Page 17 - From Good Sleep to Wellness

Promoting Adequate Sleep for Residents

Repositioning and providing incontinence care every two hours during the night has been a standard of practice in many nursing facilities. Beginning in the early 1990’s researchers at the Borun Center for
Gerontological Research, UCLA School of Medicine began studying this practice.
Over the past 15-20 years there have been numerous studies evaluating these practices. Most residents in nursing homes experience sleep deprivation. Sleep deprivation has been associated with compromised mental and physical health. As elders age sleep patterns change. Elders wake up more frequently during the night and do not sleep as deeply as they did at an earlier age. Many find themselves being sleepy earlier in the evening and waking up earlier in the morning.
The following practices by night staff have been found to adversely affect resident sleep:
• Entering the resident’s bedroom while the resident is sleeping to distribute linen, replace supplies and medications;
• Leaving lights on high in hallways, cleaning floors, and moving equipment in hallway; and
• Performance of laboratory tests and administering medications early in the morning.
Changing the above practices improved the sleeping patterns of many residents.
Several studies evaluated how often elders changed their position during the night. One study found that sixty six percent of residents had at least one large movement at the shoulder and hip per hour during periods of sleep (1).
With the development of night time incontinence products that wick urine away the resident’s skin it was found that changing the resident every 2 hours was no longer necessary for selected residents.
In the Pressure Ulcer Prevention & Treatment: Clinical practice Guideline published by the National Pressure Ulcer Advisory Panel & European Pressure Ulcer Advisory Panel (NPUAP) referenced in the MDS 3.0 manual there are recommendations for repositioning. On page M-4 of the RAI Version 3.0 Manual is the statement that “nursing homes may adopt the NPUAP guidelines for their clinical practice and nursing documentation. The NPUAP recommends that repositioning frequency will be determined by the individual’s tissue tolerance, level of activity and mobility, medical condition, the overall treatment objectives, and assessments of the individual’s skin condition. (NPUAP Page 33).
In the Household Matters Toolkit there is a procedure in the Quality of Life section, Promoting Adequate
Sleep. The following information should be collected to develop a plan for adequate sleep for a resident:
a. Usual time to arise in the morning;
b. Nap pattern including time, length and preferred location;
c. Usual bedtime;
d. Bedtime rituals;
e. Prefers bedroom door closed or open;
f. Use of night light; and
g. Toileting pattern during the night.
h. Repositioning needs.