I think I’m not alone when I say that I’m not fun to be around when I am sleep deprived. Not only am I grumpy, I don’t feel good. As we all know, sleep is important for our bodies and our minds. And it turns out that sleep is very important for physical healing. But when you’re a hospital patient, it’s impossible to sleep. How does this impact health? Is there a way to sleep better in the hospital?
The irony of it all.
Professor Matthew Walker sums it up in his recent interview with The NY Times:
“Sleep is one of the most powerful, freely available health care systems you could ever wish for. But the irony is that the one place a patient needs sleep the most is the place they’re least likely to get it: in a hospital bed on the ward.”
Why is it so hard to sleep in the hospital?
If you’ve ever stayed overnight in the hospital, you know the answer.
First, nurses and other staff regularly wake patients up – to perform well-being checks, take vitals, draw blood, perform tests and give medications. But oftentimes these interruptions are not coordinated, leading to a stream of frustrating and exhausting nighttime interruptions. And in many cases, the interruptions may be unnecessary. For example, although nurses have taken the vitals of hospitalized patients every 4 hours for well over 100 years, there is little evidence to support this practice. Additionally, researchers found that nurses frequently take overnight vital signs regardless of the patient’s risk of clinical deterioration. There is often no difference in protocol based on degree of illness – the same standard is often used for stable patients and for critically ill patients in the ICU.
Additionally, there are countless other sources of potential sleep disruptions, including:
- Noise from bedside alarms
- Beeps and chirps from equipment
- Noise from nearby patients
- Staff hallway conversations
- Loud televisions
- Bright hall lights
- Gurneys transporting patients
- Elevator dings
Why is sleep so important for hospitalized patients?
Sleep disruptions, a common occurrence for hospitalized patients, are associated with several negative health outcomes, including elevated blood pressure and delirium.
Other impacts of sleep interruption in hospitals include:
Interrupted sleep impacts your cardiovascular system.
Sleep disorders and sleep interruption have long been associated with a buildup of plaque in the arteries, which can lead to lead to serious health problems, including heart attack, stroke, or even death. However, until recently the mechanism behind the connection was unclear. A 2019 study in mice found that sleep regulates the production of blood cells and platelets and protects against a buildup of plaque in blood vessels.
Furthermore, a review of 15 previous studies found an association between difficulty falling asleep, difficulty staying asleep and/or non-restorative sleep and an increased risk of future heart attacks and strokes.
Put simply, disrupted sleep is directly linked to an increased risk of heart attack or strokes. Ironically, simply being in the hospital can hinder the healing for patients hospitalized with clogged arteries as nurses and other hospital noises interrupt their sleep.
Disrupted sleep impacts our immune system.
While you sleep, your immune system creates molecules that fight bacteria and viruses. Sleep deprivation prevents your immune systems for creating an adequate defense, which can hamper recovery from illnesses.
Sleep deprivation impacts wound healing.
A 2018 study evaluated the impact of sleep on the healing of intestinal wounds for patients with ulcerative colitis and Crohn’s disease. The researchers found that the wounds took longer to heal for patients with Crohn’s disease who scored low on a sleep quality index.
Additionally, in a very small study, researchers found that untreated obstructive sleep apnea can hinder the healing of diabetic foot ulcers.
And in 2018, researchers found that sleep restriction delays the healing of skin wounds. The authors state that “these findings support the beneficial effects of adequate sleep on immune function”.
It seems fairly safe to assume that lack of sleep could also make it harder to recover from other wounds, including surgical wounds.
Sleep loss increases the perception of pain.
A 2019 study found that a lack of sleep can worsen the perception of pain. In their sleep-lab experiment, the researchers found that even one night of sleep deprivation decreased a person’s pain threshold by 15+ percent. In a separate experiment, they found that small changes in the daily average amount of sleep could predict the overall level of pain a person felt the next day.
Patients want medications to help them sleep.
Patients frequently request sedatives to combat the difficulties of sleeping in a hospital. But, research shows sedatives (often opioids) carry risks, such as delirium, falls and addiction. Yet, doctors regularly prescribe them for patients, including elderly patients.
Some good news.
Hospitals are increasingly concerned with patient ratings and reviews, as well as with outcomes and other quality measures. As part of their continuous improvement efforts, many hospitals are working to improve the quality of sleep for patients. For example, hospitals have reduced nighttime check-ins and/or improved coordination of nighttime medications.
Yale-New Haven Hospital has made significant changes in protocol, including: no vital signs, blood draws or medication after 11 p.m. (unless it’s essential); avoiding night time cleaning; soft-soled shoes for staff; and the use of a device that indicates noise levels with colored lights.
Do these changes help? Yes! One study evaluated the impact of a new protocol which included an 8‐hour “Quiet Time” – introduced with automated lights‐off and lullaby. Additionally, staff monitored noise levels and avoided waking patients for vitals and medications. The change in protocol led to a significant decrease in the request for sedatives.
Tips to sleep better in the hospital.
Many factors impact a patient’s ability to fall and stay asleep, including environmental issues such as light, noise and temperature, and emotional stressors such as pain and anxiety. Of course, frequent interruptions don’t help!
What can you do to sleep better in the hospital?
First, talk to your doctor and nurses about scheduling medications and vital checks before you go to sleep. Tell them you really want to make sleep a priority. If they can’t avoid interrupting your sleep, ask them to coordinate the interruptions to as few wakeups as possible.
Other steps to sleeping better:
- Try to get a single room.
- Sleep with door closed if possible.
- Use ear plugs or mask the noise with a white noise machine, music, tv, or fan.
- Wear an eye mask.
- Ask the nurse if you can wear your own clothes instead of the hospital gown. If allowed, wear loose, comfortable clothing that won’t interfere with nursing tasks and mobility.
- Adjust the temperature in the room to suit your needs. If you can’t adjust the temperature, you can bring a fan or ask the staff for additional blankets, as needed.
- Try to manage your stress – listen to relaxing music, meditate, practice deep-breathing.
- Bring your own pillow and blanket from home (ask staff first!). If you choose to do this, consider throwing these items away when you get home if you can’t clean them sufficiently to eliminate potentially dangerous germs.
- If you take a medication that keeps you awake, ask your doctor if he/she can schedule it for the morning.
- Try to get some exposure to natural light – sit by a window or go outside if possible. And, keep the curtains open during the day (and closed at night).
- If possible, can get some physical activity during the day, even if it’s just a short walk in the hallway.
- If pain keeps you awake at night, ask your doctor to prescribe a pain medication for right before you go to sleep.
- Avoid caffeine for at least 4-6 hours before you hope to sleep.
- If daytime naps leave you too alert to sleep at night, try to stay awake during the day.
- As a last resort, if you absolutely cannot sleep, ask for a sedative.
All hospital stays involve risk. Read these blog posts to reduce your risk of problems:
- Germs in Hospitals and Doctor Offices – Watch Out!
- Protect Yourself from Hospital Infections.
- Why is Sepsis so Dangerous?
- Is C. Diff Dangerous for Patients?
- The Dangers of Missed Bedside Alarms.
- The Benefits of Participating in Hospital Rounds.
- How to Avoid Medication Errors in the Hospital and at Home.
- Tips for Hospital Discharges.
- What You Need to Know About Pressure Sores.
- Do Hospital Policies to Prevent Falls Help or Harm Patients?
- Is Your Hospital Safe?