Approximately 1.2 million Americans live in certified nursing homes, and another 1 million live in assisted living facilities. It’s common for residents in these facilities to have roommates, 24/7 medical devices, and round-the-clock nursing care. Not surprisingly, people living in these environments frequently experience sleep disturbances.
As the world population ages, medical researchers are looking for ways to help community-dwelling residents get better sleep.
A systematic review published by researchers from City University of New York and Cornell University takes a careful look at interventions designed to improve nighttime sleep among long-term care residents.
“Our sleep environment plays a critical role in the quality and duration of our sleep,” explained Rana Sagha Zadeh, associate professor in the Department of Human Centered Design at Cornell and an author of the paper. “Factors such as daily activity levels, nutrition, and exposure to natural light directly influence our body’s neurohormonal rhythms—internal systems that regulate both deep sleep and daytime energy and alertness. When these rhythms are disrupted, it can lead to fatigue, difficulty concentrating, and trouble falling or staying asleep at night.”
The analysis pulls together data from 54 studies that evaluated 25 different sleep-promoting interventions. Evaluating all of the evidence, three interventions demonstrated the most promising results for improving nighttime sleep.
First, increased exposure to light during the daytime and increased activity levels were considerably effective at improving residents’ sleep.
“For individuals with limited mobility—particularly those in hospitals or long-term care facilities—access to outdoor light and physical activity is often restricted, sometimes because of health reasons and sometimes because of restrictions in their environment,” she said. “But prioritizing daylight and movement clearly helped to improve nighttime sleep.”
Researchers also found that use of the supplement melatonin, a naturally produced hormone that regulates the body’s sleep-wake cycle, improves nighttime sleep.
And they found that acupressure, a traditional Chinese medicine technique that applies pressure to specific points on the body, can be used to promote relaxation and improve sleep.
Researchers also found that proper nutrition and stress reduction helped residents to sleep better at night. And, importantly, when several of these interventions were combined together, the likelihood of them working effectively over time increased significantly, Zadeh explained.
This research is important because evidence shows that sleep disturbances increase the risks of cognitive decline, falls and agitation. Poor sleep can also exacerbate existing health conditions and contribute to a higher risk of mortality.
“This research underscores an important message,” Zadeh said. “Creating supportive environments, activities and systems, can make it possible to improve sleep and prevent consequences of sleep disturbances.”
The Cornell team is expanding on this research and working to teach individuals in hospitals and nursing homes the best ways to improve nighttime sleep for patients and residents.
“The goal is that we can provide applicable solutions that are adoptable for these settings to help residents improve sleep health and reduce preventable disruptions to sleep and wake cycles,” Zadeh said. “We are working with clinical experts from Weill Cornell, New York-Presbyterian Hospital, Hunter College of Nursing, and students who are enthusiastic to support health and sleep hygiene for those in nursing homes and hospitals.”
The take-home message: while sleep disturbances are common in long-term care settings, there are proven interventions that can help residents get better nighttime sleep.
