Hospitals And Sleep: A Troubling Relationship

Spending a night in the hospital usually means one thing: you probably won't get much sleep. While some interruptions may be unavoidable, hospitals have been criticised for their sleep-disturbing routines, which can negatively impact a patient's recovery. From vital checks and lab tests to loud machines and staff noise, patients are often woken up multiple times for reasons that are not strictly medically necessary.

Hospitals often prioritise testing and staff convenience over patient sleep

For example, a patient might be woken up in the middle of the night for a blood draw or to have their blood pressure taken. In some cases, this can be avoided by scheduling these activities for a different time or coordinating them with other necessary tasks.

Another issue is the specialization of tasks across different hospital personnel. For instance, when an IV machine beeps, a nurse must come to help, and when it's time to measure vital signs, a nurse's aide is sent. If these tasks were coordinated, two interruptions could be reduced to one.

Additionally, hospitals often disrupt patients' sleep by performing all tasks on a predefined schedule, without distinguishing between those who need frequent monitoring and those who do not. This can be addressed by implementing sleep protocols that minimise unnecessary interruptions and prioritising patient sleep unless there is a clinical need for more frequent interruptions.

The consequences of too many sleep interruptions include slower patient recovery, increased medical costs, and impaired patient ability to recover from acute illnesses. Poor sleep in hospitals has been linked to falls, delirium, reduced immune function, worsening blood pressure control, and mood disorders.

Some hospitals have taken steps to improve patient sleep by reducing unnecessary interruptions, rescheduling activities, and reducing noise. These changes can have a significant impact on patient recovery and satisfaction.

Patients are frequently woken for non-urgent reasons

One patient, Peter Ubel, a physician and professor at Duke University, recalled numerous interruptions for vitals checks, lab tests, blood draws, and loud machines when he stayed at a hospital after surgery in 2013. "Not an hour went by without some kind of disruption," he said. "It's a terrible way to start recovery."

Another patient, Melissa Bartick, a physician in the Harvard medical system, fell asleep around 10 pm after being evaluated for an acute illness in the emergency department. She was then awoken at 11 pm for another vital sign check, not because her illness was so acute that she needed hourly assessments, but because hospital protocol required nurses to check vital signs at the start of each shift, which began at 11 pm.

Traditionally, hospitals have scheduled a number of nighttime activities around health professionals' needs, aligning them with shift changes or updating patients' vital signs so that the information is available when doctors make early morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins, which can mean patients are being disturbed almost every hour, whether medically necessary or not.

Hospitals could make simple organizational changes to reduce sleep interruptions. For example, phlebotomists could coordinate their work with nursing aides, so that they come into patient rooms together to check blood pressure and draw blood, eliminating one interruption. Hospitals could also allow nurses more flexibility in the timing of vital sign measures. If a patient's IV machine beeps at 11 pm and the next check of their vital signs is due at midnight, the nurse could bring the vital sign check forward by an hour, since the patient is already awake.

Some hospitals are taking steps to minimize disruptions and maximize sleep time for patients. For example, Massachusetts General Hospital has instituted quiet hours, in which staff are encouraged to reduce their noise levels and consider whether patients really need particular care at night before waking them. Yale-New Haven Hospital has adjusted their check-in schedule by allowing nurses to create the schedules and ensure tasks are completed before patients go to sleep. Taking patients' needs and schedules into account when scheduling tests and check-ins has been proven to reduce the percentage of patients reporting sleep disruptions, as well as the use of sedatives.

Poor sleep in hospitals can lead to longer recovery times

Hospitals are often noisy, bright, and full of interruptions, making it difficult for patients to get a good night's sleep. While some interruptions are necessary for medical reasons, many are not, and this can negatively impact a patient's recovery.

The impact of poor sleep in hospitals can lead to longer recovery times and even increase medical costs. Sleep deprivation in hospitals has been linked to various complications, including falls and delirium. It also impairs the immune system, making patients more susceptible to health problems and prolonging their recovery.

Additionally, poor sleep can cause hypertension and mood disorders, further complicating the recovery process. Patients who are already weak and tired from their underlying illnesses need adequate rest to heal. Disrupted sleep schedules and frequent napping during the day can further exacerbate these issues.

To improve patient sleep and recovery, hospitals can implement simple changes such as reducing unnecessary interruptions, minimising noise and light, and providing a more restful environment. Some hospitals have introduced quiet hours and encouraged staff to reduce noise levels and minimise non-essential tasks during certain periods. Others have adjusted their check-in schedules to reduce interruptions and better respect patient sleep schedules.

By prioritising patient sleep and making organisational changes, hospitals can improve recovery times and enhance patient satisfaction.

Hospitals are trying to improve patient sleep with quiet hours and better coordination

Hospitals are indeed trying to improve patient sleep with quiet hours and better coordination.

Hospitals have traditionally scheduled nighttime activities around the convenience of health professionals, often resulting in patients being woken up every hour, whether medically necessary or not. However, as hospitals chase better patient ratings and health outcomes, many are rethinking how they function at night.

Some hospitals are reducing nighttime check-ins or trying to better coordinate medicines so that more patients can sleep relatively uninterrupted. For instance, Massachusetts General Hospital has instituted quiet hours—a couple of hours in the afternoon and between six and eight hours at night, depending on the hospital unit, during which lights are turned low and staff are encouraged to reduce their noise levels.

Other hospitals are trying to reduce noise as a way to help patients get more rest. For example, Massachusetts General Hospital installed rubber floors to reduce noise in the facility, and the University of Michigan Health System installed floor tiles that reduce sound and adjusted the facility's cleaning schedule to minimize nighttime noise.

Some hospitals are also trying to improve coordination. For instance, Yale-New Haven Hospital has adjusted its check-in schedule by allowing nurses to create the schedules and ensure tasks are completed before patients go to sleep.

These changes can help, but they don't address the main problem for most patients: being woken up repeatedly. To address that, hospitals may need to look at less obvious questions. For instance, at New York's Mount Sinai Hospital, doctors are rethinking when and what kind of medicines to prescribe. Some antibiotics can be given at six-hour intervals instead of four, reducing the need for nighttime interruptions.

Overall, these changes point to the potential for making meaningful improvements in the quality of patient sleep.

Patients can also take steps to improve their sleep in hospital

It's also important to keep your normal sleep schedule and circadian rhythm. During the day, keep the window shades open for natural light and keep the room dark during sleeping hours. An eye mask might be helpful if exposure to light at night is unavoidable. Bringing a favourite blanket, pillow, photos, and your favourite music can help you relax and be more comfortable.

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