Getting sleep in the hospital

Senior patient lying on bed in hospital

If you or any of your loved ones has ever been hospitalized, one of the complaints you may have heard about most is how hard it is to sleep in the hospital. There are lots of things about hospital routines that can make things difficult for patients to sleep, besides noise and illness. While some hospitals have taken steps to ensure that patients are not interrupted unnecessarily at night, this is not universal. Here are some things you can expect, and some steps you might be able to take to help the hospital give you a better night’s rest.

Some reasons you might be woken at night might be unavoidable

You might be on a particular medication, such as certain antibiotics, that must be given in the middle of the night, depending on when the first dose was given, and blood tests for levels of some antibiotics must be timed to their dosing, resulting in blood draws in the middle of the night, too. If you are admitted to check for a heart attack, you might also be ordered for timed blood tests that might involve having your blood drawn in the middle of the night. Vital signs, such as pulse and blood pressure, are required to be taken every four hours for some conditions, which would also awaken you.

One study shows the top thing keeping patients awake is pain, followed by vital signs and tests, noise, and medications. Studies have also shown that hospital routines can disrupt patient sleep, and having a designated quiet time, where nonessential tasks are minimized and lights and noise are lowered, may help. Here is a partial list of things that keep patients awake, and what you might be able to do about them.

Pain. Pain is easier to control before it gets bad. Don’t hesitate to ask for pain medicine at bedtime, even if your pain is not yet severe.

You are woken up to have your blood pressure taken. Vital signs are usually taken every eight hours. Often these are done between 11 pm and midnight, after the night shift starts, but it’s often just after you have fallen sleep. Alternatively, the night shift could be taking your vital signs at 6 am, when you’d be awoken for other hospital routines anyway. If you are given the opportunity to give feedback during or after your stay, it would be important to mention this — hospital administrators look closely at patient feedback.

The IV pump that keeps beeping. This is usually because the flow of IV fluid is blocked (occluded), most often because the IV was inserted in the crook of your elbow. Thus, every time you bend your arm, the pump will alarm and start beeping. If this is the case, ask to have the IV put in a different place, like your hand.

You are woken to be given medications. Sometimes a medication or breathing treatment might be ordered “every four hours” or “every six hours” which means the nurse or respiratory therapist is required to wake you to give it to you even if you are asleep. You can ask if the order can be changed to four times a day instead of every six hours, or “every four hours while awake” so you don’t have to be woken.

Noise. Lots of things can be noisy in the hospital at night — staff voices, cleaning machines, your roommate if you have one. You can always ask to have your door closed, and you can ask someone to bring in ear plugs.

You are up all night urinating. If this is not the case when you are at home, it might be because you were ordered for a diuretic to be given late in the day, after 6 pm or so, or you are ordered for IV fluids at a rate that is higher than you actually require. Your nurse can ask the doctor to change these orders.

Blood transfusions at night. If you need a blood transfusion, it is best not to do it during sleeping hours, because it requires the nurse to monitor your vital signs frequently and would keep you awake for hours. If you need a transfusion at that hour, ask if it can possibly wait until daytime.

Frequent nighttime disruptions can often cause patients to want to nap during the day, and throw off their sleep schedules. Patients might already be weak and tired from their underlying illness. If you’re hospitalized, it’s important to keep your normal sleep schedule and circadian rhythm. During the day, keep the window shades open for natural light and keep the room dark during sleeping hours. An eye mask might be helpful if exposure to light at night is unavoidable. A favorite blanket, pillow, photos, and your favorite music can help you relax and be more comfortable.

My colleagues and I at Somerville Hospital (since closed to inpatients) found that when we instituted a program to decrease disruptions during the night, such as purposely avoiding all the things described above, patients used as-needed sedatives about half as often in the hospital. Most hospitals can do better to make nighttime routines friendlier for patients, but institutional change can be challenging. Knowing what to ask for is useful and will help move healthcare forward.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

 “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” – Philippians 4:6

 “Above all else, guard your heart, for everything you do flows from it.” – Proverbs 4:23

 “For God has not given us a spirit of fear, but of power and of love and of a sound mind.” – 2 Timothy 1:7

 “Consider it pure joy, my brothers and sisters,[a] whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.” – James 1:2-3

 “In all your ways acknowledge him, and he will make straight your paths.” – Proverbs 3:6

 “Commit your actions to the LORD, and your plans will succeed.”- Proverbs 16:3

 “Consider the ravens: They do not sow or reap, they have no storeroom or barn; yet God feeds them. And how much more valuable you are than birds!” Luke 12:24 – Luke 12:24

 “It’s not what goes into your mouth that defiles you; you are defiled by the words that come out of your mouth.” – Matthew 15:11

 “Make a tree good and its fruit will be good, or make a tree bad and its fruit will be bad, for a tree is recognized by its fruit.” – Matthew 12:33

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