Sleep is essential when you’re fighting a disease or recovering from illness, surgery or physical trauma. That’s because it plays an important role in immunity, as well as other physiological and mental components of the healing process. Shoddy, insufficient sleep leaves you more vulnerable to infection, more sensitive to pain and generally less able to function in a stressful environment.
The irony is that it’s notoriously hard to sleep in the hospital, the place we go specifically for medical treatment and convalescence.
“There are noises we are not used to hearing — alarms and beeps from monitors and IVs,” says Barbara Bishop, a nurse practitioner with Virginia Beach Neurology. “Lights are always on in the hallway and sometimes in your room, and the healthcare staff is constantly checking your vital signs, doing exams and giving you medications. The beds can also be uncomfortable.”
Of course, illness itself, pain, side effects of medication and anxiety can also disrupt sleep. To add insult to injury, you might be paired with a roommate who keeps you awake. But experts and experienced patients alike say there are small things you can do to help yourself (or another patient in your life) get shuteye in the hospital.
Noisy nurses, sleepless nights
A Yale University study of critically ill patients suggested that healthcare workers might be part of the problem — less-experienced nurses and doctors in particular may deliver nonessential care during the night rather than allow patients uninterrupted slumber. They also might not realize how important sleep is for recovery or have a strong handle on how to promote sleep in the hospital setting. And they can be noisy: An Australian study found that disruptive noise on hospital wards mostly came from nursing stations, and that nurses were either unaware of the amount of noise they were making or underestimated how strongly patients responded to the volume of their voices. Hospital practices, such as scheduling inpatient imaging studies at night so outpatients can undergo tests during the day, and delaying the transfer of patients from the emergency department to a hospital ward, also led to sleep deficits.
You can ask the staff to help you sleep better by requesting that they not check vital signs or perform blood draws during sleep hours unless absolutely necessary.
The same Australian study reported that patients in the hospital slept 1.8 hours less than they did at home, and that 42 percent reported sleeping poorly or very poorly. Nurses perceived patients to be sleeping better than patients said they were. Other research has found that patients in the intensive care unit wake up multiple times each hour (sometimes more than six) and spend most of their time dozing in light stages of sleep, which are less restorative than deep sleep. In turn, these sleep patterns can lead to prolonged illness and longer stays in the ICU. Finally, more than half of total sleep time in the hospital occurs during the day. Forcibly adopting an off-kilter sleep schedule can throw off a patient’s circadian rhythms (the body’s internal clock) and lead to sleep disturbances that persist long after someone is discharged from the ICU.
“Sleep deprivation and fragmentation [interrupted sleep] are associated with defects in immunity, spikes in heart rate and blood pressure, delirium and increased anxiety and depression,” according to Budhiraja Rohit, director of the Sleep Medicine Clinic at Brigham and Women’s Hospital in Boston. Lack of sleep and poor sleep can also raise levels of the “stress hormone” cortisol.
What you can do
Writer and editor Josie Rubio, a frequent patient at Memorial Sloan Kettering Cancer Center in New York City over the past year, blogs about her hospital experiences at A Pain in the Neck. Since being diagnosed with Hodgkin’s lymphoma in 2013, Rubio, now 41, has accrued more than three months of overnight hospital stays for various procedures, tests and attempts to stabilize her health. In the process, she’s become an expert at getting rest in hospital beds. For one, she notes that “hospital activity tends to be greatest in the morning, at around 6 or 7 a.m., so I tried to go to sleep on the early side. That way, I could shower and order breakfast by the time the doctors made their rounds at 9 or 10 a.m.”
Rubio also suggests:
- BYOB — bring your own blanket. Hospitals are cold and the thin blankets they provide, though warmed, don’t retain much heat. “I brought a comfortable fleece blanket for most of my stays,” she says.
- Adjust the bed to whatever position makes you most comfortable. “Don’t be afraid to use the button.”
- Dig into the welcome kit provided by the hospital. “At Sloan Kettering, the kit has an eye mask to keep out light and earplugs to help with sounds, like the beeping of monitors and hallway noise.”
- Bringing your own headphones so you can listen to podcasts or guided meditations to fall asleep. “Some of my roommates kept the TV on low as soothing background noise,” Rubio says. “I was fine with the murmur of the TV, but I’d check with a roommate first.”
- Get up and move around during the day, if possible. “The staff always tried to get me to walk around because it helps with healing, and they said it might tire me out a little bit so that I could sleep better,” says Rubio. You can also do stretching exercises in your bed or chair.
Bishop agrees with Rubio that bringing items from home can make a hospital stay less stressful. “Try to keep something comforting with you, like pictures of family members or a blanket or pillow from home,” she suggests. “You can also ask if a family member can stay with you at night.” If not, ask guests to leave by 8 p.m. so you can start to wind down and rest.
Rohit says that you can ask the staff to help you sleep better by requesting that they not check vital signs or perform blood draws during sleep hours unless absolutely necessary. He recommends asking that dinner be served three to four hours before your bedtime, and limiting caffeine intake, especially during the last few hours of the day.
Researchers have observed a phenomenon called the “first night effect,” in which the left hemisphere of the brain remains semi-active when people sleep in a new place.
Just like at home, Rohit says good sleep hygiene is essential to getting the rest you need. That means minimizing your use of devices close to bedtime, so the blue light emitted by their screens doesn’t suppress the production of melatonin, the hormone that helps you fall and stay asleep. You should also dim the lights in your room at least two hours before you want to fall asleep. Try doing some deep breathing or other relaxation exercises, meditating or listening to soothing music or white noise like the sound of ocean waves to ease you into sleep (through headphones if you have a roommate). And talk to your healthcare provider about sleep medication if you feel you need it.
Even without bright lights, beeping machines and nighttime vital checks, it might be hard to log a full night’s sleep in the hospital at first, solely because it’s a foreign environment. Researchers have observed a phenomenon called the “first night effect,” in which the left hemisphere of the brain remains semi-active when people sleep in a new place. This “unihemispheric sleep” is thought to serve an evolutionary purpose, keeping us vigilant enough during sleep to respond to unknown threats. But it appears to be a temporary phenomenon, lasting as little as one night. So, if you’re moving into the hospital for more than a night or two, give your brain a chance to acclimate.
What hospitals are doing
Efforts are underway at some hospitals to educate staff and implement “quiet time” strategies to improve sleep. The main goal of these is to shield sick patients from excessive noise, light and unnecessary nursing interventions at night. A study of this practice in a neurological ICU found that it led to lower levels of noise and light, as well as an increase in the number of patients observed to be asleep.
Still, change occurs slowly in the medical field, and despite reams of research showing that sleep deprivation is harmful for hospitalized patients, “sleep in the hospital remains elusive and is a difficult issue for hospitals to address,” says Bishop. That means it’s up to you to create the best environment you can for yourself. Your top priority should be to get the sleep you need to recover.