An evaluation of sleep disturbance on in-patient psychiatric units in the UK

Abstract

Aims and methodSleep disturbance is common on in-patient psychiatry wards. This study explored subjective and objective patterns of sleep disturbance and contributory environmental factors. Participants were recruited from mental health acute admission wards and had a range of subjective and objective assessments of sleep. Light intensity and noise levels were measured to characterise potential environmental causes for poor sleep.ResultsWe recruited 20 patients; 15% were high risk for obstructive sleep apnoea. Nineteen participants reported poor sleep quality on the Pittsburgh Sleep Quality Index, and 90% had significant sleep fragmentation with objective measures. Inside light levels were low (day <200 lux and night <10 lux). Night sound levels were 40–90 db.Clinical implicationsSleep disturbance was highly prevalent. Increased awareness of sleep disorders is needed. Modifiable environmental factors on the ward were implicated, therefore increased awareness and a change of approach to sleep disturbance in in-patient psychiatry is recommended.Declaration of interestNone.

Against the stream: intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation

“…Surveys of psychiatric in-patients find that the large majority experience insomnia because of the noise and light on the ward and from nursing observations 4 , 5 . There is a bidirectional relationship so that insomnia is not just a symptom of psychiatric disorder – intermittent sleep deprivation makes most psychiatric disorders worse 6 .…”

Minds and Brains, Sleep and Psychiatry

“…The oxygen dependence of the brain–mind is further testimony to the physical basis of waking, sleeping, and dreaming. Fortunately, sleep apnea can be treated by the application of positive airway pressure and when nocturnal brain–mind anoxia is reduced, normal waking cognition is typically restored ( 196 ).…”

Feasibility and utility of enhanced sleep management on in-patient psychiatry wards

“… 1 Previous work from our acute in-patient, psychiatry wards demonstrated high levels of objective sleep disturbance and suggested that a number of environmental factors within the ward, including noise levels at night and hourly observations, were disruptive and therefore paradoxically may be worsening mental health and delaying recovery. 4 Measures to stabilise sleep by using a high-intensity, modified version of CBTi has been shown to be possible and highly effective in acute psychiatry in-patients, 6 although it was carried out maintaining overnight hourly observations.…”

“…Noise, light and regular, typically hourly, overnight observations disturb patients independent of the psychiatric diagnosis. 4 Primary sleep disorders, including obstructive sleep apnoea and restless legs syndrome, are increased in psychiatry patients and also disturb sleep. 5 For a subgroup of patients, insomnia-specific cognitive–behavioural therapy can be effective within an acute psychiatry ward.…”