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If you or any of your loved ones has ever been hospitalized, one of the complaints you may have heard most is how hard it is to sleep in the hospital.

There are lots of things about hospital routines that can make things difficult for patients to sleep, besides noise and illness. While some hospitals have taken steps to ensure that patients are not interrupted unnecessarily at night, this is not universal.

Some reasons you might be woken at night might be unavoidable. You might be on a particular medication, such as certain antibiotics, that must be given in the middle of the night, depending on when the first dose was given. Blood tests for levels of some antibiotics must be timed to their dosing, resulting in blood draws in the middle of the night, too.

If you are admitted to check for a heart attack, you might also be ordered for timed blood tests that might involve having your blood drawn in the middle of the night. Vital signs, such as pulse and blood pressure, are required to be taken every four hours for some conditions, which would also awaken you.

One study shows the top thing keeping patients awake is pain, followed by vital signs and tests, noise and medications.

Studies have also shown that hospital routines can disrupt patient sleep, and having a designated quiet time, where nonessential tasks are minimized and lights and noise are lowered, may help.

Here is a partial list of things that keep patients awake, and what you might be able to do about them:

1. Pain. Pain is easier to control before it gets bad. Don’t hesitate to ask for pain medicine at bedtime, even if your pain is not yet severe.
2. Vital checks. You are woken up to have your blood pressure taken. Vital signs are usually taken every eight hours. Often these are done between 11 p.m. and midnight, after the night shift starts, but that’s frequently just after you have fallen sleep.

Alternatively, the night shift could be taking your vital signs at 6 a.m., when you would be awoken for other hospital routines anyway. If you are given the opportunity to give feedback during or after your stay, it would be important to mention this — hospital administrators look closely at patient feedback.

3. The IV pump that keeps beeping. This is usually because the flow of IV fluid is blocked (occluded), most often due to its insertion in the crook of your elbow. Thus, every time you bend your arm, the pump alarm will start beeping. If this is the case, ask to have the IV put in a different place, like your hand.
4. You are woken to be given medications. Sometimes a medication or breathing treatment might be ordered “every four hours” or “every six hours,” which means the nurse or respiratory therapist is required to wake you to give it to you even if you are asleep.

You can ask if the order can be changed to four times a day instead of every six hours, or “every four hours while awake.”

5. Noise. Lots of things can be noisy in the hospital at night — staff voices, cleaning machines, your roommate if you have one. You can always ask to have your door closed, and you can ask someone to bring you ear plugs.
6. You are up all night urinating. If this is not the case when you are at home, it might be because you were ordered for a diuretic to be given late in the day, after 6 p.m. or so, or you are ordered for IV fluids at a rate that is higher than you actually require. Your nurse can ask the doctor to change these orders.
7. Blood transfusions at night. If you need a blood transfusion, it is best not to do it during sleeping hours, because it requires the nurse to monitor your vital signs frequently and would keep you awake for hours. If you need a transfusion, ask if it can possibly wait until daytime.

Frequent nighttime disruptions can often cause patients to want to nap during the day, and these can also throw off their sleep schedules. Patients might already be weak and tired from their underlying illness.

If you’re hospitalized, it’s important to keep your normal sleep schedule and circadian rhythm. During the day, keep the window shades open for natural light and keep the room dark during sleeping hours. An eye mask might be helpful if exposure to light at night is unavoidable. A favorite blanket, pillow, photos and music can help you relax and be more comfortable.

My colleagues and I at Somerville Hospital (since closed to inpatients) found that when we instituted a program to decrease disruptions during the night, such as purposely avoiding all the things described above, patients used as-needed sedatives about half as often in the hospital.

Most hospitals can do better to make nighttime routines friendlier for patients, but institutional change can be challenging. Knowing what to ask for is useful and will help move healthcare forward.

 © 2020 by Harvard University