Bedtime Ritual Improves Sleep, Keeps Hospital Rooms Quiet

Marcia Frellick

April 13, 2018

ORLANDO — A nonpharmacologic intervention that promotes both sleep and quieter hospital rooms is effective, new research from the Sleep Hygiene in the Hospital Project (SHH!) shows.

The protocol can be replicated easily, at next to no cost, said lead researcher Michael Herscher, MD, from the Icahn School of Medicine at Mount Sinai in New York City.

The problem is ubiquitous in the hospital. "About 10% of patients outside the hospital complain about sleep loss, but about 50% of patients who are hospitalized will have sleep loss," he reported.

The first of the three main components — identifying champions — is particularly important because this intervention happens at night, so patient care associates or medical assistants are responsible for completing the steps, Herscher said.

Making staff understand the importance of the intervention in meetings and daily huddles, the second component, is also critical. "If the staff didn't buy into this, we weren't going to create a culture of sleep promotion," he explained.

About 10% of patients outside the hospital complain about sleep loss, but about 50% of patients who are hospitalized will have sleep loss.

The third component is providing a bag of sleep aids — an eye mask, headphones for music, decaffeinated tea, lavender oil, and earplugs, which most hospitals likely have in stock — to the patient before bedtime. When medical assistants deliver the bags, they ask a series of scripted questions, such as whether the patient wants the television or lights off and whether the patient is in pain.

Because the protocol saves assistants from having to come back for each request, it does not add to their workloads, Herscher reported here at the Society of Hospital Medicine 2018 Annual Meeting.

Herscher and his colleagues assessed the protocol in a 34-bed acute medicine inpatient unit of an urban, tertiary academic hospital. They compared data from the 6 months before implementation (January 1 to June 30, 2017) with data collected after implementation (July 1 to November 13, 2017).

In the morning, patients were randomly selected to complete the validated Richards-Campbell Sleep Questionnaire, which asks five questions on the quality of the previous night's sleep.

Quality of sleep was rated better after implementation of the protocol than before on four of the five questions, and for three of these, the difference was significant (P < .05).

Patients also completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

After implementation, there was a 10 percentage point increase — from 34% to 44% — in patients who responded "always" to the question: During this hospital stay, how long was the area around your room quiet at night?

If the staff didn't buy into this, we weren't going to create a culture of sleep promotion.

Although the team was not able to quantify how much people slept, the data indicate improvement. "These results are preliminary, and we will need to demonstrate sustainability with further implementation," the researchers write in their abstract.

One of the major strengths of the protocol is that it is "very straightforward, very simple. It could be easily implemented at other institutions," Herscher said.

The protocol sounds like it is well-suited for a private room, but Cynthia Owens, DO, from the Indiana University Medical Center in Bloomington, said she wonders how the components will work on a ward where factors are harder to control for individual patients.

And, she pointed out, sleep deficits in hospitalized patients are often made worse by vital sign checks and uncontrolled pain at night.

Still, the protocol would likely be helpful for those with arthritic or postoperative pain, which tends to be worse at night, she told Medscape Medical News.

Because lack of sleep is associated with delirium, immune dysfunction, slower wound healing, and increased risk for falls and other detrimental effects, including death, a higher-quality sleep could have far-reaching benefits, Herscher explained.

Herscher and Owens have disclosed no relevant financial relationships.

Society of Hospital Medicine (HM) 2018 Annual Meeting: Abstract 413905. Presented April 9, 2018.

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