. Research has linked sleep deprivation to poor memory recall, slower wound healing, reduced strength and vitality, increased pain sensitivity, and a higher risk of catching colds.
