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Nursing home residents often sleep poorly. American researchers recently reviewed all the previous studies that investigated methods to improve sleep in nursing homes.
People who live in nursing homes and other long-term care facilities often sleep poorly. Poor sleep is associated with many problems, including cognitive decline, heart disease, and a generally impaired quality of life. Sedative drugs, such as sleeping pills, can help sleep. However, they are associated with an increased risk of falls and fractures in the elderly. It is therefore important to find ways to improve sleep that don’t rely on sleeping pills.
Many factors lead to poor sleep in nursing home residents. These include old age, the onset of dementia, chronic illness and the side-effects of prescription drugs. The living environment in nursing homes can also contribute to poor sleep at night. For example, a non-stimulating daytime environment could cause residents to take frequent daytime naps, which makes a good nighttime sleep more difficult. Light and noise in the facility, or nightly staff routines, could also interrupt sleep at night.
Several studies have tested different methods to solve these problems. These include changing the nursing home environment, using different types of traditional medicine, and increasing social simulation. Unfortunately, the results from these studies have been inconsistent. A group of American researchers have systematically reviewed all of these previous studies, hoping to find patterns that could guide the way to methods to improve sleep in nursing homes and other long-term care facilities. Their results were recently published in the journal BMC Geriatrics.
Increasing exposure to light during the daytime
Daytime light exposure can help recalibrate the body’s internal clock, potentially improving sleep at night. The researchers found 13 studies that tried exposing long-term care facility residents to either natural or artificial lights during the daytime. Eight of these studies found that increased light exposure improved sleep by at least some measures. However, five studies found that daytime light exposure did not improve sleep at all. The studies all used different light strengths and exposure times, but there didn’t appear to be a relationship between these factors and whether or not daytime light exposure improved sleep.
Eight studies also included increased light, along with several other interventions. Most of these combinations of interventions did not improve sleep.
Complementary health practices
Complementary health practices, including alternative or traditional medicine, are becoming more popular. The researchers found 12 studies using different complementary health practices. The most promising results were for acupressure, an alternative to acupuncture that does not use needles. All four studies that investigated acupressure found that it clearly improved sleep in residents of long-term care facilities. Three of these studies were well-designed randomized controlled trials. The researchers therefore considered these results to be highly reliable.
A number of other complementary approaches yielded mixed results. These included massage, aromatherapy and melatonin treatment. On the other hand, transcutaneous electrical nerve stimulation and therapeutic touch both improved sleep. Unfortunately, these were both tested in very small studies with fewer than 15 participants, meaning that the results are not as reliable.
Social and physical activities
Carrying out social or physical activities during the daytime could potentially improve sleep during the night. Eleven studies tested this approach using a variety of methods. The majority of these studies found that these methods improved sleep, by at least some measures.
Mind-body Practices: Relaxation and Cognitive Behavioral Therapy
Mind-body practices, such as meditation, are another approach that could lead to improved sleep. Three studies tested these types of practices, trying progressive muscle relaxation, a low-intensity form of meditative yoga, and cognitive behavioral therapy. All three methods resulted in improved sleep. The researchers writing this report considered all of these to be well-conducted studies, with trust-worthy results.
Changes to clinical care practices
Simple changes to how the institute staff care for their residents could potentially improve sleep. For example, in one long-term care facility staff would normally follow a regular nightly schedule to turn and change residents. This would wake up any patients who were asleep at their scheduled time. When the staff instead waited for patients to wake before caring for them, their nightly sleep was improved. Unfortunately, this study was not considered to be high quality.
Other studies tried changing other care practices, such as providing evening foot baths or introducing more individualized care. These did not lead to any clear improvements to sleep.
Few methods consistently improved sleep
Overall, the researchers found that they couldn’t firmly point to any one intervention that clearly improved sleep. This was partly because few studies tested the exact same methods. For example, many social or physical activities effectively improved sleep, but others did not. It is not clear which method would actually be consistently reliable. Also, their results didn’t support several methods that other researchers consider to be useful. For example, melatonin is generally considered to be a safe and effective way to improve sleep in older adults. However, it did not stand out as an effective approach in the studies they reviewed.
The most consistently helpful intervention was acupressure. However, the researchers point out that daily acupressure sessions may be impractical in a typical long-term care facility. They had similar concerns for many of the other interventions, finding that many of them required specialized staff or equipment. They were also disappointed that so few studies investigated changing normal clinical care practices, such as the staff’s nighttime routines. They wondered if this was due to the reluctance of care facilities to change their normal procedures. There are also many other potential approaches that have not been investigated, such as setting cooler nighttime temperatures to improve sleep.
Despite these worries, several studies yielded promising results that deserve a follow-up. The researchers call for more emphasis on the standardization of research procedures. It is also important to focus on the practical use of these methods in routine care environments.
Written by Bryan Hughes, PhD
Reference: Capezuti, E., Sagha Zadeh, R., Pain, K., Basara, A., Jiang, N. Z. & Krieger, A. C. A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings. BMC Geriatrics 18, 143 (2018) https://doi.org/10.1186/s12877-018-0794-3.