Obtaining quality sleep is a challenge. Factor in alarms, excessive noise, artificial illumination, and people waking you up, the idea of getting any shut-eye sounds impossible. Bodies need rest and an opportunity to reset. In the hospital, it is paramount to recovery.

Hindrances

Hospitals hinder relaxation due to functioning as a 24-hour workforce. Patients are sick and demand around-the-clock care, maintenance, assessments, and medications. The hospital does not close down at night, but the patients have to get some shut-eye.

Alarms include bedside lamps, vital sign machines, infusion pumps, and emergency alerts. These cannot be off. The call bells ring when individuals receiving care or family members require assistance. The vital sign machines inform the nurse once numbers are not within range. The medical staff must intervene and return the person to a stable state. Infusion pumps alarm if the battery is about to run out, the medication is empty, or there is an occlusion in the line. These beeps notify that something interrupts the patient’s IV drug delivery and the patient is not receiving the medication. Emergency signals alert the floor and hospital staff when a patient necessitates help without delay. None of these chirps are able to be set to silence because they play a pivotal role in keeping those in care safe.

Nurses perform assessments at intervals set by the provider. Depending on the patient’s level of acuity, appraisals are every one, two, four, or six hours. The higher levels of care, such as the ICU and ER, assess their patients every one or two hours. Nurses evaluate whether the patient’s condition is improving or worsening, if medications are effective, or if further interventions require escalation. Assessments cannot stop in the evening just to allow for a break. Nurses must know right away when a change of condition occurs so that they have the ability to act stat.

Administration of medication requires full-time attention and nighttime doses are necessary. Pharmaceuticals function best when set at distinct periods because a drug’s half-life makes it less effective over time. Regular dispensation of the pills maintains the treatment at a therapeutic level.

Lights cannot be off after dark. Staff have to navigate hallways, workstations, and patient rooms. Medical personnel must have access to assess patients. ICU rooms might be even brighter if they utilize sliding glass doors instead of wooden doors that close. The glass sliding doors allow the rooms to open fully so patients transfer with all the equipment in use. The clear doors permit nurses to view the patient at all times. This is imperative because patients in the ICU are critically ill and deteriorate rapidly. Darkness tells the human system to produce a hormone called melatonin, which is naturally present in the body. Continuous illumination blocks the production of this hormone, which renders sleep unattainable.

Hospital maintenance happens more often in the late hours because there are fewer people due to visiting hour restrictions. At night, the floors get a deep cleaning, restocking of shelves, and testing of equipment occurs.

Promote Slumber

There are several ways to support proper snoozes.

Stay awake during the day. This may seem simple, but it is challenging because hospitals tend to be monotonous. Each day feels like a repeat of the previous days, weeks, and months. Sometimes there is nothing to do but lie in bed the entire period and doze off. Extreme naps during the daytime puts the body’s circadian rhythm out of sync. Short dozes at regular intervals are helpful.

Talk to the nurse that shift and see what is on the books, medications, meals, physical therapy, and visitors. Determine when there is a good time to close the eyes and rest. Plan this with the staff. That way, they know to avoid interrupting the nap, and when to wake the person up.

Planning activities throughout the daytime keeps the spirit and body up. If possible, go outside. Limits to this include needing staff accompaniment, too many monitors, and instability. Getting sunshine provides natural lighting and consumes energy. After laying in a hospital bed for so long, leaving the room may feel daunting and exhausting. This is a suitable goal to set with physical or occupational therapy. The sun provides vitamin D as well.

Eat meals sitting in a chair, or at a table if possible. Breakfast in bed might appear enjoyable, but it is not optimal for healing. Simple acts, such as sitting, may be a struggle for ill patients. Early mobility is a cornerstone of recovery. It increases lung function, prevents muscle atrophy, and improves gut performance. Getting into a chair for meals creates a routine that the brain can adapt to and know when to be awake.  

Use light to stimulate a schedule. At the right time, switch on all the bulbs. Only extinguish the lights when it is time to nap and nighttime slumber. It helps if this on-and-off schedule is the same every day. Humans thrive with structure. Full brightness and open windows make a clear distinction when it is the hour to be awake. Shut windows and the absence of light tell the soul it is time for rest. This also notifies the staff not to enter the room to allow for rest. An eye mask is capable of creating darkness in an environment where turning lights off is not an option.

Adding white noise to the darkness encourages sleep. This drowns out extra noise and the sound notifies the brain that it is now the appropriate moment to unwind. The combination of visual and auditory sensory input helps induce sleep.

Melatonin is a naturally occurring hormone in the body that endorses sleep. It is also available in pill or liquid form. This medication poses no risk to give because it is just a chemical that the body already has. Production of melatonin is unavailable by disproportionate brightness in hospitals. Scheduling ingestible melatonin before bed is a safe addition. Pediatric units prefer melatonin because it is safer than drugs, such as Benadryl, Trazodone, or Zolpidem.

Sleep Heals

Getting enough rest is essential to healing. Patients experience many challenges while in the hospital. Call bells, machines, pumps, and emergency alerts can cause interruptions in slumber. Promote respite and resets by staying awake in the daytime, increasing mobility, having a light on-and-off schedule, and the use of melatonin.

Editor: Claudia Cramer