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

Abstract

Aims and method Sleep disturbance is common in psychiatry wards despite poor sleep worsening mental health. Contributory factors include the ward environment, frequent nightly checks on patients and sleep disorders including sleep apnoea. We evaluated the safety and feasibility of a package of measures to improve sleep across a mental health trust, including removing hourly checks when safe, sleep disorder screening and improving the ward environment. Results During the pilot there were no serious adverse events; 50% of in-patients were able to have protected overnight sleep. Hypnotic issuing decreased, and feedback from patients and staff was positive. It was possible to offer cognitive–behavioural therapy for insomnia to selected patients. Clinical implications Many psychiatry wards perform standardised, overnight checks, which are one cause of sleep disruption. A protected sleep period was safe and well-tolerated alongside education about sleep disturbance and mental health. Future research should evaluate personalised care rather than blanket observation policies.

Cognitive behavioural therapy for insomnia in inpatient psychiatric care: a systematic review

“…This is complemented by other studies, showing that at least components of CBT-I are feasible in complex inpatient settings with acceptance of the programme by patients (Biancosino et al, 2006;Haynes et al, 2011;Laguna-Parras et al, 2013;Sheaves et al, 2018;Tan et al, 1987). Moreover, the selected studies show that CBT-I was implemented using existing resources of the team on the ward (de Niet et al, 2010;Laguna-Parras et al, 2013;Morin et al, 1990) supporting behavioural therapy, are essential (Hossny et al, 2019;Novak et al, 2020;Paterson et al, 2021). For instance, it might compromise treatment effects when some team members centre on prolonged periods of wakefulness in the evening to increase sleep pressure and the responsible physician prescribes highly sedating drugs.…”

“…Standard recommendations suggest times in bed of at least 5 h. Particular attention is needed for patients with bipolar disorder due to a potential shift into mania related to short sleep. Several studies highlight that coordinated activities of the entire team, including all professional groups (medical doctors, psychologists, nursing team) supporting behavioural therapy, are essential (Hossny et al, 2019; Novak et al, 2020; Paterson et al, 2021). For instance, it might compromise treatment effects when some team members centre on prolonged periods of wakefulness in the evening to increase sleep pressure and the responsible physician prescribes highly sedating drugs.…”

“…Clinic routines limit adaptations of sleep windows to individual circadian preferences. Not all these aspects, but at least some, can be addressed on clinical wards, including for instance improved activities in the evening for patients, defined rest and activity areas on a ward with adapted light conditions, and others (Novak et al, 2020).…”

The Smarter Sleep educational interventions: an initiative to reduce hypnotic prescribing in in-patient psychiatric care

“…Rotation of nursing staff between wards enabled migration of practice to spread engagement with the interventions across wards. Some wards ( n = 2) were involved in the SleepWell Project, 51 which may have motivated staff to engage with further work on sleep, but the impact of SleepWell in relation to this study is unclear. The above aspects may not exist in other settings.…”

Co-Production is Good, but Other Things are Good Too

“…The SleepWell programme, introduced on psychiatric wards in Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust in 2019, was designed as a pilot scheme in a large mental health trust after reviewing the current observation policy (Novak et al ., 2020). This programme included strategies such as reducing overnight noise and light, providing staff education about sleep and sleep disorders, and screening for sleep disorders such as sleep apnoea and restless legs syndrome.…”