How do they sleep at night?
Dr. Eleanor Barbera
Perhaps you've heard about the administrator who spent a week as a resident in his long-term care facility. After being roused from sleep daily to receive medications that could have been dispensed later in the day, he banned his physicians from unnecessarily prescribing meds during night hours.
That's an excellent way of attending to sleep hygiene, an important and often overlooked aspect of wellbeing for residents and staff alike.
Sleep challenges of older adults
By the time residents arrive at our doors, their sleep is likely to be affected by influences such as illness and pain. In addition, there are changes in circadian rhythms as people age, leading to increased wakefulness earlier in the morning and fatigue earlier in the evening, according to an article in this month's American Psychological Association's Monitor on Psychology.
While we can't alter some of these factors, as care providers we can become more attuned to the importance of sleep for our residents and train our teams to create environments that are more conducive to slumber.
Impact on care
Poor sleep is associated with cognitive and physical deficits. It can impair residents' ability to participate in rehab and negatively affect their moods and their interactions with others, including the staff members there to help them (whose job is hard enough).
Residents who can't sleep through the night due to elements within the control of the facility are not happy with this situation. They're less satisfied with their stays and therefore less likely to recommend the facility to their friends and neighbors.
As illuminating as it would be, you needn't sleep in your facility for a week to find out which staff training and policies will remedy the problem. The residents have told me what keeps them up at night and I've outlined a “sleep hygiene” training program based on that.
A basic “sleep hygiene” program will:
· Set the expectation that employees are working in the residents' homes and should be mindful of their slumber. This includes talking in calm, hushed tones and turning off unnecessary lights after nighttime care.
· Limit fluids in the evening, provide toileting before bedtime and offer swift, calm and prepared mid-night care that increases the likelihood that residents can go back to sleep.
· Communicate between shifts so that the elders who have gotten up earliest get to bed soonest if they desire.
· Prioritize pain management, particularly if it's interfering with sleep.
· Refer residents experiencing sleep difficulty due to anxiety or depression to the consulting psychologist.
· Attend to agitated residents immediately so that they don't wake their neighbors.
· Find peaceful nighttime pursuits for elders with dementia-related sleep disturbance such as magazines, drawing or music on headsets.
· Replace noisy medical equipment such as oxygen machines with quieter models.
· Select roommates with attention to sleep habits and nighttime needs.
· Create a policy for quiet hours after, say, 10 p.m. and require low volumes or headsets for electronics after that.
· Train teams to collaborate between shifts so that they identify and assist residents who are asleep during the day and up at night to reestablish regular sleep patterns.
Ironically, much of this article was written during a spell of insomnia. According to the research described in the APA Monitor, tomorrow I'll see impairments in attention, working memory, reaction time and executive function, in addition to being irritable.
While occasional nights of lost sleep aren't, well, something to lose sleep over, employers and supervisors should be aware of the effect of sleep disturbance on the moods and capabilities of employees. One under-slept and irritable nurse can wreak havoc on team functioning.
Staff training on sleep hygiene for residents can include a brief section on the importance of sleep for workers, including this reassuring fact: “Maintaining good sleep quality in young adulthood and middle age is likely to protect against age-related [cognitive] decline in later years.” 1
While we might not want to go as far as the hotel that advertises “A good night's sleep, guaranteed” or provide upscale amenities like the “pillow menu” mentioned in this article, we can make substantial improvements in quality of care and resident satisfaction by attending to the sleep hygiene of our residents.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.