Hospitalized patients often experience sleep deprivation due to poorly designed hospital environments. Patients face challenges such as loud noises, poor control of ambient light, and frequent nighttime disruptions, all of which contribute to inadequate rest. This sleep deprivation has significant physiologic consequences, including cardiovascular, immune, and cognitive dysfunction. Poor sleep quality is associated with adverse hospital outcomes, including increased readmission rates, higher hospital-acquired infection rates, and decreased patient satisfaction. To improve sleep quality, hospitals should provide patients with earplugs and eye masks, limit noise and disruptions, and align lighting with natural sleep cycles. Physicians often endure significant sleep deprivation, beginning in their training and continuing throughout their careers, that negatively affects their well-being and patient care. It also can contribute to burnout. Addressing sleep deprivation for physicians is essential for maintaining their health and improving quality of care and requires policy and culture changes.
Case 4. HK is a 72-year-old woman who was recently transferred to the medical floor from the intensive care unit where she received treatment for sepsis due to pneumonia. Although her vital signs are stable and her oxygen requirements are improving with antibiotic therapy, her mental status has worsened. She appears to have developed symptoms of delirium. The nurse reports that HK slept for much of the previous afternoon but was awake and calling out for most of the night. He asks you to consider ordering something to help HK sleep.
Sleep Deprivation in Hospitalized Patients
SLEEP QUALITY CHALLENGES
Among hospitalized patients, the estimated prevalence of insomnia is approximately 37% in older adults and 50% in younger populations.1 In general, patients in the hospital sleep for shorter durations, wake up earlier, and are awakened more frequently than at home.2
Sleep deprivation during hospitalization starts with the environment. Bright lights, loud noises, transfers, and overnight awakenings for observations or interventions are commonly cited causes of poor sleep in the hospital.1 In studies of hospitalized patients, up to two-thirds of nighttime sleep interruptions involved hospital-related factors, many of which are likely modifiable.2
On average, hospitals have nighttime noise levels of approximately 67 dB, more than eight times as loud as the maximum nighttime noise level of 35 dB recommended by the US Environmental Protection Agency.3 Occupational health studies have found that hospital noise levels are equivalent to those of a noisy restaurant 24 hours per day.3
EFFECTS ON PATIENT RECOVERY AND HOSPITAL OUTCOMES
Poor sleep quality in the hospital can negatively affect recovery from acute illness. Effects of inadequate sleep on recovery include cardiovascular, immune, and cognitive dysfunction.4 Research has shown that sleep loss in the hospital is associated with high blood pressure, hyperglycemia, and delirium. In studies of older patients, poor-quality sleep and sleep disturbances are associated with higher mortality rates 1 to 2 years after discharge.3
Poor sleep is associated with hospital outcomes such as increased readmission rates, higher hospital-acquired infection rates, and decreased patient satisfaction.4–6 Sleep disruption increases the risk for posthospital syndrome, a condition of acquired vulnerability after hospital discharge in which patients can experience readmission and adverse health events.6 The immune system regenerates during sleep; therefore, improving sleep quality could reduce hospital-acquired infection rates.4 Also, patients’ poor experience of sleep may worsen their perception of hospitalization.5
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