Implement Sleep Hygiene Measures Maintain usual bedtime Schedule activities to provide uninterrupted periods of sleep for at least 2-3 hours at night Balance daytime activity and rest Avoid naps or limit to 10-15 minutes in duration Promote social interaction Support bedtime routines Offer bedtime snack or beverage Enable bedtime reading or music Assist with personal hygiene at bedtime Encourage prayer or meditation The first line of defense against excessive sleepiness is a lifestyle that promotes and ensures adequate sleep and rest. Although there is a natural drive to sleep, environment and habituation play an important role. In the hospital, implementation of sleep hygiene measures can be challenging, however, healthcare professionals need to be knowledgeable and skilled in adapting the hospital environment and providing geriatric sensitive care in order to promote sleep. Many interventions using a common sense application of principles published in the field are included in this presentation. A nonpharmacologic sleep protocol may be particularly helpful when caring for patients at risk of delirium, thereby minimizing the need for psychoactive medication. Maintain usual bedtime by scheduling activities to provide uninterrupted periods of sleep for at least 2-3 hours during the night Balance daytime activity and rest, encourage ambulation, get out of bed for meals if appropriate, and involve patient in ADLs to the degree possible Avoid naps or limit daytime naps to 10-15 minutes in duration, and Promote social interaction Support bedtime routines by: Offering bedtime snacks or beverages according to the patient’s preference Enable bedtime reading or music Assist with personal hygiene at bedtime, and Encourage prayer or meditation

Implement Sleep Hygiene Measures Minimize or avoid foods that disturb sleep Discourage use of beverages containing stimulants in afternoon and evening Encourage use of warm milk or herbal tea Create environment for sleep Keep noise to a minimum Set room temperature to patient preference Offer warmed blanket Use night light as needed Provide soft music or white noise to mask hospital activity Minimize and avoid foods that negatively impact sleep by discouraging the use of beverages containing stimulants in the afternoon and evening hours and encouraging the use of warm milk or herbal teas. Healthcare workers can create an environment that promotes sleep by: Keeping noise to minimum Setting room temperature to the patient’s preference Offering a warmed blanket Using sufficient lighting at night for clear visualization, and Providing soft music or white noise to mask hospital activity

Implement Sleep Hygiene Measures Promote physiologic stability and comfort Elevate head of bed as required Provide extra pillows per preference Administer pain meds as needed 30 minutes before bedtime Massage back or feet for relaxation Apply warm/cool compresses to painful areas as indicated Assist with progressive relaxation or guided imagery Encourage urination before going to bed Keep bathroom path clear or provide bedside commode and assistance with toileting as needed Healthcare workers can also implement sleep hygiene measures by promoting physiologic stability and comfort. This can be done by: Elevating head of bed as required Providing extra pillows per patient preference Administering pain medications as needed 30 minutes before bedtime Massaging the back or feet to promote relaxation Applying warm or cool compresses to painful areas as indicated Assisting with progressive relaxation or guided imagery Encouraging the patient to urinate before going to bed, and Keeping the bathroom path clear or providing a bedside commode and assistance with toileting as needed

Incorporate Treatment Individualized care plan strategies include: Management of medical conditions, psychological disorders, and symptoms Review and if necessary, adjustment of medications that affect sleep  Management of patients with OSA when sedatives or anesthesia are given Healthcare workers can incorporate treatment for sleep disorders into individualized care plans by managing medical conditions, psychological disorders and symptoms, reviewing and if necessary, adjusting medications that affect sleep, and managing patients with OSA when sedatives or anesthesia are given.

Promote Communication Ensure ongoing communication among all team members Document assessment, treatment plan, and response to treatment Teach older patients and their families how to use sleep hygiene measures and incorporate behavioral strategies Promote communication by ensuring ongoing communication among all team members to coordinate the patient’s care; documenting evidence of sleep assessment, sleep hygiene measures, treatment for identified sleep disorders, and response to treatment. For patients using CPAP therapy, all treatments and responses should be documented; and teaching older adults and their families how to use sleep hygiene measures and incorporate behavioral strategies in order to promote sleep quality is essential. For patients utilizing CPAP, healthcare staff should deliver patient and family education concerning use, cleaning, and maintaining of positive airway pressure equipment and masks.

Putting It All Together Expected clinical competencies Accurate and comprehensive clinical assessment of sleep Prompt and effective management of sleep disturbances Incorporation of treatment for sleep disorders into individualized care plans Evaluation of treatment effectiveness Accurate documentation of assessment, treatment plan, and evaluation Communication with all members of care team Staff and family education The expected clinical competencies are: Accurate and comprehensive clinical assessment of sleep Prompt and effective management of sleep disturbances Incorporation of treatment for sleep disorders into individualized care plans Evaluation of treatment effectiveness Accurate documentation of assessment, treatment plan, and evaluation Communication with all members of care team, and Staff and family education