Why is it so hard to sleep in the hospital?

Welcome to this edition of?Sleepletter?where we offer you easy-to-read insights from the latest research papers from the field of sleep neurobiology and clinical sleep medicine. We hope you enjoy the content! If you also want to receive content via email, please?subscribe here.

Sleeping in a hospital environment

Nobody likes being a patient in a hospital. For most people, being in the hospital is a stressful experience because of the unfamiliar environment, noise, an inability to fulfil roles in the family, worries about financial issues, as well as the fear of the unknown. One factor that the hospital environment can impact negatively is often overlooked – and that is sleep. We know that good sleep is necessary for wellbeing, as well as cognitive and emotional functioning, all of which are of particular importance for hospital patients. Sleep also plays an important role in maintaining adequate immunity, as well as metabolic and endocrine functioning. Disrupted sleep has been linked with an increased risk of delirium and, in turn, with increased hospital and ICU length stay, postoperative complications, and higher mortality.??

However, few studies have been conducted to evaluate the prevalence of poor sleep in hospitals, let alone interventions to actually improve sleep. Small studies suggest that sleep in hospitals is, expectedly, suboptimal. Many factors can disrupt sleep in a hospital setting such as noises from alarms, discomfort, too much artificial light during the night, sleep interruptions attributable to medical procedures, as well as patient-related factors such as pain or anxiety. Thus, identifying relevant and potentially modifiable factors associated with poor sleep may be the key to raising awareness of the problem, as well as introducing remedial measures.

In 2017, the first large and nationwide study assessing sleep quality in hospital patient was conducted in the Netherlands. More than 2000 patients from 39 hospital were included, with a mean age of 68 years. The number of patients per room varied, from 1 to 5, and they stayed in the hospital for 4 nights on average. All patients had to complete a questionnaire that assessed the quantity and quality of their sleep for one night in the hospital compared with their usual sleep at home.?

The results revealed a stark difference between sleeping in the hospital compared to home. During hospitalization the patients slept on average 6 hours, almost one and a half hours less than at home, with the difference primarily resulting from earlier final awakening times in the morning. More than 80% of patients woke up at least once during the night and the average number of awakenings increased almost 50% to 3.3 times, which contributed to significantly worse sleep efficiency in the hospital (76% vs 88%). As a note, sleep efficiency is the percentage of time spent asleep while in bed and 85% or higher is considered optimal. Interestingly, there were no differences in sleep disturbances regardless of the number of patients in the same room or length of hospital stay.

The researchers also wanted to find which factors caused this deterioration in sleep. At least one hospital-related factor had a negative influence on sleep in close to two thirds of patients. Noise from other patients was the most common disturbance interfering with sleep in 23% of the people. This was followed by pain (20%) and noise from hospital equipment (19%).?

Despite certain limitation of the study, such as not measuring sleep in an objective way, but rather through subjective sleep questionnaires, this research highlights an important yet often ignored issue of poor sleep in hospital settings. Good sleep is key to any person’s well-being and as such should be prioritized, especially in a setting such as a hospital which most patients perceived as stress-inducing. Thus, increasing awareness among healthcare workers about the importance of optimal sleep and applying interventions to improve poor sleep (pharmacological and nonpharmacological) should be highly emphasized in hospitals which may in turn improve the patients’ overall hospital outcome.?

***

About the author

Alen Juginovi??is a medical doctor and postdoctoral researcher in the Department of Neurobiology at Harvard Medical School in Boston, MA, USA studying the effect of poor sleep quality on health. He is also organizing international award-winning projects such as Nobel Laureate conferences, international congresses, concerts and other, as well as participating in many events as a speaker. Feel free to contact him via LinkedIn for any inquiries.