A nurse began her morning like any other day, walking from one resident room to the next, checking vital signs, passing meds, and chatting with residents and staff. When she entered Thelma’s room and asked, “How did you sleep last night?” she suddenly realized just how important that one question is. She learned Thelma had knee pain and was unable to sleep. From Bob, she learned how noisy the staff had been during the night, waking him several times, and Barbara said she had slept well all night for the first time in two weeks.
Assessing for sleep deprivation is as important as taking residents’ vital signs. All long-term care staff should understand the importance of sleep and how it impacts the health and wellness of residents. Here are 7 facts about residents and sleep.
1. Assessing sleep reveals essential data about a resident’s health. From that one simple question, the nurse learned that Thelma had pain needing treatment that new staff needed education on the importance of sleep, and that Barbara’s new medication was working and reducing her pain. Asking about nighttime sleep is as important to quality care as taking vital signs. Sleep is essential to good health and critical for improved quality outcomes in nursing home residents.
2. Contrary to popular belief, sleep problems are not a normal part of aging. Nursing home residents need an average of 8 hours of sleep per night. Daytime napping of more than 30 minutes per day can interfere with nighttime sleep, so, as a resident’s clinical status allows, encourage him or her to avoid longer naps to improve nighttime sleep. Uninterrupted sleep during the night is crucial for health and healing.
3. The body regenerates itself during sleep. During the night, the body cycles through five stages of sleep, each important but Stages 4 and 5 are vital. During Stage 4, known as pre-REM sleep, the body recharges itself physically, much like a rechargeable battery. Stage 5 sleep, known as REM, allows the brain to recharge by reconciling the stress and the emotions of the day, cementing memories, and achieving psychological homeostasis.
4. Education on sleep is an essential first step in improving sleep. Many staff are not aware of the importance of sleep and believe that sleep deprivation is a common problem of aging. They may believe that resident napping during the day is adequate for quality sleep, but this actually interferes with nighttime sleep and inhibits a person from cycling through all five stages of sleep.
5. Promoting quality sleep during the night is essential for health and healing. Sleep assessment should be a priority nursing intervention. Sleep-deprived residents can exhibit symptoms such as decline in ADLs, increased confusion, behaviors, falls, depression, and anxiety. Research suggests that quality nighttime sleep reduces sundowning for residents with dementia.
6. Sleep deprivation in nursing home residents is a multifaceted problem that is not easily resolved. Barriers to quality sleep include environmental noise such as alarms, conversations, shutting doors, and call lights. Shift change is often a time when sleeping residents are awakened by noise. Pain can be another barrier to sleep. Pain is often unreported and undertreated in long-term care. Turning, repositioning, and toileting can also interfere with resident sleep. The latest research on sleep is causing providers to rethink traditional practices in the nursing home setting.
7. Sleep deprivation in nursing home elders is a problem not just for nurses but for the whole interdisciplinary team. Interventions to improve nighttime sleep include:
- Reducing napping in the day
- Increasing physical activity
- Increasing exposure to bright sunlight in the morning and late afternoon
- Limiting fluids before bedtime
- Using snooze foods as bedtime snacks
- Reviewing medications for diuretic and sleep-altering effects.
Once staff understand how important sleep is to residents, their first question of the day will be, “How did you sleep last night?”
Want to know if you are getting enough sleep? Take the Epworth Sleepiness Scale and find out.
Linda is a nursing consultant and Director of Education for Volunteers of America and has worked in long term care for 25 years. She serves as adjunct faculty at Bethel University and is completing her Doctorate at the University of Minnesota.
Reviewed June 1, 2017