Introduction

Being in hospital is a stressful event in anyone’s life, regardless of the reason for admission. Although being admitted in hospital usually has the goal of promoting and aiding recovery, the conditions are rarely ideal for a good night’s sleep. 

Loud equipment, medical routines, staff, and other patients can highly impact sleep when we need it the most. The way that most wards are organised is not sleep friendly. This is especially difficult in shared bays.

In this article, we will explore the main issues that impact sleep in hospitals and suggest strategies to improve the quality of sleep during a hospital stay.

The importance of restful sleep

Sleep plays a critical role in physical and mental health. It is during sleep that the body undergoes repair processes, immune function is enhanced, and the mind processes and consolidates memories and information. You can read more about what the body does during sleep by clicking here. 

For hospitalised patients, adequate sleep can significantly influence the speed and quality of recovery, reduce the perception of pain, improve mood, and boost overall well-being. Tired patients are less likely to engage in therapies such as physiotherapy, typically need more pain relieving medication, and have an overall worse experience during admission.¹

Common challenges for restful sleep in hospital

1. Noise

This is one of the main issues that negatively impact sleep quality in hospitals. The beeping of monitors, conversations between staff, other patients, call bells, the occasional emergency alarm, and the sound of equipment being moved all interfere in sleep quality, particularly at night time.

2. Lighting 

Hospitals often have continuous artificial lighting that is kept on throughout the night for safety and monitoring. Bright lights can interfere with the body’s natural circadian rhythm, making it difficult to fall or stay asleep.

3. Hospital routines 

Procedures such as monitoring vital signs and administering medicine can occur regularly throughout the night. These necessary medical interventions can wake patients and prevent them from getting continuous sleep.

4. Pain and discomfort 

Many patients in hospital  deal with conditions that cause pain or discomfort, which can make it hard to sleep. Post-surgical pain, chronic pain conditions, and the discomfort of being in an unfamiliar bed can all contribute to sleep disturbances.

5. Stress and anxiety 

Being in the hospital can be stressful. Concerns about health, upcoming procedures, and being away from the comfort of home can lead to anxiety, which in turn makes it harder to fall asleep.

6. Medications 

Some medications have side effects that can disrupt sleep, such as increased urination, restlessness, or vivid dreams. Conversely, some medications can cause drowsiness, making it difficult to maintain a regular sleep-wake cycle.

7. Changes in normal routine 

Everyone has their own routine at home Some people sleep and wake up early, others go to bed later and therefore need more sleep in the morning. Being in hospital most of the time means adjusting to the routines of the departments, which are not always compatible with what we are used to.²

Strategies for improving sleep in hospitals

Despite these challenges, there are several strategies patients and hospital staff can implement to improve sleep quality.

Noise reduction 

Providing earplugs can help drown out background noise. Some hospitals in the NHS offer these as standard items on admission.

Some hospitals have mandatory rest periods, enforced by the nursing team, where no visitors or other healthcare professionals are allowed to disturb the patients. Lights are dimmed and noises are kept to a minimum to allow for a short rest.

If a patient is expected to stay for a long period, they should receive priority for a private hospital room.³

Lighting management

Some hospitals offer eye masks to all patients on admission.

Using dimmable lights that can be turned down during the night can help mimic a more natural day-night cycle. Installing blackout curtains can help keep out external light from street lamps or early morning sun. 

Providing patients with some control over the lighting in their rooms can also help them create a more comfortable sleep environment.

Minimising interruptions 

Whenever possible, nurses and other healthcare providers should try to bundle care tasks together to reduce the number of times a patient is woken up. For example, checking vital signs and administering medication at the same time. 

Medication can also be adjusted to allow for a better night of sleep – for example, if the patient needs diuretics, these can be administered in the morning or lunch-time to avoid disturbing them at night.

Although it can be challenging in busy environments, tailoring the timing of checks and medications to the patient’s sleep patterns can help minimise disruptions.³

Pain management 

Ensuring that patients receive adequate pain relief can significantly improve sleep. This may involve adjusting medications or using alternative pain management techniques such as heat, ice, or relaxation exercises.³

Simple measures like ensuring the bed is comfortable, providing extra pillows, and helping patients find a comfortable sleeping position can make a big difference.

Managing stress and anxiety 

Providing access to support services such as counselling, pastoral care, or social workers can help address the underlying causes of stress and anxiety.³

Providing a hospital environment that is as similar as possible to the patient’s usual home environment can substantially enhance patient well-being. Familiar settings and routines can reduce stress, anxiety, and confusion, promoting a sense of security and comfort.

Speaking with the patient to agree on times when procedures will take place will help make the night as peaceful as possible. For example, if the patient is someone who typically sleeps late and is therefore awake later, perhaps some routines can be changed to fit in their cycle.

Some hospitals allow family members to stay overnight, especially when the patient needs help with self-care or is seriously ill.

Medication management

Regularly reviewing the patient’s medications can help to identify any that may be contributing to sleep problems. They can then be adjusted as necessary. 

The use of sleep aids may be appropriate in some cases. However, these should be discussed with the patient and medical team to avoid dependence or adverse effects.³

Continuity in at home medication helps maintain therapeutic consistency. This prevents potential complications from abrupt changes in treatment. Therefore, it is important to ensure patients have access to all the medications they were taking at home.

Patient and family education

It is important to educate patients and their families about the importance of sleep and how to achieve it in a hospital setting. 

Providing information on the above strategies and encouraging patients to speak up about their sleep needs can empower them to take an active role in their care.

Sleep Hygiene 

Educating patients on good sleep hygiene practices, such as establishing a bedtime routine, avoiding caffeine and heavy meals before bedtime, and creating a restful environment.

Communication 

Encouraging patients to communicate with their healthcare providers about any sleep issues they are experiencing. This can help make identify necessary adjustments that improve sleep quality.

Family involvement 

Involving family members in the process can help ensure that patients feel supported and that their needs are communicated effectively to the healthcare team.

Should patients be sedated if they are having trouble sleeping in hospital?

Sedation is linked to higher incidences of falls and bone fractures, delirium, and increased morbidity, all of which can complicate recovery and extend hospital stays.⁴ 

Adjusting nursing and medical routines in hospitals to minimise the need for sedation can significantly benefit patients by reducing the associated risks. 

By adopting practices such as enhanced pain management, environmental modifications to promote rest, and the use of non-pharmacological interventions, healthcare providers can maintain patient comfort and cooperation without the extensive use of sedatives. This proactive approach not only fosters a safer and more responsive care environment but also promotes faster recovery.

Summary

• Getting a good night's sleep in hospital can be challenging but should be considered a priority as sleep plays an extremely important role in recovery
• Identifying the barriers to good quality sleep in hospital is vital to implement adequate strategies
• Adequate sleep enhances the patient’s experience and plays a crucial role in their overall well-being
• The main challenges to achieve a good night’s sleep in hospital are noise and lighting, routine checks, pain and discomfort, stress and anxiety, and change in sleep schedule
• Strategies to improve sleep quality include reducing patient visits, adjusting medication based on side effects and time of administration, providing adequate pain relief, and counselling and regularly communicating with the patient to identify their needs