Addressing Sleep Disturbances in Long-Term Care Settings

Dr. Prashant Sharma, D.O., board-certified psychiatrist, and founder of Concise Psych

Residents of long-term care facilities frequently experience sleep disturbances, and those disturbances can lead to many other problems. While there are many factors that can predispose residents to sleep disturbances, there are also many ways that long-term care organizations can help ensure residents get a quality night’s sleep.

Why Sleep Disturbances Occur

There are many reasons to explain why sleep disturbances are so common in residents. Dr. Prashant Sharma, D.O., is a board-certified psychiatrist, an instructor in psychiatry and behavioral sciences at Johns Hopkins University, and the founder of Concise Psych. Dr. Sharma explains that residents who are admitted are dealing with an unfamiliar setting, which can make it difficult to sleep. Long-term care residents often have multiple medical problems, as well as cognitive deficits. They may have experienced past strokes, heart attacks, traumatic brain injuries, and more. Those cognitive deficits can lead to increased disorientation and sleep difficulties.

When residents experience sleep disturbances, they can’t sleep at night and become tired during the day. Residents often start to nap, and because their circadian rhythm is disrupted, it can lead to confusion. Residents may get confused about where they are, what time it is, and what’s going on, and they can’t stay active during the day. “It’s a vicious cycle,” explains Dr. Sharma. “The more they’re disturbed at night, the more they sleep during the day.”

Supporting Healthy Sleep Habits

Dr. Sharma notes that providing residents with environmental support can help to decrease confusion, as well as delirium. “During the day, the lights in a resident’s room should be on and the shades should be up,” he says. The objective is to avoid promoting a sleep environment. At night, the room should be dimly lit so that residents can see some surroundings and walk to the bathroom, but don’t feel confused about where they are.

It’s also important that if the TV is on during the day, the resident should be engaged and watching it. “Residents shouldn’t be falling asleep in front of the TV,” says Dr. Sharma. “If they do fall asleep or aren’t engaged, the TV should be turned to background music.” Additionally, it’s important to keep residents up and out of bed as much as possible during the day. Dr. Sharma notes that PT and OT activities in facilities can be key, since they keep residents up and about and interacting with other people.

Attentive care can help to avoid some sleep disturbances. Dr. Sharma recommends that if residents are in medical restraints, including catheters and IVs, that they be taken out of those restraints as soon as possible. If residents wear glasses or hearing aids, getting them to use those devices routinely can help to prevent confusion.

Getting family involved can also be very important. Family members who come by once a week or every few weeks to visit with residents can talk, play cards, and stimulate residents’ minds and brains. Having family stay overnight, while limited by the pandemic, can be particularly valuable. If residents are getting easily confused, family members who stay with them overnight can help to reorient them.

The design of a facility also plays a role in preventing sleep disturbances.  Residents who easily become confused will benefit from a room that’s not too far from a main receptionist or nursing area, which allows them to reorient themselves. Ensuring that rooms have windows that aren’t obscured by another building can help to promote healthy sleep habits. And, as much as possible, ensuring that machines aren’t beeping or making noise all night long can create an environment that’s more conducive to sleep.

Addressing sleep disturbances in long-term care settings can be a challenging process, but it can pay off with improved patient health and overall wellbeing. Many of these steps can be preventative measures, hopefully keeping residents from ever having to face some of these sleep challenges.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.