2. 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 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 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

3. 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

4. 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

5. 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.

6. 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.

7. 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