Poor Sleep and Insomnia in Hospitalized Adults

Overview

Sleep is vital for health and recovery. Yet, many patients link hospital stays with sleepless nights.

Ironically, the healing environment can disrupt recovery by hurting sleep. [1] Many factors contribute to patients' sleep problems in hospitals, which include the environment, medications, and the toll of illness. While there are many challenges to healthy sleep in hospitals, they are not insurmountable.

This article will explain why many patients can't sleep in hospitals and suggest solutions to improve their sleep.

Sleep Struggles in Hospitals

Hospitalized adults are at risk of many sleep problems. The most common are:

1) Poor Sleep Quality

Poor sleep quality is among the most frequently reported sleep complaints.[3] Many hospital patients experience long sleep latency, disrupted circadian rhythms, and poor deep sleep. They often wake up at night and feel unrefreshed. It is worse in adult ICU patients.[2] Some studies suggest that sleep disruptions are so severe that they may render conventional sleep stage tests useless.[4]

2) Reduced Overall Sleep Time

In the hospital, people may sleep less daily. A survey of 39 Dutch hospitals and 1,500 patients found that, over the past month, inpatients' sleep times were 83 minutes shorter than their usual home sleep.[5] Also, hospital patients tend to sleep in short bursts throughout the day.[6] About half of their total sleep time is at noon.

3) Acute and Long-term Insomnia

A lot of people who are admitted to the hospital have insomnia, even if they haven't been diagnosed with it before. Older adults and psychiatric patients have exceptionally high rates of long-term insomnia.[7,9]

Standard diagnostic tools show that 40-60 percent of medical inpatients over 50 have insomnia.[8]

Also, over 80 percent of psychiatric inpatients experience sleeplessness.[7] Those admitted to the hospital for chronic insomnia may still have sleep problems. These issues could worsen while in the hospital.

The Consequences of Poor Sleep in Hospitals

The effects of inadequate sleep extend far beyond fatigue. In hospitalized patients, sleep deprivation can harm nearly every organ. It can profoundly affect their recovery. These include:

1) Cognitive and Behavioral Impairment

Poor sleep makes thinking and behaving properly harder.[10] The link between poor sleep and cognitive impairment is clear. However, the effects on inpatients have been studied inadequately. It's harder to find causes and results in them.

A recent study of 1,500 inpatient psychiatric patients found a link between poor sleep and daytime sleepiness, anxiety, sadness, and suicidal thoughts.[11]However, it wasn't clear what caused these issues.

2) Cardiovascular Strain

Poor sleep activates the sympathetic nervous system. It can raise blood pressure and worsen cardiovascular diseases.[12]

3) Respiratory Problems

Experimental studies show that sleep deprivation harms lung function. [13] It is a concern for patients with lung conditions.

4) Immune Dysregulation

Studies show that lack of sleep weakens the immune system.[14] It is unknown whether sleep deprivation affects outcomes in hospitalized patients by changing immune function and inflammation.

5) Metabolic Disruption: Insomnia can alter one's glucose metabolism and cause insulin resistance. A study of 212 patients found that the longer someone slept in the hospital, the worse their glucose control was.[15] This finding was true for both diabetics and people who did not have diabetes.

6) Increased Pain Sensitivity

Lack of sleep lowers the pain threshold.[16] It creates a cycle where discomfort disrupts sleep, and poor sleep heightens discomfort.

What Factors Contribute to Poor Sleep in Hospitals?

There are two leading causes of poor sleep in hospitals: environmental and non-environmental.

Environmental Factors

Many things about hospitals can make it hard to sleep. These things only add to the problems of sleeping in an unfamiliar place. Some of the environmental factors include:

1)Hospital Noise

It is one of the main hospital sleep disruptions. Hospital noise comes from conversations, phones, TVs, pagers, alarms, and monitors.[17] Shared rooms raise these hazards.[18]

2) Light exposure

Excessive nocturnal light can disrupt circadian rhythms and fragment sleep. ICU patients often say that night light disrupts their sleep.[19]

3) Patient Care Interventions

Frequent checks for vitals, blood draws, and medications at night lead to unnecessary awakenings.[20]

Non-Environmental Factors

Aside from the hospital's environment, many other things about being very sick can make it hard to sleep or keep you awake. They include:

1) Preadmission Sleep Problems

Chronic insomnia and undiagnosed issues, like sleep apnea, often worsen in hospitals.[21]

2) Acute Illness

It is common for people with serious illnesses and surgeries to feel pain and worry. Acute pain can delay falling asleep.[22] It can cause broken sleep and reduce slow wave (N3) and REM sleep.[22] Also, symptoms like coughing and stomach issues make sleeping hard.[17]

3) Medications

Corticosteroids, beta-blockers, and antibiotics are commonly used in hospitals to treat various conditions.[23] These medications can negatively affect sleep and its architecture.[23]

How to Improve Sleep in Hospitals

Improving hospital sleep requires a multifaceted approach. It must address both environmental and individual patient factors.

Sleep experts have said that hospitals and healthcare workers need to make a plan to help hospitalized patients sleep.[24]

A) Creating a sleep-friendly hospital environment should be the first step to improving hospital sleep. It involves:

• Noise Reduction: Simple fixes like earplugs and white noise machines can help. So can "quiet hours" on the wards. These simple things can greatly improve patients' sleep quality.[25]
• Managing Light Exposure: Reducing patients' exposure to light at night can substantially improve their sleep. Some studies found that patients who used eye masks with earplugs slept better.[26]
• Minimize Nighttime Interruptions: Non-essential interventions disrupt sleep, like routine vitals for stable patients. Reducing them can allow for more uninterrupted rest.[27]
• Relaxation Techniques: These would include guided imagery, music therapy, and aromatherapy and can also help improve sleep in hospitals.[28]

B) Addressing patient's individual needs:

• Treating Underlying Conditions: Identifying and treating sleep disorders, like obstructive sleep apnea and chronic insomnia, can help.
• Prompt Treatment of Present Illness: Acute illnesses cause changes in the body and symptoms that make it hard to sleep. So, addressing the underlying medical or surgical problem should help. It includes managing pain and shortness of breath. It should improve sleep quality and duration.
• Medication Review: Some experts recommend that doctors review inpatients' medications for side effects, especially if they have trouble sleeping. They advise giving activating medicines in the morning and sedating ones at night when possible.

Is there a Role for Pharmacological Support for Patients who Sleep Poorly?

In some circumstances, pharmaceutical sleep aids may be required. It is a fairly common practice in most hospitals.

According to one study, 26 percent of inpatient patients received sleep aids.[29] Melatonin, a natural sleep hormone, is often the first-line treatment for hospitalized patients with poor sleep.[30]. This process is owing to its safety and the ability to control circadian rhythms.

Other drugs, like trazodone or low-dose doxepin, may be options.[31, 32] However, they require close monitoring.

What's the Takeaway?

Hospitalized patients can sometimes experience impaired sleep. The challenges to decent sleep in hospitals could range from environmental variables such as noise and light to the physiological toll of severe illness.

Experts recommend a multidisciplinary approach to solve these problems. It should prioritize patient comfort, use non-drug treatments, and tailor therapies for sleep disorders.

References

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