If Sleep Is Critical to Life, Why Isn’t It a Priority During Hospital Stays?

For National Sleep Month, we want to take a moment to give thanks for sleep, which is wonderful for all of us. It has long been identified as a basic human need, in addition to air, food, drink, shelter and warmth. Therefore, why do we continually deprive our patients of quality sleep? Why, as healthcare professionals, do we constantly miss out on sleep between shifts? If we know it’s crucial and one of our basic needs, why do we downplay sleep in the name of healthcare, for patients, co-workers and ourselves? For our patients, we consider medications, tests, treatment and constant interruptions to provide care as essential. For us, we often avoid our sleep needs despite knowing the importance of day/night rhythms, because there is too much to be done in our off-time or we are mandated back, just a few short hours later. It could be argued that many of our nursing care priorities are based on saving their lives; however, lack of sleep can magnify deficiencies and cause altered mental status, leading to delirium and long-term health consequences for our patients. According to research performed by Weinhouse et al, humans spend 20%-25% of their lives sleeping. Wouldn’t a hospital stay, or healthcare providers’ time off-shift, be an important time to ensure nurses are getting enough sleep to provide safe care so patients can heal properly, in both body and mind?

Mechanisms of Sleep

Two internal biological mechanisms regulate sleep cycles: the circadian rhythm and sleep-wake homeostasis. The circadian rhythm is influenced primarily by environmental cues such as light and temperature, and helps us regulate hormones, metabolism and daily fluctuations of wakefulness. Since it is based on a 24-hour clock, the circadian rhythm naturally allows us to become drowsy at night and to wake up in the morning without the stress of a beeping alarm. Our sleep-wake homeostasis helps us know when we need to sleep, almost like an internal tracker that reminds us when it is time to sleep and measures sleep intensity. Medications, stress, an inadequate sleep environment and medical conditions can disrupt this process and throw our homeostasis off-kilter. This is why our patients, night-shift nurses and healthcare professionals may have difficulty regulating sleep. Both sleep cycles can be completely disrupted!

Importance of Achieving Sleep Stages

Rapid eye movement (REM) and non-rapid eye movement (non-REM) have various stages of progress for us to have restful sleep. How often do we allow our patients to achieve REM? According to research, healthy individuals should achieve a goal of about 20%-25% of REM sleep each night; however, ICU patients experience little to no REM sleep during hospitalization, which leads to increased delirium, emotional distress and fatigue, and can lengthen recovery time. How do you know if you or your patients are having REM sleep? It first occurs about 90 minutes after falling asleep where you dream the most vividly, and your hemodynamics most mimic being awake. Oddly enough, our muscles go into near-paralysis, which prevents us from acting out our dreams. If you are checking on your patient, you may notice their eyes are moving while they dream in that peaceful state of REM. While we can’t check ourselves, if we awake refreshed and feeling rested, it is very likely we were in REM sleep for the appropriate amount of time. One key point to keep in mind is that sedation and sleep are not the same thing. Just because sedated patients look like they are sleeping, the amount of REM sleep during sedation is negligible.

Tips to Getting a Good Night’s Sleep for You and Your Patients

• Set a schedule: Go to bed and wake up at the same times every day
  • Help your patients do the same by creating a unit schedule that all patients adhere to as much as possible
  • Avoid bathing patients at night unless absolutely necessary
• Exercise 30 minutes a day (avoid it a few hours before winding down)
  • Have your patients get out of bed and move
  • If patients are restless, getting them up for short periods will provide better sleep than sedation or restraints
    • Even dangling and moving legs and arms may tire critically ill patients
• Avoid late afternoon/evening caffeine runs; nicotine and alcohol should be avoided too for best sleep hygiene practices
  • If your patient is alert and awake, also discourage late-afternoon caffeinated beverages
• Enjoy warm baths, reading or meditating … anything that allows you time to relax without the use of screens or stimulants
  • Give your patient their daily bed bath or backrub before settling them in for a peaceful night, if possible
    • Avoid bright lights and extreme temperatures for a peaceful sleep
    • Work within your unit to raise and lower lights around patient rooms during their stay
• If you can’t sleep, don’t lie in bed staring at the ceiling; do something to calm your brain, such as reading or journaling
  • Encourage patients to do the same

Resources on Sleep for You and Your Patients

1. National Institute of Neurological Disorders and Stroke: “Brain Basics: Understanding Sleep”
2. AACN CSI Project: “Quiet Is Coming”
3. AACN CSI Project “Don’t Get Delirious, Take Sleep Serious”
4. Article: “Lack of Sleep is Harming Health Care Workers and Their Patients”
5. Journal of Clinical Sleep Medicine: “Sleep Is Essential to Health: An American Academy of Sleep Medicine Position Statement”

How can you improve sleep for yourself and your patients?