Residents can experience sleep problems in nursing homes. You may wonder how your loved one’s sleep will be affected if they are currently in a nursing facility. A study published in the International Journal of Older People Nursing found that sleep problems are more common in nursing home residents than they are in community-dwelling patients.
In this article, Ill discuss how sleep is affected in seniors, specifically those in nursing homes. Ill also offer some guidance from healthcare experts on how to counteract a few of the negative sleep impacts seniors in nursing homes face.
Before we begin, I want to make it clear that I am not a physician and that serious sleep problems should be evaluated and treated by a doctor. I do, however, hope that the information in this article will help you find solutions to any sleep problems your loved one may experience in a nursing home.
Seniors And Sleep
As we age, the way we sleep changes. An Acta Paulista de Enfermagem study from Brazil in 2012 revealed that the aging process can negatively impact a person’s sleep and make it more likely for seniors to have poor sleep. This is especially true in regards to seniors in nursing homes.
To help me determine the definition of poor sleep in older adults, a 2011 study from the Handbook of Clinical Neurology surveyed sleep patterns of older adults. These points were especially useful in the study:
- A person who sleeps less than seven hours a night is considered to be poor. This is in order for them to function as well as they can.
- Patients with dementia generally have disturbed sleep.
However, Dr. Christina Pierpaoli Parker, Ph.D., a postdoctoral fellow of adult and geriatric behavioral sleep medicine at the University of Alabama at Birmingham, cautions that, total sleep need varies within and across people. While the recommended daily dose of sleep for people 65+ falls between 7-8 hours, some people may require more or less. This recommendation is a guideline and not a prescription. Individuals sleep time needs vary considerably.
Poor sleep is defined beyond the objective indicators of total sleep time, sleep duration, sleep onset, number awakes, etc. and must include subjective measures of psychological distress, (un)wellness and impairment, such as mood, cognition, as well as daytime fatigue and functioning.
Many seniors will experience sleep problems as they age. However, senior citizens who live in nursing homes may have additional obstacles to good sleep.
Sleeping In A Nursing Home
She noted that food and activities are often offered on a limited schedule. This means that seniors have to adhere to a different sleeping schedule than they used to. This can lead to fatigue and insomnia. Dr. Parker also noted that a restricted schedule could lead to a schedule that is not in line with residents‘ chronotypes, or their propensity for sleeping at a specific time within a 24-hour period.
Imposing a bedtime or attempting to initiate sleep among residents who may not feel sleepy increases their odds of spending time awake in bed, Dr. Parker explained. Over time, staying awake in bed attempting to fall or stay asleep can transform the bed into a cue for wakefulness rather than for sleep among residents, thereby perpetuating insomnia symptoms.
In addition, each patient will have their own care times (medication, bathing, etc. This can impact their sleep schedules. A 2011 Ageing and Society paper interviewed 38 residents from 6 different nursing homes. It found that residents had little control over the times they were allowed to sleep at the facility. The paper also asserted that the shifts of staff influenced residents bedtimes. This can be solved by talking to your loved ones at their nursing home. We will discuss this later.
- Alarms
- Equipment noise
- Potential interruption from roommates, since many nursing home rooms are shared
- Caregivers taking vital signs of dispensing medications throughout the night
- Uncomfortable beds
Tips For Improving Sleep In Nursing Homes
Though nursing home residents face several obstacles when it comes to their sleep, there are ways to mitigate these issues. I received the following tips after speaking with multiple health experts:
Increase Exercise During The Day.
Ben Tanner, PA of FastingWell.com recommends residents exercise daily, being sure to do so at least two to three hours before bedtime. Sleep pressure, or the bodys hunger for sleep, accumulates with increasing time spent awake and dissipates with the opportunities to sleep. Vigorous, moderate, or even mild daytime energy expenditure in the form of walking, swimming, gardening, or even bowling can stimulate something called adenosine, which builds sleep pressure.
Daytime energy expenditure means more sleep pressure and, usually, better, deeper sleep.
- Jocelyn Nadua is a Registered Practical Nurse and Care Coordinator at C-Care Health Services. She suggests that you exercise for 30-40 minutes, particularly aerobic, to help release sleep-promoting chemicals. You can find a variety of exercises that may be suitable for your loved one.dance, swim and water exercises, golf, running, cycling, and lawn bowling are all beneficial, but consult your physician before trying a new fitness program.
- Dr. Parker explains that residents should choose activities they enjoy and are able to do. Otherwise, they may become disengaged and miss out on the sleep and physical benefits. She says, Movement can and should take many forms – such as walking, tai chi, or chair yoga (all of which can yield cognitive, physical, and psychological benefits).
Participate In Enjoyable Events.
Engaging in pleasant events or scheduled pleasurable activities such as crafting, reading, or listening to music may also improve sleep quality via reduced depressive symptoms. Identifying and tailoring meaningful pleasant activities to the resident can maximize sleep and related psychiatric and physical health outcomes.
Maximize The Light Exposure During Daylight Hours, But Decrease It At Night.
External and endogenous cues known as zeitgebers, a German word meaning time givers, work to synchronize our biological clock. Light promotes awakening, while darkness promotes sleep in humans. The production of melatonin (a primary drowsiness-promoting hormonal hormone) is stimulated by darkness, while it is disrupted by light. Our biological rhythms are controlled by light signals from the eyes to the brain. While sunlight plays an important role, light emitted by artificial sources (e.g. smartphones, computers) can also impact our circadian system.
