EditorialSleep and the Nursing Home
Section snippets
Sleep Disorders
The major sleep disorders are sleep apnea, restless legs syndrome, periodic limb movement disorder, and REM sleep behavior disorder. Sleep apnea occurs in 25% to 50% of long-term care residents.61, 62 Despite this high prevalence, sleep apnea is documented in only 0.5% (0.4%–0.6%) in nursing home residents.63 Sleep apnea is associated with hypertension (including occult nighttime hypertension),64 decreased pain tolerance,65 falling asleep–related injuries,66 impaired cognition,67 diabetes,
Nonpharmacological Management of Poor Sleep in the Nursing Home
The primary treatment of insomnia (poor sleep) in long-term care is the same as at home (ie, sleep hygiene). The first approach should be natural light exposure during the day.74 Use of low-level “blush-white” lighting during the daytime increased total sleep time and sleep efficiency, and decreased depression and agitation.75 Royer et al76 reported similar effectiveness of 400-lux light in a long-term care facility. A review of the literature suggested that architectural design of long-term
Pharmacological Treatment of Insomnia
It is not recommended that hypnotic medications are given every night to residents in nursing homes. They should be given only when the resident cannot fall asleep 30 minutes after going to bed. Although these are reasonable recommendations, they do not gel very well with the reality of long-term care life. A substantial number of residents have real sleep disorders, and the ability to limit daytime napping is not really feasible. Sleep hygiene methods are difficult to put in place. There are
Conclusions
Sleep problems are epidemic in the nursing home. Approximately 60% of long-term care residents have a prescription for at least 1 antihypnotic.102 The management requires diagnosing the cause, improving sleep hygiene, and in many cases using sleep medications. Lack of sleep is a major quality-of-life problem in nursing homes.112, 113 There is a need for controlled trials, both of pharmacological and nonpharmacological treatments for insomnia in the nursing home.114
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