Sleep is important during hospitalization, and we need to maximize quality and quantity the best we can for our patients. Asking about your patient’s sleep and identifying ways to improve it when possible is one way to start.
The hospital is not a conducive place to sleep. Patients often experience major issues with sleep initiation and poor sleep quality during their hospital stay. Critical care patients are even more susceptible to sleep disruption. A patient’s single night of sleep loss can result in lethargy, irritability, confusion, and poor short-term memory, possibly leading to more tests and higher costs.
The recent New York Times article “Why Hospitals Should Let You Sleep,” points out that several hospitals are looking for innovative ways to improve sleep in the hospital to boost patient recovery and patient satisfaction, while reducing costs and posthospital syndrome. Posthospital syndrome often includes insomnia and/or circadian rhythm dysfunction.
A few years ago, our group looked into sleep in the Johns Hopkins Hospital. In an interprofessional collaborative effort involving nurses, physicians, medical volunteers, and engineers, we examined the hospital environment for potentially modifiable sleep disrupters. We confirmed that sleep disruption is prevalent among patients admitted to general hospital wards with patients having a median of five hours of sleep, three awakenings, and sleep latency of 11–15 minutes. We also identified common hospital sleep disruptors, which include vital checks, blood draws, rounding, patient care activities, noise (inside and outside the room), and light.
We then instituted ‘‘Sleep Rounds’’ at bedtime, during which sleep-promoting practices were implemented, including lights out, television off, temperature adjustment, and a final restroom usage. While we attempted to reduce some of the identified sleep disruptors, we were not able to significantly do so, because, at the end of the day, patients need medical care and to be checked on and evaluated. However, what we did learn was that patient perception of their sleep experience improved during the phases in which Sleep Rounds were implemented.
The moral of the story? Sleep is important, and we need to maximize sleep quality and quantity the best we can for our patients. Asking about your patient’s sleep and identifying ways to improve their sleep when possible is one way to start. Does my patient need vital checks every two hours, or blood draws every six hours? The answer might be yes, but at some point, the answer may change.
What we learned from our study was that when the patient sees that the healthcare team cares about their sleep, their satisfaction improved despite their poor sleep. Patients understand that a hospital is a place for medical care and that they may not be able to get a good sleep. As a clinician, we should strive for our patients to get both.