- Exposing residents to natural sunlight upon waking and throughout the day (which cues the body into wakefulness) andreducing face time with light and light-emitting devices 1-2 hours before bed (which cues the body into sleep) can optimize sleep for nursing home residents.
- Jennifer Geren, Ph.D.
, a Clinical Geropsychologist and Neuropsychologist at Executive Mental Health, suggests that using eye masks can help with any disturbing lights at night.
Nighttime Sounds Should Be Reduced
To keep sounds down to a minimum, Dr. Geren suggests using sound machines, earplugs, or headphones (both for the resident and their roommate).
Keep The Temperature At A Comfortable Level.
Dr. Parker explained the importance of setting and maintaining a residents ideal room temperature to help them sleep more comfortably throughout the night.Like light, core body temperature also works to synchronize our circadian rhythm, commonly known as our internal clock. A nocturnal decline in core body temperature by 2-16 C helps to initiate and maintain sleep. Cooling down helps the body to sleep faster, or to get to sleep quicker.
- Residents should be kept in darkened rooms and kept cool. This is usually between62 70FThis can be done (though it is still being debated).
- Some emerging evidence also suggests that passive body heating via a bath or shower 60 to 120 minutes before bed can hasten sleep onset because it reduces core body temperature, a thermoregulatory process necessary for sleep. While it may sound counterintuitive, passive body heating elicits heat out from the bodys core to the surface, thereby naturally cooling the body. Residents may find it beneficial to incorporate passive body heating into their bedtime routine, if possible.
Purchase A Brand New Mattress.
Consider buying a mattress for your loved one. As Ms. Clark points out, nursing home beds that are adjustable leave much to be desired in terms of comfort. When you purchase a mattress, make sure it is compatible with an adjustable base.
Be sure to check with your loved ones nursing home to see if they allow you to bring in a new bed or mattress.
Reduce Excessive Daytime Napping.
Increased time spent awake among residents means more accumulated sleep pressure to fall asleep. Residents will fall asleep faster if they are able to stay awake longer. Excessive daytime napping can reduce the build-up of sleepiness in older adults.
- If you can,eliminating daytime naps or keeping them brief (i.e. 15-30 minutes and are consistent (i.e. around the same time daily) can prevent withdrawals from this bank account of sleep pressure.
Encourage Residents To Only Go To Bed When Sleepy.
Encourage residents to go to bed only when they feel tired. Fatigue is a condition where there is a lack of physical or mental energy. Sleepiness refers to the inability or struggle to remain awake. As noted earlier, going to bed when sleepy (vs. fatigued) increases the chances of falling asleep quickly and of spending less time awake in the bed, which can prevent conditioned arousal that perpetuates insomnia. Learning to differentiate between fatigue and sleepiness can promote residents sleep health.
- Residents should use their beds only for sleeping and sex, not to watch television, read, scroll through their phones, or browse other devices.
- Residents who have difficulty falling asleep or getting back to sleep after a period of 15-30 minutes should get up and move., into another room, do something relaxing, and return to bed only when they feel sleepy again. Planning ahead and making the relaxing activity pleasant can help. Relaxing, reading, sketching, and listening to soft music are some options.
Make A Bedtime Routine.
Both Mr. Tanner and Nurse Nadua recommend that residents have a consistent bedtime ritual. This means that they prepare for bed at a specific time and turn off the lights to go to sleep at a particular time. This bedtime ritual can include reducing face time with sleep-disrupting, blue light-emitting devices such as smart phones 1-2 hours before bed, taking a warm bath or shower, as well as reading or relaxing outside the bedroom.
Keep A Consistent Sleep-wake Schedule.
Contrary to popular belief, residents should have a fixed daily wake-up time. Waking up at the same time daily increases the likelihood of falling asleep around the same time because humans operate on a roughly 24-hour circadian rhythm.
- To promote daily wake times among residents,Consider working with them to place an alarm clock within reach, but not too far.So if it sounds, the resident must work to turn it off. It is possible to work with the care staff.
Increase Comfort Using Familiar And Breathable Items.
When our core body temperature drops at night, the heat gets transferred/distributed to neighboring areas and residents nightwear, sheets, and mattress absorb and trap it. Combined with keeping the bedroom dark and cool, light, breathable, and cooling sheets and pillows may aid the thermoregulation the body needs to initiate and maintain sleep.
- Dr. Geren suggests that residents bring in pillows, sheets, and blankets from their home. If it is going into the laundry facility, make sure they are named on them. Pajamas made from home can make residents feel more comfortable, she said.
Talk To Your Doctor.
Ms. Clark suggests that you talk to the ordering doctor to modify any medication schedules that might be in place throughout the night. She also recommends that caregivers work with the ordering physicians to change the schedule, if that is possible.
Many medication orders are issued in hospitals and may not be needed once the person is transferred to a nursing facility.
Talk To Staff.
Dr. Celan recommends staff be consulted if problems persist or other problems arise. As mentioned in the Ageing and Society study above, certain problems can arise with shift and staffing issues. In such cases, you might want to talk to staff to find a solution.
- Ms. Clark suggests speaking to staff if the roommate pairings are not working out. This way, if one resident is a morning person they can be paired up with someone who prefers to stay awake late.
Last Word From Sleepopolis
We understand that all nursing homes are different, as are their residents, meaning sleep issues can vary from person to person. We want to point out that not all the tips above may apply to your loved one. Consult your loved one and their attending providers for their needs, preferences, and recommendations.
