If you or one of your loved ones has ever been admitted to hospital, one of the complaints you have heard the most about is how difficult it is to sleep in the hospital. There are many things about hospital routines that can make it difficult for patients to sleep, in addition to noise and illness. Although some hospitals have taken measures to ensure that patients are not unnecessarily interrupted at night, this is not universal. Here are some things you can expect and some steps you can take to help the hospital give you a better night’s sleep.
Some reasons why you may be woken at night may be unavoidable
You may be using a certain drug, such as certain antibiotics, that should be given in the middle of the night, depending on when the first dose was given, and blood tests for levels of some antibiotics should be matched to their dosage, resulting in blood also dropping in the middle of the night. If you are admitted to check for a heart attack, you may also be ordered for timed blood tests where your blood can be taken in the middle of the night. Vital symptoms, such as pulse and blood pressure, must be taken every four hours for some conditions that would also wake you.
One study shows that the most important thing to keep patients awake is pain, followed by vital signs and tests, noise and medication. Studies have also shown that hospital routines can disrupt the patient’s sleep, and having a designated quiet time, minimizing non-essential tasks and reducing lights and noise. Here is a partial list of things that keep patients awake and what you can possibly do about them.
Pain. Pain is easier to control before it gets worse. Do not hesitate to ask for painkillers before bedtime, even if your pain is not yet severe.
You wake up to have your blood pressure lowered. Vital symptoms are usually taken every eight hours. Often these are done between 11 p.m. and midnight, after the night shift starts, but it is often just after you fall. Alternatively, the night shift can take your vital functions at 6 o’clock in the morning, when you are nevertheless woken up for other hospital routines. If you are given the opportunity to provide feedback during or after your stay, it is important to mention this – hospital administrators look carefully at patient feedback.
The IV pump that keeps beeping. This is usually because the flow of IV fluid is blocked (sealed), usually because the IV is inserted into the elbow bend. So every time you bend your arm, the pump gives an alarm and starts beeping. If this is the case, ask to place the IV in a different location, such as your hand.
You are woken up to receive medication. Sometimes a medication or respiratory treatment can be ordered “every four hours” or “every six hours”, which means that the nurse or respiratory therapist must wake you up to give it to you even while you sleep. You can ask if the order can be changed four times a day instead of every six hours, or “every four hours while you are awake”, so you don’t have to wake up.
Noise. Many things can be noisy at night in the hospital – voices from staff, cleaning machines, your roommate if you have one. You can always ask to close your door and you can ask someone to bring earplugs.
You are peeing up all night. If this is not the case when you are at home, you may have ordered a diuretic to be given late in the day, after about 6 p.m. or so, or you will be ordered for IV fluids at a higher speed then you actually need that. 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 this during sleep hours, as the nurse must check your vital signs regularly and keep you awake for hours. If you need a transfusion at that time, ask if it could possibly wait until daytime.
Frequent nocturnal disturbances can often cause patients to nap during the day and follow their sleep schedules. Patients may already be weak and tired from their underlying disease. When you are in the hospital, it is important to keep your normal sleep schedule and circadian rhythm. Keep the day hues open during the day for natural light and keep the room dark during sleep hours. An eye mask can be useful if exposure to light at night is inevitable. A favorite blanket, pillow, photos and your favorite music can help you to be relaxed and more comfortable.
My colleagues and I at the Somerville Hospital (since closed for inpatients) discovered that when we set up a program to reduce disturbances during the night, such as deliberately avoiding all of the things described above, patients are about half as often in the hospital as used sedatives. Most hospitals can do better to make routines more friendly to patients at night, but institutional change can be a challenge. Knowing what to ask for is useful and helps healthcare advance.